A hiatus hernia is a medical condition where part of the stomach pushes up into the chest through the diaphragm. This can cause acid reflux, leading to symptoms such as heartburn, chest or abdominal pain, difficulty swallowing, recurrent sore throat, or a persistent cough.
In many cases, patients with chronic symptoms are prescribed proton pump inhibitors (PPIs) like lansoprazole. These drugs reduce the production of stomach acid, which is crucial in preventing damage to the esophageal lining. If left untreated, acid reflux can lead to a pre-cancerous condition called Barrett’s esophagus.
Treatment for reflux should be based on the severity of the symptoms. Research shows up to 40 per cent of symptoms can be reduced with diet and lifestyle changes
However, like any medication, PPIs have potential side effects. Long-term use of PPIs has been associated with complications such as migraines, hearing and vision problems, and memory issues. Furthermore, a study published in the journal Alzheimer’s & Dementia found that taking PPIs for over four years may increase the risk of developing dementia, including Alzheimer’s disease.
Considering these potential risks, it is essential to consider alternative treatments for acid reflux based on the severity of the symptoms. Research indicates that up to 40% of symptoms can be reduced through lifestyle changes and dietary modifications.
For patients with a body mass index (BMI) near or above 30, weight loss is recommended. Avoiding common food triggers such as caffeine, chocolate, spicy foods, fizzy drinks, and peppermint, as well as quitting smoking and limiting alcohol consumption, can also help reduce symptoms.
Additionally, it is advisable to refrain from eating for at least three hours before bedtime to prevent acid reflux during sleep. Patients experiencing nighttime symptoms like coughing may benefit from elevating the head of their bed by regarding 6 inches.
If lifestyle changes alone are not sufficient, the next step is to try H2 receptor antagonists like ranitidine. These medications reduce stomach acid but are less potent than PPIs. Should symptoms persist, a once-daily PPI may be prescribed temporarily until the symptoms subside. In rare cases where conservative treatments fail, surgical intervention to address the underlying cause of reflux might be considered.
Another question raised concerns neck and shoulder pain, which was initially diagnosed as polymyalgia. Polymyalgia rheumatica (PMR) is a common condition characterized by pain, stiffness, and aching in the shoulders, neck, and hips, usually worse in the mornings.
If the symptoms are not alleviated by low-dose steroid treatment, which is the standard approach for PMR, other potential causes should be considered. Wear and tear of the discs in the neck, resulting in arthritis, pain, and stiffness, might be a possible explanation. The nerves in the neck can also become pinched, causing neck pain that radiates to the shoulders.
Consulting with a healthcare professional and considering further diagnostic tests like X-rays or MRI scans can help identify the underlying cause of the pain. Treatment options might include physiotherapy to manage the symptoms, although it’s important to note that there might not be a permanent cure for neck pain caused by disc degeneration.
In my view… Another nail in the coffin for GPs
The current state of funding for general practitioners (GPs) deserves attention. With inflation at around 4%, the planned increase in funding for GPs in 2024/25 is a mere 1.9%. It is crucial to recognize that GPs operate as small businesses, with approximately 7,000 individual subcontractors relying heavily on income from the National Health Service (NHS).
Under current circumstances, the minimal rise in overhead costs, coupled with soaring energy prices, exerts additional pressure on these small businesses. As a result, many doctors are either leaving the profession, seeking opportunities abroad or in the private sector, or opting for early retirement. The consequences of these workforce challenges are ultimately borne by patients.
Furthermore, there is speculation that the government may be indifferent to this declining state of affairs, paving the way for the abandonment of traditional GP care. Instead, the industry might witness the rise of physician associates, who have comparatively limited training, along with increased reliance on nurses and AI technology.
Under such a scenario, doctors would find themselves confined to hospital settings. While this perception may seem somewhat paranoid, it is not entirely baseless.
