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Child has vomiting, diarrhea. Given redlan, zofran, prilosec. Done endoscopy, gastric emptying revealed hiatal hernia

My son is 19 years old and he has been vomitting for over a year now. He throws up everyday in the morning. No fever but sometimes diarrhea. He has seen a GI doctor who has prescribed Redlan that does not work. Zofran, that does now work, Prilosec doesn't work and now suppositories to stop the vomiting and that does not work. He has had an endoscopy which revealed a hiatal hernia and had a gastric emptying which revealed just a slight delay. I am worried cause this cannot be normal!
Asked On : Mon, 15 Apr 2013
Answers:  2 Views:  33
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General & Family Physician 's  Response
Sep 2013
Hello, thanks for the query to H.C.M.C
Hiatus hernia , in majority of cases gastroesophageal junction herniate from lower part of oesophagus through diaphragm.
In few cases part of stomach bulge out.
In both condition there is delay in emptying of stomach hence food don't digest properly so there is very forcible vomiting ( violent vomiting) i.e. every things come out whatever ate before.
The best treatment is reduce secretion of gastric juice from stomach by using H2 blockers and proton pump inhibitors. These medicines should be taken at the advice of some doctor.
If still no relief than only option is surgery and consult a surgeon who at the advice of some physician will operate the patient.
A medical board constituted and a team of doctor will decide the future of action.
Have a good luck for your child.
Dr. HET.
Answered: Tue, 16 Apr 2013
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General & Family Physician Dr. Nirmala P's  Response
thanks for asking for Healthcare Magic.

Medical management in Hiatal Hernia is purely symptomatic ie., treatment is according to symptoms. If the symptoms are not controlled then surgery is only the option.

The symptoms are mainly due to hyperacidity. The early morning vomiting is due to nocturnal hyperacidity (increased acid secretion during night). Prilosec (Omeprazole) is an anti ulcer agent which inhibits acid secretion. Zofran (Ondansetron) controls vomiting. Although heartburn and vomiting are frequent symptoms, diarrhea is seldom seen in hiatal hernia.

Your son needs a prokinetic agent like Domperidone. This will control vomiting and improves gastric emptying but has no effect in acid secretion. Besides Omeprazole will be more effective if it is taken during night as it will control the nocturnal hyperacidity and if the symptoms still persist then addition of Ranitidine along with Omeprazole will help as it gives additional benefit in reduction of acid level.

I hope this helps.
Answered: Tue, 16 Apr 2013
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