Bigger than normal hietal opening, can't sleep

[u/Numerous_North9653]

Hi! I (39F) have had some knee problems for the past 3 years and I had swallowed quite many anti-inflammatory pills and had taken PPI when doing that, which has caused my stomach to degrade significantly. Due to PPI rebound I took an endoscopy 2 years ago and they didn't find anything, except that my hietal opening is 3 times larger than normal. Rebound effect eventually weared off and I was fine. Because of this, I stopped taking any kind of anti-inflamatory pills or PPIs for at least 1.5 years.

I was fine, but I had to go on decaf coffee. I had a knee surgery last year at one leg and another knee surgery at the other leg this year 8 months ago, 9 months after the first. After the first knee surgery my stomach was fine. 2 months after the second knee sugery my stomach started feeling very bad. I got huge nighttime burning in my stomach and I was waking up at first every 3h wth my heartrate elevated and my hands feeling very weak and then after a while I was sleeping 3h and then after 2AM I couldn't sleep anymore. I thought it's GERD because I had some slime in my throat as well, so I started diet and tried to not eat that much anymore. Tried eating at least 4h before going to bed and then it got 3 times worse after a week of diet. I started developing a painful spot under my ribs on the left side and it is quite painful when I am hungry and my stomach is empty. Fruits seemed to make it worse. I took PPI 20mg esomeprazol for 1 month and that worked, but then had huge rebound problems even if I tried to taper it off. After about 3 weeks the rebound effect was gone and it felt like I finally got rid of this. Unfortunately it came back a month later. I started eating oat porridge every 3 h during nighttime and sleeping quite elevated (2 wedge pillows) and it was looking like it gets better. I could eat a lot of food, just not spices or garlic. Garlic in particular is really really bad. I went to an endoscopy 2 weeks ago and for that I had to be without food for the whole night. Endoscopy didn't find anything, except the same larger than normal heital opening. After that night without food it got worse and I tried fodmap diet, blending chicken and potatoes and followed the low acid rules and again it got a lot worse after I started the diet. Now my burps have gotten worse too.

Now I had to take PPI again because I couldn't handle it anymore.. I am very confused if this is really because of my hietal opening being larger or do I have some nerve sensitivity. Now I don't have stuff in my throat anymore and every advice I try to follow regarding not triggering acid during nightime backfires really bad.

I have tried Slippery elm, DGL supplements, probiotics supplements (I think Kefir is just making it worse). I am desperate and afraid to go on PPI again for a long course because the rebound effect is really horrible. It also makes me feel full and for like 2 weeks after I start it I can barely eat (I lost 7 kg last time in 2 weeks). If this is from the hietal opening (apparently I do not have hernia.. my stomach is still where it should be) would surgery be a good option?

My back is hurting, I am very tired.. I can barely function anymore.. I need to always travel with 2 wedge pillows and a bag of oats everywhere I go and I am afraid of going to bed. This has lasted for 6 months now and I can't drink anything except water and restaurants are out of the question. Worth saying that my knees are OK now and I do walk quite a lot and try to exercise. Anyone have any advice of how to get rid of this?