Giant hiatus hernia causes multiple symptoms

A previous diagnosis turns out to be not quite so simple

Peggy, a 75-year-old woman, presents to her GP with worsening cough after her evening meal and in bed at night.

Cough

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

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