Brief Answer:
Proper investigations - Barium studies.

Detailed Answer:
Hi.
Thanks for your query.
Read and understood your query.

To recapitulate: diagnosed as Hiatus Hernia - took medication for about an year - cured of the problems to maximum possible extent - now the problem is back again - **frequent big bloats - can feel the pressure with which the bloat is coming - gas formation always occurs - ** can see the stomach swelling due to it - also have frequent stomach upset after eating outside even once - *wants help and permanent solution...

Let us discuss these problems one by one:
Eating out side making the stomach upset indicates that either you have allergy to something in the outside food or you get an easy infection of the intestinal tract- say rather imbalance between good and bad bacteria and there may be some pre-existing problem in the intestines like sub-acute obstruction or so.

Secondly, the most important point you should note is hiatus hernia does not cause such symptoms unless the part of the intestine goes through the diaphragm into the mediastinum and this may not be happening in your case as the symptomatology is different. The medicines which were given at that time actually must have been for your intestinal problems as there is no medical treatment for hiatus hernia (it is always surgical correction)

Thirdly, after re-reading your symptoms, my thoughts are as follows:
- Since you can feel the pressure with which the bloat is coming with big bloats of gas where you can see the stomach is swelling indicates that you have most probably a subacute intestinal obstruction.
This need the investigations and the best one is barium studies under fluoroscope control where the Radiologist can actually see the progress of barium through the intestines, can see any kinking, stricture or so to get an appropriate diagnosis.

Other investigations like that of blood, urine, stool are done routinely in such a case. CT scan of the abdomen and colonoscopy may be needed later if indicated.

Please get these investigations done so that final diagnosis can be appeared at at the earliest.

Other causes can be:
IBS, intestinal infection and so on.

I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications or if you feel there is a gap of communication.

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