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Can hernia cause poorly coordiated muscle waves?

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Posted 9/11/2014 1:01 PM (GMT -5)
Just got my test results: very poor function with thin liquids, lower esophagus doesn't relax properly, and muscles waves poorly coordinated. pH study shows acid and non-acid reflux.

Can a hernia cause the poor swallowing, does this mean I'm not a good candidate for surgery?(not that I really want to go that route anyway)

thanks, diana
Posted 9/11/2014 3:56 PM (GMT -5)
Most hiatal hernias don't cause much in the way of symptoms. Most people who have them don't ever even know about them.

Large hernias, on the other hand, can cause all sorts of problems, although I wouldn't expect the problems you describe. (NOT a doctor!!)

Poor swallowing might mean you won't get surgery, although my swallowing was called "wimpy" and I had it. But I was in a terrible condition with a "giant paraesophageal hernia" (GPEH) due to my stomach being pushed into my chest in an accident. My swallowing was poor, and still is, but not related to stomach. I am post-polio.

Surgery will not fix poor swallowing. It can make swallowing more difficult. Because of this, I was given a Toupet fundoplication - not a floppy Nissen but a partial wrap. My swallowing is not worse. I'm SO happy I had it!
Posted 9/11/2014 5:02 PM (GMT -5)
I'm going to have to disagree with Alcie, sorry, but I have a 1cm hernia and it has ruined my life. I now have constant weak reflux and non acid reflux and my peristalsis has completly slowed because of this.
It is a well known fact that reflux reduces the amplitude of peristaltic contractions.
It is the hernia that has caused the reflux which is impacting on your peristalsis.

Pink
Posted 9/13/2014 8:45 AM (GMT -5)
Diaba,

Has your consultant given you any options and do you suffer from much regurgitating and reflux?

Pink
Posted 9/13/2014 1:41 PM (GMT -5)
I'm sooo discouraged by all of this. I have a lot of reflux, though the pH study barely showed it because the testing actually inhibited the reflux(I think you had the same experience?)Also have some regurg. but not often.

I have a follow-up apt in 2 weeks, but not sure what he can tell me. His assistant said I should drink thickened liquids and be on a ppi which i can't tolerate. so feeling pretty stuck right now.

I got my results in the mail, it showed my residual pressure in the LES was high: 10.0mmHg. peristaltic contractions low at 10%, and simultaneous contractions high at 90%. Not sure what can be done about it, but have to wonder if just fixing the hernia would help a lot. it seems to always be done with some sort of wrap, I would like to try just fixing the hernia.
Posted 9/13/2014 5:08 PM (GMT -5)
Hi,

My residual pressure last time was 8.6 this has gradually got worse as the peristalsis has slowed down used to be a 4, anything over 7.5 is classed as an incomplete relaxing sphincter according to Tom DeMeesters book. However my first manometry showed residual pressure of 11.4 and says anything under 15 is normal - I think it is as long as the sphincter relaxes compared to the starting (basal) pressure, so mine at that first manometry was a starting LES pressure of 22.5mmHg and residual 11.4mmHg was actually a relaxation of 51% anything over 40% is classed as normal. I had one manometry that showed 26% relaxation when I started getting a lot of pain.
Do you actually have any trouble swallowing foods, do you feel food gets stuck?
My sphincter has given up now, the pain has gone as it is now just open I think, but the reflux and regurgitation is odious - I'm waiting on another barium swallow.
I'm thinking of a myotomy and wrap or at worst a fundo and a feeding tube, anything to get rid of the hideous reflux which is also non acidic.
This is a really crap disease!
Hope you get some good news, a lot of doctors believe if you get rid of the reflux peristalsis can be restored or at least increased.

Pink

Post Edited (GC1pink) : 9/14/2014 2:09:36 AM (GMT-6)

Posted 9/14/2014 8:50 AM (GMT -5)
Diaba,

Might be worth mentioning the endostim to your consultant
Posted 9/14/2014 9:39 PM (GMT -5)
GC1pink, this is a crap disease for sure, especially when the treatments, even surgeries, sometimes don't help, or can even make things worse.

So does your spinchter show no pressure now? that sounds awful, why does that happen, the hernia? How are you supposed to protect your esophagus?, do you use the gaviscon advance to try to make a temp. barrier? I tried it but it gave me bad side effects, so stopped.

I swallow kind of okay, but things do feel stuck I guess where the hernia is, just above my stomach, in my lower esophagus. Even water gets delayed in going down. Makes me wonder when the acid and non-acid reflux(I have both too) comes up, does it delay also in going back down and cause further damage?

Looks like my LES pressure at mid resp was 32.6 and my residual was 10, what does that mean?

I feel like I need a Phd in this subject just to have a fair shot at learning to live with this.

What would a myotomy do? How long would you have to have a feeding tube? I really hope you can get some relief from your symptoms. It really does get to be too much to deal with all of the time.
Posted 9/15/2014 3:17 AM (GMT -5)
Hi Diaba,

I haven't had a recent manometry, last one was in June but was getting severe pain on eating then, now that the sphincter is mainly open the pain from swallowing has gone but the pain from reflux remains. My sphincter will try to tighten when acid washes over it sometimes.
I used to think it was my hernia causing food to get stuck but actually I think it was the poor motility - weak motility causes weak contractions to push the food through the LES, this can cause the LES not to open properly and food gets backed up until it us slowly pushed through, I used to get a lot of spasms with this.

Yes you are correct the delay in the clearance of acid causes further damage to the mucosa and nerves. Constant acid wash will cause a decrease in amplitude in the distal oesophagus.

To work out your relaxation percentage you need your starting or basal pressure, I don't know about mid pressure.

The residual pressure of 10mmHg means that the LES had a resting tone of this pressure when you swallowed, ideally for a good relaxation it should be less than 7.5, but it does depend on your starting pressure, as long as it relaxes to let food through you should be okay.

A myotomy would cut the LES all the way through to allow food to get through with a partial wrap to protect from reflux, I'm unsure whether this is suitable in my case. If not I would be having a fundo and a feeding tube probably for life.

If I said reflux had ruined my life it would be the understatement of the year!

Do let me know how you get on

Pink
Posted 9/16/2014 12:41 PM (GMT -5)
Pink, wow, I wish their was a easier way for you to get some relief from the symptoms/damage of the reflux. Sounds like what you would have to go through to get some relief would be challenging, but you can't leave it as it is either. rock and an hard place for sure.

I don't think anyone understands what we go though with this disease, maybe even some of the specialists don't really understand.

It's so life altering and I don't even know what started mine, I guess many others don't know either.
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