Axial diaphragmatic hernia
June 19, 2011 | 20,00 EUR | answered by Uni-Arzt Freddy Feuerstein
Hello,
During a very stressful time, I experienced strong upper abdominal pain and a few weeks later, a minor tear in my diaphragm was discovered through an endoscopy. At that time, however, I was symptom-free. It was also found that the entrance to my stomach was superficially burned, and I have been taking Pantoprazole or recently Omeprazole to reduce stomach acid since then. I have been mostly symptom-free for about a year now.
However, my doctor is recommending surgery. The alternative, according to my doctor, would be a lifelong intake of acid tablets.
(27 years old)
I need a second opinion regarding the benefits and risks of the surgery for my decision.
What are the arguments against a lifelong intake of the tablets?
Thank you in advance.
Dear questioner;
basically, your medication is a very safe and effective treatment with relatively few side effects, at least in the short-term therapy.
However, lifelong intake of PPIs (which is the group of medications that includes Omeprazole) can lead to the following:
1. PPI dependency; meaning that if you stop taking the medication, in addition to your anatomical problem, the axial hiatal hernia, you may also experience an acid problem in the stomach. The parietal cells then produce excess acid, which would further exacerbate your reflux issues.
2. Some people experience elevated liver enzymes, indicating microdamage to the liver. (Therefore, regular monitoring of liver values is necessary)
3. Long-term therapy seems to have an impact on food allergies; they appear to be more common during PPI long-term therapy.
4. There seems to be an effect on bone metabolism; it can worsen osteoporosis tendency.
5. There is a risk of bacteria settling in your stomach, as there is little acid left. This can potentially lead to chronic gastritis in the worst case scenario.
The long-term side effects are still being researched, so the list may get longer.
Due to the hernia you have, acid reaches the esophagus, which can lead to the symptoms you described. In the long term, there is an increased risk of CANCER, which is why the treatment is correct and meaningful.
Since you are still very young, I would also recommend an operative intervention for you.
While surgery carries a one-time risk, if you are otherwise young and healthy, you will tolerate and recover from the operation and anesthesia very well.
If you have any other significant pre-existing conditions, please feel free to inform me in a reply. Smoking and alcohol consumption in particular promote acid production, as do coffee and highly caffeinated energy drinks. Additionally, fruit juices can influence acid production. These are factors you can consider additionally.
I wish you all the best.
Sincerely,
T.C. Müller
