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Suggest Treatment For Hiatal Hernia

Posted on Mon, 8 Sep 2014

Question: Greetings. My 55 year old wife just returned from doing an endoscopy to check her ongoing old hiatal hernia. We are not completely clear as to what the attached photos from the endoscopy indicate, and how concerned she should be about the erosiveness in the future (when it would heal). Could you clarify what the photos show? Will treatment with Protonix be a life-long event, or could it be discontinued eventually, and does it carry the same risks vis a vis calcium depletion as omeprazole. Finally how helpful is it to stop eating certain foods such as fried foods, oily foods, etc. to stop the belching long term?

Answered by Dr. Dr Samir Patil (7 hours later)

Brief Answer:
Gastric erosion. protinix can be stopped eventualy

Detailed Answer:
Hello Mr XXXXXXX
Your wife's endoscopy picture shows the presence of an erosion in the antrum of the stomach and its size is less than 5 mm.
This erosion should not be a matter for concern in the future. Most of these erosions start disappearing within 48 hours of starting medications like protonix. At the latest it would not take more than 4 weeks to heal.
About protonix-- for the erosion , lifelong therapy is not needed and a decision to stop can be taken after 8 weeks. The risk of calcium depletion is similar to that of omeprazole. ( only if taken in high doses for more than a year)
Change in diet
The dietary restrictions which are followed are fried foods, mint , chocolate, red meat, tea/coffee restriction to 2 cups or less, carbonated beverages, alcohol, tobacco.
These are effective in reducing the symptoms by 20 %.
Hope this helps
Regards.
Dr Samir Patil

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr Samir Patil (30 minutes later)

Thank you doctor. If the hiatal hernia is permanent then won't the erosion return again after interrupting the use of protonix after 8 weeks? And then the cycle has to be repeated constantly because of the hiatal hernia? Does plain unflavored carbonated water beverage cause acid reflux?

Answered by Dr. Dr Samir Patil (3 hours later)

Brief Answer:
Might need intermittent medications.

Detailed Answer:
Hello Mr XXXXXXX
Yes there is a chance that the erosion will recur after 8 weeks because she has a hiatus hernia which makes her prone to reflux. The erosion is not very large so it should heal completely. But there is a chance that she might require intermittent courses of Protonix in case she develops symptoms again. In GERD almost 1/3 of the people require intermittent medications while 1/3 need long term PPI (protonix).Regarding your last question-Yes Unflavoured carbonated water can increase reflux.
Do get back if you have further queries
Regards
Dr Samir Patil

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju