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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had gastroscopy done which revealed Hiatus Hernia with Grade A Reflux Esophagitis and H. pylori. Suggestions?

Answered by
Dr. Amit Jain


Practicing since :2000

Answered : 1524 Questions

Posted on Wed, 28 Aug 2013 in Digestion and Bowels
Question: Hi,
I recently had gastroscopy done which revealed a Hiatus Hernia with Grade A Reflux Esophagitis and H. pylori negative Gastritis affecting the antrum of the stomach.
The histopathology report showed features suggesting gastro-oesophageal reflux disease without oesophagitis.
The gastric biopsy showed chemical/reactive gastritis, suggestive of bile reflux or drugs (NSAIDS).
I am wondering why the histopathology report is not entirely consistent with the gastroscopy report itself (one suggests oesophagitis and the pathology report does not).
Also, how is bile reflux detected?
Do these conditions have a high likelihood of bleeding?
Lastly, how is the level of liver toxicity detected and does my fatty liver condition cause greater liver toxicity?
Answered by Dr. Amit Jain 7 hours later
Hello! Thanks for putting your query in XXXXXXX I am a Gastroenterologist (DM).

Ans 1: Grade A reflux esophagitis on gastroscopy suggest there were few small erosion at lower end of esophagus. Histopathology report did not show esophagitis but showed gastroesophageal disease!? I am also wondering how the histology showed gastroesophageal reflux? without showing esophagitis. Here I want to put one query from where this biopsy was taken? However if it is taken from esophagus and did not show esophagitis is not very strange because the tissue taken during biopsy is very small and sometimes it may not be taken from the diseased site.

Ans 2:Bile reflux is detected during gastroscopy itself when bile (fluid) which is golden yellow in colour is seen in stomach or may be esophagus

Ans 3: Bleeding may occur in reflux esophagitis if persist for a long time due to formation of ulcer in esophagus but not so common

Ans 4: liver is seen as fatty on imaging like ultrasound etc.Toxicity is detected by liver function tests especially transaminase levels (SGOT and SGPT)

I hope I have answered your query and this will help you. Remain in touch and get-well soon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Amit Jain 1 hour later
Thanks Dr. XXXXXXX

I am not sure where the biopsy was taken but will include the reports. Somehow the bile reflux was suspected on the pathology but it is not confirmed.

Does the picture of the hernia look serious in the report?

Answered by Dr. Amit Jain 55 minutes later
Hello! I have gone the report of histopathology. Yes it is suggestive of reflux but there is no oesophgitis as there is no neutrophils or eosinophils. However in this regard I want to add one fact which is the senstivity of biopsy for oesophagitis is only up to 40% that is in 60% it may not be positive.

Findings on histopathology report in specimen B suggest inflammation which may be due to many causes so they have suspected bile reflux or drug induced.

Sorry, there is no picture or report of Gastroscopy
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Amit Jain 8 hours later
Thanks Dr. XXXXXXX

Sorry as the file was a little too large and it was never accepted. I have re-uploaded it.

Answered by Dr. Amit Jain 3 hours later
It appears to be a small Hiatus hernia only. Most of the time it is asymptomatic and remain so throughout life

For hiatus hernia what all you have to do is:
1.Avoid fatty meals
2. Don't lie down soon after meals for at least half hour
3.Take small and frequent meals, instead of full meals at a time
4. wear loose clothes
5. If you are overweight or obese do weight reduction with dieting and exercise
6. Avoid straining while defecation, lifting heavy weight, coughing, sneezing and smoking if you do

Among the medications:
1. take domperidone it don't simply act as a prokinetic agent but it also increase the tone of lower esophageal sphincter
2. Baclofen also helps in increasing tone of lower esophageal sphincter
3.May be proton pump inhibitor like rabeprazole

I hope I have answered your query and this will help you. Remain in touch and get-well soon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Amit Jain 10 hours later
Thanks Dr. XXXXXXX for the advice. Lastly, does anything have to be done in the case of bile reflux, it doesn't appear to be purely a stomach or throat issue. Why are diet changes not seen as effective in case of bile reflux. Limiting the amount of fats should limit the amount of bile produced and lead to less of a problem.

Answered by Dr. Amit Jain 3 hours later
Hello! I don't think that the amount of bile will be secreted less if one take low fat diet as bile is produced daily in similar amount. However fatty diet leads to decrease in motility of the gastrointestinal tract and bile which is secreted in intestine just below the lower end of stomach and due to decreased motility bile and food will stay for a longer period of time and may be refluxed into stomach. So low fat diet will be helpful in that sense. Hope you will be fine soon. Keep in touch
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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