Gpod: causes, symptoms and treatment. Rescue from a hiatal hernia What is a 2nd degree hiatal hernia?

Among the diagnosed esophageal hernias in adults, a sliding hiatal hernia is more often found, which has its own characteristics of the clinical course.

Sliding or axial hiatal hernia occurs as a result of entry into the chest of the lower part of the esophagus and the cardia of the stomach through a weakened wall of the diaphragm. Normally, these organs are located in the abdominal cavity and are held in place by a muscular ligament.

The disease itself does not pose a threat to human health unless it becomes complicated. The difference between such a disorder as an unfixed cardiac hiatal hernia is the free movement of the cardia of the stomach and part of the esophagus from the abdominal cavity to the chest and vice versa. Due to this feature, the risk of complications is reduced, but timely diagnosis becomes more difficult.

When suffering from a sliding hiatal hernia, symptoms and treatment are the two most important points, but it is also worth understanding the causes. At risk of developing a disease such as axial sliding hiatal hernia, treatment of which must be timely, includes obese people, women during pregnancy and patients with diseases of the gastrointestinal tract. Causal factors can be divided into acquired and congenital.

Congenital causes the appearance of such a disorder as a floating hiatal hernia:

• disruption of the process of lowering the stomach;
• the appearance of a hernia sac in the womb due to insufficient fusion of the diaphragm;
• underdevelopment of the diaphragm muscles around the natural opening of the esophagus.

Acquired factors, in which a sliding hiatal hernia develops:

The mechanism for the appearance of such a pathology as a sliding cardiac hiatal hernia is the weakening of the natural opening of the diaphragm, through which the lower part of the esophagus and the cardia of the stomach freely penetrate. The disease progresses very slowly, grade 1 HHPA, what it is will be better explained by a doctor, and cannot be determined at all without instrumental diagnostics.

Clinical symptoms

A feature of this form of pathology will be a long latent course. The patient may not have any signs if the size of the defect is small. Quite often, pathology is discovered by chance during an examination of the body for other diseases. But some people still experience a range of symptoms.

The pathology of sliding axial hiatal hernia (SHH) is characterized by the following symptoms:

• burning behind the sternum after eating and in a horizontal position;
• regurgitation and frequent belching without accompanying vomiting;
• difficulty swallowing, dysphagia due to narrowing of the esophagus or inflammation;
• reflux esophagitis with the addition of inflammation of the bronchi or even the lungs.

Gradual progression of the pathology leads to complications. First develops reflux esophagitis, which gives symptoms of pain and constant heartburn.

Without appropriate treatment, an axial or sliding hiatal hernia can result in the formation of erosions or ulcers, as well as internal bleeding and anemic syndrome.

The severity of the clinic will depend on the stage:

Related disorders

Symptoms are complemented by concomitant diseases:

• stomach inflammation and ulcers;
• internal bleeding;
• bronchitis and tracheitis;
• reflux esophagitis.

Signs of dental diseases may occur due to acidic stomach contents entering the oral cavity. The patient feels a burning sensation on the tongue, an unpleasant odor and a sour taste in the mouth. The voice changes, hoarseness and cough appear if the hernia is combined with pathologies of the respiratory organs, including bronchial asthma or tracheobronchitis.

Sliding hiatal hernia: treatment and its principles

When an uncomplicated sliding hiatal hernia is diagnosed, treatment is carried out depending on the symptoms. The defect itself cannot be removed with medications or non-drug methods. The doctor prescribes medications only to eliminate symptoms and improve the quality of life.

Mandatory components of maintenance treatment:

• diet;
• exclusion of heavy physical activity;
• treatment of concomitant diseases;
• taking medications to normalize the acidity of gastric juice;
• giving up bad habits, eliminating stress factors.

Surgery for this disease is performed extremely rarely when a complication develops and there is a danger to the health and life of the patient.

Indications for surgical treatment:

• severe anemic syndrome;
• chronic bleeding;
• large hernia, more than 10 cm in diameter;
• multiple erosions or ulcers;
• esophageal dysplasia;
• strangulation of the hernial sac.

Drug therapy

The main goal of drug treatment for a diagnosis of unfixed hiatal hernia will be to eliminate unpleasant symptoms such as heartburn, foreign body sensation, heaviness after eating and pain. Drug therapy for HHS:

The drug treatment regimen for a sliding hernia is determined individually by the attending physician after a comprehensive examination of the chest and gastrointestinal tract. Often, medications are prescribed only during periods of severe symptoms.

Additionally, the following funds are prescribed:

• to eliminate spasm and pain - No-Shpa, Drotaverine;
• to eliminate heartburn with belching - Motilium;
• to protect the mucous membrane and restore it – De-nol.

Treatment regimens for concomitant esophagitis:

• long-term use of proton pump inhibitors (PPIs) in high dosages;
• taking a PPI for 5 days during severe symptoms;
• Taking PPIs only when symptoms appear.

If the pathology is mild, it is prescribed prokinetics And antacids. For moderate severity, diet and histamine H2 blockers are indicated. In case of severe clinical manifestations, prokinetics, histamine H2 blockers and PPIs are prescribed. In the case of a complicated process with life-threatening manifestations, only surgical treatment is indicated.

Physiotherapy

Additionally, physiotherapeutic procedures are prescribed:

• medicinal baths;
• mud applications;
• medicinal electrophoresis;
• inductothermy;
• magnetotherapy.

Physiotherapy is indicated for additional maintenance of the condition of the gastrointestinal tract in case of esophagitis or hyperacid gastritis.

Useful video

When a sliding hiatal hernia is diagnosed, you should know what measures to take. Important recommendations are presented in this video.

Non-drug methods

For therapeutic effects directly on the diseased area, it is effective to supplement therapy with physical therapy. This is important in order to strengthen the ligaments, which in the future will help prevent strangulation of the hernial sac. Experts also recommend doing breathing exercises, spending a few minutes on it 3 hours after eating.

A prerequisite for treatment will be adherence to a diet.

Principles of nutrition for HDHS:

Folk remedies

Traditional medicine for HMS:

• infusion of orange peel and licorice root to relieve heartburn;
• a decoction of valerian root with fennel fruits for bloating;
• a mixture of cranberries, honey and aloe to get rid of belching.

The use of traditional medicine methods is in addition to the main treatment regimen prescribed by the doctor. Medicines prepared at home cannot in any way affect the disease by eliminating the hernia. They are permissible for use to relieve symptoms only after examination by a doctor and diagnosis.

Complex treatment of a sliding hiatal hernia is effective only if you adhere to a lifelong diet and take all medications prescribed by your doctor. If surgical treatment is indicated, surgery cannot be avoided, since the need for this already indicates a life-threatening condition.

The esophagus is a connecting tube between the pharynx and the stomach that passes through an opening in the diaphragm. Disturbances in the gastrointestinal tract provoke diseases of the esophagus. These include gastroesophageal reflux disease such as sliding axial hiatal hernia (HH).

Features of the pathology

During the development of the disease, the cardiac part of the stomach moves to the sternum through the diaphragmatic opening. There are several types of hiatal hernias:

• paraesophageal (this type is characterized by the fact that the enlargement and growth of part of the stomach occurs on the left side of the esophagus);
• axial (its main difference is the absence of a hernial sac, which allows it to penetrate into the chest cavity and return freely). May be fixed or non-fixed;
• combined (in this case, both types of hernia develop - axial and paraesophageal).

What is a hiatal hernia (video)

Classification of hiatal hernia according to the severity of the disease

Causes of axial hernia

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

Symptoms and signs

At the beginning of the development of the disease, symptoms almost do not appear, clinical signs are mild and the hernia does not bother you. It can only be detected by chance, for example, during a medical ultrasound examination. Visual inspection and palpation will not give results, since the hernia cannot be felt by touch due to its deep location inside the thoracic region. What makes it difficult to recognize an axial hernia is that it can periodically go back under the diaphragm.

A longer existence of a hernia or the slipping of a larger part of the stomach into the sternum area provokes the onset of symptoms, so an axial hernia is most often recognized at later stages of development. Among the main signs accompanying the development of a hernia are the following:

• periodic in nature (usually occurs after eating and in a lying position);
• burning and pain behind the sternum;
• exacerbation of bronchitis, tracheitis (pancreatic juice enters the respiratory tract during belching);
• regurgitation (the flow of food from the stomach into the esophagus and oral cavity without gagging);
• belching;
• dysphagia (a person cannot swallow as a result of cicatricial narrowing of the esophagus, which occurs due to constant inflammation of its mucous membrane with acid emissions).

If the disease was not detected in time, its further development can lead to serious complications. These may be ulcers and bleeding in their background. Periodic hemorrhages, in turn, can lead to anemia (anemia). At the slightest hint of the development of a hernia, do not delay the examination and subsequent treatment.

Diagnosis of sliding hiatal hernia

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

Treatment

Conservative

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

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

You need to eat food in small portions (no more than 200 g at a time) 5-6 times a day. The stomach needs to be given time to process food and rest, so you should not have snacks, as they provoke the production of large amounts of gastric juice, which leads to heartburn.

You should not physically overexert yourself - this creates intra-abdominal pressure and provokes an increase in the hernia. The number and intensity of loads should be kept to a minimum.

If you have occasional heartburn, it is better to sleep reclining on high pillows or raise the head of the bed, if possible.

Foods that need to be excluded from the diet (photo gallery)

Coffee and tea
Carbonated drinks
Salty foods Smoked products Spicy seasonings Fatty foods

Surgical intervention

When the disease is diagnosed in later stages, the hernia is removed through surgery. The most common methods of getting rid of a sliding hernia are:

• laparoscopy;
• plastic surgery according to Tope.

Alternative medicine

The main aggravating symptom during the disease is heartburn. It can be eliminated using traditional methods. Herbal decoctions or teas are best suited for this:

• Gentian tea will help not only eliminate heartburn and inflammation of the esophagus, but also improve digestion. A teaspoon of gentian is placed in one glass of water and infused over low heat for about 30 minutes. For taste, you can sprinkle with ginger and let stand for 10 minutes. There is no need to stir. The drug is taken before meals three times a day;
• Calendula and chamomile have anti-inflammatory effects. Tea made from these herbs will relieve inflammation of the esophagus and calm the stomach. Place half a teaspoon of chamomile and calendula in a glass of boiling water. It is necessary to insist for at least 20 minutes. Afterwards, the resulting infusion is filtered and taken a glass 3-4 times a day. During periods of exacerbation of heartburn, you can take it more often.
• herbal decoction for heartburn. A tablespoon of the collection is infused in 0.5 liters of boiling water for about 2–30 minutes. The strained infusion is taken 15–20 minutes before meals. Need to mix:
  • young nettle;
  • lemon balm;
  • oregano;
  • plantain;
  • St. John's wort.
• flaxseed soothes the stomach, reduces the acidity of its contents, relieves inflammation of the esophagus and heals the digestive system. A teaspoon of seeds is infused in a glass of hot water (no need to boil) for 30–40 minutes. You can wrap it in a towel to maintain temperature. The infusion is filtered and taken shortly before meals. You can also add flaxseed oil to food, but no more than 3 tablespoons per day.

Folk remedies for treating illness (gallery)

Melissa infusion Calendula tea Chamomile tea Gentian infusion Calendula infusion

Diet after surgery

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

What foods should you not eat after surgery?

The following should be excluded from the diet:

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

Products prohibited for consumption after surgery (gallery)

Carbonated drinks Dried fruits Legumes
Flour products High fat dairy products

What foods can you eat after surgery?

After surgery it is best to use:

• low-fat broths;
• vegetable puree soups;
• boiled lean meat or fish;
• cottage cheese (low-fat);
• liquid porridge;
• dried white bread in small quantities;
• jelly (it is advisable to prepare it not from braces containing dyes, but from fresh berries).

Consumption of plant fiber allows you to restore the functioning of the gastrointestinal tract, but excessive consumption of vegetables can lead to stagnation of coarse fiber and the formation of feces in the intestines.

Products approved for consumption during the postoperative period (gallery)

Berry jelly Gruel Boiled fish Low-fat broth Boiled meat

The best way to prevent hiatal hernia is to maintain a healthy lifestyle. Abuse of alcohol and cigarettes, poor diet and lack of sports stress on the body entails the development of multiple diseases of the digestive system, including axial hernia. At the first signs of the disease, you should consult a doctor and undergo a full examination of the abdominal organs. Advanced disease leads to more serious complications, including death.

Sliding hernias without complications are not accompanied by clinical symptoms. Symptoms occur when gastroesophageal reflux, reflux esophagitis and its complications occur. The main symptoms and signs of a hiatal hernia (HH) are as follows:

Burning and pain behind the sternum is the most common symptom, observed to one degree or another in 90% of patients. Pain can also be localized in the epigastric region, left hypochondrium and even in the heart area. Associated with reflux esophagitis. They appear immediately after eating, depend on the amount of food taken (especially painful after a heavy meal), intensify in a horizontal position and when the body is tilted forward. Pain often occurs at night when lying horizontally or on the left side. Relief occurs after taking medications that reduce stomach acidity.

Heartburn (30-47%), which worsens after eating spicy and fatty foods, in a lying position, when bending forward and down. Localized at the bottom of the sternum.

Dysphagia. Occurs in 14-30% of patients. It is noted during the intake of liquid food, cold or hot water, and during hasty eating. It may be associated with stricture of the esophagus due to esophagitis, but more often it is of a reflex nature.

Belching with air or regurgitation, bloating (due to a hernia, a lot of air enters the stomach during food intake) occurs in 18-35% of cases.

Belching food masses during sleep can cause them to enter the respiratory tract and provoke a severe cough, accompanied by shortness of breath and fear of suffocation. Regurgitation can cause frequently recurring bronchitis and pneumonia (usually on the right side).

Chest pain and persistent cough, accompanied by shortness of breath (as with asthma), may appear when the esophagus and part of the stomach move into the chest cavity; often chest pain resembles angina or worsens the course of angina.

The development of anemia due to chronic bleeding from the affected part of the esophagus occurs in some cases in patients with hiatal hernia.

There are known combinations of hiatal hernia with other diseases of the abdominal organs (from 3 to 67%), Casten's syndrome is a combination of hiatus, chronic cholecystitis and duodenal ulcer, such patients are most often interpreted as suffering from peptic ulcer, cholecystitis, angina or pleurisy, Senta's Triad - hiatus , cholelithiasis, colonic diverticulosis, patients are more often regarded as suffering from cholelithiasis or chronic colitis,

Complications of hiatal hernia include: reflux esophagitis, peptic ulcers of the esophagus, peptic strictures, bleeding from the esophagus and hernial part of the stomach, Barrett's esophagus (gastric or intestinal anaplasia of the epithelium),

Research methods

To diagnose hiatal hernia and reflux esophagitis, radiographic and endoscopic examinations, 24-hour pH measurements, esophageal manometry, scintigraphy and ultrasonography are used. According to indications, CT and MRI are used.

X-ray research method.

Polypositional survey and contrast fluoroscopy and radiography are used. The study makes it possible to establish a diagnosis, clarify the location of the hernial orifice, its size, the nature of the hernial contents, the presence of adhesions, and draw up a treatment plan. The study is carried out in direct, lateral and oblique projections, standing, on the back in the Trendelenburg position, on the stomach, on the side, using abdominal compression. Examination in a horizontal position with increased intra-abdominal pressure is especially indicated for small sliding hiatal hernias. In this case, a direct sign of cardia failure is observed - regurgitation of barium suspension. There are direct (displacement into the mediastinum, above the diaphragm of one or another part of the stomach) and indirect (absence or small size of the gas bubble of the stomach, curvature of the supradiaphragmatic segment of the esophagus, radiological signs of reflux esophagitis) signs of hiatal hernia.

Endoscopic methods.

In second place in terms of information content is EGD, which allows you to determine the severity of reflux esophagitis, the degree of shortening of the esophagus and a number of other important data. In combination with X-ray examinations, EGDS can increase the detection rate of this disease to 98.5%.

Intraesophageal pH-metry (optimally 24-hour monitoring) can detect reflux esophagitis in 89% of patients. Normally, the pH of the contents of the esophagus is 7.0-8.0, i.e. it has a neutral or slightly alkaline environment. A change in pH to 4.0 or lower indicates the reflux of acidic gastric contents into the esophagus, the long-term effect of which on the mucous membrane of the esophagus is the main cause of reflux esophagitis, erosions and ulcers, esophageal strictures and epithelial metaplasia. The number and duration of reflux episodes are of practical importance.

The manometric method allows you to determine the condition of the lower esophageal sphincter. It is believed that if the length of the abdominal part is less than 1 cm, the probability of developing reflux reaches 90%.

Esophageal scintigraphy effectively detects the presence of reflux. Currently rarely used.

Ultrasound is more often used to identify concomitant surgical pathology (gastrointestinal tract disease, exudative pleurisy, etc.), as well as in the form of endo-ultrasound during esophagoscopy (condition of the wall of the esophagus and stomach).

Laboratory data are nonspecific and uninformative.

Treatment

Surgical treatment

Surgical treatment of hiatal hernia is indicated in the following cases:

pronounced clinical manifestations (pain, heartburn, etc.);

reflux esophagitis, which does not respond to conservative therapy or provokes angina pectoris;

development of complications (dysphagia, stricture, bleeding, Barrett's esophagus);

severe regurgitation and pulmonary complications;

combinations with other diseases of the abdominal organs requiring surgical correction.

The goal is to restore the anatomical position and normal function of the cardia. The main principle is to eliminate the hernial orifice and perform antireflux surgery. This is done by mobilizing and lowering the esophageal-gastric junction into the abdominal cavity, narrowing the esophageal opening of the diaphragm and performing one of the types of fundoplication, which allows you to restore the lower esophageal sphincter, the high pressure zone in it and the angle of His. Most open (laparotomy, thoracotomy) operations developed for the treatment of hiatal hernia and reflux esophagitis in the 40-70s of the 20th century are now practically not used. The disadvantage of open methods for correcting gastroesophageal reflux is that they are highly traumatic, especially with transthoracic access.

Modern surgery of the hiatal hernia is based on the principles of surgical interventions developed by R Nissen (1961), M. Rossetti (1976), Collis, Toupet, Dor, B.V. Petrovsky, A.F. Chernousov. The main surgical approach has now become laparoscopic, which is disproportionately less traumatic (compared to open interventions) with virtually the same functional result.

The most common is the operation by Nissen, who proposed a 360° fundoplication for the treatment of a hiatal hernia complicated by esophagitis. It consists of forming a circular cuff from the anterior and posterior walls of the fundus of the stomach, enveloping the mobilized abdominal section of the esophagus, in which a 30-32F1 probe is installed. The edges of the stomach are sutured together with the wall of the esophagus. The width of the cuff is at least 2.5-3 cm. If the hernial opening is wide (more than 3.5 cm), the legs of the diaphragm are sutured together behind or in front of the esophagus (posterior or anterior crurorrhaphy) to the normal size of the POD. When the POD diameter is more than 5 cm, to prevent recurrence of the hernia, it is advisable to strengthen the crurorrhaphy with a mesh prosthesis made of non-absorbable synthetic material. To prevent slipping into the chest cavity, the gastric cuff is fixed with separate sutures to the legs of the diaphragm. This operation effectively prevents cardioesophageal reflux without interfering with the passage of food. In the laparoscopic version, the operation is usually performed using 4-5 trocars.

Fundoplication according to Nissen-Rossetti also involves a 360° fundoplication with the difference that the gastric cuff is not fixed to the diaphragm (prevention of hiccups and pain during breathing movements), but 1-2 sutures are placed between the esophagus and the gastric cuff on the side opposite to the sutures of the cuff itself (prevention of cuff straightening in fundus region of the stomach). The disadvantage of the Nissen and Nissen-Rosetti operations is the twisting of the esophagus along the axis when the fundus of the stomach is passed under it. This can be avoided by modifying the Nissen operation, in which the first short arteries of the stomach, the posterior (not covered by the peritoneum) wall of the cardia are mobilized, and the anterior and posterior walls of the fundus of the stomach are involved in creating the cuff. The method allows to prevent rotation of the esophagus and angular tension, which leads to an increase in the abdominal portion of the esophagus, and optimizes pressure in the lower esophageal sphincter. In patients, the severity of pain and the frequency of dysphagia decreases.

Fundoplication according to Toupet consists of forming a symmetrical cuff from the anterior and posterior walls of the fundus of the stomach, enveloping the esophagus at 240-270°, leaving its anterior-right surface free (localization of the left vagus nerve). Used for small stomach fundus. Many authors prefer this method of fundoplication due to the lower incidence of dysphagia in the early postoperative period (compared to the Nissen procedure). This advantage is offset in the future due to a greater number of relapses of reflux disease.

Fundoplication according to Dor. It also involves partial fundoplication, in which the anterior wall of the fundus of the stomach is placed in front of the abdominal esophagus, fixing it to the right wall of the esophagus. This operation is ineffective; it is rarely used as a forced measure when it is impossible to fully mobilize the esophagogastric junction and perform other types of fundoplication.

The Cuschieri operation (1991) is the creation of an acute angle of His using the round ligament of the liver, which, after partial mobilization from the navel, is carried out with the free end under the abdominal segment of the esophagus, pulling it to the right and anteriorly (an acute angle of His is formed). Rarely used due to low efficiency.

For hernias combined with pronounced shortening of the esophagus (congenital or due to esophagitis), the Collis-Nissen operation gives the best results. The operation consists of lengthening the abdominal esophagus due to the lesser curvature of the stomach, followed by gastrofundorraphy (enveloping the newly created esophageal tube from the lesser curvature with the walls of the fundus of the stomach according to the Nissen fundoplication type).

Complications

Intraoperative complications – bleeding (from the parenchyma of the spleen, liver, vessels of the diaphragm and stomach); perforation (esophagus, stomach, pleura, small intestine); damage to the vagus nerve trunks.

Postoperative complications - bleeding, peritonitis, intestinal obstruction, gastrostasis, transient dysphagia, diarrhea, hiccups (reflex, may be associated with suturing the legs of the diaphragm).

Late complications are esophageal strictures, flatulence, relapse of the hiatal hernia and reflux esophagitis (the result of cutting through the sutures of the legs of the diaphragm or “unraveling” of the cuff).

Postoperative management of patients

In cases of uncomplicated disease and successful laparoscopic surgery, postoperative management of patients does not go beyond standard measures (pain relief as indicated, antibiotic prophylaxis during surgery and on the 1st day after it, feeding with liquid food from the 1st day, removal of safety drainage through 12-24 hours). The duration of hospitalization is on average from 2 to 5 days. If complications develop (see above), appropriate therapy is provided. To evaluate the results of treatment, it is recommended after 3-6 months. perform gastric X-ray, endoscopy and pH monitoring.

Treatment results

According to most randomized studies, a good clinical effect of laparoscopic antireflux surgery was noted in 78-97% of cases. Relapses of the disease are quite rare (2.5-5%), especially in unadvanced cases. With large hiatal hernias, divergence of the legs of the diaphragm as a result of cutting sutures is observed in 8-20%; when strengthening the crurorrhaphy line with mesh, this figure decreases to 1-3%. Transient (from several days to 1 month) dysphagia is observed more often after 360° fundoplication (5-20%), however, the long-term results of these operations are better than those of partial techniques.

The diaphragm is a large and wide muscle that separates the chest cavity from the abdominal cavity. It is, as it were, “stretched” between the sternum, ribs and lumbar vertebrae, to which it is attached. The formation of a hiatal hernia occurs due to its weakening, as a result of which parts of the lower organs penetrate into the upper (thoracic) cavity.

In most cases, small hiatal hernias do not cause problems. If the hernia is large, stomach contents back up into the esophagus, causing heartburn, belching, dysphagia and chest pain.

Reasons

A hiatal hernia (abbreviated as hiatal hernia) is diagnosed in approximately 5% of adults. More than half of the cases occur in old age - over 55 years old, which is due to age-related changes - in particular, the natural process of weakening of the ligamentous apparatus.

Most often, a diaphragmatic hernia develops due to the fact that the tissues whose task is to limit the esophageal opening of the diaphragm become much more elastic than necessary. Many people don’t even know that such a hernia is possible. Meanwhile, this is a fairly serious problem that requires qualified medical care.

Causes:

• Abdominal and chest injuries;
• Increased intra-abdominal pressure;
• Attacks of prolonged coughing (asthma, chronic bronchitis);
• Connective tissue diseases: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
• Asthenic physique;

Paraesophageal hernia can be congenital or acquired. A hiatal hernia in children is usually associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age.

Those at risk include those who have the following diseases:

• Varicose veins
• Obesity.

Also, the development of a hiatal hernia is predisposed by impaired motility of the digestive tract with hypermotor dyskinesias of the esophagus, accompanying duodenal and gastric ulcers, chronic gastroduodenitis, chronic pancreatitis, and calculous cholecystitis.

Symptoms of a hiatal hernia

HH is a chronic disease that affects the digestive system, which is in 3rd place among other diseases, such as the duodenum and chronic cholecystitis. A hiatal hernia is a condition in which the stomach slides upward toward the esophagus.

Symptoms of hiatal hernia:

1. a sign of a diaphragmatic hernia is pain, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
2. chest pain can lead the patient to a cardiologist by mistake in diagnosis;
3. pain can occur after eating or physical stress, with intestinal tract and after a deep breath;
4. heartburn, burning in the throat, hiccups, attacks of nausea, vomiting, hoarseness;
5. cyanosis, vomiting with blood indicate strangulated hernia;
6. in some cases, blood pressure may increase.
7. At night, severe coughing attacks are observed, accompanied by suffocation, and increased salivation.

The causes of pain with a hernia of the diaphragm are compression of the nerves and vessels of the stomach when its cardiac part enters the chest cavity, the effect of the acidic contents of the intestines and stomach on the mucous membrane of the esophagus and stretching of its walls.

Pain from a hiatal hernia can be differentiated based on the following symptoms:

• pain appears mainly after eating, physical activity, in a horizontal position, with increased gas formation;
• they soften or disappear after a deep breath, belching, drinking water, changing posture;
• the pain intensifies as a result of bending forward.
• Sometimes the pain can be tingling in nature, resembling pancreatitis.

Typical symptoms of a hiatal hernia also include:

• hiccups;
• heartburn;
• pain in the tongue, burning sensation;
• the appearance of hoarseness.

Contact an ambulance immediately if:

• you feel nauseous
• you were vomiting
• you cannot have a bowel movement or pass gas.

Types of hiatal hernia

There are the following main types of hernias: sliding nutritional hernia (axinal) and fixed (paraesophageal) hernia.

Sliding (axial) hernia

An axial hiatal hernia is a protrusion of organs located below the diaphragm through a natural opening. In the vast majority of cases (approximately 90%) hiatal hernias are axial, or sliding.

With a sliding (axial, axial) hernia, there is free penetration of the abdominal part of the esophagus, cardia and fundus of the stomach through the esophageal opening of the diaphragm into the chest cavity and independent return (when changing body position) back into the abdominal cavity.

An axial hiatal hernia begins to develop with reduced elasticity of muscle connective tissues and weakening of their ligaments. Depending on the area being displaced, they can be cardiac, cardiofundal, subtotal or total gastric.

Axial hernia under the esophagus is characterized by different etiologies. The following etiological factors are distinguished:

• Dysfunction of the digestive system
• Weakness of the ligaments and other connective tissue elements
• High abdominal pressure
• The presence of chronic pathology of the stomach, liver, diseases of the respiratory tract, accompanied by intense cough.

Among all diseases of the digestive system, this pathology ranks third, representing serious “competition” with such pathological conditions as gastric ulcer and.

Fixed hiatal hernia

Fixed (paraesophageal) hiatal hernia is not that common. In this case, part of the stomach is pushed out through the diaphragm and remains there. As a rule, such hernias are not considered a serious disease. However, there is a risk that blood flow to the stomach may be blocked, which can cause serious damage and require immediate medical attention.

Patients with a fixed hernia may experience a symptom such as belching. It appears as a result of air entering the esophagus. Sometimes it gets there with an admixture of bile or gastric juice. In this case, the belching will have a characteristic taste and smell.

Quite often, patients with paraesophageal hernia complain of intense pain in the heart area. This is not surprising, because the pain in the thoracic region that they feel really imitates heart pain.

Degrees of hiatal hernia

It is important to remember that early diagnosis of the disease will help to avoid complications, and treatment will be more effective. In the first stages, you can do without surgery.

1. In the first, mildest degree, a section of the esophagus rises into the chest cavity, which is normally located in the abdominal cavity (abdominal). The size of the hole does not allow the stomach to rise up, it remains in place;
2. In the second degree, the abdominal part of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of ​​the esophageal opening of the diaphragm;
3. Stage 3 hiatal hernia - a significant part of the stomach, sometimes up to its pylorus, which passes into the duodenum, moves into the chest cavity.

Complications

Complications that may occur with hiatal hernia:

• A hiatal hernia may be complicated by the development of gastrointestinal bleeding. The causes of bleeding are peptic ulcers, erosions of the esophagus and stomach.
• Another possible but rare complication of a hiatal hernia is strangulation and perforation of the stomach wall.
• Anemia is a common complication of a hiatal hernia.
• is a natural and frequent complication of hiatal hernia.

Other complications of a hiatal hernia—retrograde prolapse of the gastric mucosa into the esophagus, intussusception of the esophagus into the hernial part—are rare and are diagnosed by fluoroscopy and endoscopy of the esophagus and stomach.

It is quite obvious that in the listed situations of complications of hiatal hernia, the central goal is to treat the underlying disease.

Diagnostics

To make a diagnosis of a hiatal hernia, you need to describe your complaints to the doctor in detail and undergo a series of examinations. Since this disease is sometimes asymptomatic, a hernia can be detected during a random examination for other complaints.

The diagnosis of hiatal hernia is made on the basis of specific complaints and data from instrumental research methods.

1. These include X-ray examination with contrast, endoscopic examination and manometry, which allows you to measure pressure in different parts of the esophagus.
2. Additionally, a general blood test is prescribed to exclude a potential complication of a hernia - gastrointestinal bleeding.
3. When, in addition to a diaphragmatic hernia, a patient has cholelithiasis, he needs to undergo an ultrasound examination of the abdominal cavity.
4. Since a diaphragmatic hernia is often accompanied by symptoms similar to those of heart disease, an additional electrocardiogram will have to be done.

In any case, studies are prescribed individually, taking into account the characteristics of the patient’s body and the collected medical history.

Treatment of hiatal hernia: drugs and surgery

Treatment of diaphragmatic hernia begins with conservative measures. Since in the clinic of hiatal hernia the symptoms of gastroesophageal reflux come to the fore, conservative treatment is aimed mainly at eliminating them.

Based on the pathogenetic mechanisms and clinical symptoms of the esophageal opening of the diaphragm, the following main tasks of its conservative treatment can be formulated:

1. reduction of the aggressive properties of gastric juice and, above all, the content of hydrochloric acid:
2. prevention and limitation of gastroesophageal reflux;
3. local medicinal effect on the inflamed mucous membrane of the esophagus, hernial part of the stomach,
4. reduction or elimination of esophageal and gastric:
5. prevention and limitation of trauma in the hernial orifice of the abdominal segment of the esophagus and the prolapsing part of the stomach.

Drugs for hiatal hernia

Your doctor may prescribe the following medications for you:

• antacids to neutralize stomach acid
• H2-histamine receptor blockers, which reduce acid production
• Proton pump inhibitors (PPIs) are antisecretory drugs for the treatment of acid-related gastric diseases.
• Medicines - proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
• Prokinetics to improve the condition of the mucous membrane of the stomach and esophagus, optimize their motility, relieve nausea, pain (Motilak, Motilium, metoclopramide, Ganaton, itomed, trimebutine).
• B vitamins to accelerate the regeneration of stomach tissue.

As a rule, the treatment of diaphragmatic hernia is 99% identical to the treatment tactics for reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow a special diet, and adhere to all the doctor’s instructions.

Surgery for hiatal hernia

Currently, surgery is the only radical and most effective way to treat hiatal hernia. It is also indicated in the absence of results from drug therapy.

Diaphragm surgery for hiatal hernias is usually planned and performed after careful examination and preparation. Emergency operations are not very often performed for complicated hernias (strangulation, perforation or bleeding from a compressed organ).

Operations for hiatal hernia are carried out in different ways. Nissen fundoplication is gaining popularity. During this operation, a cuff is made from part of the stomach wall, which is fixed around the hole where the diaphragm expanded.

Doctors operate in two ways, such as:

• removal through an open abdominal incision;
• laparoscopy with several small incisions and the use of an endoscope with a camera and optics.

Contraindications for surgery:

• Acute infectious diseases.
• Exacerbations of chronic diseases.
• Heart diseases in the stage of decompensation.
• Severe lung diseases with respiratory failure.
• Uncompensated diabetes mellitus.
• Blood diseases with clotting disorders.
• Kidney and liver failure.
• Pregnancy.
• Oncological diseases.
• Recent abdominal surgery.

In the postoperative period, antibiotics, painkillers are prescribed, and if gastrointestinal motility is impaired, prokinetics (cerucal, motilium) are prescribed. The sutures are removed on the 7th day, after which the patient is discharged from the hospital under the supervision of a gastroenterologist.

In the first months, it is necessary to significantly reduce physical activity associated with active body movements.

The most common complications after surgery to remove a hiatal hernia are:

• relapse of the disease;
• cuff slippage;
• feeling of discomfort in the chest area;
• pain;
• difficulty swallowing;
• inflammatory processes;
• divergence of seams.

The diet after surgery should be liquid and will need to be followed for approximately 3 to 5 days. Clear liquids consist of broth, water or juice. If after 3-5 days the liquid is well tolerated, the diet will switch to a soft diet.

A soft diet consists of foods that are easy to chew and swallow such as foods softened by cooking or pureing, canned or cooked soft fruits and vegetables, or tender meats, fish and poultry. If the soft diet is tolerated for three weeks, then you can switch to a regular diet.

Diet and nutrition

You need to eat food in small portions. There should be 4-5 meals a day. After eating, it is not advisable to rest in a lying position. It's better to sit or even walk. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system.

The diet for hiatal hernia and the menu suggest the introduction of:

• yesterday's bakery products made from wheat flour;
• slimy cereal soups;
• sour-milk cuisine;
• porridge, pasta;
• meat, fish, boiled, baked, steamed;
• oils of vegetable and animal origin.

It is prohibited to use seasonings and sugar in dishes for patients with a diaphragmatic hernia, as this provokes increased acidity of gastric juice and creates risks of injury to the esophagus.

It is necessary to adhere to a dietary diet, namely:

• eat food 5-6 times a day in small portions;
• after eating, do not lie down on the bed for 1 hour;
• dinner should be 2-3 hours before bedtime;
• you can eat grated fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups;
• before meals, drink 1 tablespoon of sunflower or olive oil;
• It is forbidden to eat fried, fatty, salty foods;
• Smoking is prohibited.

How to treat a hiatal hernia with folk remedies

For diaphragmatic hernia, herbal treatment against the background of traditional therapy can improve the patient’s condition as a whole and eliminate symptoms. The recipes described below accelerate the secretion of gastric juice, make food move faster through the esophagus, and also eliminate the causes of constipation.

A simple remedy is goat's milk, which should be drunk warm twice a day after meals. A single quantity is 0.5 cups.

1. Treatment is carried out using a decoction of aspen bark - take a large spoon of the raw material and brew 200 ml of boiling water, infuse and filter. Drink 2 large spoons up to 5 times a day before meals.
2. You can also use branches of young aspen and cherry. They need to be poured with a liter of boiling water and simmered over low heat for half an hour. Then let it cool and take half a glass.
3. No less effective, according to traditional healers, is the most common mint tea. To prepare it, simply add a few dried leaves of the plant to boiling water; you can add sugar to taste (although it is better to abstain if possible). Drink in small sips throughout the day and soon you will forget that you were tormented by pain and heartburn.
4. You can mix flax seed, anise fruit, marshmallow and gentian roots, and fenugreek in equal parts. The components are crushed, mixed, and a small spoon of powder is taken three times a day. It can be mixed with honey.
5. Chamomile decoction is a good remedy for any manifestations of diaphragmatic hernia. It not only soothes the stomach, but also helps improve digestion. An excellent remedy that can safely be called a panacea for all ills.
6. Calendula tea is also effective. It can be brewed with chamomile. This tea should be drunk no more than four times a day, always no earlier than an hour after meals.

People with this disease are advised to follow the following recommendations:

1. Patients must follow a special diet that excludes foods that cause intestinal irritation;
2. Take food in fractional portions every few hours;
3. Avoid bending the body forward, sudden changes in body position - this can cause pain in the sternum and heartburn;
4. Patients should not lift weights exceeding 5 kg
5. You should not tighten your belt too tightly or wear clothes that are tight to your stomach - this creates additional pressure in the abdominal cavity;
6. Avoid heavy physical activity, but at the same time regularly perform physical therapy exercises that strengthen the muscle corset and restore the tone of the diaphragm;
7. It is recommended to eat your last meal no later than 2.5-3 hours before going to bed;
8. Normalize stool - constipation and diarrhea increase intra-abdominal pressure and contribute to the formation of a hiatal hernia.
9. Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil;

Prevention

In addition to the basic measures to prevent gastroenterological diseases (healthy lifestyle, avoidance of stress, proper nutrition), it is necessary to strengthen the muscular wall of the peritoneum - exercise, therapeutic exercises, and pumping up the abs. Patients with a diagnosed hiatal hernia are subject to clinical observation by a gastroenterologist.

The nature of the pain in these very different pathologies can indeed be very similar: according to patients, it is aching or burning, appears behind the sternum or between the shoulder blades, and can be provoked by physical activity.

Pain from hiatal hernia does not disappear when taking nitrates (drugs for rapid pain relief from angina) and is often accompanied by changes in the electrocardiogram.

Therefore, patients often end up in the hospital with suspected acute myocardial infarction. In such a situation, the diagnosis of a hernia is complicated by the fact that until the diagnosis of “infarction” is excluded, endoscopic examination (FGS), which could help in establishing the correct diagnosis, is contraindicated.

There are differences between hiatal hernia symptoms and coronary artery disease symptoms that are important to know.

Differences between pain in hiatal hernia and in ischemic heart disease

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Often, diaphragmatic hernia is diagnosed at the stage of complications. During this period, the patient requires emergency hospitalization with intensive treatment.

Possible complications of a diaphragmatic hernia:

• infringement;
• solar syndrome;
• gastrointestinal bleeding;
• erosions and ulcers of the esophagus;
• organ stenosis;
• wall perforation (formation of a through defect);
• metaplasia of the gastric epithelium (growth of foreign epithelium);
• inflammation of the stomach;
• posthemorrhagic anemia.

A strangulated diaphragmatic hernia is a serious complication of the disease. The gastrointestinal tract organ located in the hernial sac cannot be reduced back. The vascular bundle is pinched, which threatens necrosis of its wall.

Symptoms of infringement:

• severe pain syndrome;
• bloody vomiting;
• shortness of breath, palpitations, drop in blood pressure, pallor;
• the chest is unevenly involved in the act of breathing.

Solar syndrome is an inflammation of the solar plexus. Symptoms:

• burning pain in the solar plexus area, aggravated by palpation;
• The pain is relieved by bending forward.

Bleeding from an ulcer is one of the most dangerous complications. There are chronic and acute blood loss. In the acute version, the patient quickly bleeds out. Chronic is difficult to diagnose, but responds well to therapy.

Congenital hiatal hernias in children are a consequence of abnormal development of the fetus in the early period of pregnancy, when the formation of the organs and systems of the unborn baby occurs.

Incorrect development of the organs of the body’s digestive system also plays a role. In children, congenital hernias are observed in 3 forms:

• esophageal opening of the diaphragm;
• actual diaphragm hernia;
• anterior hernia.

The time at which symptoms of the disease appear and the severity of the pathological process depends on the size of the defect. An anterior hernia most often makes itself felt in the child’s primary school period and rarely in newborns in the first months of life.

Stage 1 hiatal hernia - in the chest cavity (above the diaphragm) there is the abdominal section of the esophagus, and the cardia is at the level of the diaphragm, the stomach is elevated and directly adjacent to the diaphragm.

It is important to remember that early diagnosis of the disease will help to avoid complications, and treatment will be more effective. In the first stages, you can do without surgery.

Congenital diaphragmatic hernia is a severe surgical pathology in which newborns experience a serious health condition that is life-threatening. Prenatal diagnostics allows you to identify the disease in the perinatal period and provide timely medical care to the child immediately after birth.

For this purpose, a pregnant woman is placed in a specialized center.

Anterior hernias are quite rare; their manifestations are noticeable already in the first month of a child’s life.

Hiatal hernias are divided into true and false.

A true hernia is characterized by the formation of a hernial sac, while a false hernia does not have one.

— asymptomatic hiatal hernia;

— hiatal hernia, the course of the pathology during which is caused by cardia insufficiency syndrome;

— Hernias not characterized by the presence of cardia failure syndrome;

— Hernias, which appear as a complication of other types of gastrointestinal diseases (or simply develop against their background);

— paraesophageal hiatal hernia;

— congenital hiatal hernias, characterized by a short esophagus.

Typically, hiatal hernia is treated with medications, but in some cases (especially complications) surgery is required.

As for medication treatment, it consists of reducing stomach acidity (with the help of antacids), as well as reducing gastric secretion. This is the first task.

Also during treatment it is necessary to protect the gastric mucosa, which is also provided when using certain medications.

During treatment, a strict diet is prescribed, which must be adhered to unquestioningly. Basically, this diet is almost the same as for gastritis: nothing fatty, nothing spicy, sour, salty. Only healthy foods, for example, vegetables, fruits, cereals, dietary soups and broths, lean meat.

So, to eliminate heartburn and reduce gastric secretion, you can take the drug “Maalox”. What is very convenient, it is available not only in tablets, but also in the form of gels, dragees, and suspensions.

Each form of this product has separate instructions for use, which can be found in any pharmacy in your city.

You can also take products such as Rennie or Gastal. To eliminate heartburn that has already appeared, it will be enough to take one tablet, and for prevention - 4 tablets per day (an hour after meals). However, remember that these drugs only treat symptoms.

As for surgical intervention, it consists of removing the hernial formation.

For a more accurate diagnosis and treatment, you must consult a doctor (surgeon or gastroenterologist).

Diet and nutrition

There are 3 types of hiatal hernia:

1. Axial hiatal hernia (sliding hiatal hernia), occurring in 90% of patients. With this form, the cardia is located above the esophageal opening of the diaphragm, which causes a change in the relationship between the stomach and the esophagus. There is a sharp disruption of the closure activity of the cardia.
2. Paraesophageal hernia is extremely rare - in approximately 5% of patients. This type of hiatal hernia is characterized by the fact that the cardia is located in its usual position, but the fundus emerges through the enlarged passage and a noticeable curvature of the stomach appears.
3. Short esophagus. One of the rare forms of the disease, which is a developmental anomaly. As a rule, this type of disease is accompanied by a sliding hiatal hernia and is an inflammatory change in the wall of the organ.

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Before delving into the treatment of hiatal hernia, it is necessary to understand what this disease is and examine its characteristic features in more detail.

What is a hiatal hernia has become clear. There are congenital and acquired.

The congenital variant is associated with a disorder at the stage of embryonic development. This type is detected in childhood.

Those acquired in adults develop due to anatomical changes due to age. They are associated with changes in the diameter of the hiatal ring and weakening of the fascia that secures the esophagus.

What causes a hiatal hernia? Let us consider in turn the relationship of various factors and causes with the mechanism of occurrence of such a defect as a hernia in the esophagus.

1. Changes in the diaphragm in the early stages are facilitated by low functional load on the corresponding muscle. We are talking about an insufficiently active lifestyle. Sedentary work or a generally sedentary lifestyle are factors in the development of a hernia.
2. The lowering of the diaphragm is one of the reasons for the development of the hiatal hernia. What this is is described in the article and can be found out from your doctor.
3. Sprain of the fascial diaphragm ligament. This ligament is responsible for the fixed position of the esophageal part.
4. A certain contribution to development is made by the pressure that is present in the chest and abdominal cavity. Its difference becomes one of the factors. The following factors lead to an increase in the latter in the abdominal cavity:

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There are 3 options, which are characterized by corresponding characteristics. 1st degree hernia, what is it? The condition of 1st degree hiatal hernia is characterized by initial changes in the position of parts of the stomach.

Here are the following:

• the lower part opens into the chest cavity;
• the cardia is located at the border between the stomach and the esophagus;
• the remaining parts of the stomach are raised upward.

Stage 2 hiatus, what is it? A grade 2 hiatal hernia is different. It lies in the fact that in the esophageal opening itself there is already some part of the stomach.

Grade 3 is characterized by the location of the stomach above the diaphragm.

Why is a hernia in the esophagus dangerous? Complications of a hiatal hernia can be extremely serious and require emergency care. This includes strangulation of a hiatal hernia.

In this case, that part of the organ that is located in the hernial orifice is infringed. Innervation is disrupted.

If help is not provided in a timely manner, this part of the stomach will begin to become necrotic.

A diaphragmatic hernia is a serious pathology that provokes many symptoms in humans. In medical practice, the disease is usually divided into several types.

Each of them has its own anatomical features and flow patterns. Hiatal hernia is classified according to several criteria.

Sliding

Sliding or, as they are also called, wandering hernias are distinguished by the absence of a hernial sac. The disease is acquired or congenital. This type of pathology has weak signs in the early stages of development; most often the disease is diagnosed by chance when examining other internal organs.

Sliding hernias are characterized by protrusion of part of the stomach into the sternum area. A characteristic sign of pathology is that with certain postures of the patient, organs that have moved beyond the diaphragm fall into place.

Fixed

Fixed (axial) hernias are similar to the previous type, but here parts of the organs do not correct themselves. That is why this type of pathology is called fixed. Often, axial hernias are a complication of vagal hernias.

Axial type food hernia is large. Pathology provokes symptoms that significantly reduce the patient’s quality of life.

Mixed

Symptoms of mixed type esophageal hernia are usually called manifestations of both fixed and sliding types of the disease.

There is a congenital type of pathology and an acquired form. A congenital hernia occurs against the background of a short esophagus with an atypical intrathoracic location of the stomach.

When answering the question of how to treat a hiatal hernia without surgery, due attention should be paid to maintaining proper nutrition during the development of the pathology.

These include:

1. Meals should be small, and you should never overeat.
2. It is forbidden to eat before bedtime. The last meal should be 2-3 hours before going to bed; foods should be low-calorie and easily digestible.
3. It is forbidden to lie down for several hours after eating. The horizontal position increases pressure on the diaphragm.
4. It is not recommended to perform physical activity (squatting, running, bending) after eating.

If a patient is overweight, doctors recommend getting rid of excess weight. You can achieve normal body weight through diet and certain physical exercises.

Alcoholic drinks are strictly contraindicated in case of illness. Alcohol consumption can aggravate the course of the pathology and provoke complications of the disease.

For the normal functioning of the entire digestive system and to avoid exacerbation of hiatal hernia, the patient’s diet should include foods low in fat and carbohydrates. You should avoid sour, spicy, salty foods.

Food is best prepared by boiling, stewing or baking. Permitted products include:

• bananas, apples;
• boiled carrots;
• green peas;
• lean varieties of fish and meat;
• porridge;
• vegetarian soups;
• steamed casseroles and omelettes;
• bread products made from dark flour.

The principle of nutrition during illness is to eat light foods and avoid overeating.

A hiatal hernia provokes disruption of normal digestive processes. To eliminate unnecessary stress on the digestive system, as well as to avoid complications of pathology, the following should be excluded from the diet:

• drinks containing caffeine;
• ice cream;
• tea too hot;
• pickles;
• garlic and leeks;
• carbonated drinks;
• fatty types of meat and fish;
• sweet pastries, baked goods;
• dairy products with a high percentage of fat;
• hot sauces, ketchups, seasonings.

The diet for esophageal hernia does not have a strict framework. The patient's diet can be varied and rich in various dishes. By adhering to simple recommendations, it is possible to eliminate many of the negative consequences of the disease.

1. Heartburn

There are a large number of medical classifications of hiatal hernias. However, most of them are useless for the common man and are used only in medical institutions.

The diaphragm is a kind of muscular frame that separates the chest and abdominal cavity. A hernia is formed when a given anatomical structure fails. The disease causes complex functional changes in the digestive organs.

Therapeutic measures to eliminate the pathological process will depend on the degree of development of the hiatal hernia, the symptoms of its manifestation and complications during the course of the disease. Tactics in the treatment of this pathology include a conservative approach or surgical intervention according to indications.

Conservative therapy

Drug treatment of diaphragmatic hernia is aimed at eliminating pathological symptoms in the manifestation of the disease and alleviating the general condition of the patient.

Typically, conservative treatment is carried out for diaphragmatic hernia of degrees 1 and 2, when the clinical manifestations of the pathology are mild and the hernia is small.

The complex of treatment procedures includes:

• dietary food;
• antispasmodics;
• preparations with enzymes;
• proton pump blockers;
• heartburn relievers.

Treatment is prescribed and carried out only by a specialist under x-ray control and clinical observation of the patient.

Surgical treatment

If the hernia is in the 3rd degree of development, then all the symptoms of dysphagia manifest themselves to a significant extent and the disease is the most severe in terms of clinical manifestations. This degree of diaphragmatic hernia is fraught with life-threatening complications. Therefore, stage 3 hiatal hernia can only be treated surgically.

Surgical intervention is most often performed using the laparoscopic method, which uses the following types of surgery:

• suturing the fundus of the stomach to the wall of the esophagus;
• reducing the diameter of the diaphragmatic hole and fixing it with special surgical material;
• After the stomach is reduced into the abdominal cavity, it is fixed to the abdominal wall.

After surgery, conservative treatment with medications and dietary nutrition is mandatory.

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Traditional medicine methods

In the treatment of diaphragmatic hernia, it is possible to use home recipes after mandatory consultation with a doctor and only as an additional method. Herbal decoctions and infusions for this pathology are used only as remedies to relieve heartburn, belching, constipation, that is, dyspeptic symptoms from the gastrointestinal tract.

Dietary nutrition for diaphragmatic hernia is prescribed for any degree of development of the pathology. A prerequisite for complex treatment is compliance with the following nutritional rules:

• food intake should be fractional, at least 5-6 times a day and in small portions;
• food should enter the stomach in semi-liquid form;
• it is necessary to observe the temperature regime, that is, the food must be warm;
• food processing is carried out only by steaming, boiling, stewing and baking;
• Canned and smoked foods, various pickles and marinades, seasonings, alcohol and carbonated drinks should be excluded from the diet.

In approximately half of cases, hiatal hernia is asymptomatic and is diagnosed by chance. Clinical manifestations appear as the size of the hernial sac increases and the compensatory capabilities of the sphincter mechanism at the border of the stomach and esophagus are exhausted.

As a result, gastroesophageal reflux is observed - the reverse movement of the contents of the stomach and duodenum through the esophagus.

With a large hiatal hernia, reflux esophagitis, or gastroesophageal reflux disease, often develops - inflammation of the walls of the esophagus caused by constant irritation of the mucous membranes with an acidic environment.

The main symptoms of a hiatal hernia are associated with the clinical picture of reflux esophagitis, which is characterized by:

• frequent heartburn and a feeling of bitterness in the mouth;
• hiccups and belching with a sour and bitter taste;
• hoarseness and sore throat;
• thinning of tooth enamel;
• pain in the epigastrium, in the epigastric region and behind the sternum, radiating to the back and interscapular region;
• causeless vomiting without previous nausea, mainly at night;
• difficulty swallowing, especially pronounced when taking liquid food and in stressful situations;
• dyspeptic disorders.

Progressive reflux esophagitis is accompanied by the development of erosive gastritis and the formation of peptic ulcers of the esophagus, causing hidden bleeding in the stomach and lower parts of the esophagus, which lead to anemic syndrome.

Patients complain of weakness, headaches, fatigue and low blood pressure; Blueness of the mucous membranes and nails is often noticeable.

When the hernial sac is pinched, the pain sharply intensifies and takes on a cramping character. At the same time, signs of internal bleeding appear: nausea, vomiting with blood, cyanosis, and a sharp decrease in blood pressure.

About a third of patients with a hiatal hernia have cardiac complaints - retrosternal pain radiating to the scapula and shoulder, shortness of breath and heart rhythm disturbances (paroxysmal tachycardia or extrasystole).

The differential sign of a diaphragmatic hernia in this case is increased pain in a lying position, after eating, when sneezing, coughing, bending forward and passing intestinal gases.

After a deep breath, burping and changing posture, the painful sensations usually subside.

With a small hernia, medical tactics are usually limited to pharmacotherapy of gastroesophageal reflux, aimed at relieving inflammation, normalizing pH, restoring normal motility and mucous membranes of the upper gastrointestinal tract.

The therapeutic regimen includes proton pump inhibitors and histamine receptor blockers; in case of increased acidity, antacids are prescribed - aluminum and magnesium hydroxides, carbonate and magnesium oxide.

The patient must maintain a gentle daily routine, refrain from smoking and alcohol, and avoid stress and excessive physical activity. For severe chest pain, it is recommended to raise the head of the bed.

During treatment, you should adhere to diet No. 1 according to Pevzner. The eating regimen is also important: the daily diet is divided into 5–6 servings; it is important that the last evening meal takes place at least three hours before going to bed.

With low effectiveness of drug therapy, dysplasia of the mucous membranes of the esophagus and complicated course of hiatal hernia, surgery is the best solution.

Depending on the size and location of the hernial sac, the nature of pathological changes in the wall of the esophagus, the presence of complications and concomitant diseases, various methods of surgical treatment of hiatal hernias are used:

• strengthening the esophageal-phrenic ligament – ​​suturing the hernial orifice and hernia repair;
• fundoplication – restoration of an acute angle between the abdominal segment of the esophagus and the fundus of the stomach;
• gastropexy – fixation of the stomach in the abdominal cavity;
• Resection of the esophagus is an extreme measure, which is resorted to in the event of the formation of cicatricial stenosis of the esophagus.

Hiatal hernias are quite common in gastroenterology. The likelihood of developing a diaphragmatic hernia increases with age - from 9% in people under 40 years of age to 69% in people over 70 years of age.

Most often, hiatal hernia occurs in women. Moreover, in half of the cases the disease is asymptomatic and remains unrecognized.

Sometimes patients undergo long-term treatment with a gastroenterologist for concomitant diseases that determine the leading clinical manifestations - chronic gastritis.

cholecystitis. stomach ulcers.

Paraesophageal hernia can be congenital or acquired. A hiatal hernia in children is usually associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age.

About half of cases of hiatal hernia are asymptomatic or accompanied by mild clinical manifestations.

A typical sign of a diaphragmatic hernia is pain, which is usually localized in the epigastrium, spreads along the esophagus, or radiates to the interscapular region and back. Sometimes the pain can be tingling in nature, resembling pancreatitis.

Substernal pain (non-coronary cardialgia) is often observed, which can be mistaken for angina pectoris or myocardial infarction. In a third of patients with hiatal hernia, the leading symptom is a heart rhythm disturbance such as extrasystole or paroxysmal tachycardia.

Often, these manifestations lead to diagnostic errors and long-term unsuccessful treatment by a cardiologist.

To exclude tumors of the esophagus, an endoscopic biopsy of the mucous membrane and a morphological examination of the biopsy specimen are performed. In order to recognize latent bleeding from the gastrointestinal tract, feces are examined for occult blood.

A special place in the diagnosis of hiatal hernia is given to esophageal manometry. allowing to assess the condition of the sphincters (pharyngeal-esophageal and cardiac), the motor function of the esophagus at various levels (duration, amplitude and nature of contractions - spastic or peristaltic), as well as monitor the effectiveness of conservative therapy.

To study the gastrointestinal tract environment, intraesophageal and intragastric pH-metry is performed. gastrocardiomonitoring.

impedancemetry.

The complicated course of a hiatal hernia is associated with the likelihood of developing catarrhal disease. erosive or ulcerative reflux esophagitis; peptic ulcer of the esophagus; esophageal or gastric bleeding; cicatricial stenosis of the esophagus; perforation of the esophagus; strangulated hernia.

reflex angina. With prolonged course of esophagitis, the likelihood of developing esophageal cancer increases.

After surgery, recurrence of hiatal hernia is rare.

Prevention of the formation of a hiatal hernia, first of all, consists of strengthening the abdominal muscles, exercising, treating constipation, and avoiding heavy physical activity. Patients with a diagnosed diaphragmatic hernia are subject to clinical observation by a gastroenterologist.