home Audience 12 Malyshev's sliding hiatal hernia. Gpod: causes, symptoms and treatment. Basic methods for diagnosing the disease

Malyshev's sliding hiatal hernia. Gpod: causes, symptoms and treatment. Basic methods for diagnosing the disease

A sliding hernia is characterized by the absence of a hernial sac; it can be congenital or acquired, and in the early stages of formation it has a sparse symptomatic picture and is diagnosed only with instrumental examination. With this pathology, part of the stomach protrudes beyond the diaphragm, and the organ thus acts as a hernial sac. There are fixed and non-fixed esophageal hernia, which is differentiated from a congenital or acquired defect - a short esophagus. Traction hernias, which occur against the background of contraction of the esophagus, and pulsion hernias, which form against the background of muscle tissue weakness, are classified separately.

The basis of the disease, sliding hiatal hernia, is the weakness of the muscle wall, which allows part of the stomach to pass through beyond the diaphragm. This deviation is typical during a period of decreased protective mechanism: pregnancy, progressive obesity, when intrauterine pressure increases significantly and the organ becomes higher than the diaphragm. It is worth highlighting sliding hernias caused by weakness of the esophageal sphincter, as well as diseases of adjacent tissues that develop in the prenatal period.

Etiology of sliding hernia

Diaphragmatic hernia or hiatal protrusion differs from other forms of the disease in its localization. A wandering hernia involves the location of part of the stomach above the diaphragm, and thereby the organ independently forms a hernial sac. Fixed protrusion is characterized by a stable position of the affected organ, regardless of the position of the patient’s body or surges in intrauterine pressure. An unfixed protrusion is also called a wandering hernia, since its location can change.

The difference in pressure in the abdominal and thoracic cavities leads to the reflux of stomach contents back into the esophagus, which ends in serious consequences for it: the development of erosions, ulcerative lesions of the esophagus, the patient feels discomfort, and the disease is often accompanied by severe pain. Chronic reflux leads to severe inflammation of the esophagus, it becomes irritated and bleeds, which can result in anemic syndrome.

The following negative factors can trigger the formation of hiatal pathology:

Weakness of the muscular wall that holds the stomach in its anatomical place.
The muscle barrier can be weakened by exhaustion of ligaments due to increased stress on the body.
The period of pregnancy, when intrauterine pressure increases and the diaphragmatic opening increases.

With an unfixed hiatal protrusion, the stomach changes its position and returns to its place when the patient’s body position changes, but this does not reduce the protrusion and requires adequate treatment. An esophageal hernia can have different sizes; with a long course of the pathological process, a large hernial protrusion is observed. The consequence of a sliding or wandering hernia is the fixation of the stomach above the diaphragm and the formation of scars along the edges of the hernial sac. Against this background, shortening of the esophagus develops, and a fixed protrusion will constantly be outside the diaphragm.

Important! With a wandering hernia, pinching is impossible, because blood circulation is preserved and the hernial lesion does not appear for a long time, but instead stenosis or reflux esophagitis can develop.

Clinical manifestations of sliding hernia

The appearance of the first specific symptoms is observed when concomitant deviations of the esophagus and stomach appear, as well as in case of complications.

Complaints from patients with sliding diaphragmatic hernia:

pain in the stomach area is caused by the appearance of an inflammatory process and reflux;
salivation increases, which can lead to dental diseases;
burning sensation in the chest area;
frequent heartburn, belching, regurgitation;
sensation of a foreign body in the throat;
increased blood pressure, difficulty breathing.

Clinical manifestations of hiatal lesions may differ in each patient, depending on the position of the body and concomitant pathologies of the digestive system. A mandatory sign of the disease for all patients is a burning sensation in the chest. The nature of pain with a hiatal hernia has its own pattern; a painful attack occurs after the stomach is full and full, and depends on the amount of food. Increased pain and discomfort occurs with increased physical stress on the body, overeating, and the presence of congenital or acquired pathologies of the cardiovascular system.

Important! Pain from a hiatal hernia can be easily relieved with medications to treat high stomach acidity.

Treatment methods for sliding hernia

A sliding hiatal hernia can be treated with medications without complications. Antacids, antispasmodics, and painkillers are prescribed.

Antacids (Gastal, Phosphalugel) are prescribed for increased stomach acidity to normalize the pH and relieve the painful syndrome.
The drug De-nol is indicated to enhance the protective function of the mucous membrane of the digestive organs.
Antispasmodics are aimed at treating spasms and pain relief.
The drug Motilium is prescribed for the symptomatic treatment of belching, regurgitation, and heartburn.

Complex treatment of a hiatal defect requires changes in nutrition, the patient is prescribed a special diet.

Eating crushed foods in small portions, but often.
Heavy fatty, fried, pickled foods are excluded.
The diet consists of steamed dishes: vegetables, cereals, white meat.
The last meal occurs an hour before bedtime.

An obligatory stage in the treatment of a sliding hernia is the normalization of the daily routine, reduction of physical and emotional stress, and elimination of smoking. It is important to exercise regularly, and for this there are special exercises indicated for patients with a sliding hernia. Hiatal protrusion can become complicated and progress, therefore, in order to prevent bleeding, stenosis, scarring, the doctor may prescribe surgical treatment aimed at restoring the anatomical position of the stomach and excision of tissue affected by the ulcer.

Content

The diaphragm is a plate made up of muscles that separate the chest from the abdominal cavity. When doctors diagnose a patient with a hiatal hernia, it can be observed that the esophagus protrudes upward from the plane of the diaphragm. In most cases, this disease does not cause significant discomfort. But if treatment for an axial hiatal hernia does not occur in a timely manner, this can lead to serious complications. Let's take a closer look at the symptoms and treatment methods of this disease.

Symptoms of an axial hernia

There are two types of sliding hiatal hernia: non-fixed and fixed. An unfixed hernia is a less complex type of pathology, but also requires treatment. As for fixed, it is difficult to diagnose, because in the first stages it is almost asymptomatic. As a rule, the patient learns about the disease by chance during an X-ray or medical examination. Axial hernia of the second degree is manifested by pain in the epigastric region, heartburn, belching, hiccups, and anemia.

In some cases, patients confuse esophageal pain with pancreatic or heart pain. The doctor’s task in this case when diagnosing is to exclude pancreatitis, heart attack, angina pectoris, so you should know the main characteristics of pain symptoms in the disease:

Moderate intensity of pain, intensifying with physical activity.
The pain syndrome appears when the patient lies down, stands for a long time, when coughing, flatulence, after eating.
The pain goes away completely after belching or vomiting.

A hiatal hernia is dangerous because respiratory tract diseases and various inflammations of the lower parts of the esophagus can develop. Prolonged hemorrhages lead to anemia, after which the patient increases the risk of developing esophageal cancer. In most cases, after the disease develops, people experience reflux esophagitis. If, after the first signs, the disease is not treated for 7-10 years, then in patients, according to gastroenterological studies, the risk of developing esophageal cancer increases by 280%.

Causes

The disease is an acquired or congenital ailment, which ranks third after peptic ulcer and cholecystitis. Protrusion can occur in the presence of predisposing factors:

In people of retirement age, protrusion occurs against the background of aging of the ligamentous apparatus, which leads to the loss of its physiological properties. In addition, in old age, along with this disease, other types of hernias are formed: umbilical, femoral, white line of the abdomen. As a result of this, even more unfavorable consequences arise: the hole in the diaphragm expands, which can allow up to 3 fingers to pass through - this is the hernial orifice, through which the abdominal part freely passes into the upper part of the stomach.

Diagnostics and laboratory tests

Hernial protrusion is often detected incidentally during examination of other diseases of the digestive system. When a patient complains of frequent heartburn or pain in the abdomen or chest, doctors perform the following types of diagnostics:

radiography of the lower chest and abdominal cavity;
fibrogastroscopy of the stomach and esophagus;
CT scan.

The doctor can identify axial hernias while standing or lying in the Trendelenburg position, when the patient’s shoulder girdle and head are below the pelvis. Sometimes an endoscopic examination method is used to identify the degree of damage to the mucous membrane of the esophagus and the combination of the disease with other gastrointestinal diseases: chronic gastritis, duodenal ulcers, pancreatitis, cholecystitis, reflux esophagitis. Laboratory tests play a supporting role - biochemical and clinical blood tests help identify inflammation and anemia.

Which doctors should you contact?

To diagnose the disease, you should contact a gastroenterologist, who, after examination, should refer the patient to a cardiologist, pulmonologist and otolaryngologist to identify an axial hiatal hernia in relation to diseases of the cardiovascular and respiratory systems. If a person independently discovers a similar illness, then he needs to contact a surgeon who is able to detect the second stage of a hernia by palpation and, if necessary, refer the patient for a planned surgical intervention.

Treatment methods

Treatment for this disease occurs in different ways. Leading clinics in Israel, Germany, Moscow, St. Petersburg and other large Russian cities provide complex conservative treatment in the early stages of the disease, and also offer a surgical method, since it is believed that it is more effective in the final stages of the disease. Surgical intervention is indicated in cases where:

large size of education;
education is prone to infringement;
drug treatment did not produce results;
dysplasia of the esophageal mucosa has occurred;
a periesophageal sliding hernia has formed;
inflammation, bleeding, ulcers, erosion began.

The cost of treatment abroad is an order of magnitude higher than in Russian medical centers. For example, the cost of Hill's operation, called the most effective for a sliding hernia, in a German clinic will cost the patient from 3 thousand euros, and the price for a similar surgical intervention in a Moscow clinic will be exactly 2 times cheaper. However, in all countries, doctors recommend starting treatment without surgery and continuing it for as long as possible.

Conservative

Features of conservative treatment include drug therapy aimed at solving the following problems:

Prevention of reflux esophagitis.
Impact on the inflamed lining of the esophagus.
Reduced acid-peptic secretion of gastric juice.
Suppression of gastric secretion.
Correction of dyskinesias (disorders) of the stomach and esophagus.
Treatment of associated complications.

After a thorough medical examination of the first-time patient, treatment is prescribed, which is carried out in a hospital setting according to ICD-10 (international classification of diseases). Upon completion of the main course, all patients with axial hiatal hernia are registered at the dispensary, during which periodic diagnosis, prevention, and correction of relapses and complications are carried out. Often, after inpatient treatment, a patient is recommended to go to a sanatorium for rehabilitation.

After drug treatment, heavy lifting and all types of work that are accompanied by tension in the intra-abdominal muscles are not allowed. Wearing bandages, corsets, and tight belts is not recommended. The gastroenterologist must prescribe a gentle diet, which prohibits overeating, consumption of spicy, fried foods and carbonated drinks. It is advisable to exclude animal fats, coffee, tomatoes, citrus fruits, alcohol and chocolate from the diet - these products help reduce gastric secretion.

Surgical

If repeated courses of drug therapy and alternative treatment are unsuccessful, surgical intervention is indicated, in which the formation is completely removed, the hernial orifice is sutured, the esophagus and cardiac part are strengthened, and the ligamentous apparatus is restored. Surgical intervention can occur through open access or laparoscopy using several techniques:

Nissen fundoplication, during which the esophagus is wrapped around part of the stomach, creating a kind of cuff. It reduces the esophageal opening of the diaphragm and prevents stomach contents from entering the esophagus. This method is effective for cardiofundal hernias, when the cardia is located above the diaphragm.
The Belsey operation, in which an incision is made in the left side of the chest, the fundus of the stomach is sutured to the esophagus, while part of it is attached to the diaphragm. This is an effective method for hiatal hernia, when the abdominal organs move to the wrong place due to pathology of the esophageal opening.
Hill gastrocardiopexy is performed using a large incision above the belly button, called a laparotomy. During this operation, the upper part of the esophagus and stomach are sutured to the diaphragmatic parts, for example, the round ligament of the liver or the greater omentum.

Disease prevention

The most effective way to avoid the development of an axial hiatal hernia is its prevention. To do this, a person must follow a number of simple rules throughout his life:

Avoid lifting excessive weights and bending too quickly.
Monitor the proper functioning of the digestive system.
Avoid constipation.
Include only natural foods in your diet, avoid fast food, smoked foods, sweets, hot sauces and seasonings.
Eat meals in small portions.
After eating, do not subject the body to physical activity.
Do not eat 4 hours before bedtime.
Avoid afternoon naps.

Video

As the disease develops, the viscera shift from the peritoneum into the chest cavity. The diaphragm is located in the middle of these two sections, so when its muscles weaken, the upper part of the esophagus begins to bulge and move upward. This is called a hiatal hernia.

An axial hiatal hernia is a protrusion of organs located below the diaphragm through a natural opening.

The disease is also called hiatal hernia. Hernia is another name for hiatal hernia.

The protruding organs end up in the chest, although they should be in the abdominal cavity.

All information on the site is for informational purposes only and is NOT a guide to action!
Only a DOCTOR can give you an ACCURATE DIAGNOSIS!
We kindly ask you NOT to self-medicate, but to make an appointment with a specialist!
Health to you and your loved ones!

Most often, the disease affects the lower part of the stomach or esophagus. Other organs protrude into the chest less frequently.

The initial stage of a hiatal hernia does not have obvious signs, which makes it difficult to detect. As it develops, the hiatal hernia becomes similar in symptoms to gastrointestinal diseases. At the same time, the patient’s quality of life remains virtually unchanged.

Treatment of hiatal hernias is the prerogative of surgeons. Most often, therapy is limited to diet and medications. Surgery is used much less frequently for treatment.

Reasons for education

The reason why a sliding formation of the esophageal opening of the diaphragm is formed is the pathology of the ligament that holds the gastroesophageal canal inside the esophageal opening of the diaphragm.

As the upper part of the stomach moves upward during a sliding hernia, this muscle ligament becomes exhausted and stretched. The esophageal opening becomes larger in diameter.

Therefore, depending on the amount of contents in the stomach and the position of the person’s body, the hernial phenomenon (including part of the gastroesophageal canal) may first move into the sternum from the abdominal cavity and then return back.

In this case, a hernial formation of the esophagus can be both large in size and small in size. As a rule, a large hernial prolapse is observed in patients who have been suffering from a similar illness for a long time.

If the prolapse is fixed and narrowed by scars in the hernial sac, acquired shortening of the esophagus may occur. In this case, the esophageal-gastric canal, or anastomosis, as it is called, will constantly be located above the diaphragm.

The advantage of a sliding hernia is that it cannot become pinched. But with advanced variants, fibrous stenosis may occur. Also a concomitant disease of a sliding hiatal hernia is reflux esophagitis.

Strangulation of a sliding hernia

As already stated, the sliding fallout cannot be pinched. Even if the hole narrows and the cardia that has entered the sternum is compressed, this does not threaten circulatory problems. Because the contents are emptied through the esophagus, and the outflow of blood occurs through the veins of the esophagus.

The formation of a hernia can be influenced by both congenital and acquired factors.

The causes of a sliding hiatal hernia are conventionally divided into congenital and acquired. Very often they act together, that is, the preconditions already existing in the body are aggravated by external factors.

Having studied these reasons, it becomes clear that the disease can suddenly overtake anyone. Acquired causes are present to one degree or another in the lives of many people (especially excess weight), but we may not know about congenital ones.

As a rule, a sliding formation occurs without pronounced symptoms. Serious symptoms appear when concomitant diseases are added to the sliding prolapse or complications begin.

Then, the patient may complain of:

Symptoms may vary depending on the position of the patient’s body. A burning sensation occurs in almost every patient with a sliding hiatal hernia.

The pain is not like what a person with an ulcer might feel. With hernia formation, pain appears after eating and is proportional to the amount of food taken. When taking drugs that reduce acidity, the pain disappears almost instantly.

Diagnostics

You can diagnose a sliding formation in the following ways:

gastroscopy;
X-ray of the stomach, including functionality analysis;
changes in daily pH in the esophagus.

Sliding hernias are first treated with the traditional method, which involves a special diet, physical exercises and medication. If this does not help, and the patient begins to develop complications, surgery may become a question. Surgery is also indicated for bleeding.

In modern surgery, a sliding hernia is removed using a method called Nissen fundoplication. During this manipulation, a special cuff is created around the esophagus. It allows you to eliminate the disease and prevent the contents of the stomach from entering the esophageal mucosa.

This operation is performed laparoscopically, which reduces trauma to a minimum. There is a possibility of the cuff slipping, which increases the risk of relapse of the disease, but in general, surgical intervention has a positive prognosis and with proper treatment in the postoperative period, the patient quickly returns to normal activities.

The causes of the formation of a sliding hiatal hernia can be divided into congenital and acquired. Most often, a combination of several causes leads to the disease.

(if the table is not completely visible, scroll to the right)

Slowing down of the descent of the stomach into the abdominal cavity during fetal development (congenital hiatal hernia in children).

Numerous reasons associated with increased pressure inside the abdominal cavity (heavy lifting, coughing attacks, chronic constipation, obesity, pregnancy, etc.) increase the risk of organs exiting through the esophageal opening of the diaphragm, especially in the presence of congenital prerequisites.

Formation of a “pre-prepared” hernial sac due to untimely fusion of the diaphragm after descent of the stomach.

Age-related changes in the diaphragm.

Underdevelopment of the muscles of the diaphragmatic legs covering the esophageal opening, which is why it appears dilated.

(In the last two cases, the hiatal hernia can form at any age with additional external provoking influences.)

Both congenital and acquired factors can lead to the appearance of a sliding hiatal hernia.

Congenital causes

A sliding hernia can form in the fetus in the womb and appear only after a long time. With age, organs that are supported by underdeveloped muscles can extend beyond the abdominal cavity, forming a protrusion without the presence of a hernial sac.

Acquired reasons

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 burning in the esophagus, which appear as a result of overeating. Symptoms of the disease with proper nutrition are practically absent.

A large hernial sac can be pinched, causing severe pain in the epigastric region, nausea and vomiting, which are rarely accompanied by the release of stomach contents.

Axial hiatal hernia is an acquired or congenital disease, which ranks third after peptic ulcer and cholecystitis. Hernial protrusion can occur in the presence of predisposing factors:

The reasons for the appearance of any hernia, and a sliding diaphragmatic hernia of the esophagus is no exception, are only two factors:

Weakening the barrier that holds the internal organs within the anatomical location;
An increase in the internal pressure of the cavity in which the organ is located, part of which is the contents of the hernia.

When barrier tissues are weakened, a hernial orifice is formed, through which, under internal pressure, parts of organs are “squeezed out” beyond the limits of normal, anatomical localization.

When a sliding hernia is formed due to contraction of the muscles of the esophagus, it is called traction.

If a hernia is formed due to weakening of the connective tissue of the tendon ring, the mechanism of formation of the hernial protrusion is pulsating.

Such a sliding esophageal hernia is formed under the following conditions of the body:

Obesity;
Pregnancy;
Abdominal tumors.

That is, a pulsating axial hiatal hernia is formed with increased intra-abdominal pressure.

A separate type of sliding diaphragmatic hernia appears when the esophageal sphincter is insufficient.

A special form has also been identified, axial hiatal hernia, the so-called adjacent areas. Diaphragmatic hernia of the fetus, for example.

How does a sliding hiatal hernia manifest?

Regardless of the mechanism of formation, a sliding hiatal hernia has the same symptoms. And they manifest themselves in the development of reflux esophagitis.

The word “reflux” in Russian means “reverse current” or “return reflux”. Reflux esophagitis is manifested by inflammation of the esophagus (esophagitis), caused by irritation and damage to the cells of the mucous membrane by hydrochloric acid.

As a result, ulcers and cracks appear on the mucous membrane, which provoke pain.

People who develop an axial hiatal hernia report burning pain behind the sternum, similar to heart pain.

At the same time it hurts in the epigastric region and in both hypochondriums.

Often the pain radiates to the left shoulder girdle and forearm. Such symptoms are often misleading, and a person believes that his heart hurts. Moreover, he takes medications for angina pectoris. Of course, they do not bring relief.

When there is a sliding diaphragmatic hernia of the esophagus, the pain syndrome increases when the body position changes to horizontal. Standing and sitting, a dull pain is felt; lying down, it worsens, forcing you to sit up in bed.

At the same time, belching appears, similar to regurgitation of stomach contents, as in infants. Heartburn torments me constantly.

If a sliding hiatal hernia continues to progress, the person may have difficulty swallowing. Ulcerative lesions of the esophageal mucosa begin to bleed. The result is coffee-colored vomit.

Less commonly, when the wall of a vessel larger than the capillaries is corroded, more massive bleeding occurs. Then the vomit turns scarlet and the stool becomes dark.

If only small vessels are damaged, hidden bleeding can only be recognized indirectly, through blood tests. Constant bleeding, albeit in small portions, leads to a state of anemia.

The condition of the ligaments affects the formation of the esophageal opening of the diaphragm.

With this disease, the upper part of the stomach moves upward. This causes the muscle ligament to become much thinner.

Stretching the ligament provokes an increase in the diameter of the esophageal opening. The patient develops a complication due to regular overeating. If such a defect is detected, doctors refer the patient for surgery.

There are several methods for removing hernias. Through fundoplication, the surgeon creates a special cuff around the esophagus. It prevents stomach contents from refluxing into the esophagus. During the operation, the laparoscopic method is used. With its help, doctors manage to reduce trauma to a minimum. This shortens the patient's recovery time.

However, the possibility of the cuff slipping cannot be ruled out. This increases the risk of complications after surgery. Surgery in most cases helps to achieve positive results. Success largely depends on undergoing physical therapy procedures during rehabilitation.

Sometimes the hernial prolapse is fixed in one position. This occurs due to the narrowing of the scars in the hernial sac. In this case, the patient is diagnosed with acquired shortening of the esophagus. The esophagogastric canal is located above the diaphragm.

In severe cases, a person may experience fibrous stenosis. A complication of a sliding hernia is also reflux esophagitis. The sliding dump cannot be pinched. If the opening narrows, the cardia is compressed and enters the sternum. This condition does not lead to circulatory problems.

Etiology of the disease

Causes of hiatal hernia:

Congenital developmental anomalies. This applies to the period when the stomach descends into the abdominal cavity. The process may be disrupted, which will cause the appearance of a congenital diaphragmatic hernia. This disease requires surgery as soon as possible, otherwise there is a risk of death 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 the general prevention of pathologies of the musculo-ligamentous system, which includes physical therapy, dietary nutrition, and the elimination of bad habits.
Increased intra-abdominal pressure. This factor is associated with frequent constipation, bloating, overeating, excess weight, and pregnancy. 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.

At the last stage of the formation of a hernia in the chest area, most of the stomach or the entire organ is located. In this case, the disease must be treated not only with conservative methods, but also with surgical intervention.

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

Clinical picture of the disease

The symptoms of the pathology are very similar to the manifestations of diseases of the gastrointestinal tract associated with dysfunction. Against the background of deterioration in the activity of the esophageal (lower) sphincter, catarrhal reflux (reverse reflux of gastric contents) is noted.

Over time, due to the aggressive influence of the masses, an inflammatory process develops in the lower part of the esophagus. The patient begins to complain of heartburn after eating and gets worse with physical strain or in a horizontal position.

There is often a feeling of a lump in the throat. Pain may appear after eating.

They have different characters. The pain can spread to the shoulder blade, radiate to the neck, behind the sternum, to the heart area or lower jaw.

These manifestations are similar to those of angina pectoris, which is the differential diagnosis. In some cases, pain appears at a certain position of the body.

The patient may complain of bloating in the upper abdomen and a feeling of the presence of a foreign body.

Classification

There are several types of axial hiatal hernias:

This species is characterized by the free movement of organs into the chest from the abdominal cavity, and then back.
In this case, the lower part of the esophagus and the upper part of the stomach protrude.
They are located normally, being in the abdominal cavity.
Cardiac hernia is another variation of this type.
There are also cardiofundal, subtotal and total gastric hiatal hernias.

This variety is much less common than the first.
With this disease, only the lower parts of the stomach protrude through the opening of the diaphragm, while the upper ones have a normal location.
It feels like your stomach is turning 180 degrees.
Some other organs may also protrude along with the stomach.
There are fundal and antral paraesophageal hernias.

This type is something between the first two types.

Symptoms and signs

At the beginning of the development of the disease, symptoms almost do not appear, clinical signs are mild and the hernia does not bother you. It can only be detected by chance, for example, during a medical ultrasound examination.

Visual inspection and palpation will not give results, since the hernia cannot be felt by touch due to its deep location inside the thoracic region. What makes it difficult to recognize an axial hernia is that it can periodically go back under the diaphragm.

Intra-abdominal pathologies require constant monitoring, since an increase in internal pressure can lead to pinching, which will require urgent medical attention. Symptoms of strangulation will be: the appearance of acute pain, vomiting mixed with blood and bile, the presence of a lump in the throat. However, according to medical statistics, hernias of this type are practically not strangulated.

Symptoms

The signs of a wandering hernia are erased, it is almost asymptomatic. Pathology begins to worry the patient when concomitant diseases are added to it and complications appear.

Patients are concerned about:

The symptoms of a sliding hiatal hernia are hidden in most cases. Signs of a hernia are often confused with diseases of the gastrointestinal tract, and at an early stage of the disease they may not appear at all.

Among all diaphragmatic hernias in adults, the most common is a sliding esophageal hernia, which is classified as a hiatal hernia (HH). A sliding hiatal hernia (also called axial hiatal hernia) is formed when the stomach and lower esophagus are displaced into the chest cavity (and normally they are located in the abdominal cavity).

The disease does not have any critical impact on the patient’s quality of life. It lasts a long time, gradually progressing, often completely asymptomatic. The disease responds very well to conservative therapy (without surgery). The main thing is to recognize the signs of a hernia in time and begin treatment.

A feature of a sliding hiatal hernia is the weak severity of clinical signs or even the complete absence of complaints, especially with a small size of the hernial protrusion. For some patients, a sliding hiatal hernia is an accidental finding during an X-ray examination for a completely different reason.

It is also impossible to notice an axial hernia during an external examination, because, unlike other abdominal hernias. In case of a sliding hiatus hernia, the abdominal organs do not emerge under the skin, but into another internal cavity (the chest cavity), so even large formations are not visible from the outside.

However, when a sliding hiatal hernia persists for a long time, or when a significant part of the stomach slips into the chest, symptoms appear associated with the reflux of acidic stomach contents into the esophagus, which irritates the mucous membranes of the esophagus.

Heartburn - after eating, in a lying position.

Burning pain in the epigastric region and behind the sternum. The pain is especially severe when bending over (for example, when tying shoelaces - the “lace” symptom).

Belching and regurgitation (reverse movement of food from the stomach into the esophagus and oral cavity without vomiting).

Dysphagia is a swallowing disorder. At first, the dysphagia is reflex: there is no narrowing of the esophagus, and the patient experiences a feeling of imaginary difficulty when swallowing liquid food. Then, due to inflammation of the esophageal mucosa, a cicatricial narrowing (stricture) is formed and true dysphagia appears with difficulty passing the food bolus.

There are two types of sliding hiatal hernia: non-fixed and fixed. An unfixed hernia is a less complex type of pathology, but also requires treatment.

As for fixed, it is difficult to diagnose, because in the first stages it is almost asymptomatic. As a rule, the patient learns about the disease by chance during an X-ray or medical examination.

Axial hernia of the second degree is manifested by pain in the epigastric region, heartburn, belching, hiccups, and anemia.

Diagnostics

Axial hernia can be diagnosed using radiography, esophageal manometry, fibroesophagogastroduodenoscopy, gastroscopy, esophagoscopy.

When diagnosing a sliding hiatal hernia, radiography or MRI is used. These are the only two methods that allow a doctor to detect a sliding hernia.

Ultrasound is not used in this case, as its results are not indicative. To accurately determine the diagnosis, in conjunction with radiography, probing of the esophagus, endoscopy, and measurement of the pH level in the esophagus are performed.

Based on a comprehensive examination, the doctor is able to accurately confirm the diagnosis, as well as determine the degree of progression of the sliding hernia.

Like other hiatal protrusions, a sliding hernia is diagnosed radiographically.

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 its internal surfaces are examined. Special equipment records changes in the acidity of gastric juice.

Elimination of a sliding hiatal hernia can be done in several ways. Conservative therapy is based on the use of medications.

A wandering hernia is an indication for following a 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. Hernias that are prone to strangulation and the formation of adhesions are treated surgically. Emergency surgery is performed in the presence of inflammatory changes in the esophagus.

There are several types of surgical procedures used to repair 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 of the upper parts of the stomach to the diaphragmatic ligaments through an opening in the upper line of the abdomen. In a Nissen fundoplication, a cuff is wrapped around the top of the stomach to prevent the contents from escaping into the esophagus.

After installing this device, the stomach is given the correct position, and 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.

Hernial sacs of the esophagus are most often discovered during an endoscopic examination or radiography of the abdominal or chest organs. The main signs indicating the presence of the disease during such a study are considered:

increased location of the esophageal sphincter;
the absence of a subdiaphragmatic section in this digestive organ;
cardia, located directly above the diaphragm;
expanded diameter of the esophageal opening;
delay in a hernia injected directly for barium suspension contrast.

When performing endoscopy, the development of this disease is indicated by signs of diseases such as ulcers, erosion, gastritis or esophagitis, as well as the presence of the esophageal-gastric line above the diaphragm. In order to exclude the presence of malignant neoplasms in patients with suspected hiatal hernia, a biopsy is mandatory.

To detect internal bleeding from the gastrointestinal tract, stool is examined for occult blood.

After carrying out all these diagnostic measures and confirming the diagnosis, the specialist selects a treatment protocol for the disease that is appropriate for each specific patient and begins to treat the axial hernia.

The hiatal hernia often has no symptoms. Therefore, about 35% of patients have complications. It happens that the disease is discovered accidentally during an endoscopy or x-ray examination.

An esophagoscope helps to conduct a precise examination of the esophagus and the muscle structures located next to it. Soft tissue sampling helps identify the presence of malignant and benign neoplasms.

The most effective method for detecting hiatal hernia is considered to be an x-ray examination using a contrast agent. This method can help a specialist detect a protrusion located in the lower part of the peritoneum.

To confirm the diagnosis, the following additional research methods are performed:

X-ray of the esophagus with contrast solution;
Fiber dudenoscopy is an examination of the walls of the esophagus and the initial part of the stomach using fiber optics.

Using objective research methods, it is possible to determine the length of the esophagus, the expansion of its mouth above the fibrous ring.

The picture of the mucous membrane is also clearly visible, defects and ulcers are visible.

With a confirmed diagnosis of a sliding hiatal hernia, treatment is carried out conservatively.

Modern drugs are used that neutralize hydrochloric acid and reduce its production - proton pump inhibitors (omeprazole group), antacids that reduce the aggressive effect of hydrochloric acid (almagel group), prokinetics (ranitidine, domperidone).

If the size of the hernia is small and sphincter function is preserved, conservative treatment is successful, but requires regularity.

Each break in taking medications can provoke reflux esophagitis of even greater severity than before treatment.

Pathology is detected using several methods. Among the main ones are: esophagogastroduodenoscopy, x-ray of the stomach and esophagus, intraesophageal pH-metry. Ultrasound, computed tomography, and esophagometry are also used.

To identify a sliding formation, experts use several methods:

during gastroscopy, doctors use endoscopic equipment to determine inflamed areas, the presence of ulcers and erosions;
X-ray of the stomach is intended to assess the condition of hernial formations;
the study of changes in daily pH in the esophagus is intended to determine increased acidity, which leads to painful sensations.

Treatment

Uncomplicated sliding hiatal hernia is treated with conservative therapy. Home remedies from the arsenal of traditional medicine help get rid of heartburn and even cure reflux esophagitis. Surgery is performed on patients with bleeding.

Drug therapy

Antacid, antispasmodic and analgesic medications help relieve the symptoms of reflux esophagitis.

Diet food

give up everything that causes increased release of hydrochloric acid: fatty, fried, salty and pickled.
eat pureed and thoroughly chopped food;
eat small portions;
eat 5-6 times a day;
prepare steamed dishes from vegetables, cereals and white meat;
observe the condition that the interval between sleep and food should be at least 1 hour.

Establishing the rhythm of life

Patients need:

organize your daily routine;
control physical and neuro-emotional stress;
give up bad habits: alcohol, smoking;
perform therapeutic exercises;

Surgery

If symptoms worsen and treatment with conservative methods is unsuccessful, the patient undergoes surgery. In case of bleeding, emergency surgery is performed.

Hernia removal is performed under general anesthesia. Using laparoscopic instruments, the doctor forms a rosette-shaped coupling from the gastric walls that covers the esophagus. It does not allow the esophagus to be pulled up.

Do not reflux gastric contents into the esophagus. Irritation of the mucous membranes passes, ulcers and erosions heal, reflux esophagitis disappears.

Patients recover quickly after surgery. Their ability to work returns after 14-21 days.

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

Conservative

In the early stages, surgery is rare. Most often, the doctor prescribes medications and a diet that involves excluding from the diet:

fatty (meat - pork, cakes, cakes based on cream with a high fat content, etc.);
spicy (hot seasonings, onions, garlic, black and red pepper);
smoked (sausage, meat, fish, chicken products);
fried (meat, potatoes, eggs, etc.);
salty (cucumbers, tomatoes, sauerkraut, etc.);
carbonated drinks (lemonade, mineral water);
coffee, strong tea.

Surgical intervention for sliding hiatal hernia is rarely used. Typically, doctors tend to use conservative methods of therapy, which are very effective in treating the disease. This type of treatment is not as quick as surgery, but it gives positive results and does not require a long and painful recovery.

After confirmation of the diagnosis, treatment should begin immediately: the sooner it is prescribed and performed, the lower the risk of complications and the lower the risk of surgical intervention.

The mandatory and main method of treating a sliding hiatal hernia is constant adherence to a diet.

Patients are recommended to eat split meals (frequently, every 3–4 hours, in small portions of 200–300 g) with the exception of fried, fatty, spicy, salty foods, pickled, smoked and other foods that irritate the mucous membranes and stimulate the secretion of gastric juice.

The basis of the diet consists of boiled, stewed and steamed dishes from vegetables, cereals, milk, lean meat, and fresh fruits.

With true dysphagia, food should have a ground, semi-liquid consistency. You should eat no later than 1 hour before bedtime, and after eating it is advisable to rest for 15–30 minutes in a sitting or reclining position (but not lying down!).

2. Normalization of lifestyle

A complete cessation of smoking, alcohol, sufficient rest, and dosed physical activity are required. Physical exercises that can increase pressure in the abdominal cavity (with stress on the abs, flexion) are prohibited.

3. Medicines

Restoring the protection of the mucous membrane of the digestive tract

If bleeding and anemia develop as complications, patients are given iron supplements and the need for surgery is decided. Surgical treatment of sliding hernias is performed relatively rarely, and is used only when conservative treatment methods are ineffective.

The choice of treatment method, combination of drugs, their dosage and course of administration should be made only by a surgeon.

Medicines can be used intermittently, but therapy without medications (diet and lifestyle adjustments) depends only on the patient and must be carried out constantly, otherwise a positive result cannot be achieved.

As a rule, conservative therapy based on medications and diet is sufficient to treat sliding hiatal hernia. Surgical intervention is rarely performed, in extreme cases - late detection of a sliding hernia and the onset of internal bleeding.

When diagnosed with a wandering hiatal hernia, constant adherence to dietary nutrition is required. You should stick to fractional meals, in frequent small portions. Be sure to exclude fried, spicy, salty and fatty foods.

Do not consume foods that irritate the mucous membrane. The basis of the diet should be stewed and boiled dishes, vegetables, cereals, and dairy products. Eating immediately before bed is not allowed. The last meal is recommended an hour before bedtime.

Healthy lifestyle

Complete abandonment of bad habits, sufficient rest.

Regular sports and acceptable physical activity are recommended. It should be borne in mind that with this diagnosis, physical exercise with stress on the abdominals is prohibited, since they can increase the pressure in the abdominal cavity.

Taking medications

from heartburn;
painkillers;
antispasmodics;
agents that reduce gastric acidity.

The medication is taken in courses, that is, it is irregular. But you should always maintain a balanced diet and a healthy lifestyle.

If treatment is not started promptly and the disease progresses, anemia, ulcers, gastritis, bleeding in the area of internal organs and the esophagus, and shrinkage of the esophagus may develop.

The diaphragm is a plate made up of muscles that separate the chest from the abdominal cavity. When doctors diagnose a patient with a hiatal hernia, it can be observed that the esophagus protrudes upward from the plane of the diaphragm.

In most cases, this disease does not cause significant discomfort. But if treatment for an axial hiatal hernia does not occur in a timely manner, this can lead to serious complications.

Let's take a closer look at the symptoms and treatment methods of this disease.

Due to the absence of pronounced symptoms of hiatal hernia, treatment is almost always delayed. The development of the disease necessitates observation by a doctor and professional help.

The use of diets and pills in this case will not help the patient to recover, except perhaps to prevent complications in the form of gastroesophageal reflux disease from developing.

Diet means proper nutrition - in small portions, but often. The patient is prohibited from eating chocolate, flour, consuming animal fats, drinking coffee or soda. The patient should not take a horizontal position for at least 3 hours after eating.

To obtain the greatest effectiveness from non-surgical treatment, the patient must adhere to a healthy lifestyle, eliminating his bad habits. It is necessary to monitor the level of intra-abdominal pressure - it should not increase.

If a complicated axial hernia develops, only surgical treatment is indicated. In cases of bleeding, surgery is performed as an emergency.

The operation is performed under general anesthesia using laparoscopic instruments.

Under visual control, the surgeon creates a ring from the walls of the stomach in the form of a coupling, “put on” the esophageal tube. The cuff prevents the esophagus from being pulled upward and the sphincter from relaxing.

As a result, reflux disappears, and the contents of the stomach do not enter the esophagus.

After the operation, three small scars, up to 10 mm long, remain on the skin. On the first day of the postoperative period, patients are allowed and recommended to stand up. You can drink. On the second day you are supposed to take liquid food.

In the absence of complications, discharge from the hospital is made on the third day after surgery. The certificate of incapacity for work is closed in two to three weeks.

Prevention of recurrence of axial hernia

Nutrition for a sliding hiatal hernia after surgical treatment involves a strict diet as for a gastric ulcer during the first month.

Then the diet becomes softer and includes restrictions on spicy and salty foods, as well as alcohol. Carbonated water is not recommended.

Six months later, the patient returns to his normal life, that is, all dietary restrictions are lifted.

Various measures are being taken to alleviate the symptoms that accompany a sliding hiatal hernia: diet, medications. Conservative methods are aimed at eliminating the symptoms of pathology: relieving pain, heartburn, nausea.

In this case, medications are prescribed to reduce the acidity of gastric juice. Such drugs, for example, include the drug “Kvamatel”.

One of the conditions for effective treatment of patients diagnosed with hiatal hernia is diet. The diet limits the presence of fatty, spicy, fried foods, alcohol, chocolate, coffee, and foods that promote the production of gastric juice.

You should eat food in small portions, often. To prevent reflux, it is recommended that the patient sleep with the upper body elevated and avoid lifting heavy objects.

To eliminate the defect, doctors use traditional methods. The complex of treatment measures includes a special diet, therapeutic exercises, and medication.

To reduce acidity, doctors prescribe patients to take antacids (Phosphalugel, Maalox). Patients suffering from bouts of belching can be helped with the help of Motilium. The dosage is indicated by the doctor taking into account the patient's condition.

However, in case of serious complications, these methods do not achieve positive results. In this case, the patient is sent for surgery.

Diet after surgery

Following a postoperative diet is necessary to reduce the load on the gastrointestinal tract. Small meals and the exclusion of foods that cause gas formation, contribute to constipation, etc. will help achieve this.

What foods should you not eat after surgery?

The following should be excluded from the diet:

flour baked goods (cookies, pies, cakes, pancakes, pancakes, etc.);
bran bread;
fatty, smoked, salted, spicy, fried;
legumes (peas, beans, etc.);
citrus;
tomatoes, cabbage, broccoli, carrots, garlic, onions;
radish, turnip, radish;
corn, millet, pearl barley porridge;
eggs;
dairy products with a high percentage of fat;
nuts, seeds, raisins, dried apricots, prunes;
carbonated drinks, coffee, strong tea, juices with a high acid concentration.

Anatoly, 54 years old, Volgograd: “At the age of 40, I was diagnosed with an axial hiatal hernia. The surgeon said that the hernia was large, but surgery was only indicated if there were complications.

He warned me not to lift weights, but due to the nature of my work it was impossible, so I went for the operation. It was successful, and after rehabilitation I returned to a full life without dietary restrictions.”

Lyudmila, 36 years old, Voronezh: “I had Nissen surgery in Moscow 3 years ago. There was a small first degree hernia along with cholecystitis. At first it seemed that surgical treatment did not help, because for several months it was necessary to follow a strict diet and take antispasmodics. But soon everything went away, and now I have already forgotten about all the problems of the esophagus.”

Treatment of pathological protrusion of the diaphragm is carried out in two ways - surgical and conservative. The second, non-surgical method, is indicated in cases where the hernia is small in size and occurs without obvious symptoms.

An integral part of such therapy is the correction of lifestyle and diet, as well as the appointment of medication, the same as for gastroesophageal reflux. Reviews from patients who have undergone this treatment are only positive.

Almost all of them achieved complete recovery or transition of the pathology into a state of long-term remission.

But unfortunately, conservative therapy is not suitable for everyone. In this case, surgical intervention is prescribed. Indications for it are severe esophagitis that cannot be treated with medication, insufficiency of the lower diaphragmatic sphincter, and significant narrowing of the esophagus. This operation serves the following purposes:

creation of an anti-reflux mechanism that prevents the reflux of acidic gastric enzyme into the esophagus;
restoration of the anatomical structures of damaged digestive organs, as well as the natural relationship between the stomach and esophagus.

There are several operations to get rid of this pathology, and each has its own advantages and disadvantages. Access to a protruding hernial sac can be performed laparoscopically or openly.

After surgery, the patient must be prescribed a course of medications, including histamine receptor blockers, proton pump inhibitors, antacids and prokinetics.

A complete revision of the lifestyle and habits of the sick person is also necessary:

physical activity, if any, should be reduced;
a fixing bandage is worn for long-term wear;
a diet is prescribed to spare the digestive organs and also reduce weight.

Surgical techniques used

Today, specialists use two methods of intervention:

Open access. In this case, Nissen fundoplication or Topeplasty can be performed. In the first case, there is a high risk of developing many complications. Therefore, plastic according to Tope is preferable.
Laparoscopic access. This is the least traumatic method of intervention. After surgery using this method, the patient recovers faster and easier.

It should be said that laparoscopy for a hiatal hernia is often performed in conjunction with operations on other organs in the abdominal cavity. For example, cholecystomy is performed for calculous cholecystitis in the chronic stage, proximal selective vagotomy is performed for ulcers in the duodenum.

Consequences

Untimely treatment of hiatal hernia leads to complications. These include:

bleeding in the esophagus;
the appearance of gastroesophageal reflux disease;
strangulated hernia;
the appearance of cicatricial narrowing of the esophagus;
development of peptic ulcer of the esophagus;
perforation of the esophagus.

Other complications may occur during the postoperative period, including:

pathological expansion of the esophagus;
recurrence of hernia;
enlargement or expansion of the stomach area.

A type of pneumonia called aspiration pneumonia may also occur. Treatment of this disease occurs through antibiotics; they must be administered by bypassing the digestive tract.

More severe cases are characterized by a number of complications. One of them is bleeding from the esophageal vessels.

As a rule, it occurs in a latent form and manifests itself in the form of progressive anemia. Bleeding can be chronic or acute.

In some cases, even strangulation of protrusions in the esophageal opening and perforation of the esophagus are detected. The most common consequence of the pathology is reflux esophagitis.

It can develop into a peptic ulcer in the esophagus. With prolonged therapy, this condition provokes an even more serious complication - cicatricial stenosis (narrowing) of the organ.

Disease prevention

The most effective way to avoid the development of an axial hiatal hernia is its prevention. To do this, a person must follow a number of simple rules throughout his life:

Avoid lifting excessive weights and bending too quickly.
Monitor the proper functioning of the digestive system.
Avoid constipation.
Include only natural foods in your diet, avoid fast food, smoked foods, sweets, hot sauces and seasonings.
Eat meals in small portions.
After eating, do not subject the body to physical activity.
Do not eat 4 hours before bedtime.
Avoid afternoon naps.

Diet after surgery

Your doctor will provide an exact list of permitted products based on your diagnosis. During treatment, some adjustments to the diet are possible, but in general the diet will always have to be followed.

Do not forget that for the normal functioning of the body it is necessary to consume fats. High-quality vegetable oil in small quantities is quite acceptable. Oil should be used to season the salad, but do not use it for frying.

Like any other hernia, a sliding hernia is a serious disease that should not be trifled with. Despite the simple principles of therapy, they must be strictly followed, self-medication must not be allowed and you must be very careful about your health. This approach will help get rid of the disease and prevent complications.

(Total 147, today 1)

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Sliding hernias are pathologies in which one wall of the hernial sac is an internal organ located retroperitoneally and partially covered by the peritoneum. For surgeons, these hernias present challenges. They do not occur as often as ordinary ones, but for their successful treatment, the doctor must perfectly know and understand the anatomical features of sliding hernias. Without knowing the specifics, you can inadvertently open the bladder or intestinal wall instead of the hernial sac.

Predisposing factors

There are plenty of reasons for the formation of a sliding hernia. They may be related to the anatomical structure of the human body. Gender, age and body type also have a direct impact on the appearance of a hernia. Genetic predisposition occurs in 25% of cases. More often, sliding hernias are diagnosed in children under one year of age. But their maximum frequency occurs in people over 30 years of age.

Increased intra-abdominal pressure can also cause the development of a hernia. Provoking factors include indigestion, coughing, problematic urination, hysterical screaming, wearing a tight bandage, childbirth and hard work.

Reasons why the abdominal wall weakens:

pregnancy;
elderly age;
physical inactivity;
abdominal wall injuries;
diseases that reduce muscle tone.

Classification of sliding hernia

The contents of sliding hernias can be:

According to the type of occurrence, they are found congenital and acquired. At first, protrusions of organs not covered by peritoneum can only be called a hernia conditionally. But as they develop, they become overgrown with a hernial sac. According to their anatomical structure they are divided into:

ingraparietal– the intestine is fused by the mesentery with the hernial sac, against the background of which the attached mesentery slides;
paraperitoneal– the intestine partially resides behind the peritoneum, being the wall of the hernial sac;
intraparaperitoneal– a sliding hernia is connected by the mesentery to the hernial sac;
extraperitoneal– the intestine is located behind the peritoneum, and the absence of a hernial sac is noted.

Symptoms

Heartburn.
Burning pain in the hypochondrium or behind the sternum.
Belching.
Dysphagia, which is a swallowing disorder.
Chronic bronchitis and tracheitis.

The clinical picture of this disease is due to the development of reflux esophagitis, which is the return of gastric contents into the esophagus. A high level of hydrochloric acid in the gastric contents leads to irritation of the esophageal mucosa, causing damage to its walls. This often causes ulcers and erosions.

A sliding hernia causes pain behind the sternum, in the hypochondrium and epigastrium. In some cases, the pain spreads to the area of the scapula and left shoulder. These symptoms are very similar to those of angina pectoris, so patients may be mistakenly registered with a cardiologist for a long period of time.

Increased pain may occur when changing body position or during physical activity. In this case, regurgitation, heartburn or belching may occur. Progression of the disease leads to the development of dysphagia.

With a sliding hernia, hidden bleeding may occur. This can be determined by bloody vomiting or stool with blood clots.

As a rule, the sources of bleeding are ulcers or erosions in the esophagus. Another important sign that indicates hidden bleeding is anemia.

It is often difficult to diagnose a sliding hernia. Outwardly and in general manifestations, they are almost no different from ordinary ones. But with a detailed history taking, the doctor may suspect or assume the absence of peritoneum under the skin covering the prolapsed organs and prescribe an additional x-ray examination.

Diagnosis of the disease

To confirm or refute the diagnosis, the patient will have to undergo an X-ray examination and fibrogastroduadenoscopy. Such diagnostic methods make it possible to detect expansion or shortening of the esophagus and its descent into the stomach.

Examination of the patient.
Detailed X-ray examination of the esophagus and gastrointestinal tract.
Passing esophagometry.
Ultrasonography.
CT scan.

Among the listed diagnostic methods, X-ray is considered the most accurate. Using ultrasound, it is also possible to determine the location of a sliding hernia and the affected area, but in this case it is difficult to guarantee accuracy. True, computed tomography can give a good result. If it is possible to undergo such an examination, then the accuracy of the diagnosis will be ensured.

Treatment

Treatment is performed surgically. The operation is complicated by anatomical features, especially if the hernia is very large and cannot be reduced. Often during surgery the following is performed:

repositioning of prolapsed organs;
closing the defect in the peritoneum;
fixation of slipped organs;
plastic surgery of the intestinal mesentery.

To prevent the dangerous consequences of a sliding hernia, when diagnosing the disease, the doctor must always remember the possibility of developing a hernia without a hernial sac. In this regard, it is necessary to carefully study the patient’s history and symptoms, and not neglect additional examination methods. During the operation, tissue dissection must be carried out carefully, layer by layer.

If the organ wall is damaged, it is important to react quickly and decide on further actions: resection or herniolaparatomy of the damaged organ. The success of the operation largely depends on the experience and skill of the surgeon.

Conservative treatment

If the disease is at a developmental stage, then conservative therapy can bring good results, but only if you follow the doctor’s recommendations. The principle of treatment is to eliminate heartburn (Motilium), pain (No-shpa) and other unpleasant symptoms.
To reduce acidity in the stomach, Kvamatel is sometimes prescribed. To protect the mucous membrane of the digestive tract, you can resort to the help of the drug De-nol. Other medications can be used for treatment:

prokinenics (Domperidone);
inhibitors (Omeprozole, Omez);
antacids (Almagel, Maalox, Gastal).

If anemia is noted against the background of bleeding, the patient is recommended to take iron supplements. The patient should avoid strenuous physical activity. It is recommended to slightly elevate your upper body while sleeping. In addition to these rules, you will need to follow others:

exclude spicy and smoked foods from the diet;
minimize the consumption of fatty foods;
remove from the diet foods that provoke the production of gastric juice;
quit smoking and alcohol.

It is also necessary to try not to overeat and adhere to proper nutrition according to the regime. This will help avoid constipation and flatulence. But the main measure in preventing a sliding hernia is to strengthen the abdominal muscles.

Hernia surgery

Nissen method.

Cuffs are formed around the esophagus to prevent stomach contents from escaping directly into the esophagus. In this case, the upper part of the main digestive organ is located in the abdominal region, and the ends of the diaphragm are sutured. As a result, the opening of the esophagus decreases in diameter. The advantages of such an operation include minor injury to the patient, a reduction in the period of hospital stay and a reduction in the risks of consequences associated with the operation.

Allison method.

The main essence of the operation is to reduce the hernial orifice by suturing it.

Belsey method.

In this case, the lower part of the esophagus along with the sphincter is secured directly to the diaphragm, and the fundus of the stomach is secured to the wall of the esophagus. The Belsi operation differs from the first method of treatment in the presence of pain.

Gastrocardiopexy.

As a rule, patients are operated on under local anesthesia. The choice of pain relief method depends on the operation itself. The age and condition of the patient is also taken into account. For complicated hernias, the operation is performed under spinal anesthesia or under local anesthesia with multicomponent intravenous anesthesia. But the best option remains endotracheal anesthesia and adequate ventilation.

During the operation, an incision is made above the navel in the middle of the abdomen. Next, the upper part of the stomach is sutured together with the esophagus. This method of operation allows you to avoid possible complications.

The choice of the appropriate surgical method for removing a sliding hernia depends on its type and the condition of the contents. If the surgical technique is incorrect, a violation of the integrity of the lumen of the organ, which acts as the wall of the hernial sac, may occur.

The opening of the bag should occur on the side that is opposite the slipped organ, and on its thinnest section. An important process during surgical treatment is the identification of particles of the spermatic cord. Next, the displaced intestine is carefully isolated, trying to avoid damaging the integrity of the walls and blood vessels feeding it or nearby organs. After which the intestine is reduced into the peritoneal cavity.

If the presence of a large sliding hernia is noted, then the hernial sac cannot be treated in the usual way, since there is a high probability of deformation of the hollow organ.

Stitching and ligation of the hernial sac is carried out near the intestine, more often from the inside, using a purse-string suture. Any lesions found in the intestine are sutured. Similar actions should be carried out in relation to the bladder.

If necrosis of the intestinal loop is detected, the specialist must resort to a midline laparotomy followed by resection of a segment of the strangulated intestine. When necrosis is observed on any wall of the bladder, it means that resection is performed with an epicystostomy. It is also possible to use a Foley catheter to provide continuous catheterization of the bladder. But this method is acceptable only for women.

With age, internal organs not only lose the ability to fully perform the functions assigned to them, but in some cases they are displaced in different directions. In this case, a hiatal hernia, or hiatal hernia, often occurs.

This pathological condition is characterized by the fact that the esophageal opening in the body of an adult significantly expands, and through it those internal organs penetrate into the chest cavity, which, in the absence of violations, are located in the peritoneum.

The occurrence of this disease is always associated with pathological changes in the diaphragm. This organ takes part in breathing and blood circulation and is essentially the organ that separates the abdominal and thoracic cavities.

It is in the diaphragm that the necessary physiological openings are located through which nerve fibers, blood vessels and the esophagus pass. Since the pressure in the thoracic cavity is normally much lower than in the abdominal cavity, with pathological expansion of the esophageal opening of the diaphragm, some organs or parts thereof are displaced into the mediastinum. Despite the fact that in most cases this disease manifests itself due to age-related changes, in some situations it is also diagnosed in newborns.

Types of hiatal hernia

By and large, any hiatal hernia can be classified into one of two types:

axial, or sliding;
cardiac.

In 9 out of 10 patients, a sliding axial hiatal hernia develops, when the lower esophageal sphincter, the abdominal part of the esophagus, and in some cases even the upper stomach rise into the mediastinum. In this case, all organs, which by their nature are located in the abdominal cavity, freely move into the chest and return back.

Only 10% of patients experience a pathological condition in which one or more organs are displaced into the thoracic region and will no longer change their position on their own. As a rule, in such a situation, the patient is immediately admitted to the hospital of a medical institution to decide whether an urgent surgical operation is necessary.

In turn, a sliding hiatal hernia varies in the degree of penetration of organs into the mediastinum, namely:

in the first degree of the disease, the stomach itself or even a small part of it is not located in the chest cavity. Usually this internal organ is elevated and located close to the diaphragm;
in the second degree, the upper part of the stomach periodically shifts to the chest area;
finally, with the third degree of a sliding hernia, the body and fundus of the stomach penetrates into the sternum, and in some rather rare cases, even its antrum.

Causes of sliding hiatal hernia

As noted earlier, a sliding hernia can be either congenital or acquired

In most cases, the emergence and development of this disease is caused by a combination of several reasons, including:

Characteristic symptoms and methods of treatment of sliding hiatal hernia

An axial hernia may not manifest itself in any way for a long period of time. As a rule, the characteristic symptoms of this disease appear in the patient only when complications begin or other concomitant ailments join the displacement of internal organs.

It is also almost impossible to notice a sliding hiatal hernia during a medical examination. Since the stomach and other internal organs do not protrude under the skin in this pathology, they cannot be distinguished with the naked eye. In most cases, patients learn about their diagnosis only when they go to medical institutions for an X-ray or ultrasound examination during medical examination or for a completely different reason.

However, in some cases, with severe development of the disease, the patient may notice the following symptoms of the disease:

In most cases, treatment of this disease does not require surgery. However, to get rid of the problem and significantly alleviate your condition, you must strictly follow all the recommendations of your doctor.