Esophageal hernia, what stages are treated. Esophageal hernia - causes and symptoms. treatment of gastrointestinal tract without surgery, folk remedies and diet. How to prepare for instrumental studies

Refers to chronic diseases. Pathological changes in the narrow muscular tube and the ligamentous apparatus of the diaphragm lead to serious disruptions in the functioning of all organs of the gastrointestinal tract.

Any deviations negatively affect a person’s quality of life and can cause a lot of unpleasant symptoms and complications. A timely diagnosis will save you from unnecessary problems. The disease cannot be neglected; it is treatable and increases the chances of recovery for those patients who seek medical help at the first signs of the disease.

Causes

An analysis of incidence in relation to age-related susceptibility to hiatal hernia determines that this condition is observed in people under 50 years of age - in 0.7% of cases, in people aged 51-60 - in 1.2%, in 4.7% - in people over 60 years of age. Regarding gender, it is noted that the diagnosis of the disease occurs more often in women than in men.

The causes of esophageal hernias are divided into acquired and congenital.

1. The only congenital cause is a short esophagus, due to which part of the stomach is initially located in the chest cavity.
2. Acquired causes usually occur in people over 60 years of age, but can develop earlier.

Acquired causes of hiatal hernia include:

• weakening of the esophageal ligaments due to age;
• decrease in liver volume, weight and function (atrophy);
• sudden weight loss, during which fatty tissue under the diaphragm is absorbed;
• operations on the esophagus;
• ascites (accumulation of free fluid in the abdominal cavity);
• multiple pregnancy, in which the relative position of the abdominal organs changes;
• chronic constipation;
• some physical activity (weight lifting, squats);
• esophageal motility disorder;
• burns of the esophagus by hot food or chemicals (when swallowing acids and alkalis);
• excess weight;
• chronic diseases in which the normal motor activity of the stomach, initial parts of the small intestine, and gall bladder is disrupted;
• abdominal injuries without damaging the integrity of the skin.

Types of disease

In medical practice, there are three types of hiatal hernia. Let's look at their specific features:

• Axial (sliding hernia)– occurs in more than 90% of cases. With this pathology, the cardia is located above its rightful place, which leads to a change in the normal ratio of the stomach and esophagus.
• Short esophagus- an anatomical anomaly, most often found in combination with a sliding hernia. Occurs due to inflammation or damage to the walls of the esophagus.
• Paraesophageal– occurs in 5% of patients with hiatal hernia. The cardia does not change its primary localization. The disorder is characterized by enlargement of the esophageal opening, through which the stomach organs exit and enter the esophagus.

Symptoms of a hiatal hernia

A small esophageal hernia usually does not manifest itself in any way at the initial stage, so a person does not feel any suspicious symptoms.

The most common signs of a hiatal hernia are:

• Painful sensations. This is the most characteristic sign of the disease. The pain can occur suddenly and very strongly. Places of occurrence: behind the sternum, “under the stomach”, in the hypochondrium on the left side. They can intensify significantly with physical activity and movement.
• Difficulty swallowing, feeling of a lump in the throat. When you try to “swallow” it, the pain may increase, creating unpleasant sensations behind the sternum.
• Hoarseness of voice- occurs due to the reflux of stomach contents into the larynx and oral cavity, resulting in a peptic burn.
• Regurgitation, belching of bitter air;
• Heartburn that occurs on an empty stomach or after eating, while lying down. Leaning your body forward can make heartburn worse;
• Feeling short of air;
• Hiccups can be persistent and cause considerable discomfort to the patient. The main cause of prolonged hiccups is irritation of the branches of the vagus nerve and, as a result, convulsive contraction of the diaphragm.
• Increased saliva production at night, coughing attacks are accompanied by a feeling of suffocation.

Pain after eating (especially when overeating), bloating and changes in body position occur most often. Also characteristic of this disease, but much less common:

• prolonged dull pain under the shoulder blade and in the upper abdomen;
• sudden cutting pain in the chest;
• severe pain in the solar plexus area, aggravated by pressure;
• aching pain in the lower sternum and when tapping.

The presence of these symptoms indicates a complication or an advanced form of the underlying disease and the possibility of the appearance of concomitant ones.

In the presence of a hiatal hernia, the above symptoms do not occur in all cases. The likelihood of their occurrence largely depends on the type of hernia, its size and a number of other factors.

Signs of a strangulated hernia

One of the most dangerous complications of diaphragmatic hernia is strangulation. It can occur either after a long course of the disease or be the first manifestation of the disease. In order to promptly identify infringement, the patient should be assessed for the following symptoms:

• Sudden sharp or shooting pain in the lower half of the chest/upper third of the abdomen.
• Often, the pain spreads to the scapula or supraclavicular fossa. Increased pain is provoked by increased intestinal motility (due to food intake, liquids, certain medications, etc.). The intensity of the pain is extremely high, in rare cases it can lead to shock;
• Vomiting that does not stop for a long time (from several hours to days). As a rule, it intensifies at a height of pain;
• Severe abdominal bloating with increased pain.

The presence of one of these signs requires urgent medical care for the patient.

Complications

The following complications are possible:

• development of erosive, catarrhal or ulcerative reflux esophagitis;
• infringement;
• development of peptic ulcer of the esophagus;
• cicatricial stenosis (narrowing) of the esophagus;
• stomach or esophageal bleeding;
• reflex angina;
• perforation of food.

1. If you are injured, you must immediately get medical help. You should immediately go to the hospital or call an ambulance if you suspect a strangulated hiatal hernia.
2. If a person knows that he has such a disease, he should discuss with his doctor possible options for avoiding pinching. Let the specialist talk about possible risks and possible behavior in a particular case.
3. You should not wait until the disease leads to such a complication. It is worth seriously thinking about removing the disease while it is not particularly alarming and does not pose a threat to human life.

If you experience an attack of pain due to a hiatal hernia, you can try using the following methods:

• lie on your back and relax. Place your hand under the sternum and lightly massage downwards a few centimeters. Repeat twice a day;
• drink a glass of water and stand on an elevated platform, for example, on the bottom step. Lightly cushioning and jumping down. Water adds weight to the stomach and this will help the stomach slide down into place.

Diagnostics

In most cases, this disease is first detected when the patient undergoes an X-ray of the chest, esophagus and stomach, as well as during an endoscopic examination (gastroscopy, esophagoscopy). X-ray signs of a hernia are:

• Absence of the subphrenic esophagus
• High position of the alimentary sphincter
• Expansion of the diameter of the esophageal opening
• Location of the cardia above the diaphragm, etc.

Endoscopy reveals a displacement of the esophageal-gastric line above the diaphragm, signs of erosion and ulcers of the mucous membrane, and esophagitis. To exclude tumors, endoscopic biopsy and morphological examination of the biopsy specimen are performed.

How to treat a hiatal hernia

It is advisable to begin examination and begin treatment as early as possible. You should not bring the hernia to a serious condition, when irreversible processes begin in the body and treatment will be delayed. A guaranteed positive outcome and complete recovery is possible only with a responsible attitude towards your own health. In the treatment of hernial formations of the esophagus, conservative and surgical treatment methods are used.

The main treatment takes place at home and includes four methods:

• taking medications,
• diet,
• folk remedies.

Medications

Treatment with drugs takes up the majority of therapy; tablets and solutions can relieve the symptomatic complex that prevents the patient from living a normal life. Remission can be achieved with medications whose action is aimed at reducing gastric secretion and protecting the esophageal mucosa from the aggressive effects of gastric juice.

Gymnastics and exercises

For esophageal hernia, the following groups of drugs are prescribed:

1. H-2 blockers of histamine receptors, reducing the secretion of hydrochloric acid. Representatives: Nizatidine, Ranitidine, Roxtidine, Famotidine;
2. Antacid medications that bind hydrochloric acid, which constantly has an irritating effect on the gastric mucosa. Representatives: Rennie, Gastal, Almagel;
3. Proton pump inhibitors, which inhibit the production of hydrochloric acid. Representatives: Omeprazole, Esomeprazole;
4. Prokinetic drugs to normalize esophageal motility to eliminate. Representatives: Cisapride, Metoclopramide.

• breathing exercises;
• physical exercises aimed at training the abdominal muscles.

Breathing exercises should be performed on an empty stomach. Examples of exercises:

1. Starting position (IP): lying on your right side, head and shoulders on a pillow. Inhale - stick out your stomach, exhale - relax it. After a week of such training, we draw in our stomach as we exhale.
2. IP - kneeling. As you inhale, bend to the sides. In the starting position – exhale.
3. Lying on your back, twist your body to the sides while inhaling.

Surgery

The purpose of surgical intervention is to restore the natural anatomical relationships in the area of ​​the esophagus, diaphragmatic opening, and stomach.

The main indications for surgery to remove a hernia are:

• ineffectiveness of conservative therapy;
• presence of a large hernia;
• fixation of protrusion in the hernial orifice;
• development of complications (bleeding, esophagitis, erosion or ulcer of the esophagus;
• peri-esophageal (paraesophageal) sliding type hernia – if present, the likelihood of strangulation increases significantly;
• incorrect development (dysplasia) of the esophageal mucosa, as a result of which it acquires the structure of the mucous membrane of the small intestine.

The following types of operations can be used to treat hernia in patients:

• Nissen fundoplication (they envelop the upper part of the esophagus so that the contents of the stomach do not flow there).
• Belsi operation (the lower part of the esophagus and sphincter are attached to the diaphragm, the fundus of the stomach is sutured to the esophagus).
• Laparoscopy (restores the natural anatomy of the upper abdominal cavity, reduces the size of the esophageal opening).

Diet

The main task pursued by nutritionists, prescribing adherence to strict instructions for organizing the daily diet of patients with hiatal hernia, is to minimize and stop the spontaneous release of vomit, which can cause clogging of the respiratory tract and suffocation due to lack of oxygen.

A patient with a hiatal hernia must follow a diet and eat 5-6 times a day. Eating occurs much more frequently than in a healthy person, but the portions are smaller. A significant part of the diet is consumed in the first half of the day.

To the approved list of products, from which you can compose and develop recipes for medicinal dishes, include:

• Dried fruits (the main emphasis is on eating prunes, which helps narrow the diaphragm and strengthen the ligaments);
• Fermented milk products with a reduced fat content (low-fat kefir product, cottage cheese, yogurt, unsweetened yogurt);
• Low-fat varieties of sea/river fish and poultry/beef (it is recommended to consume meat products in the form of meatballs, soufflé, aspic or cutlets);
• Vegetable soups (preference should be given to potato or carrot soups, which are rubbed through a sieve before use);
• Ripe fruits (you can make salads from sweet fruits or prepare cottage cheese casseroles with their addition);
• Sweet crackers, previously soaked in warm milk or hot tea;
• Chicken/quail eggs, cooked soft-boiled;
• Porridges and grouts with added cereals and sugar, prepared with milk;
• Sweet juices, green tea with added milk.

Without an adequate diet, drawn up with a doctor, the hernia will progress and carry more and more negative consequences every day, which accumulate over time and can be life-threatening.

When following a diet during a hiatal hernia, it is imperative exclude harmful foods from the menu:

1. First of all, you need to give up spicy foods - onions, garlic, peppers, spicy seasonings, sauces. You should not eat fried, smoked, excessively fatty and salty foods.
2. It is strictly forbidden to drink alcoholic beverages, sweet carbonated water, coffee, energy drinks, sour concentrated juices and milk.
3. It is also necessary to limit the patient’s choice of fruits. Despite the fact that they are all very healthy, in this situation you should not eat sour fruits: cranberries, grapes, pomegranates, kiwis, lemons, oranges (all citrus fruits), green apples, cherries and others.
4. Most fruits should be peeled and washed thoroughly. Grated fruits and vegetables are better absorbed.

When following the diet most carefully, you must also remember that after eating you should never lie down, it is best to walk around a little. This will help the esophagus cope with its task. In addition, you should not overeat at night. Even a glass of kefir before bed can provoke an exacerbation. Eating strictly 3 hours before you go to bed.

Treatment of hiatal hernia with folk remedies

Folk remedies for the treatment of hiatal hernia are primarily aimed at relieving symptoms and preventing complications such as ulcers and even esophageal cancer. Traditional medicine inhibits the secretion of gastric juice, accelerates the movement of food from the stomach to the duodenum and prevents constipation.

Traditional recipes:

1. To get rid of bloating and bloating, use an infusion of valerian root, fennel fruit and peppermint. Take these ingredients in equal quantities and pour boiling water. Leave in a dark place until the infusion has cooled completely. Drink in the mornings and evenings.
2. aspen bark - removes bile, has a general strengthening and anti-inflammatory effect: pour a spoonful of crushed bark into a glass of boiling water and boil a little. After cooling the drink, strain. You should drink a tablespoon three times a day before meals;
3. Goose cinquefoil (2 tablespoons) is poured with 300 ml of boiling water and left for 12 hours. Take 1 tsp. 10-15 times a day.
4. Carrot juice. Relieves inflammation, reduces acidity, eliminates heartburn. Consume before meals three times a day. You should avoid this drink if you have diabetes, diarrhea, and gastritis.
5. A hiatal hernia is very often accompanied by heartburn. In this case, the well-known baking soda and water will help. Add 1 tsp to 1 glass of water. soda, the composition must be stirred before drinking. Pregnant women should not use this product because it contains a large amount of mineral salts.
6. Pour three tablespoons of cold water over a spoonful of seeds and leave overnight. The next day, warm the mixture a little and, chewing thoroughly, eat. You can also simply pour boiling water over the seeds, let it brew, and then drink the resulting liquid half a glass before bed. Flax seeds should not be used for pancreatitis, cholecystitis and gallstones.
7. Ginger helps to get rid of not only heartburn due to a hiatal hernia, but also pain. To relieve symptoms, simply chew a small amount of ginger or make tea from it.

Prevention

It is impossible to avoid all possible causes of a hernia, but you can significantly reduce the risk of its occurrence: lead a healthy lifestyle, treat diseases of the digestive system in a timely manner, and avoid injury. There are many factors that provoke the problem, and most of them are congenital. It is extremely important to monitor your own health and the health of your child so that if symptoms of the disease are detected, you can get medical help in a timely manner.

Esophageal hernia is a common ailment that mainly affects older people. This pathology occurs due to an anatomical change in the location of the internal organs located in the abdominal cavity. When the diaphragm expands, the functioning of the ligamentous apparatus of the esophageal opening is disrupted, which leads to displacement. As a result, a hernia develops, which makes breathing difficult and provokes painful spasms in the abdomen and chest.

If measures are not taken in time, the existing pathology leads to serious consequences. This may include internal bleeding, significant displacement and shortening of the esophagus, or inflammation of the gastric mucosa. Therefore, it is so important to know how to treat a hiatal hernia in order to not only eliminate the unpleasant symptoms, but also the disease itself.

Treatment Basics

Therapeutic therapy for esophageal hernia can be conservative or surgical. Most experts believe that surgery is required only in some cases, and in the rest, the hernia is treated using the following methods:

• taking certain medications;
• performing therapeutic, breathing exercises;
• compliance with dietary nutrition;
• use of traditional medicine recipes;
• maintaining a healthy lifestyle.

Surgical intervention is required only when drug treatment does not produce the expected results. If the existing pathology has become large, when there is a risk of strangulation of the hernia or internal bleeding has occurred, in all these cases surgery is prescribed.

Drug therapy

The use of medications reduces the risk of possible complications and normalizes the general condition of the patient. The main effect of the prescribed drugs is to relieve unpleasant symptoms such as belching, heartburn, discomfort and pain in the sternum, which mainly appear after eating.

The treatment regimen is based on the following medications:

• antacids;
• prokinetics;
• histamine receptor blockers;
• proton pump inhibitors.

Antacids are able to neutralize excess hydrochloric acid, which is part of the gastric juice. It is this that greatly irritates the mucous membrane of the esophagus, causing specific damage. These include Almagel, Maalox, Rennie and Phosphalugel.

Prokinetics restore the impaired movement of food entering the body through the digestive tract (Cerukal, Domirid, Motilium). Due to their therapeutic effects, they prevent the reflux of stomach contents into the esophagus.

Almagel neutralizes excess hydrochloric acid

Histamine receptor blockers reduce the production of hydrochloric acid inside the stomach several times. Usually the doctor prescribes Ranitidine, Famotidine, Roxatidine. As for drugs such as Ursofalk and Urochol, they neutralize the negative effects of bile acids that enter the stomach cavity. But proton pump inhibitors have a similar effect as histamine receptor blockers, but they have fewer side effects. These medications include Contraloc, Omeprazole, Nolpaza, Pantoprazole.

Additional treatment for complications

If complications arise with this disease, then before resorting to surgical intervention methods, the doctor tries to cure the existing hiatal hernia with the help of auxiliary drugs. Thus, when a patient experiences chronic internal bleeding, the risk of developing anemia increases. In this case, hemostatic and antianemic drugs are prescribed.

In a situation where, due to a hernia, the contents of the duodenum are systematically thrown into the esophagus, a person is prescribed medications based on ursodeoxycholic acid. They eliminate irritation of the mucous membrane of the gastric and intestinal tract.

If a narrowing of the esophageal opening occurs, antacids with a prolonged effect and drugs that block inflammatory processes are prescribed. When diagnosing concomitant gastric diseases that become chronic, the main therapy is first aimed at eliminating them and only then at fighting the hernia.

Breathing exercises

When faced with a hernia and receiving recommendations from a specialist regarding therapeutic, breathing exercises, many people think about whether it is really possible to eliminate the disease using this method. In fact, such exercises strengthen the muscle tissue of the abdominal cavity and diaphragm. And this allows you to speed up the healing process and improve the condition of the body with such a disease.

Breathing exercises should be performed only after three hours have passed since the last meal. You need to lie on your side, with your legs off the sofa or bed, take a deep breath and stick your stomach out as much as possible. Then you need to exhale and relax all your muscles. The stomach does not retract at this moment. This exercise is done in four sets of 10 minutes, and each time the breath should become deeper.

To perform the next exercise, you need to kneel down and slowly begin to bend in different directions. It is important to monitor your breathing. When the body bends, inhalation occurs, and when returning to its original position, the air is exhaled. Then this exercise is repeated, but standing.

Special gymnastics will strengthen the walls of the diaphragm and abdominal cavity

To complete this small complex, you need to lie on your back and begin to turn your upper body in both directions. At the turn itself, you inhale, and in the starting position you exhale and completely relax the muscles. When performing such gymnastics at home, you need to ensure that each exercise is performed correctly. Otherwise, when the exercise is done incorrectly, a person can only aggravate the situation and worsen his condition, since even greater pressure begins to be exerted on the diaphragm, which causes complications to develop.

Diet for hiatal hernia

A hiatal hernia (HH) requires a special diet.

This will not only alleviate the condition of the patient himself, but will also have a positive effect on the rate of recovery. The basic rule that must be followed is a slight feeling of hunger. That is, you should not eat until you feel completely full in one sitting, as this leads to increased stress on the stomach. Therefore, it is better to eat slowly and little by little, chewing your food thoroughly.

Overeating is strictly prohibited. This will provoke a feeling of discomfort and painful spasms. You will need to give up smoked and sweet foods, fried and spicy foods, as well as various seasonings. Such food increases the concentration of hydrochloric acid in the gastric juice, which is thrown into the esophagus. As a result, the tissues and mucous membrane of the gastrointestinal tract become irritated, and an inflammatory process begins to develop.

Overeating will aggravate the situation with a hiatal hernia

The condition of a hiatal hernia is aggravated if gases accumulate in the body and constipation occurs. Therefore, products that provoke such processes should be limited. This:

• legumes and peas;
• yeast and mushrooms;
• carbonated drinks;
• cabbage and corn.

The diet should be based on fresh and healthy foods rich in vitamins and minerals. These are vegetables and fruits, as well as fermented milk products that support the normal functioning of the digestive system. There should be no fast food or semi-finished products on the table. All foods consumed should be easily digestible, without causing heaviness in the stomach.

Traditional recipes that help with hernia

It is possible to cure a hiatal hernia without surgery if the therapy is comprehensive and, in addition to taking medications, begins to include the use of traditional medicine recipes. Many plants and herbs have beneficial properties and alleviate the condition of the patient with such an illness. However, their use should only be done after consultation with your doctor.

The basis of treatment is plants that eliminate heartburn and bloating, as well as relieve constipation. Herbs that have these properties include:

• stone drupe;
• propolis;
• red shoe.

You can also ease your well-being with a hernia using the following folk remedies:

• Gooseberry infusion.
• Flax harvest based on mint and coltsfoot.
• Propolis tincture.

To prepare gooseberry infusion, you will need the leaves of this plant. One tablespoon will be enough. It is better to first dry and chop the leaves, then pour 500 ml of water into them. This decoction will need to be infused for two hours, after which the finished home medicine is taken four times a day, 120 ml.

Flaxseed tea, which will help reduce painful and uncomfortable symptoms, is prepared from flax seeds, coltsfoot leaves, peppermint and marshmallow root. All components in dry and crushed form are taken in equal proportions. After mixing the ingredients together, you need to take three tablespoons of the resulting mixture and fill them with one liter of cold water. The collection should be infused for an hour, after which it is cooked for another five minutes over medium heat. The finished broth is filtered and drunk up to six times a day, 150 ml.

A collection of flax seeds and medicinal herbs will eliminate discomfort

Propolis tincture is prepared on the basis of alcohol and then taken with milk (30 drops of tincture are taken per 50 ml of liquid). This medicine should be taken before the main meal twice a day.

To get rid of constipation, you can drink compote made from dried fruits every two hours during the day. You can also brew buckthorn leaves as tea. This plant has a mild laxative effect. If you need to eliminate burping, you can prepare a cranberry drink. Juice is squeezed out of fresh berries, to which a little honey and aloe juice are then added. The resulting drink is mixed and drunk throughout the day.

An infusion made from licorice root and orange zest will help cope with heartburn. These ingredients are first crushed to a powder state, after which one teaspoon of the resulting composition is poured into a glass of boiling water, cooled and drunk. But an infusion of cumin seeds and chamomile tea can combat flatulence. All these recipes may not cure the hernia itself, but they speed up drug treatment and get rid of all the accompanying signs of the disease.

Only complex therapy can cope with a hiatal hernia. Therefore, at the first symptoms of the disease, you should consult a doctor. The specialist will conduct a diagnosis and prescribe a course of medication, which will include exercises aimed at strengthening the diaphragm and following a diet.

Among gastroenterological problems, hiatal hernia most often remains untreated. Its symptoms are similar to ulcers or esophagitis. Moreover, many signs of a hiatal hernia are completely nonspecific: chest pain, cough. This masks the disease, delaying the correct diagnosis.

The esophagus is located inside the chest cavity, and the stomach is located in the abdominal cavity. Their border lies at the esophageal opening of the diaphragmatic muscle, where the sphincter is located. Such a clear division turned out to be important, given the processes occurring in the abdominal organs:

1. The esophagus has a neutral environment. Its pH ranges from 6.0-7.0. Its function is transient. It only passes food through without digesting it.
2. The environment in the stomach is acidic – pH 1.5-2.0. The main functional purpose of the stomach is digestion.

In a hiatal hernia, the cardiac part of the stomach slips into the chest cavity. This moment is accompanied by unpleasant symptoms associated with pressure and the reflux of acid from the stomach into the esophagus.

Important! This condition is almost always accompanied by inflammation of the esophageal mucosa - esophagitis.

Promotes development disease a number of factors:

1. Weakness and inferiority of the ligamentous apparatus. The structures that hold organs in position may weaken. Sometimes this occurs against the background of congenital diseases associated with connective tissue deficiency. Sometimes changes in the structure of the ligaments and their elasticity occur with age - they lose their elasticity and cease to perform their previous functions of maintaining the desired position of the esophagus and stomach.
2. High intra-abdominal pressure. Its cause may be excess weight, cough, persistent constipation or flatulence. Less common is a hernia associated with high blood pressure due to obstructive pulmonary disease. With the development of obstruction, emphysema naturally appears - expansion of the lung tissue. These phenomena contribute to an increase in intra-abdominal pressure.
3. Incorrect peristalsis, associated with upward traction of the esophagus. Such hypermotor dysfunctions always accompany the most common diseases of the gastrointestinal system - gallstone disease, gastric ulcer, gastritis with high acidity.

Symptoms

Manifestations of a hiatal hernia are associated with the ingress of acidic contents from the stomach cavity and the appearance of an “extra” organ in the chest cavity in the form of a section of the cardia. This accompanied by:

1. Heartburn- long, painful. Heartburn appears with the same frequency both on an empty stomach and after a heavy meal. Spicy, hot foods especially provoke a burning sensation.
2. Chest pain. It has a burning, pressing character, often simulating an attack of angina pectoris.
3. Feeling of discomfort, distension behind the sternum. This is directly related to the area of ​​the stomach that has risen upward.
4. Feeling air shortage, suffocation.
5. Cough, especially when lying down and at night.
6. Hoarseness of voice.
7. Persistent belching, especially when bending. Sometimes it reaches the point of regurgitation - then the contents just eaten are thrown into the oral cavity.

Cough and hoarseness often accompany a hiatal hernia. The reason is the reflux of acid onto the vocal cords and into the laryngopharynx. As a result, an obsessive dry cough appears. Patients visit a general practitioner, pulmonologist, or family doctor for a long time, since the symptoms mimic pharyngitis, tracheitis or laryngitis.

Pressing pain in the chest always requires the exclusion of an attack of angina. Therefore, their appearance during physical activity must be accompanied by an ECG recording. The exclusion of angina pectoris and confirmation of pathology with FGDS allow us to speak about a hiatal hernia as a source of pressing retrosternal pain.

Important! Nitroglycerin can alleviate the condition of both angina and hiatal hernia. It cannot be used to differentiate between these conditions.

All symptoms of a hiatal hernia are provoked by physical activity, in particular by lifting weights. The tension causes increased pressure on the diaphragm from below.

Loads after overeating are especially dangerous, when a full stomach already puts undue pressure on the diaphragm. You can provoke the symptoms of a hernia after eating simply by bending sharply, for example, to tie shoelaces or if you take a horizontal position for half an hour after eating. All these processes are accompanied by the slippage of part of the overfilled stomach into the chest cavity.

Treatment

All therapy for hiatal hernia consists of a number of therapeutic interventions. It is absolutely impossible to consider the treatment of a hernia only as medicinal. Normalization of lifestyle and nutrition must be mandatory. Drug therapy will complement non-drug methods. If conservative methods of treating a hiatal hernia are ineffective, surgical intervention is recommended.

Lifestyle

The mechanisms of occurrence of hiatal hernia were described above. Taking them into account, we can provide recommendations that, if followed, will help reduce the risks of exacerbations:

1. After any meal, you should not lie down for at least 1.5-2 hours. A reclining position on chairs is also excluded.
2. Bend over should be avoided. If possible, it is better to put on your shoes using a stool and footrest. Washing floors - using a mop, excluding deep bends.
3. Too heavy weights should be avoided. During the period of remission, it is permissible to carry a small weight, but always before meals or 40-60 minutes after meals.
4. It is recommended to sleep on a bed with a raised headboard. If necessary, you can use a second pillow, but it is better if these are supports under the legs of the bed. This will allow you to completely raise the head end of the bed, and not just your head.
5. Excess weight, flatulence, constant constipation, persistent cough - all those diseases, in the presence of which it will not be possible to effectively treat a hiatal hernia. Getting rid of diseases that increase intra-abdominal pressure will reduce the frequency of hernia exacerbations.
6. Some medications relax the sphincter and make symptoms worse. Their use for esophageal hernia should be limited: Nifedipine, Diltiazem, Aspirin, Diclofenac.

Video - Hiatal Hernia

Diet

Nutrition for a hiatal hernia is recommended to be as gentle as possible. Food is prepared by boiling, stewing, baking or steaming. Avoid rough foods that can damage delicate mucous membranes. Products that Not recommended apply in food:

• roast;
• fat;
• smoked;
• mint;
• Melissa;
• chocolate;
• coffee;
• strong tea;
• products that increase gas formation.

The exclusion of mint, lemon balm, coffee and tea has a pathogenetic justification. These products can weaken the sphincter and increase the likelihood of exacerbation of a hernia.

Important! It is worth paying attention to the composition of herbal teas and sedatives - many of which contain mint.

For products that increase gas formation in the intestines relate:

• grape;
• cabbage;
• black bread;
• yeast baked goods;
• legumes;
• carbonated drinks.

However, their influence is individual. In some people they cause significant flatulence, while in others they have little effect on gas production.

Persistent constipation that increases intra-abdominal pressure is also subject to dietary therapy:

Possible for constipation	Undesirable for constipation
Coarse bran bread	Butter baked goods made from premium flour
Porridges other than rice	Pasta, rice, semolina
Lean fish, meat	Fatty fish and meats
Fermented milk products – kefir, yogurt	Whole milk
Juicy varieties of apples and pears, plums, dried fruits	Blueberries, quince, dogwood, bird cherry, unripe apples and pears, applesauce

Video - Diet for GERD

Treatment is medicinal

Drug therapy is carried out in three directions:

• agents that reduce secretory activity;
• prokinetics, normalizing motility of the esophagus and stomach;
• antacid medications that relieve symptoms.

The first group of drugs includes proton pump inhibitors: Omeprazole, Lansoprazole, Pantoprazole. Additionally, H2-histamine receptor blockers are used: Ranitidine, Famotidine.

The second group of drugs – prokinetics – is small in number. These include Motilium, Metoclopramide.

Important! Metoclopramide or Cerucal more often causes side effects from the central nervous system. It is especially undesirable for older people to use it.

The latest drugs are antacids. These are Maalox, Gastal, Almagel. Antacids can easily relieve acute symptoms: heartburn, chest discomfort.

Dosage of drugs used in the treatment of hiatal hernia.

Operations

The ineffectiveness of conservative methods of therapy forces one to resort to surgical interventions. All operations include two goals:

• remove the hernial orifice;
• form an anti-reflux barrier.

Among modern invasive measures there are both abdominal and laparoscopic methods:

1. Classic Nissen fundoplication.
2. Laparoscopic reconstruction according to Nissen.
3. Laparoscopic intervention with crurorrhaphy.
4. Hill gastropexy.

Important! Any laparoscopic intervention is much safer: shorter hospitalization periods, fewer side effects.

When determining indications and contraindications for surgical intervention, the severity of esophagitis, the severity of the hernia and a number of concomitant pathologies are taken into account. Planned reconstruction is not carried out in case of serious cardiovascular problems, decompensated diabetes mellitus, cirrhosis of the liver, or severe oncological pathology.

With a favorable course of the operation and good postoperative support, most patients note a sharp improvement in their quality of life. Regular heartburn and belching disappear, and regurgitation does not appear. However, even after reconstructive surgery, a person must follow lifestyle and dietary recommendations appropriate for a hiatal hernia.

The correct name for this disease is hiatal hernia. Sometimes it is simply called a diaphragmatic hernia or hiatal hernia. The essence of the disease is the protrusion of the lower esophagus through the diaphragmatic opening.

Between the abdominal and thoracic cavities there is a thin muscular plate - the diaphragm; it has only one large opening through which the esophagus passes. Normally, the diameter of this opening is equal to the diameter of the esophagus. For some reason (see below) this hole widens. When intra-abdominal pressure increases, part of the stomach is squeezed into the chest cavity. This protrusion is called a hiatal hernia (gastric hernia, etc.).

Every third woman and every fifth man has a hiatal hernia to one degree or another, but most people are not aware of it. There is an interesting pattern: while a person does not know about his diaphragmatic hernia, the symptoms of the disease do not bother him, but it is worth making a diagnosis, and even more so. that an operation is necessary, the patient begins to harass himself and the doctors with complaints about the symptoms of a gastric hernia. And he himself gradually begins to believe that his torment is painful and unbearable. Therefore, a hiatal hernia is to some extent a psychosomatic disease.

For esophageal hernia, surgery is recommended only in 10% of cases: for large hernias and if complications arise (ulcer with bleeding). The operation does not eliminate the causes of the hernia (overeating, bad habits), so the disease may develop again

Causes

1. Overeating
2. Obesity
3. Excessive exercise, especially after eating
4. Flatulence.
5. Chronic constipation
6. Chronic diseases accompanied by a prolonged cough
7. Pregnancy and childbirth
8. Smoking, alcohol

Esophageal hernia - symptoms

The symptoms of a hiatal hernia are very similar to those of other diseases, so it can be difficult to make a correct diagnosis. Sometimes a diaphragmatic hernia is mistaken for an ulcer, bronchial asthma, or coronary heart disease.

Symptoms of a hiatal hernia:

1. Heartburn
2. Shortness of breath, cough, attacks of suffocation, interruptions in heart function at night after a heavy dinner.
3. Chest pain
4. Belching of air and food.

Heart pain with diaphragmatic hernia increases when taking a horizontal position, and decreases after taking alkalis

If you have a hiatal hernia, you cannot

1. Overeat
2. Avoid constipation
3. Wear tight belts,
4. Lift weights
5. Bend sharply forward
6. Eat less than 3-4 hours before bed

Diet

Eating for a diaphragmatic hernia should be frequent, small portions. Do not eat 3 hours before bedtime. Fried foods, sweets, spicy seasonings, alcohol, sour juices, smoked foods, strong tea, coffee should be excluded from the diet - all these products increase the acidity of gastric juice and intensify the symptoms of a gastric hernia. Limit fermented milk drinks, milk, cabbage, fresh bread, peas, grapes, carbonated drinks in the diet - these products increase flatulence, which is also harmful for the patient.

Before and after meals it is useful to take 1 tsp. unrefined oil. After eating, under no circumstances should you lie down or engage in heavy work or bending exercises - it is better to walk or jump. During the day, to neutralize the acid in the esophagus, drink mineral water Borjomi, Essentuki No. 17 without gas.
It is better to sleep on the right side, then there is less chance of stomach contents refluxing into the esophagus.

The best medicine for hiatal hernia is Almagel A (according to 2002). It provides long-term neutralization of continuously secreted gastric juice, reducing the level of hydrochloric acid in it. Drink this drug 2 tsp. 3 times a day 30 minutes before meals, when the pain disappears, then reduce the intake to 1 tsp.
(Based on materials from the newspaper “Bulletin of Healthy Lifestyle”, 2002, No. 23, pp. 6-7, 2011, No. 16, p. 15)

Esophageal hernia – Treatment of hiatus hernia with folk remedies – healthy lifestyle newspaper recipes – how to treat hiatus hernia

Recipe No. 1 for hiatal hernia Pour 20 g of dry crushed marshmallow roots into 200 g of boiling water and leave for 5 hours. Take 2 tbsp. 5 times a day
Recipe No. 2 Add 30 drops of 50% alcohol tincture of propolis to 50 g of milk. Drink 2 times a day before meals
Recipe No. 3 Add the white of one chicken egg and 75 ml of a 3% tannin solution to 0.5 liters of fermented baked milk. Drink 2-3 sips through a straw 5-6 times a day before and after meals.
Recipe No. 4 – For bloating (flatulence), pour 1 g of carrot seeds into 2 cups of boiling water and leave for 10 minutes. Drink 100 g 3-4 times a day along with seeds. (HLS 2002 No. 23, pp. 6-7)

Breathing exercises and exercises for the treatment of hiatal hernia

Breathing exercises are very effective in the treatment of diaphragmatic hernia; they are done 2-3 hours after eating.
Exercise No. 1 Lie on your right side on an inclined surface (head 15 cm above your feet). Inhale, protruding your stomach as much as possible, exhale, relaxing your stomach, but without retracting it. Gradually deepen your breathing. Do this exercise 4 times a day for 10 minutes. After 6 days of such training, begin to draw in your stomach as you exhale.
№2 Get on your knees and bend to the right and left. Then the same bends, but from a standing position.
№3 Lie on your back, twist your torso to the right and left.
№4 Squats.
To treat a hiatal hernia, do these exercises 1-2 times a day, gradually increasing the load. After 2-3 months the condition will improve. (HLS 2009 No. 13, p. 15)

Traditional treatment with gooseberry leaves

An infusion of gooseberry leaves is effective in the treatment of diaphragmatic hernia of the stomach. 1 tbsp. l. leaves pour 0.5 liters of water and drink 1/2 cup 3-4 times a day before meals

Folk remedy for heartburn with diaphragmatic hernia

Grind and mix 1 tbsp. l. marshmallow root, peppermint herb, coltsfoot leaves, flax seeds. 3 tbsp. l. pour 1 liter of cold water over the mixture, leave for 1 hour, bring to a boil and boil for 5 minutes. Drink 0.5 glasses 5-6 times a day.

Folk remedy for constipation

Constipation should be avoided with this disease. A good folk remedy for constipation is a glass of kefir in which 1 tbsp is mixed. l. vegetable oil. You should drink kefir before bed, slowly, in small sips. (HLS 2011 No. 16, p. 16)

) is a chronic relapsing disease in which the initial abdominal section of the digestive tube is displaced into the chest cavity through the esophageal opening of the diaphragm.

Source: lechenie-simptomy.ru

Elderly people are susceptible to esophageal hernia; in the age group under 40 years old, the pathology is diagnosed in 10% of cases, and in people over 70 years old - in 70%. Women get sick more often than men. Hiatal hernia is more common in developed countries, which is believed to be related to dietary habits. In patients with gastroenterological pathology, esophageal hernias are detected 6 times more often than in others.

Patients with a hiatal hernia whose occupation involves prolonged periods of sitting are advised to change jobs.

The lower esophageal sphincter (cardia) separates the esophagus and stomach and prevents the reflux of chemically aggressive gastric and duodenal contents into the esophagus. The angle of His (the acute angle at which the esophagus meets the stomach) also contributes to the unilateral movement of the food bolus. The distal part of the esophagus is fixed by the diaphragmatic-esophageal ligament, which also prevents the movement of the cardiac part of the stomach into the chest cavity during longitudinal contraction of the stomach. The subdiaphragmatic fat layer and the natural arrangement of the abdominal organs help keep the esophagus in its normal position.

The chest and abdominal cavities are separated by the diaphragm, which consists of muscles, fibrous tissue and has a dome-shaped structure. The esophagus, blood vessels and nerves pass through the openings in the diaphragm. On the left side of the diaphragm is the esophageal opening, which normally corresponds to the external size of the esophagus. When the esophageal opening expands, part of the anatomical structures that are normally located under the diaphragm protrude into the chest cavity.

Causes of hiatal hernia and risk factors

The causes of a hiatal hernia are a weakening of the ligamentous apparatus that secures the cardiac part of the stomach and an increase in intra-abdominal pressure.

Risk factors include:

• genetic predisposition;
• impaired motility of the gastrointestinal tract;
• overweight;
• chronic flatulence;
• frequent constipation;
• pregnancy (especially repeated);
• excessive physical activity;
• severe prolonged cough in chronic obstructive pulmonary disease, bronchial asthma, etc.;
• uncontrollable vomiting;
• large neoplasms of the abdominal cavity;
• connective tissue dysplasia;
• abdominal injuries;
• chemical or thermal burns of the esophagus;
• advanced age;
• incorrect posture.

Common signs of a hiatal hernia include heartburn, which appears after eating, with a sudden change in body position, and also at night.

Forms of the disease

Depending on the anatomical features, the following forms of esophageal hernia are distinguished:

• sliding (axial, axial)– free penetration of the fundus of the stomach, cardia and abdominal part of the esophagus through the esophageal opening of the diaphragm into the chest and independent return to the abdominal cavity;
• paraesophageal– the distal part of the esophagus and cardia are located under the diaphragm, part of the stomach is displaced into the chest cavity and is located next to the thoracic esophagus;
• mixed;
• congenital short esophagus– the length of the esophagus does not correspond to the height of the chest, while part of the stomach is located above the diaphragm in the chest cavity, the lower esophageal sphincter is absent.

Sliding esophageal hernias, depending on the area being displaced, are divided into total gastric, subtotal, cardiofundal or cardiac.

Paraesophageal hiatal hernias can be antral or fundic.

Source: myshared.ru

Symptoms of a hiatal hernia

The clinical picture is polymorphic and depends on the shape and size of the hernia.

Often, hiatal hernias do not manifest themselves at all or have mild clinical symptoms. A severe course is characteristic of large esophageal hernias, in which most of the stomach and intestines penetrate into the posterior mediastinum.

The main manifestation of a hiatal hernia is pain. Pain can be observed in the heart, left hypochondrium, epigastric and interscapular region, spread along the esophagus, and the pain usually worsens immediately after eating (especially when overeating), physical activity, bending the body, and subsides when taking a horizontal position of the body. In some cases, the pain mimics an angina attack. In approximately 35% of cases, patients with a hiatal hernia experience paroxysmal tachycardia and extrasystole.

Severe pain, which occurs in some patients after eating, can cause aversion to food and, as a result, weight loss to the point of exhaustion.

Common signs of a hiatal hernia include heartburn, which appears after eating, with a sudden change in body position, and also at night. Other symptoms: vomiting (often mixed with blood), episodes of breath-holding during sleep, periodic cyanosis of the skin, difficulty swallowing and passing food through the esophagus (can be provoked by eating cold or hot food, fast food, psychological factors), pain and burning in the tongue , hoarseness of voice, prolonged hiccups, cough, bulging of the left side of the chest, feeling of fullness in the epigastric region, belching. Nocturnal regurgitation, which usually occurs with medium-sized hiatal hernias, can cause the development of tracheobronchitis and aspiration pneumonia. Regurgitation of food, as a rule, is not preceded by nausea, and there are also no stomach contractions. The contents of the stomach are thrown into the oral cavity due to contractions of the esophagus, and when the body position changes, it can be poured out.

When the hernial sac is compressed (strangulated hernia), constant dull or intense cramping pain is observed behind the sternum and in the epigastric region, radiating to the interscapular region. In this case, the severity and irradiation of pain depend on what part of the digestive tract is strangulated in the hernial orifice, as well as on the condition of the strangulated organ.

The causes of a hiatal hernia are a weakening of the ligamentous apparatus that secures the cardiac part of the stomach and an increase in intra-abdominal pressure.

With the progression of the pathological process, disturbances in the obturator function of the cardia increase, which leads to the appearance of signs of gastroesophageal reflux disease. Patients with a hiatal hernia may experience anemic syndrome caused by hidden bleeding from the lower esophagus.

Diagnostics

About a third of small hiatal hernias that do not have obvious clinical manifestations are an incidental diagnostic finding during an examination for another reason.

The main methods for diagnosing a hiatal hernia are x-ray examination and esophagogastroduodenoscopy. During an endoscopic examination, an unchanged esophagus is discovered; the diaphragm rhythmically closes around its lower part in time with respiratory movements. The cardiac part of the stomach is visualized, which bulges circularly into the lumen of the esophagus. However, these signs may be a consequence of gagging caused by passing the endoscope through the pharynx, which causes an erroneous diagnosis of a hiatal hernia. Thus, esophagogastroduodenoscopy in most cases allows only to establish the reflux of stomach contents into the esophagus.

Source: medweb.ru

In patients with gastroenterological pathology, esophageal hernias are detected 6 times more often than in others.

An X-ray examination for suspected esophageal hernia is carried out in several stages. First, a survey radiography of the abdominal organs is performed, while the shadow of the esophagus, the location of the gas bubble of the stomach and the domes of the diaphragm are recorded. Next - radiography of the esophagus and stomach with the introduction of radiopaque substances in a vertical position. At this stage, the rate of passage of the radiocontrast agent through the digestive tube and the rate of gastric emptying are assessed. After this, radiography is performed in a horizontal position of the patient’s body and with the head end down. In clinically healthy individuals, no return movement of contrast into the esophagus is observed, and in the presence of a hiatal hernia, gastroesophageal reflux is observed. The patient is then returned to an upright position with further examination of the position of the gas bubble and the presence or absence of a radiopaque substance in the esophagus.

To confirm the diagnosis, a manometry of the esophagus may be necessary, during which the condition of the lower sphincter is assessed, its ability to relax during swallowing, and episodes of relaxation outside the act of swallowing are detected.

To detect latent bleeding, a fecal occult blood test is used.

To differentiate a hiatal hernia from other diseases, ultrasound, computed tomography or magnetic resonance imaging, electrocardiography, general and biochemical blood tests may be needed. Differential diagnosis is carried out with lesions of the nerves of the thoracic spinal cord, conditions accompanied by esophagitis, relaxation (usually relaxation of the left dome) or paralysis of the dome of the diaphragm, Saint's syndrome, angina pectoris, myocardial infarction, neoplasms of the esophagus.

Treatment of hiatal hernia

Treatment of a hiatal hernia usually begins with conservative measures. The patient is advised to avoid wearing tight belts and belts, sleep with the head elevated, and, if necessary, normalize body weight.

Patients with a hiatal hernia are advised to follow a gentle diet and a regimen of fractional meals.

Drug treatment of a hiatal hernia is primarily aimed at preventing the development of gastroesophageal reflux disease. For these purposes, proton pump inhibitors are used in a gradually decreasing dose over a course of up to two months, followed by transferring the patient to antacid drugs. According to indications, prokinetics may be included in the treatment regimen.

Conservative treatment of first-time patients with a hiatal hernia is usually carried out in a hospital setting, where a thorough examination of the patient is easier to carry out than in an outpatient setting. If a relapse develops, drug therapy begins on an outpatient basis, and hospitalization is indicated only if the treatment is ineffective.

When treating a hiatal hernia against the background of other diseases of the gastrointestinal tract (chronic cholecystitis, pancreatitis, peptic ulcer of the stomach and duodenum), the leading pathology is first determined and corrected.

In the case of the development of severe forms of gastroesophageal reflux disease, torpid reflux esophagitis, which is not amenable to conservative therapy, or Barrett's esophagus, surgical treatment is indicated for patients.

Surgery for esophageal hernia can be performed either open or laparoscopically. Among the surgical methods of treatment, the most widespread are surgical interventions that are aimed at suturing the hernial orifice and strengthening the diaphragmatic-esophageal ligament (crurorrhaphy), fixing the stomach in the abdominal cavity (gastropexy), eliminating gastroesophageal reflux (fundoplication), and restoring the acute angle of His.

After surgical treatment of a hiatal hernia, relapses are extremely rare.

Contraindications to surgical treatment of esophageal hernias are concomitant pathologies that can cause severe complications in the postoperative period (for example, chronic cardiovascular diseases in the decompensation stage).