Home Audience 12 Gpod axial sliding causes treatment. What is a sliding hiatal hernia: symptoms and treatment. Symptoms of diaphragmatic hernia

Gpod axial sliding causes treatment. What is a sliding hiatal hernia: symptoms and treatment. Symptoms of diaphragmatic hernia

This pathology in most cases refers to age-related diseases. sliding hernia The esophagus is formed as a result of protrusion of the esophagus into the sternum cavity through the diaphragm. Over time, human muscles become less and less flexible and elastic. The same applies to the muscles of the diaphragm. The development of pathology is also facilitated by pressure differences: the pressure in the peritoneum is much higher than in the chest cavity. This factor is decisive in conditions such as prolonged cough, intense physical activity.

Classification

Depending on the place of origin this phenomenon Cardiac hernia and axial hernia can be distinguished. There are several types of hiatal hernia:

congenital;
paraesophageal;
sliding.

Based on the volume of the part of the stomach that has penetrated into the sternum cavity, the pathology is classified into three degrees:

first degree - the stomach is adjacent to the diaphragm, the abdominal esophagus is located in the chest cavity directly above the diaphragm, the cardia is at its level;
second degree - located in the chest cavity abdominal part the esophagus, and in the POD area - part of the stomach;
third degree - the body of the stomach, its fundus, and the abdominal part of the esophagus are located above the diaphragm.

A sliding hiatal hernia is a fairly common pathology, however, despite this fact, it can be quite difficult to establish accurate diagnosis: the symptoms are not always characteristic, and the hernia itself cannot always be seen.

Causes

The gastric canal and esophagus are held inside the corresponding opening of the diaphragm by means of a special ligament. It is its pathology that causes the occurrence of such a disease as a sliding hiatal hernia. In the process of displacement of the upper part of the stomach, thinning and stretching of the retaining muscle ligament occurs. As a result, the opening of the esophagus increases.

A sliding hernia is characterized by the fact that depending on how full the stomach is and how the person is positioned in at the moment, the hernia can either protrude or take a normal position. This does not depend on the size of the hernial formation itself.

The falling part can become fixed in this position, this leads to acquired shortening of the esophagus, when the anastomosis occupies a permanent location above the level of the diaphragm. Pinching a sliding hiatal hernia is impossible. But in some, especially severe cases, fibrous stenosis develops.

A hiatal hernia can be congenital. Thus, during the period of intrauterine development, a slowdown in the movement of the stomach into the peritoneal cavity may occur, which leads to a hiatal hernia in children. After the stomach descends with some delay, a hernial sac is formed. It is also possible that the muscles of the diaphragm are underdeveloped, causing the esophageal opening to widen.

Acquired causes mainly come down to factors that increase blood pressure abdominal cavity. These are cough, exercise, constipation, pregnancy, overweight. These factors, together with other prerequisites, allow the disease to develop. Can contribute to disease chronic diseases, such as cholecystitis, peptic ulcer, in which contractions of the esophagus occur.

Symptoms

As already mentioned, pronounced symptoms may not be observed with this pathology. If complications arise and join concomitant diseases symptoms of this nature begin to appear: heartburn, belching, a burning sensation in the area behind the sternum, increased salivation, a feeling of a lump in the throat, regurgitation, painful sensations. An increase in blood pressure may occur.

Depending on what position a person occupies, his sensations and symptoms may change. But the main symptom – a burning sensation – is present in almost all patients with this disease. The pain in this pathology is specific and cannot be confused with an ulcer. It occurs after eating and depends on how much the patient consumed. If after this you take any medicine that reduces acidity, the pain immediately disappears.

The picture of the disease is given by the concomitant pathology of reflux esophagitis. This is a periodic reflux of stomach contents into the esophagus. The contents of the stomach contain large amounts of hydrochloric acid. Because of this, being in the esophagus, it negatively affects the walls of the esophagus, irritates the mucous membrane, ultimately leading to the occurrence of ulcerative lesions and erosions. This is the reason burning pain in the area of the hypochondrium, stomach. Sometimes the pain carries stupid character, gives to left shoulder, which makes it possible to mistakenly diagnose angina pectoris in such a patient.

When the position of the body changes, especially when moving to a lying position, as well as during physical activity, the pain intensifies. An attack of heartburn and belching appears. Over time, swallowing problems may develop. In some cases there appear hidden bleeding, which are formed due to damage to the esophageal mucosa. It manifests itself as anemia and bloody vomiting.

A sliding hiatal hernia may be accompanied by frequent bronchitis, tracheitis or pneumonia. This occurs due to getting into respiratory tract acidic gastric contents during belching.

There are two main diagnostic methods for identifying a sliding hiatal hernia: endoscopic and radiological. This way you can identify shortening of the esophagus, its expansion, and damage to the mucosal surface.

Treatment

The initial unadvanced stages of the disease imply traditional treatment. This includes diet, medication and exercise therapy. If such treatment does not lead to positive dynamics, or the disease is accompanied by bleeding, surgical intervention is recommended.
The method used for surgical treatment, involves the formation of a special cuff around the esophagus. This prevents stomach contents from entering the esophagus. The operation in our time occurs in the least traumatic way, laparoscopically. Surgical method gives full recovery patient after surgery, he quickly returns to normal life.

Diet, as the main method of treating hiatal hernia, involves small meals every three or four hours. Food servings – up to 300 grams. Avoid any food that may irritate the gastric mucosa or increase the production of gastric juice– spicy, fried, salty, fatty, smoked and pickled foods. At the core dietary ration If you have a hiatal hernia, eat steamed dishes, cereals, vegetables, meat low-fat varieties, as well as milk and fruits. IN advanced cases food should be ground, in the form of puree. You cannot lie down after eating; you need to wait at least half an hour.

Very important role A lifestyle change plays a role: quitting smoking and alcohol. It is necessary to devote enough time to rest. Physical activity should be moderate in nature, exercises with stress on the abdominal muscles are prohibited. These measures can significantly improve the patient’s condition and relieve painful symptoms, but it is impossible to completely get rid of the problem in this way. A hiatus hernia can only be repaired surgically.

This pathology of the esophagus can be either hereditary or acquired. A sliding hiatal hernia is also called a sliding hiatal hernia and is quite common; women are more susceptible to this disease than men. The disease is latent, so initial stage it is difficult to identify, but without treatment it can have severe consequences, for example call internal bleeding.

sliding axial hernia esophageal hiatus is the most common type of disease; another type is sliding cardiac hernia. It is called so because the cardiac part of the stomach fits into the hole in the diaphragm.

Axial sliding hiatal hernia: degrees of disease

Hernias are classified by degree and depend on the location and size of the pathology:

the first degree is characterized by the location of the abdominal segment under the diaphragm, the hernia develops gradually;
in the second degree, the cardiac part of the stomach is located above the diaphragm, and the gastric mucosa enters the esophagus;
in the third stage of the disease, part of the stomach enters thoracic region, the pathology is quite rare;
the fourth is called giant; almost the entire stomach enters the sternum and puts pressure on other organs. This degree of hernia requires immediate hospitalization. Drug treatment will not help, surgical intervention is necessary.

The risk group is mainly women and older people over 50 years of age, this is due to age-related changes organs. The main reason for the development of pathology is a decrease in the tone of the muscles that regulate the expansion and contraction of the alimentary section of the diaphragm. With such disorders, the esophageal opening cannot completely close, which causes protrusion of part of the stomach and the formation of a hernia.

Causes of sliding hiatal hernia

One of the causes of hiatal hernia can be excessive physical activity.

When a hernia forms, part of the stomach is displaced into the thoracic region due to protrusion lower section esophagus. The pathology develops over a long period of time, but without any signs, which complicates it timely diagnosis. If detected early, the disease can be easily treated; it is caused by various reasons and they are divided into congenital and acquired.

Congenital:

underdevelopment of the diaphragm muscles and too large opening of the esophagus;
delayed diaphragmatic fusion;
delayed prolapse of the embryo's stomach.

Purchased:

age-related pathology of the diaphragm;
relaxation of the diaphragm due to injury or inflammation;
diseases of the digestive system, causing spasmodic contractions of the muscles of the esophagus - cholecystitis, peptic ulcer;
diseases of the pancreas and liver;
increased physical activity, carrying heavy objects;
disruption of bowel function;
increased abdominal pressure due to constant overeating.

A sliding axial hernia can be caused by pregnancy, postpartum pathologies, overweight body and other diseases that cause increased pressure in the esophagus. Almost any person can develop this disease, the only advantage is that blood circulation is not impaired and pinching does not occur.

Symptoms of a sliding hiatal hernia

Typically, a hiatal hernia causes severe discomfort and pain

Symptoms depend on the size of the hernia and are often not pronounced, but pain in the stomach area most often occurs, and heartburn may also appear. In an axial hiatal hernia, the upper part of the stomach extends into the hiatal hernia and then returns. If the protrusion is small in size, symptoms may not appear; in many people, the pathology is discovered during examinations related to other diseases.

During an external examination of the patient, a sliding hiatal hernia (HH) does not make itself felt and is not detected. If the disease began to develop a long time ago, the esophagus is constantly irritated by the contents of the stomach, which are thrown into it. But still, the main signs of the disease are identified:

if a person lies down after eating, he experiences severe heartburn;
belching, in which food is thrown into the esophagus or oral cavity, there is no vomiting;
severe pain in the stomach and burning behind the sternum, becomes more intense when bending forward;
when belching, gastric juice refluxes into the respiratory tract, which causes the development of tracheitis, bronchitis and pneumonia;
The swallowing reflex is disrupted, the person does not feel the passage of food into the esophagus, which becomes inflamed and makes it difficult for the food coma to pass.

In some patients, a sliding hiatal hernia may contribute to increased blood pressure and increased salivation. Sometimes the symptoms are confused with a stomach ulcer, but the difference is that with a hernia, the intensity of the pain depends on the amount of food eaten, and it goes away after taking medications to reduce acidity.

Complications with sliding diaphragmatic hernia

The picture shows gastroesophageal reflux

If a sliding hernia is not treated, serious complications may occur:

Even after surgery, relapse of the disease may occur.

Diagnosis of sliding hernia

Diagnosis of a sliding hernia using x-ray examination

Diagnosis of a sliding hiatal hernia is carried out not only on the basis of symptoms, and treatment is prescribed by the attending physician after full examination. For this, a number of diagnostic measures are prescribed:

After being carried out full diagnostics, the doctor prescribes treatment. It must be started immediately to avoid surgery. If the hernia is discovered late and internal bleeding begins, treatment is carried out only surgically.

Treatment of sliding hiatal hernia

Fractional meals are extremely necessary to maintain the body in good shape during illness.

Except drug therapy treatment should include a mandatory diet. A patient with hiatal hernia needs to eat in small portions, portions should be no more than 250 g per meal. It is necessary to exclude:

fat;
spicy;
smoked meats;
roast.

All of these products increase production hydrochloric acid and provoke irritation of the gastric mucosa. The diet should consist of dishes:

Stewed vegetable stew

Should be excluded alcoholic drinks and quit smoking. Light physical activity should be alternated with rest. Exercises that put pressure on the abdominal cavity should be discontinued. As drug therapy For sliding axial hiatal hernia, the following drugs are used:

to reduce the acidity of gastric juice - Maalox, Gastal;
for heartburn – Motilium, Rennie;
suppressing the production of hydrochloric acid - Omez;
antispasmodics – No-shpa;
painkillers.

Treatment of a sliding esophageal hernia has a positive prognosis if the diagnosis is made on time and the disease is not advanced.

Prevention of sliding axial hernia

Exercise therapy greatly reduces the risk of a hernia.

It is easier to prevent any disease than to treat it. The same applies to a sliding gastric hernia; to prevent it, you need to follow some recommendations:

engage in physical therapy;
treat diseases of the digestive system;
fight constipation;
control your weight;
follow the diet and regimen.

Constant internal bleeding can cause the development of anemia, and a sliding gastric hernia left untreated causes irreversible diaphragmatic changes and the risk of developing stomach or esophageal cancer.

Sliding hernias are hernias, one of the walls of which is an organ that is partially covered by the peritoneum (descending and ascending colon, bladder, etc.).

The hernial sac may be completely absent, then the protrusion will be formed by parts of the slipped organ that are not covered by the peritoneum. With direct inguinal hernias, sliding hernias are more common bladder, and with oblique ones - the colon and cecum. 1-1.5% of all hernias groin area make up the moving ones.

According to the mechanism of occurrence there are:

congenital - when organs, due to various reasons(this process can begin already in the embryonic period), some of its parts, which are not covered by the peritoneum, can gradually descend (slide) along the loose retroperitoneal tissue to the area of the internal gates of the hernia, exit the abdominal cavity and become integral part hernias without a hernial sac;
acquired - arise due to mechanical contraction by the peritoneum of those segments of the bladder or intestine that are adjacent to it and lack serous cover.

Sliding inguinal hernias large intestine usually look like large sizes protrusions in the groin area with wide hernial orifices, more often in older people. Diagnosed using X-ray methods of examining the colon (irrigoscopy).

Sliding hernias of the bladder manifest themselves as dysuric disorders. A symptom such as urinating twice is observed: first the patient empties the bladder, and then, when pressing on the hernial protrusion, the urge to urinate appears again, the patient urinates again.

For diagnosis, catheterization of the bladder is performed and cystography is performed, which reveals the size and shape of the hernia, the presence of stones in the bladder itself.

If a sliding hernia is detected, its treatment is only surgical. The peculiarity is that the operation must be performed extremely carefully, since without knowing it anatomical features, instead of the hernial sac, you can open the wall of the bladder or intestine.

Sliding hiatal hernia

A sliding hiatal hernia (hiatal hernia) or hiatal hernia is the movement of the stomach or other abdominal organs through the dilated esophageal opening in the diaphragm into the chest cavity.

The disease occurs in 5% of the entire adult population, despite the fact that half of the patients do not note any clinical manifestations. This happens because with a sliding hiatal hernia, the symptoms (signs) of a typical hernia are erased, since it is located inside the body and cannot be seen during a routine examination of the patient. More often observed in women than in men; in children they are mainly congenital.

Sliding (axial) hiatal hernia (HHH), which refers to one of the variants of hernia of the esophagogastric opening in the diaphragm, is divided into:

cardiac;
cardiofundic;
total gastric;
subtotal gastric.

Another variant of hernias is paraesophageal, classified into:

fundamental;
antral;
omental;
intestinal;
gastrointestinal.

There is also a classification depending on the volume of the stomach penetrating into the chest cavity:

sliding hiatal hernia of the 1st degree – above the diaphragm, in the chest cavity there is the abdominal part of the esophagus, the cardia is located at the level of the diaphragm, the stomach is in an elevated position and is adjacent directly to the diaphragm;
sliding hiatal hernia of the 2nd degree - the abdominal part of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of the POD;
sliding hiatal hernia of the 3rd degree - the abdominal part of the esophagus, the fundus and body of the stomach (sometimes antrum), the cardia are located above the diaphragm.

Symptoms of a sliding hiatal hernia (stomach)

The symptoms are rather similar to diseases of the gastrointestinal tract, due to disruption of its functioning. When the activity of the lower esophageal sphincter deteriorates, gastroesophageal catarrhal reflux(reflux of gastric contents into the esophagus). After a certain time, due to exposure to aggressive stomach contents, inflammatory changes appear in the lower part of the esophagus.

The patient has the following complaints: heartburn after eating, aggravated by physical activity, in a horizontal position. Complaints of a lump in the throat are common.

Pain may appear immediately after eating, of a different nature, radiating to the sternum, neck, shoulder blade, lower jaw, in the region of the heart. Such pain resembles angina pectoris, which is treated differential diagnosis. Sometimes pain with a sliding hiatal hernia occurs only in a certain position of the body. The patient may complain of bloating in the upper part, sensation of a foreign body.

In more severe cases, as a complication, bleeding occurs from the vessels of the esophagus, which, most often, occurs latently and manifests itself only as progressive anemia. Bleeding can be acute or chronic; there are even strangulated hernias in the esophageal opening of the diaphragm and perforation of the esophagus.

Reflux esophagitis is the most a common consequence hernia of the POD, which can transform into peptic ulcer esophagus.

Over a long period of time, this condition leads to a more severe complication – cicatricial stenosis (narrowing) of the esophagus.

For diagnosis, esophagogastroduodenoscopy, X-ray examination of the stomach and esophagus, ultrasound, intraesophageal pH-metry, esophagometry, and computed tomography are used.

Treatment of sliding hiatal hernia (stomach)

For a sliding gastric hernia, conservative treatment is initially recommended; it is aimed more at alleviating the symptoms of reflux esophagitis: heartburn, nausea, pain. Drugs that reduce the acidity (PH) of gastric juice are used (such as the drug Kvamatel from Gedeon Richter).

The patient must follow a diet limiting spicy, fatty, fried foods, chocolate, coffee, alcohol, all products that promote the production of gastric juice. You need to eat often, in small portions. To avoid reflux, it is recommended to sleep with an elevated position. top part torso, avoid lifting heavy objects.

But, unfortunately, conservative therapy for a sliding hiatal hernia, the treatment of which was carried out medications, following a diet, does not eliminate the cause of the disease (the hernia itself) and brings only a temporary effect. Therefore, elective surgery is recommended.

For surgical treatment of hiatal hernia, the criteria are:

the presence of complications such as bleeding, anemia, ulcers and erosions of the esophagus, esophagitis;
inefficiency conservative methods treatment;
large size of a sliding gastric hernia and its fixation in the hernial orifice;
paraesophageal (paraesophageal) sliding hernia, due to the high risk of strangulation;
signs of dysplasia of the esophageal mucosa, which acquires signs of the structure of the mucous membrane of the small intestine.

The essence of the operation is to restore the correct anatomical relationships between the stomach and the esophagus: elimination of the hernia, elimination of the hernial orifice by suturing the esophageal opening of the diaphragm until normal sizes and the creation of an anti-reflux mechanism that prevents gastric contents from refluxing into the esophagus.

Today there are two types of techniques used for surgical treatment:

open access - Nissen fundoplication (complications of which may include early dysphagia, small ventricle syndrome, cascade stomach) or, more preferably, Topeplasty (with fewer complications);
laparoscopic access - allows you to perform the operation in the least traumatic way (with incision sizes of 1-2 mm by 5-10 mm), promotes more rapid recovery patient after surgery.

Laparoscopic surgery for hiatal hernia is often combined with surgery for other pathologies of the abdominal organs: for chronic calculous cholecystitis, cholecystectomy is performed, for peptic ulcer Duodenum – selective proximal vagotomy.

Video: Operation EsophyX - hiatal hernia

A sliding hiatal hernia is characterized by the free movement of abdominal organs into the chest and back. This phenomenon occurs due to weakness of the diaphragmatic ligament, which is aggravated by the presence of an inflammatory process of the esophagus or its congenital anomalies.

In another way, the pathology is defined as a hiatal hernia, cardiac or axial, and its clinical picture largely depends on the severity pathological process.

The main symptom of a sliding hernia is dyspepsia. The patient experiences frequent heartburn, belching of sour contents, and hiccups. These conditions indicate damage to the mucous membrane of the esophageal tube due to the reflux of acidic contents from the stomach.

So what is a sliding hernia? This is a pathological movement of abdominal organs through the esophageal opening into the chest. This condition is not dangerous and has virtually no effect on the quality of life, if only the patient adequately assesses the potential risk and takes measures to prevent complications.

General characteristics of the sliding hiatal hernia

A sliding hiatal hernia is predominantly asymptomatic, which complicates diagnosis. 75% of patients have no symptoms and no treatment for this reason for a long time is not carried out. Ignoring the problem leads to the fact that the hernia progresses, and everything penetrates through the diaphragm most stomach.

The main cause of the disease is muscle weakness.

But one factor alone is not enough for the disease to appear. The combination of pathology of the musculo-ligamentous apparatus with increased intra-abdominal pressure is already more likely to lead to a hiatal hernia.

The dysfunction of a slipped organ does not occur immediately. The consequences of pathology arise as the disease develops. Uncomplicated sliding hiatal hernia of the first and second degree requires only dietary nutrition and reception medicines. At the third stage it is already selected specific treatment. A fourth degree axial hiatal hernia will require surgical treatment to restore the anatomy of the abdominal organs.

Etiology of the disease

Causes of hiatal hernia:

Congenital malformations. This applies to the period when the stomach descends into the abdominal cavity. The process may be disrupted, which will cause congenital diaphragmatic hernia. This disease requires surgery as soon as possible, otherwise there is a risk fatal outcome within a few days after birth. A hiatal hernia in newborns can be removed on the first day, but it will be even more effective to perform the operation during pregnancy, then the prognosis is more favorable if only the child undergoes normal rehabilitation in a specialized center.
Underdevelopment of the diaphragm muscles. This phenomenon is associated with the physiological aging of the body, therefore it is almost impossible to avoid this factor. This phenomenon can be prevented only by following general prevention pathologies of the musculo-ligamentous apparatus, which includes physical therapy, dietary nutrition, elimination of bad habits.
Increased intra-abdominal pressure. This factor is associated with frequent constipation, bloating, overeating, overweight, pregnancy period. This can be avoided if you promptly treat pathologies of the gastrointestinal tract, cope with excess weight, and use a special support belt during pregnancy.

The clinical manifestations of the pathology will depend on the stage of formation of the diaphragmatic hernia. With grade 1, there is a slight displacement of the abdominal part of the esophagus through the enlarged opening of the diaphragm, while the stomach remains in its place. At stage 2 of the pathological process, a mixing of the cardia of the stomach occurs, which is located at the level of the diaphragm. At the third stage, the body of the stomach is located above the diaphragm.

On last stage When a hernia forms in the chest area, most of the stomach or the entire organ is located. In this case, it is necessary to treat the disease not only conservative methods, but also surgical intervention.

Without surgery, severe pathology threatens compression of the stomach with its subsequent death.

How does hiatal hernia manifest itself?

Basic clinical manifestations sliding hiatal hernia:

Dyspeptic phenomena. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient takes horizontal position after the stomach is full. Such manifestations can occur without apparent reason, for example, at night and in the morning.
Dysphagia or difficulty swallowing. Such a phenomenon with a hiatal hernia will be more psychological, because while swallowing food, the patient may feel discomfort and pain associated with inflammation of the esophagus, which creates a fear of recurrence discomfort. As a result, food intake begins to be accompanied by a lack of swallowing reflex. The patient switches to eating exclusively liquid and semi-liquid foods. This, in turn, leads to weight loss. In this regard, the patient is prescribed a therapeutic diet.
Frequent pathologies respiratory system . Bronchitis and aspiration pneumonia appear as a result of particles of poorly chewed food entering the respiratory tract. It's threatening purulent inflammation lungs and chronic respiratory diseases, which only aggravate the situation serious condition sick.
Regulation. This phenomenon is associated with the backflow of stomach contents into the oral cavity. Lasting impact stomach acid leads to dental diseases. A patient with a hiatal hernia faces hypersensitivity enamel, papillitis, various stomatitis and gingivitis. Treatment of a local problem in the oral cavity does not lead to positive results, and until the main problem is eliminated, dental pathologies will only progress, and constant irritation of the mucous membrane may end precancerous conditions and even oncology.

Diagnosis of a hiatal hernia is carried out by endoscopic examination.

Additionally, the patient is prescribed laboratory tests to identify or exclude the inflammatory process. Esophagogastroduodenoscopy, that is, examination of the condition of the gastric mucosa, is also indicated. Inserting a probe will not be the most pleasant procedure for the patient, but only in this way can many related problems, which must be dealt with in parallel.

Principles of treatment

In case of hiatal hernia, it will be extremely important to adhere to dietary nutrition, which should become part of not only treatment in acute period, but also to prevent complications and relapse throughout life. Additional measures there will be classes therapeutic exercises, swimming, taking medications.

The patient must undergo treatment with a gastroenterologist to prevent such a frequent companion of a hernia as reflux esophagitis.

The latter is manifested by the release of stomach contents into the esophagus, which leads to inflammatory processes and the addition of a complex of disorders. Additional symptom complex for esophagitis requires separate treatment.

To eliminate reflux without surgery, the following remedies are used:

Antacids. Indicated for reduction negative impact acidic contents onto the walls of the esophagus.
Enveloping. Used to eliminate irritation of the mucous membrane of the stomach and esophagus.
Antispasmodic drugs. Prescribed by a doctor when a sliding diaphragmatic hernia is accompanied by a peptic ulcer of the stomach and duodenum.
De-Nol. Indicated for inflammatory and ulcerative diseases of the gastric mucosa and esophageal tube.
Motilium. Prescribed to improve digestion processes.
Inhibitors proton pump . They inhibit the synthesis of hydrochloric acid, thereby reducing its irritating effect on the walls of the esophagus and stomach.

Surgical treatment of a sliding hiatal hernia is prescribed by the attending physician in cases where organs are pinched in the diaphragm area.

Other complications of the pathological process include internal bleeding and stenosis, that is, narrowing of the esophageal tube. During the operation, the diaphragmatic ligament is strengthened, and a special tube can be additionally installed, which artificially expands the esophagus, eliminating stenosis. After the operation, a long period of rehabilitation begins. It includes following a diet, eliminating physical activity, and performing a set of therapeutic exercises.

What is a sliding hiatal hernia, and how does it appear? current information for people facing this problem. Organs healthy person held in position by ligaments. If there are abnormalities in the structure of the diaphragm muscles, part of the esophagus protrudes into the abdominal cavity, causing a hiatal hernia to form. If the organ does not move along its axis, the protrusion is called sliding.

In medicine, this disease is called wandering hernia. Its identification presents some difficulties, because the esophagus during examination may be in a physiological position, and pathological changes occur only under certain conditions. The stomach often penetrates into the hernial sac; its upper parts remain above the level of the diaphragm.

There are several types of wandering hernias. A protrusion in which its contents are held by adhesions is called fixed. A floating hernia occurs only when a certain position is taken.

Causes of the disease

In the presence of a small sliding hernia, the patient’s well-being practically does not deteriorate. Symptoms of the disease are mild. These include frequent hiccups, belching, and belching, which appear as a result of overeating. Symptoms of the disease when proper nutrition practically absent. A large hernial sac may become incarcerated, causing severe pain in the epigastric region, nausea and vomiting, which are rarely accompanied by the release of stomach contents.

Sliding hernias are also classified based on which organ has entered the protrusion cavity. With gastric diseases, not only the esophagus is displaced, but also the upper parts of the stomach. With esophageal, only the esophagus exits into the hernial orifice. Cardiofundal protrusions represent prolapse of the cardia and gastric fundus. There are many factors that can lead to the development of a sliding hernia:

Decreased tone of the muscles and ligaments of the diaphragm. Such pathological changes often occur in the body of an elderly person and in people with weak, untrained abdominal muscles.
Injuries to the chest and abdominal area. Various injuries to the diaphragm can lead to the formation of a hiatal hernia.
Increased intra-abdominal pressure. It can be both sudden (high physical activity, pregnancy, difficult childbirth and injuries) and gradual ( increased gas formation, overeating, constipation).
Congenital structural defects digestive organs- chest stomach.
Long-term course of peptic ulcer, accompanied by tissue scarring.

Diseases that disrupt the motility of the esophagus and stomach (pancreatitis, cholecystitis, ulcers) can also contribute to the development of a hernia. Disturbances in the formation of connective tissues are another cause of protrusion.

Clinical picture of the disease

Heartburn is the main symptom hiatal hernia. It intensifies when taken supine position or use large quantity food. The cause of heartburn is gastroesophageal reflux, the reflux of gastric juice and semi-digested food. A feeling of a lump in the throat when eating and pain behind the sternum are no less common symptoms of a sliding hernia. Dysphagia in the presence of a large protrusion occurs even when a person consumes semi-liquid food and water. The appearance of the symptom is associated with the stage in which the inflammatory process occurs or adhesions form.

Problems with swallowing may be due to: incorrect position organs. Belching of air and regurgitation of food are caused by the reflux of stomach contents into the esophagus, especially if a person lies down immediately after eating. Similar symptoms may be associated with a decrease in cardiac tone. Often the patient feels a feeling of fullness in the epigastric region, which forces him to independently belch, after which the condition improves.

The occurrence of hiccups contributes to defeat vagus nerve. Attacks occur rarely and can last from several hours to a month. Hiatal hernia also has symptoms that are unusual for it, which significantly complicate diagnosis. A person is unsuccessfully treated for other diseases, not realizing that the digestive organs are displaced. The hernia enlarges, causing inflammatory processes and other complications. The most dangerous is considered to be infringement of content. Symptoms of a complicated hernia appear as acute pain in the epigastric region, nausea and vomiting. Semi-digested masses often contain admixtures of blood and bile.

Diagnosis and treatment of the disease

The examination of the patient begins with an examination and questioning, during which the doctor analyzes the symptoms of the disease and determines their dependence on food intake. X-ray examination allows you to assess the position of the digestive organs. It is mandatory to conduct an FGDS - insertion of an optical tube into the esophagus, with the help of which it is examined internal surfaces. Special equipment records changes in the acidity of gastric juice.

Elimination of a sliding hiatal hernia can be done in several ways. Conservative therapy based on application medicines. Vagal hernia is an indication for compliance special diet and performing exercises aimed at strengthening the abdominal muscles. For small hiatal hernias, treatment is carried out according to the same scheme as for gastroesophageal reflux.

The operation is prescribed if there is a large protrusion and an obstacle to the normal movement of the food bolus, frequent reflux of stomach contents into the esophagus, or cardiac failure. Surgically hernias prone to strangulation and the formation of adhesions are treated. Emergency surgery performed in the presence of inflammatory changes in the esophagus.

There are several types surgical interventions, used to eliminate a sliding hernia. The operation can be performed open or laparoscopically. The Allison technique is used in conjunction with other therapeutic measures, since it is not able to completely eliminate gastroesophageal reflux. During the operation, an incision is made between the 7th and 8th ribs, through which the hernial orifice is sutured.

Gastrocardiopexy involves fixation upper sections stomach to the diaphragmatic ligaments through an opening in the upper line of the abdomen. For Nissen fundoplication upper part The stomach is wrapped with a cuff that prevents the release of contents into the esophagus. After installing this device, the stomach is given correct position, the hernial orifice is sutured. The Belsey method is used when the hernia reaches a critical size, while the fundus of the stomach is sutured to the wall of the esophagus, and the cardia is fixed to the diaphragm.