I had hiatal hernia surgery two years ago. A few months ago, I got the stomach flu. The first thing I did was run to the bathroom to throw up, but I couldn't. I had the dry heaves and diarrhea all night. Am I now not able to throw up?

Donna

A hiatal hernia is an abnormality in which the upper part of the stomach (which is connected to the esophagus) herniates (protrudes) up through the diaphragm and into the chest. Normally, the junction between the esophagus and stomach is right at the diaphragm, and the diaphragm actually helps to support the gastroesophageal sphincter, which separates these organs and keeps stomach contents from flowing up into the esophagus. As a result of the upward bulging of the stomach, the sphincter may lose its ability to prevent reflux of stomach contents back into the esophagus, causing heartburn.

Although a hiatal hernia is very common, most patients with it do not suffer any symptoms. Those who do experience gastroesophageal reflux disease (GERD) are typically managed with acid-suppressive medications. A subset of patients are referred for surgical therapy, most often because of GERD-related complications or due to the desire to avoid taking acid-suppressive medications indefinitely. The surgical procedure, known as fundoplication, involves wrapping the upper portion of the stomach (the fundus) around the lower esophagus in order to strengthen the gastroesophageal sphincter. If a hiatal hernia is present, it is pulled back into its place in the abdomen before the fundoplication.

The most common long-term complication of fundoplication is difficulty swallowing, known as dysphagia. This occurs when the fundal wrap around the lower esophagus is too tight and prevents swallowed food from easily traveling down the lower esophagus into the stomach. Although up to 30 percent of patients experience dysphagia shortly after fundoplication, only about 4 percent of patients report long-term swallowing problems. In these cases, it is managed with dilation of the esophagus.

Another complication of fundoplication is the "gas bloat" syndrome. Patients complain of abdominal bloating and inability to belch. Again, the reason for this is usually an overly tight fundoplication that keeps air from passing easily back through the tightened gastroesophageal sphincter. The therapy for bloat is anti-gas medications (typically containing simethicone, which is found in many over-the-counter formulations). Rarely, the fundoplication requires a surgical modification to loosen it.

Based on the description you provided, it is possible that you have an overly tight fundoplication. However, it is unusual for you to have gone two years before encountering these symptoms. You did not mention if it is generally difficult for you to belch, or if you have had difficulty with swallowing. It may be that your fundoplication is slightly overtight and that the attempt at vomiting made it apparent to you. Regardless, this is a symptom that you should discuss with your gastroenterologist, who can decide if further diagnostic tests or therapies are necessary.