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Forum Name: Gastroenterology Topics

Question: Hiatal Hernia & Heartburn


 chrissy757 - Wed Sep 10, 2008 10:21 pm

I was diagnosed with a hiatal hernia a couple months ago and was prescribed Protonix but it ended up making my stomach feel more acidic. I tried Tagament because I heard that it didn't become acidic in the body like Protonix/Prilosec do but it doesn't work. I have also tried Pepcid chewable tablets and they didn't work either. So are there different types of heartburn? Are there certain medications I can take that won't leave my body feeling acidic but still get rid of the pain?
 John Kenyon, CNA - Tue Nov 04, 2008 9:47 pm

User avatar Hello -

While there is technically only heartburn or no heartburn, there is a difference in the mechanism causing it when one compares regular GERD and esophageal acidity caused by a hiatal hernia. Mechanically GERD is caused by a simple failure of the ring muscle (sphincter) at the bottom of the esophagus to close properly and so doesn't keep the stomach's acid from backing up. With a hiatal hernia there is actually a hernia (opening, split or tear) in the bottom of the diaphragm, which allows part of the stomach to slide upward and telescope into the esophagus off and on. Sometimes this becomes a constant situation with part of the stomach staying up in the chest. It isn't clear which form you have, but the sliding type is generally treated the same way GERD would be, while the "trapped" type is usually repaired surgically. With GERD-like symptoms, usually the simplest (and least expensive) drugs designed to prevent excess stomach acid from being formed are prescribed, and if those don't work, the ante is upped in terms of more sophisticated (and usually more costly) medications, til one or a combination are found that works.

If you've tried over-the-counter medications and they aren't working, you may need a trial of one of the very potent prescription medications such as Nexium (esomeprazolse magnesium) or something equally potent (and expensive). It's important to treat the symptom of heartburn, because it means there is stomach acid getting into the esophagus and irritating it. Over time this can cause a lot of problems, from the chronic and serious to, sometimes the very serious. While it takes time for the damage to be caused, this is the point to preventive care, to keep this from happening.

It sounds as though you're having a hard time finding a medication or combo that works for you. You'll need to take this problem back to your doctor and stress your discomfort and the need for symptomatic relief. You may wind up having to get a second opinion, since your problem is slightly more complicated than that of simple GERD.

I hope this is helpful to you. Please keep us updated as to how you're doing and if anything changes. Best of luck to you.

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