Hello, XXXXXX,
The hernia that you mention occurs because of a defect in the
diaphragm, muscle separating the chest and abdomen.
The stomach is usually below and the esophagus is above the
level of the diaphragm. In this case the sphincter muscle
between the esophagus and the stomach is week and thus
allows the acid and the stomach contents to reflux back up
into the esophagus and can cause irritation and damage thee
lining. The symptoms could be hearrtburn,coughing, especially
at nights, hoarseness of the throat, repeated sinus infections etc.
Some people can have a large hernia and have no symptoms.
Since your wife is quite symptomatic, she needs to be treated.
Surgery is not indicated in all cases. Some dietary measures
she should follow,avoid tomato based products, citrus, cheeses,
caffeine, tobacco.
Make sure she does not eat late at night. Try to keep the head
of the bed elevated at nights.
There are effective medications to control the acidity in the stomach.
These are P.P.I.s including Prilosec (Omeprazole),Prevacid,Aciphex,
Protonix, Nexium etc.
These are all available over the counter.
If you talk to the doctor or pharmacist, they can tell you how to
take these. The best time to take them is about an hour before the
meals.
Let her take the medications for 4-6 weeks steady. I f there is
significant improvement, then she needs to be on maintenance.
If no improvement, she needs to see a gastroenterologist for
further evaluation such as endoscopy, biopsy etc.
If all medical treatment fails or if the hernia is very big, then
surgery should be considered. Laporocopic surgery called
"Fundoplication" can be done. The surgeon wraps a portion of
the stomach around the sophagus to tighten the sphincter and
this prevents the acid from backing up the esophagus.
Hope this information helps you, so that you can discuss with
your doctor,
Wish her well.

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