Giant hiatus hernia causes multiple symptoms
Peggy, a 75-year-old woman, presents to her GP with worsening cough after her evening meal and in bed at night.
She is unable to sleep lying flat because of coughing.
She has a longstanding background of heartburn and regurgitation for which she takes a PPI in the morning and at night.
Previous endoscopy has reportedly shown a 5cm sliding hiatus hernia without esophagitis.
The symptoms of heartburn and regurgitation have only been partly controlled with maximal PPI therapy.
She is a keen gardener and reports that, after eating she