Hello there! Thank you for asking. I read your query and i want you to know that your main problem is Hiatal hernia which has led to chronic GERD and pulmonary trouble because of aspiration and if it stayed this way then the odds of malignancy will be very high ass most of the barret esophaguses end in that way if left untreated. the three goals of your treatment are Prevention of reflux of gastric contents Improved esophageal clearance Reduction in acid production which are achieved by three ways Modifying lifestyle factors Neutralizing acid or inhibiting acid-producing mechanisms Enhancing esophageal and gastric motility You really need Dietry modifications. Avoid stimulants mentioned below Fried or fatty foods Chocolate Peppermint Alcohol Coffee Carbonated beverages Citrus fruits or juices Tomato sauce Ketchup Mustard Vinegar Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) Follow my below mentioned 12 POINTS AGENDA to treat symptoms 1.lose weight ( if overweight) divide your weight to the height in meters twice and if the result is more than 25 reduce the weight. 2.Avoid alcohol, chocolate, citrus based fruits,tomato based products 3.avoid pepper mint coffe and possibly the onion family 4.eat small freequent meals rather than large meals. 5.wait at least 3 hours after the meal to lie down or sleep. 6.refrain from ingesting food (except liquids) with in 3 hours of bed time. 7.eleate te head of your bed at least 8 inches 8.avoid bending or stooping positions 9.dont use nsaids 10.dont smoke 11. have a proper sleep routine 12. use cold milk as drink avoid all hot beverages and carbonated ones You need Medications Like Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole etc) But you are just 39. And i wont recommend with this conservative lifestyle for the rest of life. So here is what i think you should do. COnsult your doctor and discuss surgical ways to permanent correction of your hernia. All of your troubles will go away. The sooner the better. The 3 major types of surgical procedures that may be considered are as follows: Nissen fundoplication (or a variant, the Toupet procedure) Belsey (Mark IV) fundoplication Hill repair You can discuss it with your doctor and he will decide what is best for you. Hope i was of some help. Take very good care of yourself. regards Dr S Khan