hiatal hernia advice.. have endoscopy, 24 hr PH, manometry results.

Hi everyone- I just found this forum and it looks like there are many very helpful and knowledgeable people here. Hopefully I can help others, and I would like to get your input on what I've been dealing with the past couple years. I will try to keep it short but will probably not succeed.

I am 34 male, 5'10 about 145 lbs, very healthy diet, exercise regularly, no smoking, fairly relaxed guy.

CLIFF Notes: Continuous sour taste when on PPI or H2 blocker, 1cm hiatal hernia, "chronic gastritis", no heartburn, no h. pylori.

The first indication I had a problem was that I was always swallowing, I always had throat tightness and needed to swallow, but that didn't relieve the need to swallow. I lived with it for over a year, thinking maybe it was in my head, and finally went to see a dr. She diagnosed me with GERD which was surprising to me as I have never had heartburn nor had I noticed regurgitation or any other common symptom the dr. asked me about. I was put on Omeprazole 20mg/day and to cut out coffee and alcohol (I had 1 cup of coffee on empty stomach in AM and 1 beer in PM typically).

The first morning after taking Omeprazole and not drinking coffee, I felt much more relaxed feeling in my gut in the morning, it was a huge difference. I noticed after a few days that my throat was not tight anymore (what a relief) but I had a sour taste ALL day -- starting about 10 minutes after my first meal, lasting the rest of the day. I went off Omep., kept with the good diet, but the throat tightness came back. Went to see dr. again who referred me to a gastro. He ordered 24 hour PH study and manometry.

The PH study showed a low DeMeester score (not indicative of GERD), low to normal amounts of refux episodes etc (I checked against healthy subject data.. I work in public health and do lots of journal searches), and my sour taste symptom was associated with "weakly acidic" reflux.

The manometry study was normal and the results did not suggest hiatal hernia (however data shows that manometry is not an accurate test for detecting HH compared to endoscopy). I again compared against healthy subject data, and my numbers were actually very good.

(I thought my symps might be a pylori infection, so my primary doc let me try the sequential eradication therapy for 10 days.. tolerated it fine but do not know if it helped anything).

I went back on Omeprazole just to keep the throat tightness away but continued to have the sour taste all day. I asked the gastro for an endoscopy. That was done on April 6. He noticed a small hiatal hernia (1cm), did not "see" any gastritis but did see changes around the esophageal junction consistent with acid reflux. Biospies were taken. No H Pylori however the analysis of the stomach sample showed "chronic gastritis".

All the gastro doc said was to continue following anti reflux measures and that if the sour taste continued, he could give me an low dose of antidepressant since I was "overly sensitive" to the sour taste (which can be very strong, about 6-7 on a scale of 1-10).

So that's what I know so far. I went back on Omeprazole after the endoscopy, but 20mg twice a day, to get rid of that throat tightness but still have the sour bitter taste all day. I am going to stick with this for 6 or so weeks to see if the sour taste goes away somehow. I have also tried ranitidine but it had the same sour taste effect for me which I concluded is a weakly acidic mixture that still somewhat irritates my throat.

I am puzzled as to what is causing this weakly acidic mixture to come up. Is "chronic gastritis" the cause, or is the small hiatal hernia the cause? I do not have any stomach pain, so I'm not sure if the gastritis is the culprit. If the hiatal hernia is the issue, it would be quite a relief since I have tried everything and the sour taste continues when I am on acid reducing/blocking meds. When I am not on those meds, my throat gets tight, I swallow a lot, but very little to no sour taste (I guess I'm swallowing enough to keep it down).

Anways if anyone has any thoughts, I'd love to hear them. I am thinking I'll try another gastro doc who might be open to surgery if the hernia is the issue here, my current gastro doc doesn't seem to think I have much of a problem and I don't want to just mask the sensation of the acidy taste with an anti-depressant.

Thanks for any thoughts.

Post Edited (drtinsac) : 4/17/2012 9:14:14 PM (GMT-6)

Hi Denise, thank you for the reply and the information on DeMeester.

To answer your question, yes I do have the head of my bed elevated approximately 7 inches. I did that as soon as I was first diagnosed with GERD, in addition to other lifestyle measures of cutting out caffeine and alcohol.

Another frustrating part of it is that other than the reflux symptoms, I felt fine and led a very healthy life. I mean literally eating chicken breast, brown rice and veggies for lunch and dinner, exercising at least 30 minutes a day. So when I read the lifestyle recommendations about eating smaller meals, decreasing fatty and spicy foods, avoid excess alcohol etc, losing weight, stopping smoking, none of them really applied.

But anyways, as far as lifestyle, I am and have been doing whatever I can, however these reflux symptoms continue. I am really hoping the hernia is the cause since it's one of the only things that makes any sense to explain it.

Dear,

Welcome to Healing Well.

Most people have a hiatal hernia of some size. Most people don't ever know they have it unless they start having GI issues. The size of yours is actually relatively small. The hernia is where the esophagus goes through the diaphragm and normal life activities usually won't enlarge it, but things like car wrecks where the seat belt pushes very hard on the belly can enlarge it.

Have you tried any meds or anything else to help with the reflux? If it's worse at night you can raise the head of your bed a few inches to help keep things down and try not to eat at least 3 hours before going to bed. Don't just add more pillows to your head as that actually puts more pressure on your belly and makes things worse.

Take care,
Bill