hiatius hernia

[Radars]

hI,I have been struggling with hiatus hernia for years ,been on 20mg of rabeprazole for years but now rabeprazole has become less effective, I am now getting thudding in upper back,the gp has put me on another ppi lansoprazole 30mgs, does changing from 1ppi work straight away or do you have to wait until it kicks in, I am on my 4th day now and no better, any help please.

[Hidden]

I suggest that if you have not responded to the change to Lansoprazole it is not working as intended or the PPI dose is not high enough. When I was first prescribed esomeprazole (Nexium) nearly 15 years ago for reflux disease I started on the highest dose 40mg tabs, and after 2-3 years dropped the dose to 20mg then 10mg, but found my symptoms returned at 10mg so increased the dose back up to 20 mg where it stayed keeping the situation under control. Then four years ago I was changed to 30mg Lansoprazole (equivalent to 20mg Esomeprazole) due to the Esomeprazole interaction with Clopidogrel which I was prescribed for 12 months post HA. I have taken 30 mg Lansoprazole since then and it seems to work. I suggest you give it a few more days and if you don't improve go back to your GP and ask him/her to change your PPI to 40mg esomeprazole or to double up on 30mg Lansoprazole (say one in the morning one in the evening) to see how that goes. My only other comment is if your insides have been inflamed due to them being washed with stomach acid it takes a while for things to settle down again, sometimes as much as two weeks in my experience. Finally as a long term sufferer of a hiatus hernia I am sure you are well aware of the life style management processes you have to put into place to make the best of a bad job, such as diet , small and more frequent portions, and minimising aggravating body positions like bending over. Hope this is of help and you get sorted.

[Radars in reply to Hidden]

Thanks lowerfield I will give it a bit longer with 30mgs to see how I go on if no better up the dose ,I recently had a endoscopy result was just a bit mild inflammation, nurse said it is a good report,so it's hard to understand I am still having problems.

[Radars]

Try to eat all the right foods but when out and about and having a meal just do the best you can,I do eat fruit that's berries with alpro no sugar yoghurt, and I eat veg every day, alcohol only on special occasions, got to have some quality of life.

[Hidden]

For someone with reflux disease 'life style' changes are mostly finding out which foods act as triggers and bring on acid reflux symptoms aka 'indigestion'. This seems to fall into three groups

-those that create gas as they are digested and force acidic stomach liquids back into the oesophagus, typically onions

- those that relax the valve at the inlet to the stomach allowing back flow, apparently coffee and chocolate do this

- and those that irritate the soft tissue such as citric fruit juice, spirits and spicy food.

I suggest to anyone who suffers from 'indigestion' that they keep a food diary to help identify what causes them problems, with the objective of avoiding them.

Next anything that compresses the abdomen such as bending down.

Next avoid large meals, chew your food properly, don't eat large quantities of meat since this stays in the stomach for longer, and leave three hours from last food intake to going to bed.

And some people find sitting up in bed helps, as well as not lying on your right side.

NHS guidance here

nhs.uk/conditions/hiatus-he...

nhs.uk/conditions/heartburn...

However if all that doesn't stop 'indigestion' prescribed PPIs will help but notably with the lifestyle changes above.

Finally for anyone who has a relapse my suggestion is to go back to basics and eat bland boring food for a week or so to allow the body to heal.

[Radars in reply to Hidden]

Thanks, I can only try my best,I have got adjustable bed so that's ok,I can't sleep on my left side all the time, I don't get heartburn, it's having to clear my throat a lot and throbbing and thudding in my upper back that I can't understand.

[Radars in reply to Radars]

Oh,and I am on my 4th day of lansoprazole and I am beginning to get stomach ache.

[fishonabike in reply to Hidden]

.... and my mum was advised (rather late) to try to avoid caffeine - she found this advice very helpful and wishes she had known earlier, so I try to pass it on

sadly it means she has to limit her dark chocolate intake, one of her only treats

[Wellservicer]

Hi I've been through same ezmaprol is now the hospital choice for acid reflux and it works nearly straight away .I'm on 40 mg per day and I'm a happy bunny .ask your Dr if you can change over I found lansopazole didn't work on me .hope it helps

[Hidden in reply to Wellservicer]

I share your delight at being on medication that works for you, for I was in a similar position when I started on 40mg esomeprazole some time ago especially since it finally got my reflux under control. However long term use of PPIs does come with a risk, especially at high doses, although for some with reflux disease and similar gastro related conditions that risk can only be reduced where possible, since stopping PPIs will result in symptoms returning. You are currently on the maximum dose of esomeprazole like I was, which as I understand it is the max normal dose of any PPI, and so I suggest that you discuss with your prescribing professional a trial of reducing the dose if/when appropriate especially if your treatment is going to be long term. After many months of 40mg I reduced the dose to 20 mg which still worked for me, but found a further reduction allowed my symptoms to return, so I upped the dose back up to 20mg where it remained and I was able to live with that.

[Radars in reply to Hidden]

Hi,I was on 20mg rabeprazole for years, but it seemed it wasn't working as well had to keep clearing my throat and burping after food also drinking water, also throbbing in my back and uncomfortable in my chest and a bit breathless, have now been on 30mgs of lansoprazole for ten days but still the same, gp said to give it a bit longer, then up it to 2 a day,any thoughts on this.

[Hidden in reply to Radars]

My medically unqualified guess is that doubling the dose (to the current max prescription dose) may get rid of the acidic burning sensation you may be getting causing you discomfort but it won't stop the choked feeling nor food coming back up, since these are symptoms of a hiatus hernia as I understand it, and the prazoles don't treat that, only reduce stomach contents acidity to make life more bearable and prevent oesophageal complications. But if you feel you are getting nowhere with all of this and medication and lifestyle management aren't helping, I suggest you discuss the keyhole surgery option with your GP with the objective of getting a referral to a gastroenterologist.

Finally you might find this useful regarding PPI doses.

nice.org.uk/guidance/cg184/...

[Radars in reply to Hidden]

Thanks, I don't get choking sensations or acid reflux, it's having to clear my throat and burping, and throbbing in my back and chest discomfort,

[needlewoman22]

Have a look at A. Vogel's Centaurium-it is a natural liquid supplement which is added to water or a drink 10-15 drops up to three times a day, and helps to rebalance the acid, and also helps to strengthen the sphincter at the end of the oesophagus, to prevent the acid coming up. The trouble is we need the acid to help start the digestion of food, and if there is not enough the food passes into the small bowel undigested and can trigger other unwanted symptoms.

[Radars in reply to needlewoman22]

Thankyou, I will look into that but at the moment I'm trying to sort out the best ppi for me.

[wischo]

Hi, I have a hiatus hernia for over 20 years and been taking omeprazole 20mg since, changed to pantoprazole while on clopidegrel. The pantoprazole did not work nearly as well so sfter the year on it I returned to omeprazole 20mg. I am now on 40mg of omeprazole daily since 2020 and despite the assumptions and concerns all my blood tests are normal (no B12 or other deficiences ever). I also had a dexa scan done a few months ago and bones are well within normal levels. I am happy out on the 40mg and no acid or pain from reflux at all.

[Radars in reply to wischo]

Thanks, I am on the 5th day of lansoprazole no change from rabeprazole 20mg I will give it till next Monday if no change will ask to switch to omeprazole, your story is good.