<s>[INST] I am a 45 year old female, 5" weighing in at 118 pounds. I have had bile duct spasms(which occur on and off) as well as stones in my bile duct(every 15 years or so)over the past 15 years. I also have panic disorder which is being well controlled. I am under a great deal of stress due to relationship issues and the caretaking of both my ill parents. Over the past year I have been experiencing episodes of feeling like I have eaten way toooooo much(even though i have eaten very little), shortness of breath, heart palpitations, pain in upper middle quadrant(middle under breast bone)through the back, the feeling of needing to burp and/or have a bowel movement. I have been checked for heart trouble(it is not this). My liver enzyemes are normal and the ultrasound taken to show possible liver issues are okay. I do not have a gallbladder and I have had a few ERCPs and one 2 that cut the bile duct to make it larger. The ERCPs showed nothing wrong. I am wondering if the stress that I have been experiencing may have changed avenues. In otehr words..instead of having panic attacks-I now have these bile duct spasms and what I believe might be a hiatal hernia. My question to you...given my background. Outside of the panic and bile duct issues...do you think I could be suffering from a hiatal hernia? [/INST] 1) I think so, yes.2) these symptoms are not bile duct spasm, which generally originate/locate on right upper part of abdomen.3) pain in middle upper part of abdomen, burping, difficulty in swallowing, all suggests possibility of hiatus hernia.4) if symptoms are severe and interfere your daily activity then further evaluation to confirm diagnosis is required with surgical correction of hernia, if needed. </s>