Hernia of the esophagus but no heartburn as such. Hernia of the esophagus (Hiatal hernia, Diaphragmatic hernia, Paraesophageal hernia)

Among the most serious diseases of the gastrointestinal tract, a hernia of the esophagus occupies one of the leading positions. For a successful cure, it is necessary to conduct a diagnosis in a timely manner, to establish an accurate diagnosis.

The type and methods of rehabilitation are selected depending on the stage of the disease, taking into account the general condition of the patient. In combination with medical and surgical treatment, various recipes for folk healing are allowed. After completion of the treatment course, a sparing diet is prescribed, sports are limited.

Causes

As we initially noted, the appearance of a hernia of the esophagus contributes to a number of reasons. Meanwhile, most often as factors determining their appearance, the following are distinguished:

1. A certain type of endocrinopathy;
2. Simultaneous chronic or, conversely, systematic chronic sudden increase in pressure in the abdominal cavity. The reasons that lead to a pathological increase in pressure are blunt abdominal trauma, severe labor, chronic constipation, significant physical exertion, in which a heavy load is lifted while tilting, etc .;
3. Age-related changes provoked by certain degenerative processes, as a result of which the connective tissue ligaments are thinned;
4. The presence of chronic diseases directly related to the digestive system, in which the motility of the stomach, gallbladder, duodenum is disturbed;
5. The presence of bad habits, as well as old age - these reasons are also defined as factors predisposing to the appearance of a hernia of the esophagus.

Classification

Depending on the characteristics, doctors distinguish several types of pathologies. Each type requires individual treatment. An incorrect diagnosis leads to ineffective treatment, the appearance of concomitant diseases.

1. Sliding (wandering) hernia. The organs that make up the hernial protrusion move to different planes with each change in body position. In this case, a thin sheath of connective tissue (hernial sac) is formed.
2. Paraesophageal (perioesophageal) hernia. The fundus of the stomach, the intestinal loop and the omentum move into the chest cavity.
3. For a mixed hernia, symptoms of a sliding and fixed pathology are characteristic.
4. Congenital hernia. With a congenital pathology of the short esophagus, the cardial gastric section is located in the sternum. The gastric mucosa is located in the distal esophagus.
5. Fixed (axial) hernia. The displacement of the entire stomach or its separate part occurs along the vertical axis. Changing the position does not affect the size, the protrusion is not reduced on its own.

According to the volume of protrusion, the hernia is divided into 3 degrees:

1. Hiatal hernia of the 1st degree - the stomach is slightly raised, a small part of the lower esophagus enters the opening of the diaphragm;
2. Grade 2 is characterized by a slight displacement of the cardia relative to the diaphragm, the entire lower intestine is located in the sternum;
3. At stage 3, the cardia, the lower esophagus, the bottom and body of the stomach create a hernial protrusion.

Symptoms

In 5–50% of cases, these hernias have no clinical manifestations at all; pathology is detected by chance (during ultrasound, abdominal or chest X-ray).

The main symptoms of a hernia of the esophagus:

1. Pain is a clear symptom of a hernia of the esophagus. Most patients are familiar with the pain syndrome, which most often manifests itself when bending over and lying down. Pain can be localized behind the sternum, in the hypochondrium, abdomen, in the region of the heart. Pain is usually aching in nature. After eating, they increase, weaken after belching or deep inspiration.
2. The most common symptom that accompanies almost all known types of disease is heartburn. It can disturb the patient when bending over, after eating, often intensifies at night. Heartburn attacks can be triggered by strenuous exercise, overeating, or drinking too much alcohol. Sometimes the symptom manifests itself in a mild form and does not affect the patient's well-being. There is also a severe degree of heartburn, when it is difficult for the patient to endure a burning sensation in the chest. This condition can be supplemented by flatulence, nausea and an unpleasant aftertaste in the mouth. When the contents of the stomach are in the esophagus, heartburn becomes sour or bitter. All these manifestations affect the psychological and physical health of a person. Sleep is disturbed, the patient loses efficiency and appetite. (Read also: Causes and symptoms of heartburn, how to get rid of heartburn?)
3. In 35% of patients diagnosed with a hernia of the esophagus, regurgitation is observed. The reasons are the same: eating, tilting, horizontal position. This symptom is typical for formations of medium size and causes a lot of inconvenience. Ingoda, the volumes of vomit are quite large, so the patient has to stock up and carry special containers for vomit.
4. Common symptoms that accompany esophageal hernia include dysphagia or swallowing disorders. This phenomenon can be provoked by haste in the absorption of food, too hot (cold) drinks, neurogenic factors. Dysphagia may be rare or may become permanent. This is usually associated with the addition of complications. With an exacerbation of the disease, complete or partial obstruction of the food consumed is possible. This symptom usually accompanies heartburn. When filling the esophagus, the patient simply cannot swallow food. These unpleasant difficulties cause anxiety and nervousness. Over time, the discomfort increases, which can lead to refusal to eat and serious consequences.
5. Belching. This symptom can be caused by spasms of the alimentary canal, active work of the stomach and increased intra-abdominal pressure. Involuntary release of air can appear during conversations and eating. Often an attack is accompanied by a characteristic sound and smell. When belching, not only air can be released, but also the contents of the stomach. Taking antispasmodics, which some patients use to relieve a symptom, rarely brings relief, so patients often belch on their own, thereby relieving themselves of discomfort. (See also: Causes and types of belching after eating).

Depending on the type of hernia, clinical manifestations may differ. With a sliding hernial formation of the esophagus, the protrusion goes into the hernial sac. Signs of the disease appear only when the contents of the stomach enter the esophagus. In medicine, this phenomenon is defined by the concept of "gastroesophageal reflux". The patient may be disturbed by heartburn and pain between the ribs, there are frequent belching and regurgitation.

Complications

The disease sometimes leads to a number of complications, and this will not depend on the classifications and causes of its origin. This hernia may be accompanied by esophageal bleeding, the passage of the esophagus into the so-called "hernial sac" or the gastric mucosa, inflammation of the gastric mucosa, shortening of the esophagus, strangulation of the hernia (here surgery will be inevitable).

A strangulated hernia of the esophagus is characterized by increased pain, bloating and strong tension of the abdominal walls, the appearance of prolonged, uncontrolled vomiting. In such a case, emergency suturing of the diaphragmatic opening to a normal size is performed after the esophagus is repositioned into the abdominal cavity.

Diagnostics

The first step in diagnosing a diaphragmatic hernia is to look for the patient's characteristic symptoms and possible causes. After that, it is necessary to proceed to a direct examination, in which the following signs of the disease can be detected:

1. Palpation of the abdomen (palpation) - it becomes dense in the upper sections of the abdominal wall, due to strong muscle tension. It is also possible the appearance of pain on palpation;
2. Inspection - with a hernia of the esophagus, the chest practically does not move during breathing, due to impaired diaphragm function. If a person suffers from this pathology for a long time, the stomach becomes "hollow". This symptom may not be observed in overweight people;
3. Auscultation (listening with a phonendoscope) - a characteristic sign of a diaphragmatic hernia is the appearance of intestinal noise in the chest cavity. The normal sound of breathing is usually absent or significantly reduced.

The above signs are enough to suggest a diagnosis. However, it is possible to reliably confirm the presence of a hernia of the esophagus only with the help of instrumental diagnostic methods.

Treatment Methods

How to treat a hernia of the esophagus is decided jointly by a gastroenterologist and an abdominal surgeon. To draw up the correct method of therapy, the type and features of the pathology are important (sliding or fixed hernia, whether there is an organ infringement).

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

• diet,
• taking medication,
• folk methods.

With the following complications resort to surgical intervention:

• infringement of a hernia;
• bleeding;
• the introduction of one organ of a hernia into another;
• a large number of organs got into the chest cavity, and they squeeze the heart.

In other cases, the operation is performed as planned (the term is not limited, but it is recommended within a few weeks) in a specialized department of "thoracic surgery".

Medical treatment

Treatment of hiatal hernia without surgery, that is, with the help of medication, is justified with moderate symptoms or in advanced stages as a preparatory stage before surgical treatment.

For the treatment of esophagitis with a hernia, 3 main groups of drugs are used:

• Antisecretory drugs - blockers of the proton pump, histamine receptors.
• Antacids.
• Prokinetic drugs.

Gastroenterologists around the world have recognized the use of proton channel blockers as the gold standard in the treatment of inflammation of the esophagus and stomach. These are omeprazole, rameprazole, lansoprazole. The remedies are very effective with minimal side effects. They reduce the aggression of gastric contents and promote the regeneration of the mucosa.

Antacids are an emergency remedy for severe heartburn and do not require systemic use. Prokinetics - metoclopramide - treat the dysmotility underlying the appearance of hernia and peptic esophagitis. The course of use is no more than a month.

Preparing for a planned operation

Before surgical treatment, the anesthesiologist / surgeon asks the patient in detail about his state of health, the presence of allergies, past blood transfusions, etc. The patient is assigned a number of studies that will assess the functions of the main organs: general blood and urine tests, biochemical analysis of venous blood, acid-base status, ECG.

If necessary, the patient's condition is somewhat improved (pressure, heart activity, respiratory function, etc. are stabilized). Immediately before the operation, the intestines are cleansed (if there is no infringement of the hernia of the esophagus), the bladder is catheterized and the necessary medications are administered.

Surgery for a hernia of the esophagus

There are different methods of surgical intervention:

1. Operation Belsey. It is performed if the hernia is large. It is performed through an incision in the sixth intercostal space, on the left side of the sternum. The essence of the operation is that the lower part of the esophagus and the esophageal sphincter is attached to the diaphragm.
2. Fundoplication according to Nissen. One of the most common operations. It is performed using laparoscopic technique or open method. In this case, the upper third of the stomach is wrapped around the esophagus. This "cuff" prevents the contents of the stomach from entering the esophagus.
3. Allison method. The incision is made in the seventh and eighth intercostal space. At the same time, the hernial ring is sutured.
4. Gastrocardiopexy. It is carried out through an incision above the navel, along the midline of the abdomen. The upper third of the stomach and esophagus are sutured to the subdiaragmatic structures.

The purpose of the surgical intervention is to restore the anatomical structure of the esophagus and create an anti-reflux mechanism that will prevent the reflux of gastric contents.

Diet

The main goal of the diet for a hernia of the esophageal opening of the diaphragm is the fight against heartburn. Nutrition recommendations:

• It is better to eat during the day often, in small portions.
• Avoid foods that cause heartburn, such as chocolate, onions, spicy foods, citrus fruits, and tomato-based foods.
• Avoid alcohol.
• The last meal should be no later than 2-3 hours before bedtime.
• Maintain a healthy weight. You need to lose weight if you are overweight or obese.
• Quit smoking.
• Raise the head end of your bed so that it is 15 cm above the foot end.

Allowed products:

• Sweets - honey, jelly, jelly, dried fruits.
• Bread can only be eaten dried.
• Porridge should be viscous and mashed. Vegetable dishes only from boiled products.
• Spices that help reduce bloating and improve digestion - cumin, dill, fennel, rosemary, thyme.
• You can drink special or green tea, natural sweet juices.
• Dairy products - cottage cheese, one-day kefir. Meat and fish should be steamed or boiled.

Prohibited Products:

• Fried, spicy, spicy foods, sweet pastries, confectionery increase the level of acidity. Citrus fruits, sour berries, bananas have the same properties.
• From the diet, it is necessary to exclude products that provoke flatulence - cabbage, legumes, whole milk, kvass and yeast dough products.
• Products with a high content of fiber and connective tissues - radish, hard fruits, sinewy meat, cartilage.
• Pasta, semolina, peeled rice, walnuts are foods that cause constipation.
• Pickled, salty products, too hot and cold food irritate the gastric mucosa.

Proper nutrition is an integral part of the complex of therapeutic measures. For the smooth passage of food, you need to eat often, regularly, in small portions. Food should be soft, ground, thermally processed.

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Diseases of the digestive system in our time have reached such a prevalence that it is customary to talk about them as often as about colds or allergies. At the same time, diseases of the stomach and intestines are taken into account, and we forget about such an important organ as the esophagus - a muscular tube through which food enters from the oral cavity to the stomach. It would seem that something threatens her, except perhaps too spicy or sour food, which passes in passing. However, for some reason, even in the area of ​​​​this organ, a hernia can form, which, if left untreated, can develop into cancer or cause inflammation in the stomach. It is difficult to insure against this pathology, therefore it is useful for everyone to know the symptoms of a hernia of the esophagus in order to seek help from doctors in time to help stop the development of the disease and its complications.

What is a hernia of the esophagus?

Before starting to consider the symptoms of the disease, let's briefly mention what a hernia of the esophagus is and what are the reasons for its appearance. Our body is a strictly structured system, where each organ has its own place, and any changes in location are considered as a pathology (congenital or acquired). The abdominal and thoracic cavities have a common border along which lies a muscular plate called the diaphragm.

The stomach and almost all other digestive organs, with the exception of the upper part of the esophagus, are located under the diaphragm. And in order for food to pass through the esophageal tube into the lumen of the stomach, a hole of a small diameter is provided in the muscle plate.

The lower part of the esophagus, like the stomach or intestines, is located under the muscular plate, and normally never protrudes into the thoracic region. If the lower part of the esophagus, some sections of the stomach or even the intestines are found in the thoracic region above the diaphragm, they speak of a hernia. The diagnosis may sound like "hernia of the esophagus" or "hernia of the esophageal opening of the diaphragm."

The causes of this pathology can lie both in the malformations of the child in the prenatal period (a shortened esophagus or the so-called “thoracic” stomach), and in age-related changes in the tone of the ligamentous apparatus, which should not allow displacement of organs (the disease most often affects people over the age of 50-60 years). But the displacement of organs, even with a healthy ligamentous apparatus, can cause increased intra-abdominal pressure. The cause of increased pressure in the abdominal cavity can be pregnancy, chronic flatulence or severe bloating due to intense gas in the intestines, trauma and extensive tumor processes.

The displacement of the digestive tract relative to the diaphragm can also be caused by some pathologies accompanied by indomitable vomiting or a severe painful cough (for example, food poisoning or obstructive bronchitis). Chronic inflammatory and ulcerative diseases of the gastrointestinal tract are often characterized by a decrease in peristalsis of individual structures of the digestive system, and dyskinesia is considered a risk factor for hernia formation, i.e. displacement of organs relative to their normal position.

Improper arrangement of organs, due to which the process of digestion of food is disturbed, and the contents of the stomach can enter the esophagus, causes the symptoms of a hernia of the esophagus characteristic of the pathology. If the size of the hernia is small, then it may not bring much discomfort to a person. In this case, we are talking about an asymptomatic course of the disease. But with an increase in the hernia, discomfort also appears, which we will discuss in more detail in the next section.

How does a hernia of the esophagus manifest itself?

The distal part of the esophagus, the cardia of the stomach, and sometimes even intestinal loops can protrude beyond the abdominal cavity through the gap in the diaphragm. It is clear that in these cases not only the appearance and size of the hernia will differ, but also its symptoms. With a slight bulging of the lower esophagus, symptoms may not be observed at all, because such a pathology does not affect the process of digestion.

But if the stomach or intestines begin to protrude into the chest cavity through the hole in the diaphragm, the symptoms will not slow down to appear. After all, gastric juice, bile and other digestive enzymes in this case can be thrown back into the esophagus, as in reflux disease. But this body is not designed for contact with such irritating factors, because it does not have special protection. Regular casting of caustic substances worsens the condition of its walls, causing pain and other unpleasant symptoms.

First, the sphincter of the stomach suffers, which ceases to perform its functions and passes the contents of the stomach back into the esophagus, and then the irritation of the walls of the esophagus by gastric enzymes causes their inflammation. Gradually, the inflammatory process can spread to other organs of the digestive system.

Pains and their nature. Since there is irritation of the walls of the esophagus, and later on the stomach, the person begins to experience pain. How does an esophageal hernia hurt? The pain syndrome depends on the type and size of the hernia. If the hernia is small (esophageal or cardiac, when only the lower part of the esophagus or a small part of the upper, cardial part of the stomach protrudes into the sternum), there may be no pain at all, as well as other symptoms of pathology. In this case, diseases are detected by chance during fibrogastroscopy or ultrasound, after which the behavior of the hernia is monitored.

If the hernia is of considerable size, but the sphincter of the stomach is still functioning normally and does not allow the return of food into the esophagus, the patient will be tormented by aching pains that can become stronger after eating. Relief occurs in connection with a deep breath or discharge of air from the gastrointestinal tract (belching).

If the locking mechanisms at the junction of the esophagus and stomach are damaged, and reflux is observed (cardia insufficiency syndrome is diagnosed), the pains become sharp, burning. They are directly dependent on food intake and the position of the patient's body. The pain becomes worse when lying down (horizontal) or while bending forward. An identical situation is observed after eating when the contents of the stomach are thrown into the esophagus.

The localization of pain is somewhat blurred. This may be the area of ​​​​the epigastrium and chest. Pain behind the sternum can resemble heart pain, in addition, they can be removed with the same nitroglycerin. Intercostal pain and pain in the abdominal cavity may suggest pathologies of the stomach and liver. Sometimes the pain radiates to the back between the shoulder blades, which makes diagnosis even more difficult.

When partially digested food with gastric enzymes is thrown into the esophagus, it can rise higher to the throat. At the same time, patients begin to complain of burning and sore throat caused by the irritating effect of gastric juice. Some even have a slight cough, while the temperature against the background of the inflammatory process in the upper gastrointestinal tract with a hernia of the esophagus can rise to 37-37.5 degrees, which suggests a cold.

Dysphagia and lump in throat. The irritant effect of the acid in the gastric juice and the pain caused by the squeezing of the hernia can lead to difficulty in eating. With a hernia of the esophagus, patients note such a symptom as a lump in the throat, or rather the feeling of some obstacle in the way of food. In fact, we are talking about a nervous reaction that causes a spasm of the esophagus. It is the feeling of a lump along the esophageal tube that leads to pain between the shoulder blades and in the region of the heart, radiating to the shoulder, as in angina pectoris.

Almost half of patients with large axial hernia have a condition such as dysphagia, i.e. difficulty swallowing. An important point is the fact that it is easier for patients to swallow solid food than liquid or semi-liquid. Dysphagia can occur against the background of nervous experiences, eating too cold or hot food, rushing while eating. An increase or infringement of a hernia of the esophagus leads to the fact that spasms do not appear situationally, but on an ongoing basis, which leads to an unpleasant sensation of a lump in the throat even outside the meal or during the use of solid foods that have to be “pushed” by the liquid.

Dyspepsia. One of the most common symptoms of a hiatal hernia is heartburn. The frequency of this symptom in axial hernia, which is considered the most common and is characterized by protrusion of the esophagus and the cardial part of the stomach, is even greater than that of pain. The appearance of this symptom is most often associated with food intake, although with physical activity and a sharp change in body position, it can also remind of itself on an empty stomach.

At night, heartburn with a hernia of the esophagus appears even more often than during the day or in the morning. This is associated with an increase in the tone of the vagus nerve during this period, going from the brain to the abdominal cavity, and a general relaxation of the body and, in particular, the sphincter at the border of the stomach and esophagus, which is called the lower esophageal sphincter.

The intensity of the manifestation of the symptom varies. In most cases, we are talking about a mild form, the fight against which is successfully carried out through antacid preparations. But sometimes heartburn can be so severe that it deprives a person of sleep and rest, and a strong painful burning sensation in the chest interferes with work, negatively affects well-being, mood and appetite.

The strength of heartburn is determined not so much by the size of the hernia as by the characteristics of the gastric juice (increased, normal or low acidity of the stomach), the ingress of bile from the duodenal region into the esophagus, the force of stretching of the esophagus during reflux (the amount of food thrown, associated with the work of the lower esophageal sphincter).

During heartburn, a person may feel a sour or bitter taste in the mouth, characteristic of the contents of the stomach and duodenum. He may experience nausea and bloating. The last symptom is not directly related to heartburn, although it often occurs in combination with it. Patients who do not have severe pain often complain of flatulence, but only slight discomfort and a feeling of squeezing in the epigastrium are noted.

Another problem with a hernia of the esophagus is belching, and we can talk about both belching with air and regurgitation of food, up to vomiting. The feeling of bloating does not appear in patients by chance. It is associated with increased intra-abdominal pressure due to compression of the stomach in the opening of the diaphragm, while sometimes spasmodic contractions of the esophagus can occur and lead to belching, i.e. involuntary release of air, and sometimes food. Belching can occur both during and after eating, accompanied by a specific sound, which is another reason for psychological discomfort in patients, especially since the use of antispasmodics in this case does not give the desired result.

It must be said that the eructation itself, despite the unaesthetic nature of its manifestations, in a sense benefits the patients, alleviating their condition. Belching usually relieves pain and heartburn. Therefore, it is not surprising that patients often provoke belching on their own, swallowing a large amount of air and trying to push it out of the esophagus by force.

Belching food is most often observed immediately after eating or during the adoption of a horizontal position, and sometimes with sharp inclinations. The amount of regurgitated food may be different, depending on the performance of the esophageal sphincter. With a greatly reduced tone, it can even reach a single vomiting. At the same time, such a symptom as nausea does not accompany belching, regardless of its strength.

A small percentage of patients also complain of hiccups, which torment them for several weeks and even months. Usually, the onset of a symptom is associated with food intake and is determined by convulsive contractions of the diaphragm, for which the hernial sac is an irritant. The ongoing treatment has no effect on the severity and frequency of hiccups.

The clinical picture of a hernia of the esophagus, depending on the degree and nature of the pathology

A hernia of the esophageal opening of the diaphragm is a generalized concept, because pathology can have various forms of course and degree of development, depending on which the clinical picture of the disease also changes. So it is customary to distinguish between floating and fixed hernia of the esophagus. The latter is considered a rarer, but at the same time more dangerous pathology, which is characterized by frequent complications in the form of strangulated hernia, perforations of the esophageal tube and bleeding from the gastrointestinal tract, disorders in the heart, and an increased risk of oncology of the esophagus.

A floating hernia of the esophagus (it is also called a sliding or axial hernia) is a protrusion into the chest cavity of the distal part of the esophagus and some part of the stomach. Sometimes almost the entire stomach can fall into the hole, which indicates a large hernia that compresses the chest organs (lungs, heart), causing disruption of their work and corresponding symptoms in the form of cough and heart pain.

Stretching of the diaphragmatic opening, which enters the esophagus, is controlled by the esophagophrenic ligament. With a decrease in its tone and degenerative processes, manifested in the form of thinning of dense connective tissue, the hole in the diaphragm may increase. With increased intra-abdominal pressure, pregnancy, obesity, age-related changes, congenital defects of the diaphragmatic opening, the cardial part of the stomach can shift upward relative to the diaphragmatic opening, thereby forming a hernia.

A floating hernia of the esophagus is said when, with a change in body position and physical exertion, the stomach, together with the esophagus, can move in the opening of the diaphragm. Thus, they either protrude into the thoracic region, or return to their place in the abdominal cavity. With a small hernia and the normal functioning of the sphincter, the sliding variant of the pathology is asymptomatic. But in violation of the tone of the lower esophageal sphincter, there is a reflux of the contents of the stomach into the esophagus (gastroesophageal reflux), which is accompanied by belching, heartburn, pain, burning sensation behind the sternum. There is a clear connection between the emerging unpleasant symptoms with food intake (especially plentiful) and a change in body position, on which the displacement of the esophagus and stomach cardia depends. Infringement of a hernia of the esophagus of this nature is not observed.

With a fixed hernia, which is often called paraesophageal, the middle and lower parts of the stomach and even the duodenum can protrude into the chest cavity, while the position of the esophagus remains fixed. That is, a hernia is formed not along the esophagus, but next to it, and it does not tend to change its size and position. But when the position of the body changes, the hernia can be compressed (infringed), which is fraught with overstretching of the walls of the protruding part of the stomach and their rupture. In this case, there is an accumulation of fluid in the pleural cavity, severe acute pain and signs of blood poisoning appear.

The most characteristic symptoms for this type of pathology are pressing pain in the pit of the stomach and a feeling of heaviness that appears after a heavy meal, which causes patients to limit the amount of food, belching, regurgitation of food and vomiting. Violation of the movement of food from the stomach to the intestines provokes the development of a peptic ulcer, which is complicated by perforation of the stomach tissues and active hemorrhages. With a sliding hernia, hemorrhages occur in the esophagus, but they are minor and do not appear outwardly.

Reflux with a fixed hernia is not observed, heartburn is rare. True, in the case of a combined hernia, the appearance of such symptoms is not excluded.

Symptoms of a hernia of the esophagus may vary depending on the degree of development of the disease, because this pathology is considered progressive, especially if it is caused by age-related changes that negatively affect the tone of the ligaments of the diaphragmatic opening and the lower esophageal sphincter. Each of the 3 stages of the development of the disease has its own symptoms, but it is difficult to determine the exact diagnosis only for them without an instrumental examination.

A hernia of the esophagus of the 1st degree is the initial period of the disease, when the lower part of the esophageal tube penetrates into the hole, and the stomach remains on the other side of the diaphragmatic plate, tightly adhering to it and forming a kind of dome. Usually at this stage of the disease, patients rarely complain of any symptoms of malaise. Some discomfort and mild epigastric pain may be mentioned.

The initial degree of hernia development is detected by chance during the instrumental diagnosis of other diseases. It is impossible to detect it by palpation. But the treatment of this pathology usually comes down to following a special diet and observing the behavior of the digestive organs.

A hernia of the esophagus of the 2nd degree is characterized by penetration into the thoracic part of not only the distal esophagus, but also the lower esophageal sphincter, as well as a small part of the stomach. Symptoms of pathology begin to manifest themselves more clearly. Patients complain of pain behind the sternum or in the epigastrium, discomfort (a feeling of squeezing or fullness), the appearance of belching and burning in the chest area. A little later, there is a feeling of a food lump, a violation of the swallowing process, heartburn (with a sliding hernia).

Treatment of the second stage of the disease, in addition to diet, involves medication: taking antispasmodics, enzyme preparations, antacids and drugs that reduce the production of hydrochloric acid.

Hernia of the esophagus 3 degrees- this is not only an unpleasant, but also a dangerous pathology, which is fraught with various complications. In this case, a significant part of the stomach, and sometimes intestinal loops, is displaced into the sternum, which leads to a violation of the digestion process. In addition to the symptoms described above, patients complain of severe heaviness in the stomach after eating, a lump in the throat, severe pain in the chest, frequent belching of air, and sometimes spitting up food. Patients with combined hiatal hernia complain of heartburn attacks.

Diet and conservative treatment in this case are relevant only after surgical intervention (laparoscopic surgery to return the digestive organs to the abdominal cavity and suture the diaphragmatic opening, antireflux operations - fundoplication).

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Esophageal hernia in children and pregnant women

Hiatus hernia is considered by many to be an age-related disease due to the fact that this pathology is diagnosed in most cases in people over 50 years of age. Yes, a decrease in the tone of the esophageal opening can be facilitated by a metabolic disorder in the muscle and connective tissues caused by diseases accumulated over many years of life, and the chronic course of ulcerative inflammatory pathologies of the gastrointestinal tract. But according to statistics, there is a certain percentage of morbidity caused by congenital anomalies or temporary conditions that lead to an increase in intra-abdominal pressure, which is already higher than chest pressure.

A hernia of the esophagus in a child, as in an adult, is a pathology characterized by a displacement of the digestive tract from the abdominal cavity to the chest. But unlike adults, we are talking about a congenital pathology, and not an acquired disease, so the symptoms of a hernia of the esophagus in children can be observed already in the first days of their life.

Pathology is usually diagnosed already at an early age, it is not typical for adolescents (congenital pathology reminds of itself much earlier, and it is still too early for an acquired one). A hernia of the esophagus in infants can occur due to insufficient length of the esophageal tube or congenital weakness of the diaphragmatic opening, the causes of which lie even in the prenatal period of the child's development.

At a later age, the cause of a hernia of the esophagus can be an injury that led to an increase in intra-abdominal pressure, frequent hysterical crying, diseases that occur with a prolonged painful cough, overfeeding and obesity, a tendency to constipation, excessive physical activity (for example, lifting heavy objects).

The clinical picture of a hernia of the esophagus in young children includes persistent vomiting and regurgitation after eating. With congenital pathology, these symptoms remind of themselves already during the first month, and conceived even in the first week of the baby's life. It is not possible to stop the symptoms with medications, which gives reason to suspect the organic nature of digestive disorders, not related to the nature and amount of food.

In some cases, doctors diagnose hemorrhagic syndrome. Its symptoms are bloody vomiting and the presence of blood in the baby's stool. Blood loss leads to tissue cyanosis and the development of anemia, which are considered one of the signs of pathology in an infant who cannot yet tell about pain in the abdomen or chest.

Doctors associate pain behind the sternum, which older children complain about, and tissue cyanosis with developing reflux esophagitis (irritation and damage to the esophageal mucosa due to reflux of the acidic contents of their stomach), as well as with partial infringement of the hernia.

Unpleasant sensations after eating in a child can cause a deterioration in appetite or refusal to eat, which only aggravates the course of anemia. Vomiting may be accompanied by swallowing disorders and the development of aspiration pneumonia, i.e. inflammation of the lungs caused by food particles entering the respiratory tract. With a large hernia, the symmetry of the chest may even be disturbed due to the appearance of an unusual protrusion.

Nutritional and respiratory disorders due to aspiration pneumonia lead to the fact that the child begins to lag behind his peers in development. After eating, such children may experience shortness of breath, the pulse quickens, which indicates squeezing and disruption of the cardiovascular and respiratory systems.

The severity of symptoms in children can vary, so the disease is not always diagnosed at an early stage. The fact is that reflux and regurgitation in the first months of life are considered normal, which means that in the absence of vomiting and frequent belching, parents and doctors may not attach due importance to these symptoms, especially since esophageal hernia is diagnosed very rarely in childhood. Anxiety appears when the child himself declares that he has a burning sensation in his throat and a pain in his chest. In the best case, the disease is detected by chance and it will be possible to stop its progression in time.

Hernia of the esophagus during pregnancy is not so rare, however, in many cases it occurs without pronounced symptoms, so it can be seen after childbirth. Pregnancy itself becomes a risk factor for the development of a hernia due to a decrease in the tone of the diaphragmatic plate and the lower esophageal sphincter (hormonal changes affect metabolism and tissue characteristics), an increase in intra-abdominal pressure as the baby develops and an increase in the uterus in size, toxicosis of pregnant women, which accompanied by vomiting and the development of reflex esophagus spasm.

True, a hernia of the esophagus does not appear in all pregnant and giving birth women. At risk are women over 30 who have more than one pregnancy and childbirth behind them.

Symptoms of a hernia of the esophagus in pregnant women do not differ from those in other groups of the adult population. They can also be tormented by heartburn and belching, pain behind the sternum and in the upper abdomen, swallowing disorders, regurgitation of food. Some also note increased salivation due to irritation of food receptors in the mouth by the acidic contents of the stomach that enter there. With a hernia of the esophagus and frequent vomiting caused by early toxicosis, women note that their voice becomes hoarse, and the mucous membrane of the tongue becomes painful.

Toxicosis and vomiting in the early stages in pregnant women is not new, and this symptom usually has nothing to do with a hernia of the esophagus. But frequent vomiting in the last trimester of pregnancy can be one of the obvious symptoms of a hernia. Anemia for more than 4 months may also indicate the development of pathology.

Axial hernia of the esophagus, characterized by a benign course and not prone to infringement, is treated during pregnancy by conservative methods and is not an obstacle to independent childbirth. But a fixed hernia poses a danger to the life of the mother and fetus, requires special control over the course of the disease and involves a caesarean section. After all, during childbirth, at high pressure inside the peritoneum, its infringement can occur, accompanied by sharp pains up to loss of consciousness.

Diagnosis of a hernia of the esophagus

As we have already managed to understand, the symptoms of a hernia of the esophagus are not particularly specific. Those who have diseases such as gastritis, pancreatitis, stomach ulcers and some others can say that all of the above symptoms are familiar to them. Moreover, many patients who have a hernia and have not consulted a gastroenterologist, who first prescribes diagnostic studies, and then, based on their results, makes a final diagnosis, independently treat a non-existent pathology, diagnosing the same gastritis or stomach ulcer, and sometimes even heart and lung disease.

Diagnosing a hernia of the esophageal opening of the diaphragm by external manifestations alone is a thankless task, since the symptoms of this pathology are characteristic of most diseases of the gastrointestinal tract. Questioning the patient and ordering standard blood and urine tests can only nudge the doctor in the right direction.

The doctor pays attention to any of the symptoms listed below, but if they are present in the complex, this clearly indicates the existing pathology of the digestive system:

• Dull, aching or sharp pains in the upper abdomen and chest, changing their intensity with a change in body position and depending on food intake.
• The appearance of excruciating heartburn, which is present for a long time, a burning sensation behind the sternum.
• Regularly repeated belching of air and food, regurgitation after a heavy meal or bending forward.
• Frequent episodes of hiccups lasting several minutes.
• The appearance of pain and burning in the throat and tongue, a change in the timbre of the voice, coughing, not associated with colds and heart pathologies.

Any of these symptoms may indicate ill health, but it is impossible to say what kind of disease it is, and even if the entire symptom complex is present, it is impossible to say with certainty that we are dealing with a hernia of the esophagus. And since the reason for the change in the patient's well-being lies inside the body, doctors place the main emphasis on instrumental diagnostics, which makes it possible to examine internal structures hidden from the eye.

The standard diagnostic study for a hernia of the esophagus and many other pathologies of the gastrointestinal tract is gastroscopy. Fibrogastroduodenoscopy (abbreviated FGDS) is a study of the esophagus, stomach and part of the duodenum from the inside, by inserting a flexible tube with a mini-camera at the end through the patient's mouth. In other words, this is a low-traumatic endoscopic examination, which allows, without making incisions, to see the state of the internal surfaces of the digestive organs, to identify inflammatory and erosive-ulcerative processes in them.

FGDS allows you to visually assess the condition of the mucosa, changes in the shape of the stomach and esophagus, their size, and contractile function. What signs during EGD help to suspect a hernia of the esophagus:

• Insufficient length of the esophagus, which in adults ranges from 23 to 30 cm, a decrease in the size of its abdominal region and the distance from the lower incisors to the cardia of the stomach.
• The presence of foci of stenosis of the esophagus and stomach and hernial cavity.
• Poor functioning of the lower esophageal sphincter, which does not close completely or contracts inactively.
• Reflux of stomach contents into the lumen of the esophagus and the resulting uneven surface of the mucous membrane of the lower part of the esophagus.
• Change in the size and severity of the angle between the esophagus and the wall of the stomach (the angle of His increases and smoothes).
• Small expression of the folds of the stomach at the confluence of its connection with the esophagus.
• Increased acidity of gastric juice, which doctors also have the opportunity to measure during FGDS.
• The appearance in the epithelial cover of the esophagus of an uncharacteristic cylindrical epithelium, which is present in the intestinal mucosa (Barrett's esophagus or Barrett's metaplasia - a precancerous condition caused by gastroesophageal reflux, which chronically occurs with a hernia of the esophagus).

All of the above points may indicate a hernia of the diaphragmatic opening of the esophagus only indirectly, but they are the reason for the appointment of a more detailed examination. The change in the position of the digestive organs relative to the diaphragmatic plate can be seen and evaluated using x-rays.

X-rays are mandatory for patients with suspected esophageal hernia, because it is this study that allows diagnosing this pathology with great accuracy and differentiating it from stenosis, stomach ulcers, short esophagus, reflux disease, etc.

Usually, doctors prefer conventional radiography, but since the soft tissues that make up the digestive organs are less visible on an x-ray than hard ones, the study is performed with contrast (barium sulfate usually acts as a contrast agent).

Axial hernia during fluoroscopy is detected with great accuracy, since the shift of the esophagus and stomach upwards is clearly visible in the picture, while the lower part of the esophagus, the cardia of the stomach, and sometimes the entire stomach are above the diaphragm. Even with a plain chest x-ray, a bright spot in the posterior mediastinal region can be seen in the shadow of the heart. After the introduction of contrast, fluoroscopy in the supine position with increased intra-abdominal pressure with a hernia of the esophagus will show the reflux of a barium compound into the esophagus from the stomach cavity, thickening of the gastric fornix, a change in the angle of His, and displacement of the esophagus at the time of inspiration by more than three centimeters.

In a less common fixed hernia of the esophagus, conventional radiography is uninformative. In this case, to clarify the diagnosis, a tomogram (computer or magnetic resonance) may be prescribed. CT of a hernia of the esophagus allows you to recreate a three-dimensional image of the organs of the gastrointestinal tract, using all the same x-rays and contrast, so it is prescribed for a controversial diagnosis or if there are questions that cannot be resolved with a conventional x-ray.

Most often, a hernia is diagnosed by chance during a CT scan of the chest or abdomen. At the same time, protrusions of the gastrointestinal tract into the chest, an increase in the opening of the diaphragm, the presence of an omentum in the area of ​​the hernial sac with a fixed hernia, an “inverted stomach” protruding into the chest (viewed in a three-dimensional image) are detected.

MRI of a hernia of the esophagus is also not a fairly popular diagnostic study. Sometimes it simply does not make sense to conduct an expensive diagnosis if the problem is detected during budgetary studies such as x-rays of the esophagus. Nevertheless, it must be said that with magnetic resonance imaging, soft tissues are visualized better than with x-rays and CT scans, and the study itself is considered safer.

Ultrasound of the esophagus and stomach with a hernia of the esophageal opening of the diaphragm is not a sufficient study, although it makes it possible to suspect this disease in a patient. The final diagnosis can only be made after an x-ray, CT or MRI of the stomach and esophagus.

With fixed hernias of the esophagus, it is also necessary to study such as pH-metry, which allows to assess the frequency and characteristics of the reflux of the contents of the stomach into the esophagus, to determine the acidity of the gastric juice and the reasons for its increase. The study is carried out during the day by means of a probe inserted through the nose and a portable recorder, fastened with a belt on the belt. During the study, the patient can move freely, eat food that does not affect the acidity of the stomach, rest, etc.

Such a study in time allows you to evaluate the work of the stomach and lower esophageal sphincter, and not just fix the static size and location, as in radiography. If increased acidity of gastric juice caused by gastritis or gastric ulcer is detected, further treatment of these concomitant pathologies is carried out.

Since the symptoms of a hernia of the esophagus also include difficulty swallowing, patients can be assigned such a study as esophagomanometry, which allows to assess the strength of contraction of the muscles of the esophagus when swallowing. This study is indicative of violations of the upper gastrointestinal tract, since it allows you to assess the contractility and condition of the tissues of various parts of the esophagus and stomach. Manometry helps diagnose a leak in the lower esophageal sphincter that allows food to move backwards (reflux).

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Esophageal hernia treatment

If you pay attention to the pathology when its first symptoms appear and undergo a proper examination, the treatment of the disease is much simpler and gives good results even without surgery. A very important role is played by the diet, which helps to maintain a normal level of acidity of gastric juice, which reduces irritation of the walls of the esophagus during reflux, and also adjusts the amount of food taken, which makes it possible to reduce the frequency of belching.

Since the bulk of unpleasant symptoms (pain in the chest and epigastrium, heartburn, burning along the esophagus and throat, fever to subfebrile values) is associated with reflux esophagitis (reflux of gastric contents into the esophagus and associated inflammatory and destructive processes), then The treatment of a hernia of the esophagus is generally similar to the treatment of this pathology. The purpose of such treatment is to reduce the irritating effect of the contents of the stomach on the esophagus by neutralizing its aggressive components, to facilitate the movement of the food bolus through the esophagus, and to increase the tone of the stomach and lower esophageal sphincter.

Treatment is carried out in a complex way through:

• drugs that increase gastrointestinal motility (prokinetics) and help fight symptoms such as reflux, hiccups, spitting up food, vomiting,
• drugs that reduce stomach acid (antacids),
• drugs that reduce the production of hydrochloric acid (proton pump inhibitors),
• blockers of histamine receptors used in gastoenterology (they act similarly to the previous drugs and are prescribed when it is impossible to take them).

Sometimes, to prevent congestion and relieve heaviness in the abdomen, it is recommended to take enzyme preparations: Mezim, Festal, Creon, Pancreatin and even Cholenzim, which stimulates the production of bile and its transportation to the duodenum, and thereby speeds up the process of digestion.

But if other enzyme preparations are quite often prescribed for various pathologies of the stomach to facilitate its work, since they do not have an aggressive effect on the mucous membrane, then Cholenzim is mostly used for pathologies of the liver, gallbladder and pancreas and provokes the release of bile, which with a hernia the esophagus would be of dubious benefit. Especially when it comes to reflux, when semi-digested food can be thrown into the esophagus from the stomach and the initial sections of the intestine, where it will be generously flavored with bile.

It is better to help the stomach still opt for conventional enzyme preparations, which are safer for pathologies of the stomach and esophagus. With constipation, which often accompanies various pathologies of the gastrointestinal tract, it is worth paying attention to the drinking regimen, and if necessary, taking laxatives, because straining with a hernia of the esophageal opening of the diaphragm contributes to an increase in intra-abdominal pressure, which should not be allowed.

Probably, readers have noticed that among the drugs prescribed for reflux and hernia of the esophagus, there is no indication of analgesics. But pain in the chest and epigastrium is one of the main symptoms of pathology. The similarity of these pains with heart causes patients to try to stop them with nitroglycerin. This method works, but its side effect is that such treatment strengthens the patient in the thought of an existing disease of the cardiovascular system and distracts from the true cause of the deterioration in well-being.

How to relieve pain with a hernia of the esophagus? Pain with reflux and hernia of the esophagus is associated with stagnation of food in the gastrointestinal tract and its reflux into the esophagus. The irritating action of digestive enzymes causes irritation and inflammation of the walls of the organ, which is accompanied by pain. It turns out that pain can be stopped with drugs that reduce the acidity of gastric juice and form a protective film on the walls of the stomach and esophagus. We are talking about preparations in the form of a suspension (Almagel, Phosphalugel, Maalox), which begin to act already during passage through the esophagus, while tablet forms of drugs require dissolution in the stomach. Drugs that are prescribed to combat the increased acidity of gastric juice will also act as painkillers at the same time.

Many folk remedies also help to deal with the unpleasant symptoms of a hernia of the esophagus. So, natural flower honey, which is used in the treatment of many diseases, including diseases of the gastrointestinal tract, is of great benefit in hernia of the esophagus.

Honey is not a cure for reflux esophagitis, and during an exacerbation of the disease, it can only increase irritation of the esophagus if consumed in its pure form. But in the chronic course of the inflammatory process in the esophagus, observed with a hernia, this natural medicine will have an antibacterial and anti-inflammatory effect. True, it is better to use it as part of multicomponent recipes or diluted in water (up to 50 ml per day), giving preference to easily digestible linden honey.

For example, to combat heartburn, you can prepare a simple and tasty medicine from equal parts of honey and walnuts, which must be cleaned and crushed in advance. You need to use the composition after eating 1 tbsp.

For the treatment of heartburn, honey can be mixed with other components:

• aloe juice (1: 1 ratio, take 1 spoon before and after meals),
• warm milk (1 tablespoon of honey per 1 glass of milk, drink one hour before the main meal, as well as when painful attacks appear),
• potato juice (1 tsp honey per ½ tbsp. juice, taken one hour before meals).

In one recipe, you can combine the detoxifying and tonic properties of apple cider vinegar and the antibacterial, restorative and anti-inflammatory effects of honey. 1 tbsp natural apple cider vinegar should be mixed with the same amount of honey and diluted in a glass of water. Take this unusual medicine regularly before meals, which helps prevent heartburn, pain and other symptoms of a hernia of the esophagus.

To combat burping, a composition based on honey, cranberry berries and aloe juice, taken in equal amounts, is suitable. Berries and peeled aloe leaves must be passed through a meat grinder or chopped in a blender, mixed with honey and poured with boiled water. Infuse the remedy for at least 6 hours, after which you need to drink it a little during the day.

Flax is also considered useful for a hernia of the esophagus. A decoction of flax (1 tbsp per 0.5 l of water, boil for 3-5 minutes and leave for at least 2 hours) will create a protective film on the walls of the stomach and esophagus, thereby reducing the likelihood of irritation of the mucous membranes by digestive enzymes. The same remedy is considered an effective antacid, since it can reduce the acidity of gastric juice.

Another recipe for a hernia of the esophagus based on flax seed. For 1 tbsp. flax seeds take 3 tbsp. cool water, leave to infuse overnight. In the morning, heat to a boil, but do not boil. We use the entire mixture completely, carefully chewing the grains.

Tea with a hernia of the esophagus is a dubious medicine. But it depends on what kind of tea. If we are talking about strong hot black tea, then it is better to refuse such a tonic drink, because it will only stimulate the production of digestive enzymes and increase the acidity of the stomach, especially for those who already suffer from this disorder. But nutritionists even include warm green tea in the menu for hernia of the esophagus.

But herbal teas are especially useful for this pathology. The first in the list of healthy drinks for diseases of the gastrointestinal tract is anti-inflammatory chamomile tea (1 tbsp per glass of boiling water). You can drink it both before and after meals without any special restrictions.

A similar effect has calendula flower tea, which is prepared according to the same principle, but they drink no more than 4 times a day an hour after eating. You can combine 2 plants in one drink: calendula and chamomile.

Linden tea, which many people are used to drinking for colds and headaches, is also useful for hernia of the esophagus. It can be consumed without restrictions as a healthy drink that does not increase the acidity of the stomach. Linden tea with honey is especially tasty and healthy (1 teaspoon per glass of drink).

Patients with a hernia of the esophagus can prepare a vitamin tea from the leaves and shoots of blackberries (50 g of crushed vegetable raw materials per 1 tablespoon of boiling water), which can also be drunk without restrictions.

Teas from mint and lemon balm, yarrow and St. John's wort, licorice root help fight heartburn and hiccups. As a delicious vitamin drink, tea is prepared from raspberry leaves and fruits. It is very useful to prepare drinks from the collections of the above herbs, adding a little honey to them before drinking.

Living with a hiatal hernia

It is possible that a hernia of the esophagus gives patients some discomfort, but life does not end with this diagnosis. Diet and medication help to reduce the severity of the symptoms of pathology. Breathing exercises and special physical exercises that train the abdominal and chest muscles help restore the normal position of the stomach with a sliding hernia, remove dyspeptic symptoms, and reduce the likelihood of reflux. If these measures do not help, and the symptoms of a hernia of the esophagus do not subside, the patient is prepared for surgery.

Any disease affects our lives. So a hernia of the esophagus requires certain restrictions from us. And this applies not only to nutrition, but also to the physical activity of a person, as well as the time of night rest.

A hiatal hernia is a pathology in which the esophagus and stomach have an abnormal location, so it is not surprising that symptoms increase with a change in body position. So after the patient takes a horizontal position, pain intensifies. But does this mean that a person should sleep in a sitting position? And if not, on which side can you sleep with a hernia of the esophagus?

There is no need to sleep standing or sitting with this disease, because proper rest is needed to maintain the strength and energy of the body. But doctors recommend choosing the position lying on the right side, which reduces the load on the digestive tract due to their anatomical location and the likelihood of pinching. In addition, reflux in this position of the body usually does not occur, which means there will be no pain.

But in whatever position a person falls asleep, you need to go to bed no earlier than 2 hours after eating. This also applies to healthy people, and is especially important for patients with esophageal hernia.

There is bad news for fans of alcoholic beverages. Hernia of the esophagus and alcohol are incompatible concepts. The fact is that alcoholic beverages, like coffee or black tea, are products that stimulate the secretion of gastric juice, and increased production of hydrochloric acid causes heartburn. In the case of reflux, this can play a cruel joke, causing severe irritation of the walls of the esophagus and even their perforation. Yes, and alcohol itself is an irritating factor, it is not in vain that after taking it inside, a person feels a burning sensation throughout the esophagus.

Another reason why you will have to give up regular alcohol consumption is an increased risk of developing inflammatory pathologies of the liver and pancreas, which become risk factors for increased intra-abdominal pressure, which pushes the digestive organs through the opening of the diaphragm into the chest cavity.

Many questions from readers and on the topic "hernia of the esophagus and the army." Most conscripts consider the presence of a hernia of the esophageal opening of the diaphragm as a sufficient basis for exemption from military service, and when this does not happen, the guys are very surprised. The fact is that only guys with the 3rd most severe degree of the disease are subject to mandatory exemption from military service (they are issued a military bill for health reasons), and for those who are diagnosed with 1st degree, there are no restrictions, they serve on a general basis. .

But with a 2 degree hernia of the esophagus, there may be problems. According to the law, with such a pathology, a conscript must be exempted from military service, he is enrolled in the reserve and issued a military ID for health (Article 60 of the Schedule of Diseases, paragraph "c"). But in fact, in order to obtain such a conclusion, it is necessary to prove the presence of 2 degrees of hernia, i.e. undergo an x-ray with contrast, considered the "gold standard" for diagnosing a hernia of the esophagus. If there are no X-ray results, you will not be able to get an exemption from military service.

Now, with regard to physical activity and sports. A hernia of the esophagus is a pathology that does not require hypodynamia. On the contrary, for the normal functioning of the digestive system, you need to move, otherwise you cannot avoid stagnation in the stomach and constipation, which are very dangerous with a hernia of the esophagus. Straining increases intra-abdominal pressure, which only complicates the situation, provoking the progression of the disease.

With a hernia of the esophageal opening of the diaphragm, walks in the air, moderate physical activity, special exercise therapy exercises, yoga, Pilates, and breathing exercises will be useful. But sport with a hernia of the esophagus is not available in full. For example, training the chest muscles, running and swimming with a hernial protrusion will not bring harm, unlike weightlifting and other sports that involve stress on the abdominal muscles.

It is clear that in connection with the foregoing, the question of whether it is possible to pump the press with a hernia of the esophagus disappears by itself. Such a load increases intra-abdominal pressure, which in turn provokes reflux and even more protrusion of organs into the chest. To increase the tone of the abdominal muscles as part of the DFC complex, there are special exercises that will not provoke complications of the disease.

Is it possible to squat with a hernia of the esophagus? This is a moot point. In general, according to gastroenterologists, squats, cycling and training on an exercise bike are not prohibited if they are practiced within reasonable limits. But squats with a load (with a load in your hands), this is a completely different matter. With such exercises, as with lifting weights, the pressure in the abdominal cavity increases, which should not be allowed with a hernia. Any activity should not provoke an increase in intra-abdominal pressure - this is an important requirement for all athletes and fans of a healthy lifestyle.

If a person, after making a diagnosis, wants to continue playing sports, he should first consult with a doctor who will help develop a safe training program and determine which sports are allowed for this pathology.

And one more important question, is disability possible with a hernia of the esophagus? On the one hand, if a hernia is left untreated, it can progress over time and cause serious eating disorders. Prolonged irritation and inflammation of the esophagus leads to the appearance of esophageal strictures that impede the passage of the food bolus. But on the other hand, as long as this does not affect a person's ability to perform work, no one will give him a disability.

Disability is possible only with a narrowing of the esophagus, which limits life and work in full. For example, the need for fractional nutrition in case of a hernia of the esophagus, complicated by organ stenosis, may be the reason for assigning a 3rd disability group, which is considered working. Those who have a 2 degree narrowing of the esophagus or have had an operation to reconstruct the organ (for the period of adaptation) can count on group 2.

And for the 1st group of disability, it is required to limit not only life, but also self-service, which happens extremely rarely with a hernia of the esophagus. The cause can be a strong narrowing of the esophagus and an extreme degree of exhaustion of the body caused by malnutrition, as well as an operation in which 2 holes (stoma) are made in the neck and stomach, necessary for the communication of organs and the passage of food.

Usually, with appropriate treatment and diet, the prognosis of axial hernia is favorable. Symptoms of hernia of the esophagus subside after the course of treatment and the disease does not actually affect the quality of life of patients. But the risk of complications of paraesophageal hernia remains even with active conservative treatment, so surgical intervention is indicated for such patients.

Complications of a hernia of the esophagus

A hernia of the esophageal opening of the diaphragm is a progressive pathology, the symptoms of which become pronounced with the complication of the disease. By itself, the displacement of the peritoneal organs into the chest cavity is not a reason for the appearance of severe pain, so most patients indicate discomfort in the epigastrium and dull, aching pain behind the sternum. But the appearance of sharp, cutting pains indicates inflammation of the hernia of the esophagus and the development of erosive and ulcerative processes.

Inflammation of the walls of the esophagus is associated with reflux esophagitis. Regular reflux of the acidic contents of the stomach and duodenum into the lumen of the esophageal tube causes irritation of the walls of the esophagus and inflammation of the tissues. A long-term inflammatory process becomes a risk factor for the formation and increase in the volume of fibrous tissue, due to which the lumen of the esophagus narrows. And this becomes an obstacle to the use of solid food.

Hydrochloric acid and pepsin in the composition of gastric juice can corrode the unprotected walls of the esophagus with the formation of erosions and ulcers on them (peptic ulcer of the esophagus). The irritating effect of these substances again leads to narrowing of the esophagus (peptic strictures).

Erosive and ulcerative damage to the walls of the esophagus can lead to their perforation, and then there are such symptoms of a hernia of the esophagus as bloody vomiting and chocolate-colored stools. Frequent bleeding against the background of the chronic course of the disease, in turn, causes the development of iron deficiency anemia.

Chronic inflammatory and erosive changes in the esophagus increase the risk of degeneration of organ wall cells and can cause esophageal cancer. No less dangerous is the infringement of a hernia, in which the patient feels severe pain caused by a violation of the flow of nutrients and oxygen to the organ and damage to nerve fibers.

During the infringement, the movement of food through the esophagus is limited, which hardly passes through the reduced lumen of the organ or cannot enter the stomach squeezed by the diaphragm. This increases pain, causes nausea and vomiting, and does not allow a person to eat normally. With a complete infringement of the esophagus or stomach in the opening of the diaphragm, the patient cannot even drink, however, this happens extremely rarely and requires emergency care.

During diagnostic measures, you can see a change in the color of the hernia. It becomes darker or grayish due to the necrotic processes occurring in it, caused by tissue starvation and poisoning of the body with cell decay products. Necrotic changes in the tissues of the esophagus and stomach lead to impaired functionality and can cause a serious condition provoked by sepsis.

Surgical treatment of the disease gives good results, but cannot completely exclude the recurrence of esophageal hernia, which, according to various data, occurs in 12-30% of cases in the long-term period after surgery. Diaphragmatic plasty can prevent such a complication.

Many patients, noting the absence of previously observed symptoms, may think that the disease has passed, so on the Internet you can sometimes find questions on the topic, can a hernia of the esophagus disappear on its own? It's not worth counting on. The periodic disappearance and appearance of symptoms of a hernia is characteristic of the axial type of pathology, when the stomach and esophagus can move in the opening of the diaphragm. Depending on this, the symptoms may either appear or disappear, which does not mean getting rid of the disease.

No drugs can help restore the diaphragmatic opening to its original size and tone, they only prevent complications caused by reflux and spasm of the esophagus. In the absence of treatment and non-compliance with the diet, the hernia will not only not disappear, but will continue to progress.

This deviation is caused by the penetration of parts of the stomach into the sternum due to the dilated opening of the esophagus of the diaphragm. The norm is when the ligamentous system of the opening of the diaphragm is dense and prevents the movement of the lower organs.

Causes of this pathology

The factors that cause such an ailment are diverse. In the vast majority of cases, a hernia of the esophagus occurs in people who have crossed the fifty-year threshold. This is due to the weakening of the ligamentous system of the esophageal opening. Particularly susceptible to this disease are people with an asthenic structure.

Other causes of this disease may be the following factors:

1. increased intrauterine pressure due to pregnancy, various tumors, excessively frequent bouts of nausea or persistent severe coughing;
2. various inflammatory diseases that have a chronic form and entail violations of peristalsis: stomach ulcers, pancreatitis and other diseases;
3. congenital abnormalities leading to a shortened esophagus or an incorrect position of the digestive organs.

For the most part, the first signs of disease in a small hernia are asymptomatic. The danger of this pathology lies in the penetration of gastric secretion into the esophagus, causing inflammation of the mucous membranes. The most serious consequence of a hernia is the pinching of the esophagus, in which acute paroxysmal pain appears and the swallowing function is impaired.

The most life-threatening manifestation is the constant ingress of gastric fluid into the esophagus, which subsequently corrodes its walls and can cause malignant tumors.

In order not to lead to such consequences, it is necessary to be examined by a doctor in time at the first symptoms or a genetic predisposition to the disease. A timely diagnosis will help to cure the disease more easily without causing serious harm to the body.

Diaphragmatic hernia symptoms

Diaphragmatic hernia has its own characteristic symptoms:

• attacks of heartburn after eating, at night, when the torso is leaning forward;
• sharp pains that appear behind the sternum, sometimes in the area under the ribs;
• sometimes there are pains in the cardiac region, resembling the symptoms of coronary disease, however, they quickly pass after taking nitroglycerin;
• aching pains over the obvious process of the sternum;
• frequent belching, accompanied by acidic stomach contents;
• difficulty passing food through the esophagus, constant hiccups.

Disease classification

Esophageal hernia is divided into two types:

1. Sliding hernia. This type of disease is characterized by free penetration of the stomach through the opening of the diaphragm into the chest cavity and returning to its place. A similar phenomenon is pronounced when changing the position of the body. However, there is a fixed hernia, unable to "return" into place. This phenomenon may be caused by its too large size. This type of disease, which occurs without complications, may not cause any symptoms.
2. Axial hernia. In this case, the section of the esophagus remains in its place, but the fundus of the stomach or large parts of it emerges through the large opening of the diaphragm. This position of the organ can take place next to the thoracic esophagus. This arrangement leads to a displacement of the stomach into the sternum, which later became known as the “thoracic stomach”, and the esophagus itself becomes short. This pathology is considered quite rare. In most cases, the esophagus is shortened due to changes in scar tissue.

It is divided into three degrees of severity, which are determined by the size and volume of the formation itself:

1. Only a small part of the esophagus enters the thoracic region, and the stomach itself, rising slightly, fits snugly against the diaphragm.
2. Parts of the organ fall into the diaphragmatic opening.
3. The gastric fundus or its body is in the chest cavity.

Diagnostic methods

Due to the fact that a hernia can occur in combination with many other diseases, the diagnosis of this disease can be complicated due to the similarity of symptoms.

To diagnose a hernia, doctors use the following methods to detect it:

• X-ray apparatus is designed to examine the internal cavity of the body. Since the body has different, in terms of density, parts, they appear differently on an x-ray. The denser parts are the bones, which are clearly visible in the picture. To detect organ pathologies, it is necessary to inject a special contrast agent. "Illuminated" internal organs allow you to determine the presence of pathologies;
• to determine the quality of esophageal motility, intra-esophageal manometry is used. Food entering the esophagus must be delivered to the digestive organs with the help of muscle contractions. This procedure helps to determine the dysfunction of the muscular apparatus, determine the quality of pressure during contractions and observe the amplitude of movements. To do this, a probe with pressure sensors is inserted through the nasopharynx.

Treatment

Treatment of esophageal hernia in the early stages is conservative. The goal of treatment is mainly to prevent GER (gastroesophageal reflux) and relieve symptoms. Drugs that help correct esophageal motility and restore gastric function are used for prophylactic purposes.

In order to prevent the development of the disease in people predisposed to it, there are the following recommendations:

1. exclude from the diet foods containing animal fats, fiber, carbonated drinks, bright spices, etc .;
2. eat at short intervals, in small portions;
3. finish eating 2-3 hours before going to bed;
4. it is necessary to get rid of bad habits: smoking, alcohol;
5. try to avoid increasing pressure inside the abdominal cavity.

If the disease is severe and manifestations, and treatment with drugs does not help, then surgical intervention is required. Such operations and subsequent treatment require mandatory registration with a gastroenterologist.

Proper nutrition with a hernia of the esophagus

If this disease is detected, it is necessary to begin preventive and therapeutic procedures. One of the effective methods of treatment is special nutrition. With a diaphragmatic hernia, a diet is prescribed that helps restore the normal functioning of the esophagus.

To find the right foods, you need to find out which ones can cause bloating and increased gas formation. You will need to eliminate these foods from your diet. The purpose of such nutrition is to restore the normal functioning of the digestive tract. In order to choose the right diet, you need to consult your doctor.

With a hernia, nutrition must meet the following requirements:

• fractional nutrition;
• eat small meals;
• products must be well processed;
• food should be soft and light;
• exclude from the diet foods that cause high acidity and require high costs for digestion.
• avoid overeating;
• inclusion in daily life of special gymnastics and physical exercises.

In order to reduce the acidity of the esophagus, it is recommended to drink alkaline water, in particular before going to bed. During sleep, it is best to lie on your right side, which reduces the penetration of acid into the esophagus. It is also recommended to raise the head of the bed. To do this, you can use extra pillows or place solid objects under the bed legs.

A hernia of the esophagus is a common ailment that is mainly faced by the elderly. This pathology occurs due to an anatomical change in the location of the internal organs located in the abdominal cavity. When the diaphragm expands, the work of the ligamentous apparatus of the esophageal opening is disrupted, which leads to movement. As a result, a hernia develops, which makes it difficult to breathe and provokes painful spasms in the abdomen and chest.

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

Fundamentals of treatment

Therapeutic therapy for a hernia of the esophagus can be conservative or operative. Most experts believe that surgery is required only in some cases, and in the rest, the hernia is treated through the following methods:

• taking certain medications;
• performance of medical, respiratory gymnastics;
• adherence to dietary nutrition;
• use of traditional medicine recipes;
• maintaining a healthy lifestyle.

Surgical intervention is required only when medical treatment does not give its expected results. If the existing pathology has become large, when there is a risk of infringement of the hernia or internal bleeding has occurred, in all these cases an operation is prescribed.

Medical therapy

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

The treatment regimen is based on taking the following medications:

• antacid agents;
• prokinetics;
• histamine receptor blockers;
• proton pump inhibitors.

Antacids are able to neutralize excess hydrochloric acid, which is part of the gastric juice. It is she who strongly irritates the mucous membrane of the esophagus, provoking a kind of damage. These include Almagel, Maalox, Rennie and Phosphalugel.

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

Almagel neutralizes excess hydrochloric acid

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

Complementary treatment for complications

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

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

If a narrowing of the esophageal opening occurs, antacids with prolonged action and drugs that block inflammatory processes are prescribed. When diagnosing concomitant gastric diseases that become chronic, the main therapy is first directed to their elimination and only then to the fight against hernia.

Breathing exercises

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

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

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

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

At the end of this small complex, you need to lie on your back and begin to turn the upper part of the body in both directions. At the turn itself, a breath is taken, and at the initial position, exhalation and complete relaxation of the muscles occur. Performing such gymnastics at home, it is necessary to monitor the correct execution of each exercise. Otherwise, when the exercise is done incorrectly, a person can only aggravate the situation and worsen his condition, as even more pressure begins to be exerted on the diaphragm, which causes complications.

Diet for hernia of the esophagus

Esophageal hernia (HH) requires a special diet.

This will not only alleviate the condition of the patient himself, but will also have a positive effect on the rate of recovery. The main rule that must be observed is a slight feeling of hunger. That is, you should not eat up at one time until you feel full, as this leads to an increased load on the stomach. Therefore, it is better to eat slowly and a little bit, chewing food thoroughly.

Overeating is strictly prohibited. This will provoke a feeling of discomfort and painful spasms. It will be necessary to refuse smoked and sweet foods, fried and spicy dishes, as well as various seasonings. Such food increases the concentration of hydrochloric acid in the composition of gastric juice, which is thrown into the esophagus. As a result, the tissues and mucosa of the gastrointestinal tract are irritated, and an inflammatory process begins to develop.

Overeating will aggravate the situation with a hernia of the esophagus

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

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

The diet should be based on fresh and healthy foods rich in vitamins and minerals. These are vegetables and fruits, as well as dairy products that support the normal functioning of the digestive system. There should not be any fast food and semi-finished products on the table. All consumed products should be easily digested, without provoking heaviness in the stomach.

Folk recipes that help with a hernia

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

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

• stone drupe;
• propolis;
• red shoe.

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

• Gooseberry infusion.
• Linen collection based on mint and coltsfoot.
• Propolis tincture.

To prepare an infusion of gooseberries, you will need the leaves of this plant. One tablespoon will suffice. It is better to pre-dry and grind the leaves, then pour them with 500 ml of water. It will be necessary to insist on such a decoction for two hours, after which the finished home remedy is taken four times a day, 120 ml each.

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

Collection of flax seeds and medicinal herbs will eliminate discomfort

Propolis tincture is prepared on the basis of alcohol and then taken with milk (30 drops of tincture are taken per 50 ml of liquid). You need to use this medicine before the main meal twice a day.

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

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

Only complex therapy can cope with a hernia of the esophagus. Therefore, at the first symptoms of the disease, you should consult a doctor. The specialist will diagnose and prescribe a course of drug treatment, which will include exercises aimed at strengthening the diaphragm and dieting.

Among all diseases known to science, pathologies of the gastrointestinal tract occupy the second place. The hernia of the esophagus accounts for 30% of the total number of diseases of the gastrointestinal tract. This is a fairly large figure, and a hernia diagnosed in time would significantly lower this percentage. The problem is that in the early stages the hernia is almost not felt, and the manifestation of symptoms occurs in the later stages.

Hernia of the esophageal opening of the diaphragm and its types

In the normal state, the lower part of the esophagus and the stomach are located under the diaphragm, since the diaphragmatic opening tightly covering the esophagus prevents them from moving into the chest cavity. There are a number of factors that relax the ligamentous apparatus of the diaphragm. This leads to an increase in the opening of the diaphragm and protrusion of the abdominal organs through it into the chest. In medicine, this pathology is called hiatal hernia (HH).

Protrusion of the lower part of the esophagus and the upper part of the stomach through the opening of the diaphragm into the chest cavity

Most often, the disease affects people over 50 years of age. In this case, HH is acquired in nature, for example, after an exacerbation of an ulcer, gastritis, chronic, in the case of nicotine addiction. Younger people suffering from a hernia, only 5% of the total number of people with this pathology. Often this is due to congenital causes, such as delayed gastric descent during embryonic development and a weak ligamentous apparatus due to underdevelopment of the muscles of the legs of the diaphragm. Taking into account the characteristics of the course of the disease, a hernia is divided into several types.

1. Paraesophageal hernia. Part of the stomach is displaced into the diaphragmatic opening to the left of the esophagus. The size of the hernia can reach 8-10 cm in diameter.
2. Axial hernia. The upper part of the stomach and the cardial part of the esophagus move freely into the chest cavity and return back under the diaphragm. This is due to the absence of a hernial sac.
3. Combined hernia. In this case, both types of hernia are present in the disease.

Video: hernia of the esophagus, its signs, methods of treatment

Symptoms of HH

Like any disease, hiatal hernia is accompanied by symptoms that appear in the later stages of its development. At first, a hernia practically does not bother and its presence can be determined only when examined with special equipment. Undetected at an early stage, the pathology progresses into a serious disease, which is recognized by the following symptoms:

• pain sensations;
• belching;
• food passes through the esophagus with difficulty;
• hiccups
• hoarseness;
• pain in the tongue;
• dyspnea;
• cough.

Heartburn

Food enters the stomach through the cardiac sphincter of the esophagus. This is a kind of "hatch", which normally opens in front of food and closes when it is already inside the stomach. The sphincter prevents hydrochloric acid from entering the esophagus. When parts of the esophagus and stomach are displaced to the sternum, the functions of the cardiac sphincter are disturbed. It no longer protects the esophageal mucosa from the burn caused by hydrochloric acid splashing out of the stomach. The resulting burning is heartburn, the frequent exacerbation of which after eating or lying down may be a sign of the presence of HH.

Pain

The presence of a hernia is indicated by a sharp, cutting, burning or stabbing pain in the sternum, sometimes spreading along the interscapular region. Its intensity increases as the disease develops and the hernia increases. Pain may occur in the following cases:

• during physical exertion, when squeezing and pinching of the hernia occurs;
• during a coughing fit;
• after eating;
• due to stagnation of food that has fallen into the hernial sac;
• at .

The pain decreases or disappears after belching, taking a vertical position, taking a deep breath.

Belching

During belching, the air accumulated in it and the gases formed during digestion come out of the stomach. In a healthy person, belching occurs infrequently and is the result of air entering during a meal or after drinking carbonated drinks. In those suffering from a hernia of the esophageal opening of the diaphragm, belching is permanent, and the burping air smells unpleasant. Belching is preceded by bursting in the area of ​​​​the substrate, and after that, air or gases come out. During regurgitation, not only air, but also part of the food can come out of the stomach.

Violation of the passage of food through the esophagus

A hernia leads to deformation of the walls of the esophagus, which provokes uneven contraction. This failure has two consequences:

• spasms and narrowing of the esophagus;
• atony (expansion of the esophagus due to weakening of the muscles of the walls).

Spasms of the esophagus block the passage of food and it gets stuck in the place of narrowing of the walls. With atony, food moves slowly, sometimes sticking to the walls of the esophagus.

hiccup

Hiccups are a rather peculiar symptom, since sometimes they can occur in a completely healthy person. In the case of diseases of the gastrointestinal tract, hiccups are permanent, as they are the result of increased gas formation in the stomach. This type of hiccups is called pathological and can last from 2-3 hours to several days. Hiccups are caused by convulsive reflex contractions of the diaphragm, aimed at pushing a large amount of air out of the stomach.

Hoarseness

With HH, hoarseness occurs due to the release of acid-containing stomach into the oral cavity and onto the vocal cords. The acid acts on the tissue of the ligaments, damaging it and leading to a hoarse voice.

Pain in the tongue

This symptom accompanies a hernia quite rarely. It, like the previous one, is due to the ingress of hydrochloric acid from their stomach into the oral cavity. Pain in the tongue occurs due to burns caused by acid. In the initial stage of the development of HH, this does not happen, but in a neglected state, the patient begins to be disturbed by unpleasant and painful sensations in the tongue - from a slight burning sensation to intense cutting pain.

Dyspnea

Shortness of breath can occur for various reasons. One of them is the presence of HH, when a protruding hernial sac disrupts the functioning of the lungs and heart. This makes it difficult to breathe, provokes arrhythmia, causes shortness of breath.

Cough

The hernial sac protruding into the chest cavity compresses the lungs and prevents them from functioning properly. Cough is a reflex reaction to a lack of oxygen in the lungs.

Not all of these symptoms may accompany a hernia. Their intensity can also vary. The manifestation of this or that symptom depends on the individuality of the patient, the cause of HH and the nature or type of the disease.

Symptoms specific to different species

Depending on the type of hernia of the esophagus, the symptoms manifest themselves in different ways. Their frequency and nature are presented in the table.

Table "Symptoms depending on the type of hernia"

If symptoms of a hernia of the esophagus are found, do not self-medicate. Only a doctor can diagnose a hernia with a hardware method. He will prescribe the right treatment and surgery if necessary. Treatment of a hernia at home can lead to the onset of the disease and further complications.