Hiatal Hernia
If a hiatal hernia is present on the esophagogram, consider it a coincidental finding. Although a hernia may trap acidic gastric contents above the diaphragm, thereby facilitating reflux into the esophagus, its role generally is secondary: Many persons with heartburn gerd have neither reflux nor esophagitis.
Once you exclude more serious underlying causes of the patient’s distress, consider adding one of the H2-antagonists to the antireflux regimen as follows:
Cimetidine (Tagamet), 300 mg qid for 4-6 weeks With good response after 2-4 weeks, you can try tapering the dosage to 400 mg bid. Since antacids reduce cimetidine absorption, have the patient stagger doses of these agents by at least one hour.
You might want to consider prescribing an H2-antagonist for intermittent use when antacid therapy alone does not control a flare of symptoms.
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