Dear Doctor: Could you explain what a hiatal hernia is and what treatment options are available?

View pictures in App save up to 80% data.

View pictures in App save up to 80% data.

DEAR DR. ROACH: I am a 74-year-old woman who maintains an active and healthy lifestyle. I recently underwent an endoscopy, which revealed a hiatal hernia measuring approximately 5 centimeters, accompanied by some inflammation. I have been experiencing episodes of acid reflux nearly every day.

The gastroenterologist prescribed me a course of 40 mg omeprazole for a duration of six weeks, and it was incredibly effective. I experienced no stomach discomfort or acid reflux during that time. Once the treatment concluded, the doctor advised against taking it daily. However, if I felt the need to continue, he suggested using the over-the-counter (OTC) version at 20 mg every other day, which I found to be just as effective when I tried it. He also recommended managing any future acid-related issues with Pepcid or considering surgery for the hernia.

During my routine medical appointments, my primary care physician mentioned that it's fine for me to use the low-dose, over-the-counter omeprazole. Could you provide an alternative perspective on this? -- G.P.

The diaphragm is a sizable muscle that divides the chest from the abdominal area, and several vital structures pass through it. Consequently, there is an opening in the diaphragm known as the hiatus. A hiatal hernia occurs when there is a weakness in this hiatus, where the esophagus travels through, permitting the stomach (and occasionally other abdominal contents) to move into the thoracic cavity.

The primary indication of a hiatal hernia is acid reflux, which occurs when stomach acid flows back into the esophagus. Consequently, the management of a symptomatic hiatal hernia aligns with the approach taken for treating acid reflux.

Your gastroenterologist discovered inflammation, leading him to prescribe a sufficient duration of antacid treatment to promote healing. Moving forward, you shouldn't require such extensive medication to avert future issues. He is rightly cautious about the potential long-term effects of proton-pump inhibitors, such as omeprazole. I believe he made the right choice in presenting you with alternatives: a low-dose PPI, an H2 blocker like Pepcid, or even surgical options.

Among the available options, Pepcid and comparable medications are the safest, which is why I typically suggest them as my primary recommendation. If a patient still experiences bothersome symptoms, I may then advise a low-dose proton pump inhibitor (PPI). Surgical intervention is usually considered for individuals who do not find relief through medications, and it is occasionally performed on younger patients with intense symptoms to avoid the need for long-term medication use.

Dear Dr. Roach: I’m curious about ear candling. I've come across some positive reviews, but I've yet to hear a medical expert endorse it. What is your opinion on this practice? -- B.M.

RESPONSE: Ear candling is a method used to eliminate surplus ear wax. Some proponents claim it may also benefit conditions such as Meniere’s disease or issues related to the temporomandibular joint. There are also various exaggerated assertions regarding its effectiveness.

Please refrain from trusting these misleading claims and avoid attempting it. There are significant risks involved, such as burns from hot wax, pushing wax further into your ear, and the possibility of perforating your eardrum. Ear candling has been linked to two house fires, one of which resulted in a fatality. There are no advantages to this practice, only evident risks.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2022 North American Syndicate Incorporated.

所有权利均保留