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Does Hiatus Hernia Cause Indigestion And Acidity?

Posted on Tue, 27 May 2014

Question: I am 76 year male who has had mild indigestion for many years. It got worse 10 years ago with acid reflux at night, which is when I found out I had a hiatal hernia. Aciphex and a raised headboard stopped the acid coming up, but I still get severe indigestion for no apparent reason that lasts up to three days at a time. Just this week I had my morning cereal and got indigestion even though its the same cornflakes I have everyday .Just had an endoscopy and no change from before. What happens is I get severe gnawing pains. Then I eat something and get immediate heartburn and sometimes nausea. Then I usually take sodium bicarbonate , 1/2 teaspoon in warm water to get that burp. I also take peptobismol. I still feel lousy though with a sour stomach,no desire to eat.I should mention that my GP has me on a daily am dose of 40mg Prilosec. At night I take Zantac before going to bed.If my nausea is bad I take Raglan, but as little as possible. I often wake up in the night with heartburn even though I haven't eaten for an hour or two before bed. My GP has suggested having a light snack at bed time to soak up the acid, but that doesn't work. My biggest worry is I don't understand why these attacks last several days no matter what I eat or don't eat. I have read the Prilosec at this constant dose can cause Mg loss and heart problems. I am somewhat lactose intolerant so only drink lacose free milk, no dairy products.What can you suggest is wrong? Other meds are atenolol, vicoprofen, diazepam.

Answered by Dr. Binu Parameswaran Pillai (11 hours later)

Brief Answer:
VICTOPROFEN is the probable culprit

Detailed Answer:
Hello,
Good day.
Noted that you have trouble with indigestion and acidity. Hiatus hernia does cause acid reflux and as you correctly said, responds well to raising the headend of your cot.
There are number of reasons for a refractory acid reflux disease.
1. Few hormone conditions
2. Helicobacter Pylori infection ( H.Pylori)
3.Drugs

As an endocrinologist, hormone conditions are certainly on top of my mind, however, they are relativelt uncommon. the other two are more common.
I am sure that, while doing endoscopy, they would have done a test for H.Pylori.
You must discuss this with your gastroenterologist.

I NOTED THAT YOU ARE ON VICTOPROFEN ( this contain a potent drug called IBUPROFEN). THIS IS NOTORIOUS to cause acid reflux disease and even stomach ulcers. Why are you taking it ?. You should consider stopping it and changing over to Paracetamol/codeine combination for pain relief.

If the symptoms persists even after stopping Victoprofen, we need to do hormone tests. For that, you might have to meet an endocrinologist. Firts test would be a fasting gastrin level ( but for this, we might have to stop your anti reflux medications like Prilosec to be stopped for many weeks, which is not practical now).

Please try to stop Victoprofen and see what happens.
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (12 hours later)

Thank you for your reply. However, I was still experiencing acid reflux or indigestion ten years ago when I was taking Tylenol3. Would the codeine have had a bad effect since I know acetominophen is OK?
Regard
Stu

Answered by Dr. Binu Parameswaran Pillai (8 minutes later)

Brief Answer:
Hi

Detailed Answer:
Acetaminophen ( paracetamol) can vary rarely cause reflux, but it is comparatively a safer drug as far as acid reflux is concerned. Codeine may cause retching and nausea, but not much of acid reflux. As you mentioned earlier, you have hiatus hernia and with that, you always have a tendency for reflux. Drugs like Victoprofen/Diclofenac etc surely can worsen that.
Regards
B

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar