A Case Of Hiatus Hernia with Reflux Oesophagitis

© Dr.R.S.Mann 2011

 Presented By 

Dr. R. S. Mann

 A patient, Mr S.Kumar, 33 yrs male, has following complaints since last 7 years, increasing year after year.

Eructations, violent, continuous, loud, starts from morning, increase in afternoon after lunch and constantly increasing, pain in hypochondriac region, epigastrium, back, chest, sometimes left arm, sometimes pain knee with these eructations. Vomiting which relieves for few minutes. Burning and pain in epigastrium region which relieves by eating (it seems a mild relief) and sitting bent. Sleep disturbs by these eructations, have wake up and stand up so that he can eruct and get relief when flatulence passes that is collected in stomach. Can sleep very late and not more then 4 – 5 hours. When he has flatulence, no position gives him relief, sometime lie down, sometime stand up and then sit up but no relief anyway.

He thinks how good it would be if there is no need and provision to eat. He is very much worried about his disease, works very far from his native place, he thinks to resign the job and shift back to that place, thinks what will happen about his wife and kids after him. Thinks if he will die so far, how his dead body will go to his native place.

Angry, very easily on kids when they want to play with him, even he slap them, get angry on wife, noise hurts him.

Thirst very less, not want to eat.

Due to vomiting, he feels rawness in throat and eruptions, which bother him.

Stool hard sometimes. Go once for stool in a day.

Pulse slow. He says his pulse drop as less as to 62 sometimes, and then he feels become much more worried about his health.

Endoscopy report says he has Hiatus hernia and gastritis.

D/H – Taking different kind of antacids, antibiotics off and on since his disease.

P/H – Three years back he quit tobacco chewing.

Repertorization

Radar :

STOMACH - BENDING - forward - amel.

STOMACH - THIRSTLESS

STOMACH - ERUCTATIONS - constant

STOMACH - ERUCTATIONS - violent

STOMACH - VOMITING

STOMACH – PAIN

ABDOMEN - PAIN - Hypochondria

ABDOMEN – FLATULENCE

STOOL - HARD

BACK - PAIN

EXTREMITIES - PAIN - Upper arm

EXTREMITIES - PAIN – Knee

SLEEP - DISTURBED

GENERALS - NIGHT - midnight - before

GENERALS - CHANGE - position - amel. - not amel.

GENERALS - NOISES - agg.

GENERALS - FOOD and DRINKS - food - aversion

GENERALS - PULSE - slow

GENERALS - VOMITING - amel.

MIND - DESPAIR - recovery, of

MIND - ANXIETY - health; about - own health; one's

MIND - ANGER - easily

MIND - DEATH - thoughts of

MIND - FEAR - happen, something will - himself; to

Phos 22/48, Puls 19/43, Acon 19/32, Ars 18/42, Lyco 18/42, 
Nux V 18/38, Sulphur 18/35, Ferrum Met 18/32, Kali Carb 18/31,
Lach 18/31

Another Repertorization on

Complete Dynamics

Generic Symptoms:
Throat; pain; sore, bruised
Heart & circulation; pulse; slow, brachycardia
Back; pain
Sleep; disturbed
Generalities; food and drinks; food in general; aversion to
Generalities; noise; agg.
Generalities; vomiting; amel.

Stomach:
Stomach; bending; amel.; forward
Stomach; eructations; constant
Stomach; eructations; empty; profuse
Stomach; eructations; violent
Stomach; pain
Stomach; thirstlessness
Stomach; vomiting
Abdomen:
Abdomen; flatulence
Abdomen; pain; flatulence; from
Abdomen; pain; hypochondria
Stool; hard
Extremities:
Extremities; knees
Extremities; pain; upper limbs
Mind:
Mind; anger; easily
Mind; anxiety; health, about
Mind; death; thoughts of
Mind; despair; recovery, of
Mind; fear; happen; something will; family, to, or to him

Prescription:-
Phosphorus is the most similar medicine for the case which comes out in both repertorization.

Oct. 14, 2011

Phos 200 CH 3 doses prescribed 6 hourly. With Sac lac for 10 days.

Oct. 21, 2011

Very much relieved, no vomiting, eructations reduced lot much. Sound sleep. After many years he has some days when he has no burning, eructations or abdominal discomfort.
Sac Lac for 15 days.

Nov. 5, 2011

Remain normal on every alternate day. Mild eructations on alternate day for few hours.
Pain throat as if raw and stinging.
Phos 1M CH 3 doses prescribed 6 hourly. With Sac lac for 10 days.

Nov. 8, 2011

Vomiting this morning, just after drinking water, water becomes hot as if boiling in stomach, and vomited out.
Restless, anxious.
Note*:- Phos 1M must not be given; it was early to shift to upper potency, early repetition.
Sac lac prescribed with assurance.

Nov. 16, 2011

Eructations, burning, pain, vomiting reduced.
If he has some discomfort after eating, it remains just for half to one hour.
Sleeping very well.
Stool normal.
Appetite good can eat everything now without any burning and worry about abdomen.

Sac Lac prescribed for 10 days.

Nov. 26, 2011

Very much improved.
Eructations only 2 times in 1 day.
Sleep very good.
No vomiting.
Sac Lac prescribed for 10 days.

Dec. 6, 2011

Pain head, from 3 days, continuous whole the day, with vertigo.
Throat feels raw and heavy.
Eructations better.
Vomiting once, just 2 days before.
Worried again for his disorder, although better.

Phos 200  1 dose.
Sac lac for 10 days.

Dec. 17, 2011

Head pain and vertigo improved on next day of last prescription.
Sac Lac for 10 days.

Dec. 27, 2011

Patient has started some discomforts again. Eructations which improves after eating.
Burning pain in throat which also ameliorates after eating. Patient is feeling feverish constantly.
Throat inflamed. 

Another Repertorization on
Radar: 

THROAT - INFLAMMATION
THROAT - PAIN - burning - eating, after - amel.
THROAT - PAIN - burning
THROAT - PAIN - rawness
STOMACH - ERUCTATIONS
FEVER - FEVER, heat in general
GENERALS - EATING - after - amel.

Mez 7/15, Phos 6/17, Merc Sol 6/15,Natrum Mur 6/15,Puls 6/15, Sepia 6/15,Aconite 6/14, Hep 6/14, Lachesis6/14,Nux V 6/14,Sulphur 6/14.

Phos prescribed on Dec. 6 although help in headache and vertigo but it produced new symptoms in patient. On repertorization Mez seems best similar now which also antidotes the Phosphorus.

Prescription:- Mez 30 Ch 3 doses prescribed with sac lac for 10 days.

Jan 7, 2012

All the symptoms relieved very next day of prescribing Mez 30. Not any symptom and discomfort present.
Sac lac for 10 days.

Jan 18, 2012

Not any discomfort or symptom is felt by patient. Medicine is discontinued.

Heartburn Or Hyperacidity

Esophagus is a tube like structure which passes food from mouth to stomach. At lower end of esophagus a valve like structure called Lower Esophageal sphincter (LES) act as one way valve which let pass food from esophagus to stomach but stop its regurgitation.
Secretion of acid in stomach is normal process to digest the food. Inner most lining of stomach wall is acid resistant, so stomach itself does not get any harm from acid secreted in stomach but esophagus has not such kind of protective lining. In normal conditions acid mixed food does not regurgitate up in esophagus. But when food and acid refluxes back into esophagus it produces symptoms from mild discomfort to severe burning. This is known as Gastro-Esophageal Reflux( GER).
Acid Reflux is a very common symptom but if it is felt more than twice a week in long term it can produce Gastro- Esophageal Reflux Disease ( GERD).
Symptoms of Gastro- Esophageal Reflux Disease ( GERD) :-
1. Frequent Heartburn- although it is a burning sensation in mid chest or lower part of esophagus but it has no relation with heart.Burning mostly increases with eating and may last for hours after eating. Burning may increase with stooping, lying down.
2. Acid Belching- Eructation of acid or acrid water in mouth with eructation.
3. Symptomless- Less incidentally GERD may occur without usual symptoms of burning or heartburn. Instead in children there may be Dry cough, Asthma like symptoms or difficult swallowing indicating to GERD.
Factors or Causes Responsible for GERD:-
In many cases exact cause remains unclear but some important factors are underlined.
A. Acid reflux caused by Hiatus Hernia, a structural abnormality in which stomach and LES ( Lower Esophageal Stricture) junction moves above the diaphragm.
B. Pregnancy- Many women feel heartburn first time in pregnancy, it occurs due to increasing level of hormones and growing size of fetus which increases intra-abdominal pressure which reflux acid into esophagus. Most women feel worst symptoms in third trimester and after delivery symptoms go away completely.
C. Smoking- Smoking increases heartburn episodes by increasing acid secretions, reducing salivation in mouth which neutralize acid effects in esophagus, reducing lower esophageal sphincter muscle’s function which increases acid reflux into esophagus.
D. Obesity- Obesity increases intra abdominal pressure which increase acid leakage into esophagus.
E. Foods and Food Habits– Eating large meals and eating just before bedtime can increase heartburn.Some foods increases events of heartburn as :- Alcohol, Carbonated beverages , chocolate, tomato and tomato products like sauce, citrus food , coffee and tea, spicy food, garlic and onions. All these foods can trigger heartburn.
F. Mental stress related to shift working, emotional and economical issues may increase Heartburn symptoms.
Diagnosis :-
Frequent heartburn, sour and acrid eructation is sufficient to diagnose this condition. But sometimes to know extent of disease further examination is needed-
A. Barium Swallow.
B. Endoscopy.
C. pH Monitoring.
D. Biopsy in cases of suspicion of cancer.
Management and Treatment :-
Lifestyle and dietary changes can improve episodes of Heartburns and prevent Gastro-Esophageal Reflux Disease.
A. Avoid food and beverages which trigger heartburn as alcohol, soda, carbonated drinks, chocolates, tomato based foods, garlic etc.
B. Quit Smoking.
C. Food Habits- Eat small meals at a time.Finish your food 2-3 hours before going to bed.
D. Weight Reduction and manage obesity- Weight reduction and managing obesity can improve recurrent episodes of heartburn.
E. Improve your sleep- Quit night watching and improving sleep quality can reduce heartburns.
F. Raise 6 inches of your head side of bed- Raising head side 6 inches improve the flow of acid in stomach away from esophagus which reduce the heartburns.
G. Stop wearing tight clothes.
If using these tips is not sufficient to stop episodes of heartburn then further treatment is necessary because frequent acid spilling in esophagus can produce ulcers, bleeding and can develop cancer of esophagus.
Allopathic Treatment-
Antacids are used to reduce heartburns and acrid eructation. Foaming agents, H2 blockers, Proton pump inhibitors and Prokinetics are most common type of drugs used for antacid effects.
Long term effect of antacids can result in side effects as diarrhea, altered calcium metabolism and extra build up of magnesium in body. Too much magnesium can effect patient of kidney disease.
So continuous use of antacids without consultation may endanger health.
Homeopathic Treatment-
Homeopathy has very effective medication for acute and chronic cases of Hyperacidity and heartburn. Regular use of homeopathy on one hand can prevent from GERD and on another hand homeopathic medicines prevents from side effects as in case of regular use of allopathic antacid drugs.
Homeopathy has 274 medicines for Heartburn, Acrid Eructation and burning esophagus. Long term use of these medicines never impose any side effect on health. Some very common medicines are-
Lycopodium, Nux Vomica, Acid Sulf, Robinia, Sang. Can., Arsenic Alb, Nitric Acid, Phosphorus etc.
When to Consult a Physician:-
1. If heartburn occurs more then two times a week.
2. If You wake up in night due to heartburn.
3. If routine medicines which you are using is not working now.
4. If heartburn associated with difficulty in swallowing.
5. If there is hoarseness, difficulty in respiration after eating or lying down after eating.
6. If there is unexplained weight gain or weight loss.
7. If heartburn is started to disturb your routine life.