Kathleen:
I was recently told I had a hiatal hernia the size of a lemon. I was told not to be concerned until it gets to be the size of a grapefruit. Is this true?

Anil Rustgi, MD responds:
A hiatal hernia occurs when part of your stomach presses upwards into your diaphragm — a sheet of muscle across the bottom of the rib cage through which the esophagus passes. When you swallow, food moves through the esophagus into the stomach for digestion.

The larger the hiatal hernia is, the greater the chance that the hernia will impede food and acid from traveling through the esophagus. This can cause reflux and chest pain. It may be helpful to get a second opinion in regards to whether your hernia requires immediate treatment or not.

If you would like to schedule an appointment with a Penn gastroenterologist, Sanford L. Herold, MD, can consult with you and recommend next steps. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Jenn asks:
I had fundoplication surgery for Barrett's esophagus in 2003 at Penn Presbyterian Medical Center. I get a routine endoscopy every year to check the Barrett's. However, I am noticing that I am having trouble swallowing again even with liquids. What does this mean?

Anil Rustgi, MD responds:
There are many possible causes for difficulty swallowing. If you don't already take medication, this may be something that can help. If you do take medication, it may need to be adjusted. It would be beneficial for you to see a gastroenterologist who can evaluate your new symptoms as well as your medical history.

Gary Falk, MD, is a renowned gastroenterologist in Barrett's esophagus and medical and surgical therapy. Dr. Falk is joining Penn Medicine in January 2010, and he can evaluate your case and recommend a course of treatment. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Jane:
I had gallbladder surgery in October. I felt great for several weeks, but then the same pain I had prior to surgery came back. Is it possible I could now have sphincter of Oddi dysfunction? I still have right quadrant pain with elevated liver tests.

Anil Rustgi, MD responds:
It is not uncommon to have lasting pain in the upper right quadrant after gallbladder removal. This pain can have a number of different causes, such as:

• Small gallstones remaining in the bile ducts
• Irritable bowel syndrome
• Peptic ulcer disease
• Sphincter of Oddi dysfunction

David A. Ingis, MD, FACG, is a Penn gastroenterologist who can evaluate your condition. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Kym asks:
I have experienced right-side upper-abdominal burning and pain on and off for the past 14 months. An ultrasound and endoscopy were performed with no findings, and a DISIDA scan (EF of 35 percent). My gastroenterologist said none of the tests had any significant results or answers. I am again in daily pain with burning and tenderness in the area. Please let me know how I can find some answers and relief.

Anil Rustgi, MD responds:
Gastroesophageal reflux disease (GERD) can cause a burning sensation as well as pain in the upper abdomen. GERD is a condition in which acid from your stomach backs up into your esophagus and irritates the lining.

Try taking an over-the-counter acid reflux medication like Prevacid® to see if this helps decrease the pain and burning. You can also try adjusting your diet by eating less fried food, chocolate, alcohol, caffeine, garlic and a variety of other things. If your symptoms do not improve, you may want to see another doctor for a second opinion.

Gary Falk, MD, is a renowned gastroenterologist in Barrett's esophagus and medical and surgical therapy joining Penn in January 2010 who can evaluate your case and recommend a course of treatment. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Melissa:
I recently had my yearly complete blood count that showed a level of 195 for B12. All other readings were normal. My doctor sent me to a stomach specialist and I am still awaiting test results. Other than some irritable bowel symptoms when I was young, I have had no other stomach problems. Is this something to worry about? People often mention stomach cancer when I mention low B12.

Anil Rustgi, MD responds:
To ease your mind from the start, a low B12 level is not typically an indicator of stomach cancer. Some possible causes are the following:

• Diet low in B12 – usually lacking meat, fish, eggs or dairy products
• Previous abdominal or intestinal surgery that affects absorption
• Crohn's disease
• Tapeworm infection
• Malabsorption disorders
• Pernicious anemia

Further testing is necessary to narrow down the cause of your B12 deficiency. David A. Ingis, MD, FACG, is a Penn gastroenterologist who can evaluate your condition. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Jenny asks:
I recently suffered a gallstone attack. My symptoms were intense pain under my right rib cage, diarrhea and chills. My ultrasound indicated gallstones were not blocking my ducts, but they were traveling and causing intense pain.

My blood work showed an elevated white blood cell count. My gallbladder is not diseased or inflamed. My pain has dramatically improved; however, I am still tender and sore. It has been three days since my attack and I was wondering when I will feel better?

Anil Rustgi, MD responds:
After a gallstone attack it is normal to be sore for a few days, but if the soreness lasts for more than a week it is probably wise to see a doctor again. David A. Ingis, MD, FACG, is a Penn gastroenterologist who can evaluate your condition. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.