Hiatus Hernia

[southofthedowns]

Hi all

I am trying to 'join the dots' regarding my failing health and would appreciate any useful input.

it's a bit of a saga - please bear with me. The last 15 months have been challenging, scary and at times plain ugly for this formerly active 61 yr old.

Subsequent to heart ablation last July (see angry posts... - I've calmed down a bit now) I have been diagnosed with a 3cm sliding hernia, diverticulosis, osteopenia and iron deficiency anaemia.

I have diarrhoea, feel very bloated and cannot do a days work - or anything requiring bending over or significant exertion.

I recently saw my biochemistry Dr (lipid clinic - heart), she looked back at my records and said I may have been bleeding from my oesophagus since 2012 as my iron dipped then.

I have been on PPI's for decades, and very glad to have them - and the GP who prescribed them. so we can say that reflux has been a life-long condition.

Last July 29 (a Wednesday)I had an ablation for paroxysmal atrial fibrillation. I was discharged on the day and went home at around 1700. I turned out a couple of hours later for a very gentle stroll. during my perambulations I developed hiccups of epic magnitude - more convulsions really. I went home. On going to bed I had tremendous reflux and had to cough up my last meal from my lungs.

So clearly something unhappy in the diaphragm department.

Things generally went downhill from there, ambulance ride to hospital after panic attack on the Friday. Diagnosed with total heart block on the Sunday, pacemaker on the Tuesday. And plenty more of the same.

I am now booked for manometry and PH tests with a view to hernia repair. Reflux is less of an issue now because I eat several hours before going to bed and don't exert myself physically. That management strategy isn't sustainable long term but right now it works. The bigger issue is the discomfort when I work.

Surgeon is keen to carry out fundoplication but says I will be unable to vomit or burp which seems a high price to pay. I asked about Linx procedure which he does carry out but I gained the impression he was unenthusiastic.

I have discovered that I can resolve the significant discomfort around my middle by taking a huge breath and sort of 'bearing down'. The relief is huge though I have nearly fainted doing it!

I have read about a condition called saints triad involving hiatus hernia, diverticulitis and a gall bladder condition but don't understand the connection - or if it even applies to men.

So that it the state of play. As I said I am trying to understand my condition in order to manage the resolution of same. Does anyone see any connections? Could anaemia and osteopenia be related to long term PPI use? Where on earth does diverticulosis and diarrhoea fit in, if at all?

Regards

Paul

[focused1]

You may have other things in terms of illness than me, but aged 58 in 2018 I had the Nissan procedure via NHS day surgery for hiatus hernia . I could burp afterwards and can certainly vomit . Personally I would get a second opinion about this as I was never informed about either. Today I am a positive new person . I was warned that long term use of PPI'S can lead to ulcers and generally not really help -but did I want that - no -so for me the surgery was brilliant . I promised to lose weight which because you are on a liquid diet for about 3 weeks I had lost 8lb by then anyway . My general advice is to keep your weight down and manage condition by eating 3 reasonable meals per day - avoid snacks so your body has the time to digest this food . I found I have better energy levels and am not carting around access weight which made me sluggish but I think the tablets anyway made me like this .Surgery was the only thing that worked . Beforehand I was given a few awful tests such as a fine tube down my nose and throat with an attached monitor for 24 hours plus camera procedures etc so you do endure before they finally give in and you actually get that magic date for the nissan but it really helped me get my life back.

[southofthedowns in reply to focused1]

Many thanks for your reply focused1.

I think the procedure you are talking about is a form of fundoplication.

I have had the camera tests and booked for manometry and ph this coming week.

I will have a chat with the Dr doing the tests to try to get a better understanding of the issues.

It does sound as though you have had a good outcome, I hope I can achieve the same. I think I will have a look around to see if any particular hospital has a reputation for this kind of thing.

Thanks again

[Mauser1905]

Sorry to read your struggle.

the dots are clearly relevant, however nobody can put in black and white per say.

Natural ageing may be main ingredient for the Osteopenia and potentially exacerbated due to long term PPI use. Yours is anyways a complex case history and there may be further complications if bone related fractures are experienced. Please do watch out for that side of the thing.

The inability to sustain pressure on stomach due to movement etc signifies that the LES/LOS is compromised beyond medicine (symptom) management which you were on for decades as per you.

The surgeon will know better on the appropriate best solution for the case in hand, as the inclination towards NF against LINX points me to the higher grade of HH and as such obvious prima fascia.

diarrhoea/bloating are closely related to collateral damage to digestion system affected by ppi use. malabsorption of iron may be linked to systematic digestion compromise over longer duration.

plainly speaking none of those could be interconnected and be part of normal ageing process with underlying's getting detected due to more and more secondary care diagnostics made available.