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What Causes Acid Reflux While Treating Hiatal Hernia?

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Posted on Fri, 27 Oct 2017
Question: Two questions:

1. Does a small hiatal hernia effect reflux?
2. On a 24 hr ph impedance test should you eat poorly or well? My ENT says that everyone would reflux on chicken wings and pizza..
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Answered by Dr. Ramesh Kumar (2 hours later)
Brief Answer:
The presence of a hiatal hernia does not necessarily mean you will have GER

Detailed Answer:
Hello my dear patient,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

I would answer your question but initially i will give you a small briefing about anatomy pathophysiology of this problem so that you can understand things better.

See,
The diaphragm is a large muscle that lies between your abdomen and chest. You use this muscle to help you breathe and this breathing is regulated by pressure difference across your thorax and abdomen.Normally, your stomach is below the diaphragm, but in people with a hiatal hernia(even small), a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus.Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia as the the stomach bulges up into the chest through that opening there appears a difference in pressure between the chest cavity and the abdomen, movement of the stomach and lower esophagus upward causes an already poorly functioning LES(in perdiagosed cases of gerd) to get even worse.Therefore person with Hiatal hernia are on increased risk of worsening symptoms of GERD. However its not necessary or mandatory that in every patient GERD is there or will become worse.

So answer no 1 is you may have GERD or worsening of GERD symptoms;however its not like that you will definitely have it.
But yes even a small hernia would effect reflux as the space would cause severe pressure problem across abdomen and chest.

2)The 24-hour esophageal pH test is an outpatient procedure performed to measure the pH or amount of acid.
So eat what you eat regularly.
WHY?
Because we are performing this test to see how your body acid secretion and Ph are responding to your daily food habits.
In easy words if you are eating pizza daily then we are performing this test to see the amount and Ph of your stomach on that diet.Drinking a lots of cold milk on day of test( alkaline) would neutralize all acid and would show the result as normal.
But tell me one thing would that result be considered as True negative?
Of course not because you have deliberately taken milk to make test negative.

So my dear patient i won't suggest you to alter your diet on day of test.If you have pizza and cola daily then do have it on that day also so that your gastro can have a correct idea about intensity of problem.Doses of medicines depends on intensity only.

As per chicken wings and pizza is concerned no i don't have any reflux or acidity after having them though i am 65 plus. Just want to explain you that this explaination by your ENT is not appropriate.
Every person is different and so is the response of a persons body to particular food.

An easy example is some person are very sensitive to some foods like corn or glutien but that does not mean that every one would be sensitive to it.

I have tried to explain things in easy language so that you can understand things well.

I wish you a great life ahead and a very fast recovery.
In case you have any other query please feel free to follow up my dear patient.

Have a good day ahead.


Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2805 Questions

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What Causes Acid Reflux While Treating Hiatal Hernia?

Brief Answer: The presence of a hiatal hernia does not necessarily mean you will have GER Detailed Answer: Hello my dear patient, Thanks for choosing HealthcareMagic for your query. Have gone through your details and i appreciate your concerns. I would answer your question but initially i will give you a small briefing about anatomy pathophysiology of this problem so that you can understand things better. See, The diaphragm is a large muscle that lies between your abdomen and chest. You use this muscle to help you breathe and this breathing is regulated by pressure difference across your thorax and abdomen.Normally, your stomach is below the diaphragm, but in people with a hiatal hernia(even small), a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus.Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia as the the stomach bulges up into the chest through that opening there appears a difference in pressure between the chest cavity and the abdomen, movement of the stomach and lower esophagus upward causes an already poorly functioning LES(in perdiagosed cases of gerd) to get even worse.Therefore person with Hiatal hernia are on increased risk of worsening symptoms of GERD. However its not necessary or mandatory that in every patient GERD is there or will become worse. So answer no 1 is you may have GERD or worsening of GERD symptoms;however its not like that you will definitely have it. But yes even a small hernia would effect reflux as the space would cause severe pressure problem across abdomen and chest. 2)The 24-hour esophageal pH test is an outpatient procedure performed to measure the pH or amount of acid. So eat what you eat regularly. WHY? Because we are performing this test to see how your body acid secretion and Ph are responding to your daily food habits. In easy words if you are eating pizza daily then we are performing this test to see the amount and Ph of your stomach on that diet.Drinking a lots of cold milk on day of test( alkaline) would neutralize all acid and would show the result as normal. But tell me one thing would that result be considered as True negative? Of course not because you have deliberately taken milk to make test negative. So my dear patient i won't suggest you to alter your diet on day of test.If you have pizza and cola daily then do have it on that day also so that your gastro can have a correct idea about intensity of problem.Doses of medicines depends on intensity only. As per chicken wings and pizza is concerned no i don't have any reflux or acidity after having them though i am 65 plus. Just want to explain you that this explaination by your ENT is not appropriate. Every person is different and so is the response of a persons body to particular food. An easy example is some person are very sensitive to some foods like corn or glutien but that does not mean that every one would be sensitive to it. I have tried to explain things in easy language so that you can understand things well. I wish you a great life ahead and a very fast recovery. In case you have any other query please feel free to follow up my dear patient. Have a good day ahead.