Brief Answer:
ibs need management hiatus need repair

Detailed Answer:
Thank you for asking
The reason PPIs are not responding is because of an underlying hiatal hernia.unless and until that gets fixed, nothing ain't gonna happen. Schedule a corrective procedure with a Nissan fundoplication for help.you are in 2 percent of population who does not respond to diet and lifestyle modification and medications and finally had to go through surgery to treat the underlying cause

Lose your weight. If your BMI is 25 or above you need to lose weight. Calculate you BMI Here  http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmi-m.htm Alcohol ? say no to it. Now is the time. Get sign up to Alcohol Anonymous and seek help to gradually resolve this addiction. Booze will ooze the health out of you.Coffee,Chocolates, citrus juices, tomato based products like ketchups, sauces, pastes etc, Peppermints, all the onion family, beans are some of the diet you need to avoid to relieve symptoms. If you are fond of eating, time to stop it. reduce diet intake, instead of increasing the quantity, increase the frequency, 5 times short meals instead of 3 bigger ones will be better. If you sleep just after or with in 3 hours of meal intake, this habit needs to be stopped. Increase the interval. When you sleep, elevating the head side of the bed at least 8 inches would be a good addition to the plan to combat GERD. Bending and stooping and upside down hangings with all other unnatural postures need to be avoided..


One More reason of resilience is associated IBS.



Fiber supplementation may improve symptoms of constipation and diarrhea
Polycarbophil compounds (eg, Citrucel, FiberCon) may produce less flatulence than psyllium compounds (eg, Metamucil)
Judicious water intake is recommended in patients who predominantly experience constipation
Caffeine avoidance may limit anxiety and symptom exacerbation
Legume avoidance may decrease abdominal bloating
Lactose and/or fructose should be limited or avoided in patients with these contributing disorders
Although evidence is mixed regarding long-term improvement in GI symptoms with successful treatment of psychiatric comorbidities, the XXXXXXX College of Gastroenterology has concluded the following:
Psychological interventions, cognitive-behavioral therapy, dynamic psychotherapy, and hypnotherapy are more effective than placebo
Relaxation therapy is no more effective than usual care
Pharmacologic agents used for management of symptoms in IBS include the following:
Anticholinergics (eg, dicyclomine, hyoscyamine)
Antidiarrheals (eg, diphenoxylate, loperamide)
Tricyclic antidepressants (eg, imipramine, amitriptyline)
Prokinetics
Bulk-forming laxatives
Serotonin receptor antagonists (eg, alosetron)
Chloride channel activators (eg, lubiprostone)
Guanylate cyclase C (GC-C) agonists (eg, linaclotide)
Antispasmodics (eg, peppermint oil, pinaverium, trimebutine, cimetropium/dicyclomine
In nut shell IBS needs management and hiatal hernia needs repair. They both together are potentiation each other and causing resilience.
I hope it helps. Take good care of yourself and don't forget to close the discussion please.
May the odds be ever in your favour.
Regards XXXXXXX

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