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Digestive Disorders

Will a Hiatal Hernia Get Worse Over Time?

12/08/2010

Question:

I`m a 32 yr old female and was diagnosed with a hiatal hernia, GERD and (if I`m remembering correctly) a "few spots of erosion" in my esophagus and stomach after an endoscopy about 7-8 yrs ago. I took Nexium for several years, but haven`t really had any heartburn or other symptoms the past 1-2 yrs after I lost about 40 lbs. (I weigh around 137 now and am 5`4".) My doctor told me weight loss can help reduce GERD symptoms and said I did not need to continue taking medication if I no longer had symptoms.

Over the past 4-5 months I`ve noticed that any pressure on my breast bone, or just below it, is painful. Most of the time I can barely tolerate the pressure from my bra even if I`m wearing a loose fitting one. I often feel nauseous and have very mild heartburn, taking a tums tablet usually cures the heartburn instantly.

During the past couple weeks the pressure/discomfort/nausea have been getting worse and a few days ago I started having pain when I swallow. It feels like something scratched my esophagus from about the middle of my throat all the way down into my stomach. I`ve started taking Previcid again, but nothing helps. I feel like I might feel better if I threw up, but don`t want to make myself vomit.

So my question is, is it "normal" for a hiatal hernia to get worse over time and could the symptoms I`ve been experiencing be caused by the hernia getting worse?

Answer:

Hiatal hernias can get worse with time but not necessarily. We even have seen them in one endoscopy and not in the next (usually called sliding hernias). Restarting Prevacid is a good idea because once you have a hernia, you are prone to heartburn and the heartburn can cause inflammation and erosions or ulcerations of the esophagus which can produce the symptoms you are feeling. However, Prevacid does not work immediately and make take up to a month to get complete relief and start healing the esophagus.

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Response by:

Annette  Kyprianou, MD Annette Kyprianou, MD
Senior Clinical Instructor of Medicine
School of Medicine
Case Western Reserve University