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Is A Nissen Fundoplication Required For A Partial Rolling And Sliding Hiatal Hernia?
Question: Hello again Dr.
I just got the results back from my barium swallow. It shows a moderate to large partial rolling and sliding hiatal hernia, with mild reflux. Does this mean I should have the nissen? Or is there any way around this?? Thank you!
I just got the results back from my barium swallow. It shows a moderate to large partial rolling and sliding hiatal hernia, with mild reflux. Does this mean I should have the nissen? Or is there any way around this?? Thank you!
Brief Answer:
No surgery is not compulsory.
Detailed Answer:
Hello,
As suggested earlier, you can go for fundoplication or aggressive medical management.
As per the books, fundoplication is done only when you have para-esophageal hiatel hernia or symptoms are not controlled despite maximal therapy (you were treated only by ppi that too in optimal dose).
My suggestion is to go for medical therapy initially for 3 months as suggested earlier. If not relieved then make fundoplication an option.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
No surgery is not compulsory.
Detailed Answer:
Hello,
As suggested earlier, you can go for fundoplication or aggressive medical management.
As per the books, fundoplication is done only when you have para-esophageal hiatel hernia or symptoms are not controlled despite maximal therapy (you were treated only by ppi that too in optimal dose).
My suggestion is to go for medical therapy initially for 3 months as suggested earlier. If not relieved then make fundoplication an option.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
The funny thing is, my only symptoms are throat related and not at all heartburn related!
Brief Answer:
Follow up.
Detailed Answer:
Hello,
Reflux diseases are divided into two parts as per the anatomy of esophagus available. More common is GERD where almost lower 2/3 esophagus is involved. The second one is laryngo-esophageal reflux where upper 1/3 rd is involved. Medications are the same.
Hope I cleared your doubt. Feel free to follow up.
Thanks.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Follow up.
Detailed Answer:
Hello,
Reflux diseases are divided into two parts as per the anatomy of esophagus available. More common is GERD where almost lower 2/3 esophagus is involved. The second one is laryngo-esophageal reflux where upper 1/3 rd is involved. Medications are the same.
Hope I cleared your doubt. Feel free to follow up.
Thanks.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Prasad
What about all the people that say that ppi's and antacids and H2 inhibitors just mask the symptoms and you can still get esophageal cancer or barrettes taking them? What is the reality of this theory??
What did these people do wrong that take the PPI's?
https://www.YYYY.com/watch?v=XXXX
What did these people do wrong that take the PPI's?
https://www.YYYY.com/watch?v=XXXX
Brief Answer:
Follow up answer.
Detailed Answer:
Hello,
PPI is one of the safest class of medication known till date.
They may cause side effects when used for years without proper consultation but so does breathing (a number of bacteria enters our lungs from air we inhale. This does not mean that we have to use oxygen cylinder every time).
Rest assured if they would be that toxic then could they be over the counter? I myself have a paralyzed limb and have to take a PPI daily (with other medicines). Start taking medicines and slowly we would taper you off.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Follow up answer.
Detailed Answer:
Hello,
PPI is one of the safest class of medication known till date.
They may cause side effects when used for years without proper consultation but so does breathing (a number of bacteria enters our lungs from air we inhale. This does not mean that we have to use oxygen cylinder every time).
Rest assured if they would be that toxic then could they be over the counter? I myself have a paralyzed limb and have to take a PPI daily (with other medicines). Start taking medicines and slowly we would taper you off.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Kampana
Why would I wean off when I had a large hiatal hernia? Wouldn’t I have to be on them for life because the hernia doesn’t allow for proper closure?
Brief Answer:
Follow up answer.
Detailed Answer:
Hello,
By that I mean that initially we are going to put you on three medications, namely PPI's, Acotiamide and Antacid.
There after, as you would start feeling better, we would start tapering the number as well as doses of medicines and would try to keep you on minimum possible doses of H2 blocker (weaker than PPI's).
After fundoplication, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating foods makes dumping syndrome which is a worse condition. Fundoplication is not a 100% percent successful operation always. Therefore for any doctor, surgery is always the last option.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Follow up answer.
Detailed Answer:
Hello,
By that I mean that initially we are going to put you on three medications, namely PPI's, Acotiamide and Antacid.
There after, as you would start feeling better, we would start tapering the number as well as doses of medicines and would try to keep you on minimum possible doses of H2 blocker (weaker than PPI's).
After fundoplication, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating foods makes dumping syndrome which is a worse condition. Fundoplication is not a 100% percent successful operation always. Therefore for any doctor, surgery is always the last option.
Hope I have answered your query. Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Kampana
Isn't esophageal cancer the worst out of all the conditions though? I'm looking at long term results of taking ppi's or H2 inhibitors for a long time vs. surgery . I don't feel like I have a lot of reflux, but I feel my large hernia is a problem. I've heard that the PPI's just mask the syndrome. Is this not true?
Who are the people that get esophageal cancer and are taking PPI's? I hope you get paid every time you answer! I'll give you a great review!!
Who are the people that get esophageal cancer and are taking PPI's? I hope you get paid every time you answer! I'll give you a great review!!
Brief Answer:
Follow up.
Detailed Answer:
Hello,
Let me first explain you what a PPI does to your body. A PPI inhibits the over production of extra acid plus inhibits the baseline production of acid into the cells of stomach. Therefore, intially, for better control of symptoms PPIs are given.
Now, moving on to H2 blockers. What they do is that they just prevent production of extra acid and have no effect on baseline production of acid.
I really don't know people who developed esophageal cancer from PPI's but I have treated hundreds who have not controlled their symptoms and landed up in adenocarcinoma. Prognosis of esophageal cancer is very poor.
Let me explain to you this physiology also.The cells of stomach are resistant to acid (by nature) however cells in esophagus and duodenum are not.Therefore if a persons esophagus or duodenum is exposed to acid regularly then body would naturally change the type of cells in esophagus and duodenum to the type which are there in stomach (this is called metaplasia). If still left untreated 20% patients develop adenocarcinoma in next 5 years.
Surgery is also not a bad option but some times patients may land up into dumping syndrome and many other problems.
So basically you are the one who have to take the call.
Hope I have answered your query. Please feel free to follow up. I am here to clear all your doubts.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Follow up.
Detailed Answer:
Hello,
Let me first explain you what a PPI does to your body. A PPI inhibits the over production of extra acid plus inhibits the baseline production of acid into the cells of stomach. Therefore, intially, for better control of symptoms PPIs are given.
Now, moving on to H2 blockers. What they do is that they just prevent production of extra acid and have no effect on baseline production of acid.
I really don't know people who developed esophageal cancer from PPI's but I have treated hundreds who have not controlled their symptoms and landed up in adenocarcinoma. Prognosis of esophageal cancer is very poor.
Let me explain to you this physiology also.The cells of stomach are resistant to acid (by nature) however cells in esophagus and duodenum are not.Therefore if a persons esophagus or duodenum is exposed to acid regularly then body would naturally change the type of cells in esophagus and duodenum to the type which are there in stomach (this is called metaplasia). If still left untreated 20% patients develop adenocarcinoma in next 5 years.
Surgery is also not a bad option but some times patients may land up into dumping syndrome and many other problems.
So basically you are the one who have to take the call.
Hope I have answered your query. Please feel free to follow up. I am here to clear all your doubts.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
Above answer was peer-reviewed by :
Dr. Prasad
So, if I'm looking at a lifetime of controlling acid, what dose of H2 inhibitors should I be on considering I have a hiatal hernia that is about 4cm. I mean what dose of H2 inhibitor is safe and effective for a lifetime with this crazy hernia. Thank you! I am never sure if my throat is completely related to my reflux, but I do know when I reflux and can feel it mildly. On a dose of 80mg of PPi's I didn't reflux at all on the 24 hour test, but still had throat symptoms, so I am not sure I should be going the PPI route. But I would consider living on zantac if I knew the proper dose to control reflux and living with that dose.
Brief Answer:
PPIs stop cells in the lining of the stomach producing too much acid. This can help to prevent ulcers from forming or assist the healing process. By decreasing the amount of acid it has nothing to do with reflux prevention.
Detailed Answer:
Hello,
It depends on the type of H2 inhibitor - For example: Ranitidine is optimal and safe dose. Fomatadine a day is safe.
PPI has nothing to do with reflux. Reflux means regurgitation of acid back into esophagus.
You wouldn't find text anywhere (in a standard book not on youtube etc) which says that PPI inhibits motility of muscles. PPI just reduces secretion of acid that's it and that's all.
Motility regulators like Levosulpiride or Itopride are therefore given for a complete treatment because they prevent the reflux of this acid back into throat.
Part 1 acid reduction - Done by PPI's
Part 2 - Prevent reflux done by Itopiride etc.
Your gastroenterologist has not provided you with specific information.Please show this to your gastroenterologist and tell me what he says.
Hope I have answered your query.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
PPIs stop cells in the lining of the stomach producing too much acid. This can help to prevent ulcers from forming or assist the healing process. By decreasing the amount of acid it has nothing to do with reflux prevention.
Detailed Answer:
Hello,
It depends on the type of H2 inhibitor - For example: Ranitidine is optimal and safe dose. Fomatadine a day is safe.
PPI has nothing to do with reflux. Reflux means regurgitation of acid back into esophagus.
You wouldn't find text anywhere (in a standard book not on youtube etc) which says that PPI inhibits motility of muscles. PPI just reduces secretion of acid that's it and that's all.
Motility regulators like Levosulpiride or Itopride are therefore given for a complete treatment because they prevent the reflux of this acid back into throat.
Part 1 acid reduction - Done by PPI's
Part 2 - Prevent reflux done by Itopiride etc.
Your gastroenterologist has not provided you with specific information.Please show this to your gastroenterologist and tell me what he says.
Hope I have answered your query.
Thank you.
Regards,
Dr. Ramesh Kumar
Gastroenterologist
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Above answer was peer-reviewed by :
Dr. Kampana
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