DEAR DR. DONOHUE: If I understand it correctly, in hiatal hernia, a part of the stomach protrudes into the esophagus. If the stomach is protruding into the esophagus, how is the doctor able to take the endoscope through it during endoscopy of the stomach? Also, how do food and drink get into the stomach? Is there a nonsurgical treatment for hiatal hernia? – D.S.

ANSWER: Let me give you a clearer picture of what a hiatal hernia is. It all starts with the diaphragm muscle, the large, horizontal muscle that separates the chest from the abdomen. To reach the stomach, the esophagus – the swallowing tube – has to pass through a hole in the diaphragm to join the stomach. That hole is the hiatus. The stomach can protrude upward through the hole and encircle the esophagus. It doesn’t enter the esophagus. A scope can be passed into the stomach without any problem, and food and drink reach it just as they normally do.

However, some people with a hiatal hernia have an upward splashing of stomach acid into the esophagus. That’s heartburn, or as it is medically called, GERD – gastroesophageal reflux disease. Not all people with a hiatal hernia have GERD or any other symptoms. Their hernias are left alone. Those who do have heartburn are treated with antacids, a change in diet or medicines that stop the production of stomach acid. Prilosec is one example. Those are the nonsurgical treatments for hiatal-hernia GERD. People without a hiatal hernia can also suffer from GERD, heartburn.

The booklet on hiatal hernia goes into the details of GERD treatment, both surgical and nonsurgical. Readers can order a copy by writing: Dr. Donohue – No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

DEAR DR. DONOHUE: I am a woman who loves to dig in the dirt – an avid gardener. I have joint pain in my elbow and knee. I’ve spoken with my doctor about it, and we’re sure it’s due to my digging. I had been taking a glucosamine and chondroitin supplement. I also take Lipitor for cholesterol.

I did feel that they lessened my pain, but I stopped taking them because a nurse friend said they raise cholesterol. Do they? Do you believe they really do anything for joint pain? – J.M.

ANSWER: Chondroitin comes from the cartilage of cows or sharks. It has no alarming side effects.

Glucosamine is manufactured synthetically or derived from the shells of shrimp, crab and lobster. It’s a compound made up of a sugar and an amino acid. There’s a theoretical possibility that it could raise blood sugar but, if it does so, the effect is not great in most people. In long-term studies, it hasn’t affected cholesterol.

Chondroitin and glucosamine are components of joint cartilage and joint fluid.

My belief in the efficacy of these two substances doesn’t have much significance. If you found them to be helpful, you can safely resume taking the combination again.

DEAR DR. DONOHUE: I am interested in information about abdominal adhesions. I have had lower abdominal/pelvic pain that has gotten worse since a hysterectomy three years ago. I know of only one person who has had adhesions. Can you give me any information? I don’t know for sure that I have them, but I suspect they could be the source of my pain. – R.W.

ANSWER: Adhesions are bands of scar tissue that arise in the abdominal cavity from previous surgery or from abdominal infections. Sometimes the bands wrap around the small intestine and obstruct the passage of food through it. The symptoms are abdominal pain, vomiting and distention.

These symptoms are common to many, many conditions. Laying the blame on adhesions can be done with certainty only when those other conditions have been excluded and when adhesions have been proven to exist. The proof comes from X-rays and scans. Laparoscopic examination of the abdominal cavity offers definite proof. A laparoscope is a telescopelike device inserted into the abdominal cavity through a small incision. The doctor can see adhesions with it.