Don't know what to do

I'm really at a loss now over what to do. I was previously on Nexium 40mg twice a day but still with symptoms. I decided to try reducing it to 20mg twice a day because I didn't like being on so much medication and didnt notice much difference. Next I tried going to Omeprazole 20mg 2x a day and after a week my heartburn started to get worse.

I waited a week to see if it was just coincidence but it has continued to be bad, so I go back to the doctors this morning and ask to be put back on Nexium.

The dr says because Nexium is so expensive they will only prescribe it for another 8 weeks, then I am stuck with Omeprazole. So I asked to be referred to a surgeon as even with Nexium I am not symptom free and I cant take it living like this anymore.

But the problem is all my tests have been normal except for a rolling hiatus hernia seen only by endoscopy, which he said showed up because of the wretching.

My LES pressure is normal, my pH test was normal despite being symptomatic, but the GI said I hadn't been off PPIs long enough (only 5 days - couldnt take longer tbh), my barium swallow showed no reflux and no hiatus hernia despite my having heartburn throughout.

I just don't know what to do, I am terrified of going through with surgery only to find out that it doesn't solve my problems, but I feel like I have exhausted every other possibility of why I have heartburn almost constantly. I don't have Eosinophils, tried cutting out different foods with only limited easing of pain but probably due to acid levels. I'm on anti-depressents for anxiety and haven't had any episodes of anxiety for months which always tend to make it worse.

I am 100% convinced it is my esophagus and nothing else, it constantly feels inflamed and the only thing that makes it feel better is to eat something and feel something neutral and plain in my esophagus which eases the pain a little. Of course, eat too much and it only makes it worse!

I'm at my wits end, don't even know if I will be offered the surgery or not. Is there anyone out there that had the same problems as mine? Constant (and I mean literally constant, severity fluctuates) heartburn, tests showing nothing wrong, medication only partially effective even at extremely high doses that has had success with surgery?

In my first endoscopy they just said "large" and I remember the clinician saying "wow thats a big one" but it wasn't diagnosed as rolling.

In my second endoscopy he said it was 2cm rolling hernia, but I got the impression that it was only moving up because of the wretching. I do the drop from toes trick quite regularly and relax my abs so I think this keeps my stomach down, but it does worry me a bit because I have heard that the paraesophageal hernias can be life threatening

How are your bowell movements? Have you had a gastric emptying test?

As far as I know

Omeprezole is generally 20 mg.

Protonix (Pantoprozole) is 40mg.

Nexium is 40mg as well.

I think that is the only difference.

Hi Andy,

Nexium is a much stronger ppi, so that perhaps is why it is working better for you.

I am interested to know what techniques you did at home to reduce your hernia?

Prokinetics like domperidone - not only empty your stomach faster therefore reducing your acid levels but domperidone also helps tighten the les sphincter.

Please do enquire whether you have a rolling hernia, and discuss options with your consultant.

I think my pH was only acid. I have been considering whether to ask for the impedance test as I couldn't take being off ppis for 2 weeks like they asked for a redo of the pH test.

I had 10 acid reflux episodes, 1 significant, with DeMeester of 10.4.

My esophagus is weak, about 24 pressure measure vs normal which should be 30-140 so I think the full nissen is not an option, but partial one could be. Given my hernia I think I will go for this option. I have been putting it off because I love weightlifting and dont think Ill be able to go hard at it in the gym after, but my quality of life is suffering too much now and if I cant be on Nexium after 2 months then I dont really have an option.

I have tried pantoprazole but that was rubbish, nothing else except nexium and omeprazole tried.

The techniques I used for my hiatus hernia are quite simple but I think very effective.
- The first is to drink about 1/2 - 1 pint of warm water in the morning. Then stand on tip toes and drop hard onto your heals repeatedly. The weight of the water will drag the stomach back down.
- The second is to massage the stomach down, there are youtube videos showing how to do it. I dont do this often though as I dont really like to mess about with it like that.