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Esophageal hernia symptoms and treatment diet. Esophageal hernia: treatment, symptoms, diet, recommendations. Conservative methods as a method of treatment

Any person knows that a hernial formation is a dangerous thing, as it can lead to pinching of the organs included in it and provoke dangerous conditions, including tissue death. Among gastroenterological problems, diaphragmatic formation of the esophageal opening of the muscular plate is very common. This problem manifests itself in different ways, but it definitely needs to be treated. In order for treatment to be prescribed correctly, it is extremely important to establish the original cause of the disease.

Hiatal hernia: description of the problem

A hiatal hernia is an abnormal condition in which part of the digestive system organs moves from the abdominal cavity to the thoracic cavity through an enlarged esophageal opening in the diaphragmatic plate. As a rule, this concerns parts of the esophagus and stomach itself, but even loops of the small intestine can be displaced. This phenomenon is called a hiatal hernia.

Doctor's note: in many patients, the hernia does not make itself felt at all for a long time, being asymptomatic. However, you should not assume that this condition is harmless, because, like any other hernial formation, the esophageal hernia can also shrink, pinching the organs passing through the opening. The condition threatens to cause anemia, bleeding and other unpleasant consequences.

Esophageal hernia is a common disease; statistics show that every fifth adult suffers from this problem. The risk group includes people who have chronic diseases of the digestive system and (or) are over 50 years of age.

What does a hiatal hernia look like?

Types of hernias

Depending on the specific situation and localization of the hernial formation, experts distinguish several types of this disease.

Type of esophageal hernia	Description
Sliding (fixed and not fixed)	The upper part of the stomach moves to the area above the diaphragmatic plate (into the chest cavity), thereby participating in the formation of the hernial sac. The main feature of the condition is that the stomach is displaced not near the esophageal tube, but along its axis. A non-fixed “dumping out” is not permanent; it appears only under certain circumstances, often without provoking specific symptoms, which makes diagnosis much more difficult. The concept fixed means that the location of the hernia does not depend on changes in body position, but a non-permanent hernia changes its location, for example, when a person assumes a vertical position.
Constant (perioesophageal)	In this situation, the lower section of the esophageal tube and cardia (the muscular ring connecting the esophagus and stomach) remain in their normal position, and through the hole in the diaphragm, strongly curving, part of the stomach emerges into the chest cavity, as if parallel to the esophagus itself. This condition is accompanied by obvious symptoms associated with difficulties in passing food.
mixed type	A mixed type is diagnosed when the formation mechanism cannot be attributed to one or another variety.

Causes

To prescribe the correct treatment, it is of great importance to establish the mechanism of formation of a hiatal hernia. Experts say there are two main groups of reasons: weakness of the diaphragm muscles and too high pressure inside the abdominal cavity. Such conditions can provoke both sliding and permanent hernia formation. Let's look at the common reasons in more detail:

changes in the muscles that form the esophageal opening itself - they relax, stretch and form a hernial orifice. Relaxation may occur due to nerve entrapment or traumatic injury;
under the diaphragmatic plate, adipose tissue is absorbed with age, which causes muscle weakening;
genetic predisposition;
atypical pulling up of the esophageal tube (due to a violation of its motor function, shortening due to scarring against the background of chemical and thermal burns);
closed and open injuries;
congenital pathological feature of the structure of the diaphragmatic plate or esophageal tube;
a significant increase in pressure in the abdominal cavity of the body. Due to the fact that the pressure in the chest cavity is already lower than in the abdominal cavity, when it increases, pressure is exerted on the diaphragm, and it bends, during which the hole expands. If this happens on an ongoing basis, then the organs can easily form a hernial sac. The direct cause of this condition can be: pregnancy, severe due to chronic diseases of the respiratory system, heavy lifting, severe obesity, overeating and frequent bowel movements, namely constipation;
a decrease in sphincter tone can be provoked by the abuse of nicotine and alcohol, taking certain hormonal and medications, which also creates favorable conditions for the appearance of a hernia.

We can also talk about specific reasons that provoke a certain type of hiatal hernia. Thus, a congenital sliding hernia can form during intrauterine development due to a slowdown in the process of moving the stomach into the abdominal cavity. There may also be a pre-formed “bag” (a place where organs may descend in the future), which is formed due to untimely or incomplete fusion of the diaphragmatic plate during the period when the stomach has already descended. It happens that acquired causes that can be at the origin of the appearance of a sliding hiatal hernia include the presence of strong reflex contractions of the esophageal tube due to peptic ulcer or cholecystitis.

A permanent paraesophageal hernia is considered more dangerous, since it is this formation that is most often pinched. In addition to general causes, this condition can be provoked by dyskinesia of the esophageal tube - a violation of motor function without the presence of organic lesions. The formation can be pinched either immediately after the stomach is displaced or after some time due to the influence of certain factors:

strong laughter;
eating large amounts of food;
physical stress due to heavy lifting;
falling from height;
overflow of the intestines with feces, etc.

Esophageal hernia video

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- a disease associated with expansion of the esophageal opening of the diaphragm and sprain of the ligaments connecting the esophagus and stomach. As a result, bile and gastric juice enter the esophagus, an inflammatory process develops and the integrity of the mucous membrane is disrupted. If left untreated, after 7 to 10 years the hernia can develop into a malignant state, that is, esophageal cancer. Let's find out the opinion of gastroenterologists about the causes and methods of treating hiatal hernia.

Causes of hiatus hernia

Experts identify the following factors predisposing to the development of a hiatal hernia:

abdominal trauma;
chronic diseases of the abdominal organs;
intestinal problems, constipation;
heavy physical activity, mainly lifting weights;
bad habits (overeating, fast food, smoking, alcohol abuse).

In some cases, a hiatal hernia occurs as a result of natural age-related changes, when thinning and disruption of the integrity of connective tissues occurs, which is why most often elderly people suffer from hiatal hernia.

Drug treatment of hiatal hernia

When treating hiatal hernia with medications, 5 groups of drugs are used:

Antacids that neutralize hydrochloric acid in the stomach (Almagel, Maalox, Phosphalugel).
, helping to restore the proper movement of food through the gastrointestinal tract (Domiid, Motilium, Cerucal).
Proton pump inhibitors that reduce the production of hydrochloric acid (Omeprazole, Nolpaza).
Histamine receptor blockers, which also reduce the production of hydrochloric acid (Roxatidine, Ranitidine, Famotidine).
Bile acids that neutralize bile that enters the stomach (Ursofalk, Urocholum).

Surgery for a hiatal hernia is not always necessary, but there are times when it is necessary. If complications occur with an esophageal hernia (strangulation, bleeding, etc.), surgical intervention is recommended. 4 types of hernia repair operations have been developed, each of which is aimed at reducing the hernial protrusion into the abdominal cavity and suturing the damaged area of the diaphragm.

Traditional methods of treating hiatal hernia

Along with medications, natural products (herbs, vegetables, etc.) are used in the treatment of hiatal hernia at home.

So, to eliminate heartburn the following are used:

infusion of flax seeds;
carrot juice;
potato juice;
gentian tea

Helps with bloating:

infusion of chamomile flowers;
tea with fennel and peppermint;
infusion of caraway seeds.

Belching can be eliminated by taking:

cranberry juice with honey and aloe;
infusion of rowan flowers.

Traditional medicine has in its arsenal many remedies that help with constipation, including:

infusion;
senna infusion;
decoction of rhubarb root;
steamed dried apricots and prunes;
Boiled beet salad with vegetable oil.

Diet for hiatal hernia

A hiatal hernia (HHH, hiatal hernia) is an anatomical defect, the essence of which is the displacement of part of the esophagus or stomach into the chest cavity. When the ligamentous apparatus of the esophageal opening (cardia) is in a normal state, movement of organs is impossible. The risk of pathology appears if the ligaments and subdiaphragmatic fatty tissue are weakened.

Classification of hiatal hernia

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.
A short esophagus is 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.

Causes of the disease

One of the key causes of a hiatal hernia is a weakening of the ligamentous apparatus of the esophagus and stomach. According to statistics, this risk factor is present in 5% of people aged 20 to 40 years and in more than 50% of people over 50 years of age. Let us note that in medicine, hiatal hernia is more common in those who avoid sports. Predisposing causes also include a thin physique and poor diet.

Another circumstance that can lead to a hiatal hernia is an increase in intra-abdominal pressure, which can be caused by the following reasons:

Flatulence.
Pregnancy with complications.
Frequently recurring bouts of vomiting.
Hurting cough.
Abdominal tumors.
Disorders of esophageal peristalsis caused by chronic inflammatory diseases.
Disorders of intrauterine development of the fetus.

Clinical picture of the disease

In the initial stages, symptoms of a hiatal hernia usually do not appear. If it is small in size, then to make a diagnosis it is necessary to carry out a set of diagnostic procedures that will reveal weakening of the muscles of the esophageal opening. In this regard, it is possible to detect pathology at first only if there are other diseases of the stomach or intestines that manifest themselves in a similar way.

If the hernia has reached a larger size, but this has not yet led to disruption of the esophagus, then the disease can be diagnosed by the following symptoms:

Chest pain (may feel like heart pain).
Inflammation in the oral cavity, larynx, esophagus.
Pain when swallowing food.

As a rule, at this stage of development of the pathology, pain occurs immediately after eating food, during physical activity and in moments of stress. The duration of attacks can vary from 2-3 minutes to several days.

The last stage of the development of the disease is the depletion of the apparatus of the esophageal opening to such an extent that it is no longer able to perform its function. The main manifestation in this case is heartburn, which occurs after eating or with a sudden change in body position. As a rule, at night the symptoms intensify, causing the patient severe discomfort.

Advice! If you experience some of the above symptoms of a hiatal hernia, treatment and diet are essential to avoid complications. To achieve the most effective results, be sure to consult your doctor.

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Possible complications of pathology

The consequences of a hiatal hernia can be very dangerous. In particular, this pathology can cause the development of coronary disease, weakening of the cardiovascular system and even myocardial infarction. Another very unpleasant consequence of hiatal hernia is belching of gastric juice, which in the future can cause the development of aspiration pneumonia (inflammation of the lung tissue). And here is a list of complications that may arise if you do not start treating a hernia in a timely manner:

Reflux disease.
Peptic stricture and esophageal ulcer.
Acute and chronic bleeding in the esophagus.
Prolapse of mucous membrane into the esophagus.
Infringement of protrusion.

Conservative treatment options

There are several ways to get rid of hiatal hernia at home. But before we begin to consider how to cure hiatal hernia without surgery, it is worth emphasizing that these methods should be used only after a preliminary examination by a doctor. In addition, in no case should treatment be stopped prematurely, otherwise this may cause a relapse of the disease.

To eliminate the symptoms of a hiatal hernia and restore the functions of the esophageal apparatus, the following is used:

Drug treatment reduces the production of hydrochloric acid and normalizes the motor functions of the esophagus.
Therapeutic exercises - allows you to restore the tone of weakened cardia ligaments.
Diet - involves split meals, reducing the secretion of gastric juice and preventing excessive gas formation.
Folk remedies - relieve heartburn, constipation and flatulence; normalize acidity and prevent stomach contents from entering the esophagus.

Let's consider each of the described methods in more detail.

On a note! Non-surgical treatment of hiatal hernia is used in 90% of cases. The operation is prescribed only in cases where conservative methods have not given the desired result.

Drug therapy

If the patient has been diagnosed with a hiatal hernia, treatment with medications is an integral requirement of conservative therapy. To normalize acidity and eliminate symptomatic manifestations of the disease, the following drugs are used:

Antacids (Gastal, Almagel, Maalox) - prevent gastric juice from entering the esophagus.
Omeprazole, pantoprozole - reduce the amount of hydrochloric acid produced.
Metoclopramide, domperidone, cisapride - normalize the motor functions of the esophagus, thereby preventing the ejection of stomach contents into it
Ranitidine, roxatidine - act on the centers of hydrochloric acid production, reducing its amount.

Physiotherapy

The following techniques help strengthen the ligaments. Exercises should be done on an empty stomach, half an hour to an hour before meals:

Lie on your back. Place a pillow under your head and shoulders. Place the middle and index fingers of both hands in the hypochondrium in the midline of the abdomen. Take a breath. As you exhale, press on the abdominal cavity. Repeat 5 times.
Roll over on your side. As you inhale, push your stomach out as much as possible. As you exhale, relax your muscles. Repeat 5 times on the left and right sides.
Get on your knees, keep your back straight. Take a deep breath and at the same time bend your whole body to the left. Return to the starting position and make the same movement in the other direction. Repeat 5 times in both directions.

Diet

Improper eating behavior is one of the fundamental factors provoking the occurrence of pathology. In this regard, a dietary menu for hiatal hernia is one of the key ways to conservatively eliminate hiatal hernia. Adjusting nutrition in the treatment of this disease comes down to the following principles:

Eating schedule - since overeating contributes to acidity disorders, the first thing to do is to reduce the load on the stomach. You need to eat 5-6 times a day, and the volume of food consumed at one time should not exceed 300 ml. You need to eat at approximately equal intervals. For dinner, you can only eat foods that are easily digestible.
Normalization of acidity - food that promotes the production of gastric juice should be permanently excluded from the diet. Here we are talking about spicy dishes, smoked meats, spices, sweet desserts and confectionery products in general. If this restriction is not observed, the hiatal hernia can cause complications in the form of ulcers and erosions.
Prevention of constipation and flatulence - to reduce the load on the stomach, it is recommended to avoid foods such as corn, beans, yeast baked goods, cabbage, milk, and carbonated drinks.

Recipes from the people

Although doctors mostly insist that to eliminate the symptomatic manifestations of hiatal hernia it is necessary to take medications, it is possible to partially replace them with decoctions and tinctures. Let's look at the most common recipes for treating hiatal hernia using folk remedies:

To eliminate heartburn, a decoction of dried orange peel and licorice root is used. The drink is prepared as follows: take an equal amount of licorice root and orange zest. Pour in water so that it covers the mixture by a few centimeters. Boil until the water is reduced by half. Take 3 tablespoons before meals.
To get rid of bloating and flatulence, 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.
An infusion of cranberries, honey and aloe will help get rid of belching. Take these components in equal quantities and grind in a meat grinder, then add warm water and leave for 6 hours. Drink the composition 2-3 tablespoons after meals.

Advice! Before using any prescription, consult a gastroenterologist. This is necessary because only a competent specialist can determine how useful a particular composition will be in your particular case. Thoughtless self-medication can not only not bring positive results, but also cause serious damage to health.

Surgical intervention

If the above methods are unsuccessful, and the disease continues to develop, then the patient has no choice but to agree to surgical intervention. Let's consider the list of complications that may indicate the need for surgical treatment of the hiatal hernia:

Erosion of the esophagus.
Ulcerative lesions.
Internal bleeding.
Decreased hemoglobin and anemia.
Large size hernia (diameter more than 10 centimeters).
Dysplasia of the esophageal mucosa.

Depending on the type of complications, the operation may pursue the following goals:

Returning part of the stomach from the esophagus to its “native” place.
Repairing a hernial opening by suturing the breach to prevent stomach contents from entering the esophagus.
Fixation of the wall of the esophagus and stomach in the area of the anterior diaphragmatic wall.

There are two main ways to perform hiatal hernia surgery:

Laparoscopy.
Open cavity method.

The choice of one method or another is influenced by factors such as the age and condition of the patient, as well as the diameter of the hernial orifice. The recovery period depends on the type of operation. Thus, with laparoscopy, the patient can get back on his feet by the evening and be discharged from the hospital in 3-5 days, whereas in the case of using the abdominal method, the patient needs to remain in bed for another 5 days, and complete rehabilitation occurs only after a month.

On a note! Regardless of the type of operation, the patient must follow the prescribed diet for at least six months. If this is not done, the risk of relapse increases many times over.

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In conclusion of the article, we note its most important points:

To prevent HH, you need to eat right and exercise.
Persistent heartburn is one of the key signs of a hiatal hernia.
It is almost always possible to cure HH without surgery.
The diet must be continued even when the symptoms have completely disappeared.
Folk remedies can partially replace medications, but the choice of prescriptions should always be discussed with your doctor.
The operation is performed in cases where conservative treatment has not yielded positive results.

) 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 bottom 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 the 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 hernias of the esophagus, depending on the displaced area, 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 squeezing the hernial sac (infringement of the hernia), there are constant dull or intense cramping pains behind the sternum and in the epigastric region, radiating to the interscapular region. In this case, the severity and irradiation of pain depend on which part of the digestive tract was strangulated in the hernial ring, as well as on the state of the strangulated organ.

The causes of hernia of the esophagus are the weakening of the ligamentous apparatus, which fixes the cardial part of the stomach, and an increase in intra-abdominal pressure.

With the progression of the pathological process, violations of the obturator function of the cardia increase, which leads to the appearance of signs of gastroesophageal reflux disease. Patients with a hernia of the esophagus may experience anemic syndrome due to occult bleeding from the lower esophagus.

Diagnostics

Approximately one third of small hernias of the esophagus, which do not have pronounced clinical manifestations, are an accidental diagnostic finding during an examination for another reason.

The main methods for diagnosing a hernia of the esophagus are x-ray examination and esophagogastroduodenoscopy. During the endoscopic examination, an unchanged esophagus is found, the diaphragm closes rhythmically around its lower part in time with the respiratory movements. The cardial 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).

No competent doctor will diagnose a hiatus hernia. Because there is no such disease in the International Classification. It is impossible to detect where this hernia is located. The correct name of the pathology is hiatal hernia (abbreviated hiatal hernia). This is what the diagnosis sounds like, and this is what medical workers call the disease.

Those who are far from medicine and have forgotten anatomy do not go into details. The main thing is that the disease is accompanied by signs of damage to the esophagus. Therefore, we will not constantly correct “folk terminology”. It is much more important to pay attention to the symptoms of the lesion, prevent complications and find out the possibilities of treatment without surgery and with surgery.

Statistical analysis shows that hiatal hernia is most common in women in the age group of 60 years and older. In people under 50 it occurs with a frequency of 0.7%, in the period from 51 to 59 years the prevalence increases to 1.2%. The maximum is 4.7%.

Let us recall the anatomy of the “path” from the esophagus to the stomach

After swallowing, the bolus of food is sent to the stomach through a muscular “tube” (esophagus). In an adult, it has an average length of 25 cm. Its task is to deliver crushed food processed by saliva to begin digestion. The organ has longitudinal muscles that push the contents towards the stomach, and powerful circular muscles that prevent return.

The esophagus in the upper part is surrounded by large vessels and the bronchial tree

The structure has 7 anatomical segments. We will be interested only in the 3 lower sections of the esophagus:

Supradiaphragmatic- located 3–4 cm above the diaphragm. Here, diverticula, varicose veins are more often detected, ulcers and inflammation, and hernias form.
Intradiaphragmatic(epicardial) - no more than 2 cm, passes through the thickness of the diaphragmatic muscle, through a special opening called the “esophageal”. In addition to the above pathology, it plays an important role in functional disorders, participates in the mechanism for regulating the opening of the cardia, has a powerful fibromuscular ring, ensures closure of the lumen and complete tightness between the esophagus and stomach at rest. Surrounded by fatty tissue, mobile.
Abdominal or subphrenic- 3–4 cm in size, also called the “vestibule” of the cardiac part of the stomach, functionally united with the diaphragmatic one, at the age of one year it forms an angle (His) with a greater curvature at the confluence with the stomach. Inside the corner there is a fold that acts as a valve. It closes with pressure inside the stomach and prevents the reverse movement of food (regurgitation, belching).

The diaphragm is formed by a dense muscle layer. It separates the thoracic cavity from the abdominal cavity. It has through diaphragmatic openings for the passage of the esophagus, abdominal artery, sympathetic nerve and inferior vena cava. It entwines them with tendons to ensure pressure fluctuations and creates the necessary conditions for the functioning of the respiratory organs, heart and large vessels, and digestion.

In the mechanism of formation of an esophageal hernia, it is important to take into account such a natural weak point as the canal through which the esophagus passes inside the diaphragm.

Why does a hernia occur?

There are congenital and acquired causes of esophageal hernia. A developmental anomaly such as a short esophagus “pulls” the upper part of the stomach into the chest cavity. A lack of collagen in the structure of the muscle fibers of the diaphragm weakens muscle tension and contributes to sagging and stretching of the tissue surrounding the esophagus.

By old age, a person acquires various disorders that the body is no longer able to correct or compensate for. These include:

general changes in the structure of the connective tissue (loss of collagen, elastin), which significantly weakens the muscle ligaments;
heavy physical activity, especially when suddenly lifting or squatting;
gaining excess weight or sudden weight loss, the amount of abdominal fatty tissue affects the mobility of the diaphragm, intra-abdominal pressure, with a significant decrease in weight, biochemical processes in muscle tissue change, its atrophy occurs;
pregnancy in women with a large fetus or carrying twins temporarily changes the location of organs inside the abdomen;
tendency to constipation;
previous operations on the esophagus do not occur without dysfunction of the organ;
chronic cough of smokers;
an increase in the abdomen due to ascites puts pressure on the dome of the diaphragm from below;
diseases of the esophagus associated with impaired motor function;
injuries and burns of the esophagus (thermal and chemical);
diseases of the stomach, small intestine, bile ducts, leading to impaired evacuation of food, secretions, changes in the motor activity of the muscle layer (for example, reflex contraction of the longitudinal muscles of the esophagus in peptic ulcer, cholecystitis);
blunt abdominal trauma.

Mechanism of Education

Under the influence of one or more causes, an enlarged opening of the esophageal canal is formed - a diaphragmatic hernial ring. They can get adjacent organs located below the dome: the upper part of the stomach, omentum, loop of the intestine. Such hernias are called hiatal hernias. Among all diaphragmatic hernias they account for 90%.

There are different types of hernias of the esophageal opening, they differ in localization and mobility:

axial (axial), refers to sliding hernias - more common than others (95% of cases), the cardia of the stomach and the lower part of the esophagus move freely in the axial direction from the bottom up and back (such hernias are also called "floating"), as a result, the stomach may lie above diaphragm, the process of passing the food bolus is disrupted;
fixed periesophageal (paraesophageal) - rare (5%), does not move, one of the sections of the stomach or the entire organ, omentum, loop of the small intestine, part of the spleen emerges into the opening.

An important difference for the diagnosis and course of the disease is the ability of fixed hernias to be strangulated

Sliding hernias vary in degree into 3 options:

1st degree - is the initial stage, penetration into the chest cavity is possible only of the subdiaphragmatic part of the esophagus, is asymptomatic, treatment of a hiatal hernia does not require surgery, usually following a diet is sufficient;
2nd degree - in addition to the lower parts of the esophagus, the upper part of the stomach extends into the hernial opening, the symptoms of the disease are pronounced, it is necessary to create a combined scheme for how to treat a hiatal hernia, if no measures are taken, it leads to complications;
Stage 3 is the most severe in its manifestations; most of the stomach moves into the space above the diaphragm, possibly the entire organ, intestinal loops; it is impossible to cure this form without surgery.

Symptoms

Patients feel clinical manifestations of the disease only from the second stage of the disease. The main symptoms are as follows. The pain is localized in the epigastric region, usually on the left, occurs suddenly, is quite intense, very similar to angina pectoris, and also intensifies with heavy physical activity and during movement.

The difference is the connection with food intake, especially with overeating, aggravated in a lying position.

Impaired swallowing - described by patients as “a feeling of a pressing lump in the throat.” Belching - bitterness, food eaten, sour contents, occurs after eating, does not go away for a long time. Hoarse voice - causes acidic gastric juice to flow into the larynx and onto the ligaments, causing a chemical burn.

Heartburn - happens both after eating and on an empty stomach, worsens in a lying position, when bending forward. Persistent hiccups - the cause is overstimulation of the branches of the vagus nerve, which causes convulsive contraction of the diaphragm. Patients experience excruciating discomfort when hiccupping. At night, salivation increases; if it enters the larynx, it contributes to coughing attacks and insomnia.

It is important to notice signs of complications in the pain syndrome:

the pain becomes almost constant, dull, aching;
the localization changes (“goes” under the left shoulder blade, into the stomach);
manifests itself as an attack with a “cutting” character;
aggravated by pressure in the epigastric region.

In the photo - with pain and difficulty swallowing, some patients experience a feeling of suffocation

What are the possible complications?

Negative consequences of untreated hiatal hernia can lead to:

to the development of inflammation of the esophagus in catarrhal, erosive form or in the form of reflux esophagitis;
peptic ulcer in the lower sections with subsequent stenosis of the esophagus due to cicatricial narrowing or perforation;
strangulation of a fixed hernia;
gastric or esophageal bleeding from varicose veins;
attacks of reflex angina pectoris.

What are the signs of abuse?

Incarceration of a diaphragmatic hernia occurs due to a sudden spasm of the dilated esophageal ring. Sometimes it is the first symptom of the disease. More often it occurs in patients who are aware of their pathology, in violation of doctor’s recommendations, refusal or contraindications to surgery to remove a hernia.

Against the background of normal symptoms, sharp pain suddenly appears in the upper part of the epigastrium and in the chest. Irradiates to the collarbone, left shoulder blade. At very high intensity, it is accompanied by a state of shock. Prolonged vomiting, aggravated at the height of pain, lasts almost a day.

The abdomen is swollen, intestinal motility is preserved, provokes pain. If such signs appear, then surgical treatment of a hiatal hernia is necessary for life-threatening reasons. The patient should immediately call an ambulance.

Diagnostics

To make a diagnosis, the doctor clarifies in detail the symptoms, connections with risk factors, and the presence of digestive diseases. Objective signs of enlargement of the esophageal opening and disturbed arrangement of organs are obtained using the X-ray method and endoscopy. X-ray examination is carried out with contrasting the digestive organs with a barium suspension.

With a hernia, it is possible to detect an enlarged ring of the esophageal opening, the cardiac part of the stomach above the diaphragm, the absence of the lower segment of the esophagus, and a high-lying sphincter in the space under the dome of the diaphragm.

Fibrogastroscopy shows the transition of the esophageal-gastric junction into the supradiaphragmatic space, and signs of complications are detected (inflammation of the esophageal mucosa, erosion, peptic ulcers, various forms of gastritis). A differential diagnosis with a tumor is required. For this purpose, material is taken for a biopsy.

During an x-ray examination, several images are taken to capture the moment of barium passage through the hernial canal area

How to treat a hiatal hernia

The doctor should tell the patient about the possibilities of treating the disease after confirming the diagnosis using additional methods. Treatment methods for hiatal hernia (we mean “esophageal hiatus”) are selected depending on the stage of the process, the patient’s condition, age and concomitant diseases.

At the first stage, in the absence of symptoms, treatment requires compliance with prophylaxis to prevent the worsening of the hernia process. The patient is recommended to go on a diet and undergo physical therapy. Great importance is attached to the ban on lifting heavy objects and normalizing weight.

In the second or third stage, it is impossible to treat a hiatal hernia without surgery. Elderly people with decompensation of the cardiovascular system, severe cerebral insufficiency have to manage only with conservative methods. For them, the main thing is, if possible, to eliminate the causes of increased pressure in the abdominal cavity, to treat chronic diseases that contribute to pathology.

Treatment without surgery includes gymnastic exercises, diet, medicines.

What to add to daily gymnastics?

The exercises are available to patients of any age. They help support the muscles of the diaphragm and abdomen and prevent atrophic changes. Breathing exercises should be done in the morning on an empty stomach.

It includes: in a lying position - protrusion of the abdomen as you inhale and retraction as you exhale, while standing - bending to the sides as you inhale, returning to the starting position as you exhale. Common muscle exercises include leg raises, bicycle kicks, and scissors.

The role of diet

Dietary meals should help eliminate constipation, bloating, normalize weight, and prevent overeating. Patients are recommended to eat at least six times a day, in small portions. It is prohibited to include in the diet:

alcoholic drinks, carbonated water, coffee;
hot seasonings, garlic, onions;
fatty and fried foods;
pickles;
sour juices, berries and fruits;
whole milk;
fresh pastries, rye bread.

It is better to first peel sweet fruits and grate them. Allowed:

dried fruits (especially prunes);
low-fat fermented milk products (kefir, cottage cheese, yogurt);
boiled dishes from lean meat, poultry and fish;
vegetarian soups;
cook porridge with diluted milk;
scrambled eggs;
dried white bread, sweet crackers for tea;
You can add milk to tea.

After eating, you should not lie down, you should walk around. It is not recommended to eat before bed. It is good to drink kefir 3 hours before bedtime.

The drug reduces belching and heartburn

Use of medications

Medicines for a patient with hiatal hernia are necessary to support digestion and prevent functional disruptions in secretion and motility. If the patient has increased acidity, then drugs with antacid properties (Almagel, Gastal), acid production blockers (Ranitidine, Famotidine, Nizatidine, Omeprazole) are recommended. Cisapride and Metoclopramide improve motility; they prevent and eliminate manifestations of gastroesophageal reflux with heartburn and belching.

Types of surgical treatment

The purpose of the operation is to restore the tightness of the esophageal opening in the diaphragm, to return and fix the esophagus and stomach to their natural position. Surgical treatment is indicated for patients with second or third degree hernia if:

the hole forms a fairly wide hernial canal;
prolapsed organs are fixed in the hernial orifice;
there are complications;
the hernia formed against the background of impaired development of the mucous membrane (dysplasia) and is dangerous due to degeneration into a malignant tumor;
strangulation of a sliding hernia is assumed.

Various methods are used for plastic surgery of the hernial orifice, fixation of the esophagus and stomach.

The enveloping properties of flax seed decoction protect the esophagus and stomach from inflammation

Treatment with folk remedies

Folk remedies for hiatal hernia help diet and medications eliminate unwanted manifestations of impaired functions of the digestive organs. To relieve intestinal bloating, it is recommended to use decoctions of mint, fennel, valerian, flax seeds or dill. Tea with ginger or a little grated root helps relieve pain and heartburn. Carrot juice is useful for healing inflammation.

A hiatal hernia most disrupts the functions of the stomach and esophagus. The overall outcome depends on the work of the initial section of the digestive tract. Therefore, without treatment, other organs also suffer. Timely consultation with a doctor will help prevent the progression of the pathology.