Does a sliding hernia outgrow? Sliding hiatal hernia: treatment and pathology features

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

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

Causes

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

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

Causes:

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

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

Those at risk include those who have the following diseases:

Phlebeurysm
Obesity.

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

Symptoms of a hiatal hernia

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

Symptoms of hiatal hernia:

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

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

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

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

Typical symptoms of a hiatal hernia also include:

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

Contact an ambulance immediately if:

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

Types of hiatal hernia

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

Sliding (axial) hernia

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

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

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

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

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

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

Fixed hiatal hernia

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

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

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

Degrees of hiatal hernia

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

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

Complications

Complications that may occur with hiatal hernia:

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

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

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

Diagnostics

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

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

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

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

Treatment of hiatal hernia: drugs and surgery

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

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

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

Drugs for hiatal hernia

Your doctor may prescribe the following medications for you:

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

As a rule, treatment of diaphragmatic hernia without surgery is 99% identical to the treatment tactics for reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow a special diet, and adhere to all the doctor’s instructions.

Surgery for hiatal hernia

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

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

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

Doctors operate in two ways, such as:

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

Contraindications for surgery:

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

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

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

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

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

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

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

Diet and nutrition

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

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

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

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

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

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

How to treat a hiatal hernia with folk remedies

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

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

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

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

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

Prevention

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

This is all about hiatal hernia (HH): what kind of disease it is, what are its symptoms, treatment features. Do not be ill!

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

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

Etiology of sliding hernia

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

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

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

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

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

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

Clinical manifestations of sliding hernia

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

Complaints from patients with sliding diaphragmatic hernia:

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

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

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

Treatment methods for sliding hernia

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

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

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

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

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

With age, the muscle septum loses elasticity and flexibility. The esophagus protrudes into the sternum through a hole in the diaphragm. hiatal hiatus most often occurs in adulthood.

Esophageal hernia most often occurs in adulthood.

Depending on the location of the defect, there are:

axial hernia;
cardiac prolapse.

There are several types of pathology:

shortened (identified in people with a birth defect);
paraesophageal hernia;
sliding hernia.

A feature of a sliding hernia is the difficulty of diagnosis. The reason is that the symptoms of this disease are quite mild. The fallout itself can only be determined under certain conditions.

A distinctive feature of this defect is that the displacement into the sternum occurs along the axis of the esophagus. The location of the hernia affects the position of the upper part. In this case, the prolapse leads to the fact that the upper part of the patient’s stomach is above the level of the diaphragm.

The stomach takes part in the formation of hernial formation. There are 2 types of sliding hernia: fixed and non-fixed. The position of the patient does not affect the location of the hernial sac. If a person assumes an upright position, the fixed hernia will remain in the sternum. The formation is held in place by adhesions that form in the hernia area.

Experts distinguish between sliding hernias with congenital and acquired defects. There is a difference in pressure between the sternum and. Thanks to this difference, the contents of the stomach enter the esophagus.

The esophageal mucosa is quite sensitive to such substances. This causes erosions and ulcers. The patient experiences discomfort, discomfort and severe pain. The inflammatory process in the esophagus develops gradually. In this case, the mucous membrane bleeds and is constantly injured.

The patient begins to develop anemia due to iron deficiency due to tissue ulceration.

This video will tell you what a hiatal hernia is:

Reasons for the formation of a sliding hernia

Increased salivation is a sign of a sliding hernia.

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

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

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

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

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

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

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

What are the signs by which the disease can be identified?

Heartburn is a symptom of a sliding hernia.

A sliding hiatal hernia does not have any obvious manifestations. The patient's symptoms appear only when various complications of the disease occur.

There are several characteristic signs of a sliding hiatal hernia:

the patient begins to complain about;
he suffers from bouts of belching;
pain appears in the esophagus;
regurgitation occurs after eating;
people experience a burning sensation in the chest;
a lump appears in the throat;
increased secretion of saliva occurs;
Some patients have increased blood pressure.

Symptoms of the disease depend on the position of the patient's body. A burning sensation occurs in almost every person with this pathology. A person with a stomach ulcer experiences severe pain. A large amount of food can trigger the appearance in the esophagus.

By taking acid-reducing agents, you can get rid of discomfort.

How is diagnostics carried out?

To identify a sliding formation, experts use several methods:

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

Features of treatment

Maalox will help reduce the acidity of the esophagus.

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

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

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

Sometimes patients experience a slipping of the cuff, and the disease occurs again. Repeated surgery can help such patients.

Patients need to adhere to. During your illness you will have to stop eating fatty and spicy foods. Eliminate smoked meats and marinades from your diet. You need to eat food in small portions to speed up the digestion process.

After surgery, patients should not engage in intense physical labor. It is forbidden to do exercises that provoke an increase in pressure in the abdominal cavity.

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Classification, treatment and symptoms of hiatal hernia. Details about...

A sliding hiatal hernia is characterized by the free movement of abdominal organs into the chest and back. This phenomenon occurs due to weakness of the diaphragmatic ligament, which is aggravated by the presence of an inflammatory process of the esophagus or its congenital anomalies.

In another way, the pathology is defined as a hiatal hernia, cardiac or axial, and its clinical picture largely depends on the severity of the pathological process.

The main symptom of a sliding hernia is dyspepsia. The patient experiences frequent heartburn, belching of sour contents, and hiccups. These conditions indicate damage to the mucous membrane of the esophageal tube due to the reflux of acidic contents from the stomach.

So what is a sliding hernia? This is a pathological movement of abdominal organs through the esophageal opening into the chest. This condition is not dangerous and has virtually no effect on the quality of life, if only the patient adequately assesses the potential risk and takes measures to prevent complications.

General characteristics of the sliding hiatal hernia

A sliding hiatal hernia is predominantly asymptomatic, which complicates diagnosis. 75% of patients have no symptoms and therefore no treatment is carried out for a long time. Ignoring the problem leads to the fact that the hernia progresses, and more and more of the stomach penetrates through the diaphragm.

The main cause of the disease is muscle weakness.

But one factor alone is not enough for the disease to appear. The combination of pathology of the musculo-ligamentous apparatus with an increase in intra-abdominal pressure is more likely to lead to a hiatal hernia.

The dysfunction of a slipped organ does not occur immediately. The consequences of pathology arise as the disease develops. Uncomplicated sliding esophageal hernia of the first and second degrees requires only dietary nutrition and medication. At the third stage, specific treatment is already selected. A fourth degree axial hiatal hernia will require surgical treatment to restore the anatomy of the abdominal organs.

Etiology of the disease

Causes of hiatal hernia:

Congenital malformations. This applies to the period when the stomach descends into the abdominal cavity. The process may be disrupted, which will cause the appearance of a congenital diaphragmatic hernia. This disease requires surgery as soon as possible, otherwise there is a risk of death within a few days after birth. A hiatal hernia in newborns can be removed on the first day, but it will be even more effective to perform the operation during pregnancy, then the prognosis is more favorable if only the child undergoes normal rehabilitation in a specialized center.
Underdevelopment of the diaphragm muscles. This phenomenon is associated with the physiological aging of the body, therefore it is almost impossible to avoid this factor. This phenomenon can be prevented only by following the general prevention of pathologies of the musculo-ligamentous system, which includes physical therapy, dietary nutrition, and the elimination of bad habits.
Increased intra-abdominal pressure. This factor is associated with frequent constipation, bloating, overeating, excess weight, and pregnancy. This can be avoided if you promptly treat pathologies of the gastrointestinal tract, cope with excess weight, and use a special support belt during pregnancy.

The clinical manifestations of the pathology will depend on the stage of formation of the diaphragmatic hernia. With grade 1, there is a slight displacement of the abdominal part of the esophagus through the enlarged opening of the diaphragm, while the stomach remains in its place. At stage 2 of the pathological process, a mixing of the cardia of the stomach occurs, which is located at the level of the diaphragm. At the third stage, the body of the stomach is located above the diaphragm.

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

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

How does hiatal hernia manifest itself?

The main clinical manifestations of a sliding diaphragmatic hernia:

Dyspeptic phenomena. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient assumes a horizontal position after filling the stomach. Such manifestations can occur for no apparent reason, for example, at night and in the morning.
Dysphagia or difficulty swallowing. Such a phenomenon with a hiatal hernia will be more psychological, because while swallowing food, the patient may feel discomfort and pain associated with inflammation of the esophagus, which creates a fear of repetition of the unpleasant sensations. As a result, food intake begins to be accompanied by a lack of swallowing reflex. The patient switches to eating exclusively liquid and semi-liquid foods. This, in turn, leads to weight loss. In this regard, the patient is prescribed a therapeutic diet.
Frequent pathologies of the respiratory system. Bronchitis and aspiration pneumonia appear as a result of particles of poorly chewed food entering the respiratory tract. This threatens purulent pneumonia and chronic respiratory diseases, which only aggravate the patient’s already serious condition.
Regulation. This phenomenon is associated with the backflow of stomach contents into the oral cavity. Long-term exposure to stomach acid leads to dental diseases. A patient with an esophageal hernia is faced with increased sensitivity of the enamel, papillitis, various stomatitis and gingivitis. Treatment of a local problem in the oral cavity does not lead to positive results, and until the main problem is eliminated, dental pathologies will only progress, and constant irritation of the mucous membrane can result in precancerous conditions and even oncology.

Diagnosis of a hiatal hernia is carried out by endoscopic examination.

Additionally, the patient is prescribed laboratory tests to identify or exclude the inflammatory process. Esophagogastroduodenoscopy, that is, examination of the condition of the gastric mucosa, is also indicated. Inserting a probe will not be the most pleasant procedure for the patient, but only in this way can many associated problems be detected that need to be dealt with in parallel.

Principles of treatment

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

The patient must undergo treatment with a gastroenterologist to prevent such a frequent companion of a hernia as reflux esophagitis.

The latter is manifested by the release of stomach contents into the esophagus, which leads to inflammatory processes and the addition of a complex of disorders. An additional symptomatic complex with esophagitis requires separate treatment.

To eliminate reflux without surgery, the following remedies are used:

Antacids. Indicated to reduce the negative impact of acidic contents on the walls of the esophagus.
Enveloping. Used to eliminate irritation of the mucous membrane of the stomach and esophagus.
Antispasmodic drugs. Prescribed by a doctor when a sliding diaphragmatic hernia is accompanied by a peptic ulcer of the stomach and duodenum.
De-Nol. Indicated for inflammatory and ulcerative diseases of the gastric mucosa and esophageal tube.
Motilium. Prescribed to improve digestion processes.
Proton pump inhibitors. They inhibit the synthesis of hydrochloric acid, thereby reducing its irritating effect on the walls of the esophagus and stomach.

Surgical treatment of a sliding hiatal hernia is prescribed by the attending physician in cases where organs are pinched in the diaphragm area.

Other complications of the pathological process include internal bleeding and stenosis, that is, narrowing of the esophageal tube. During the operation, the diaphragmatic ligament is strengthened, and a special tube can be additionally installed, which artificially expands the esophagus, eliminating stenosis. After the operation, a long period of rehabilitation begins. It includes following a diet, eliminating physical activity, and performing a set of therapeutic exercises.

Diaphragm holes (pathology photos are presented below in the article) and reflux esophagitis are quite dangerous diseases. Against the background of these conditions, stretching of certain areas of the gastrointestinal tract is noted. In particular, changes occur in the ligaments that support the stomach and esophagus, a photo of which is also presented in the article. As a result of stretching, displacement occurs. In particular, the upper gastric part extends into the thoracic region. As a result, the functioning of the sphincter connecting the stomach and esophagus is disrupted (the photo illustrates this area).

Probable risk

When the angle of His changes and the activity of the esophageal (lower) sphincter is disrupted, acidic stomach contents or bile flow into the esophagus from the duodenum. The process is accompanied by the development of inflammation and restructuring of the mucosa. This significantly increases the risk of cancer. Of particular importance in the development of pathology is a sliding hiatal hernia. Surgery is the only available method to eliminate this disorder. However, surgical intervention has its own nuances. Next, let's take a closer look at what a hiatal hernia is. Degrees, types and manifestations will also be described in the article.

General information

A hiatal hernia usually develops in combination with gastroesophageal disease. GRD is accompanied by a complex of cardiological, pulmonary and dyspeptic disorders. They arise mainly due to hernia and gastroesophageal reflux. According to data from the American and European Associations, if a person has had a hiatal hernia for 5-12 years, the likelihood of developing cancer after five years increases by 270%, and after 12 - by 350-490% (depending on age).

Prevalence of pathology

The hiatal hernia, according to some authors, is considered the same frequently diagnosed disease as, for example, cholecystitis or an esophageal ulcer. In terms of their prevalence, these pathologies occupy leading positions among gastrointestinal diseases. The hiatal hernia, like an esophageal ulcer, is considered a rather dangerous disease that requires timely diagnosis and careful monitoring.

Classification

There are three main categories of hiatal hernias. These include:

sliding hernia

This form of the disease has some characteristics. In general, a sliding hernia is a protrusion in which one of the walls is an organ partially covered by peritoneum. This could be, in addition to the area considered in the article, the bladder, ascending and descending colon, and so on. However, it may not be. In this case, the protrusion is formed by areas of the organ that are not covered by the peritoneum.

Mechanism of occurrence

In accordance with this feature, the following are distinguished:

Inguinal sliding hernias in the large intestine are usually large protrusions with a wide gate. Diagnosed, as a rule, in old age. It is detected using x-ray examination of the large intestine. A sliding hernia in the bladder is manifested by dysuric disorders. Patients experience double urination. At first, emptying is carried out as usual, and then, when pressing on the protrusion, another urge appears, and the patient urinates again. Diagnosis involves catheterization and cystography. During these procedures, the shape and size of the hernia, the absence or presence of stones in the bladder are determined.

Axial hiatal hernia

This pathology is a displacement of the stomach or other abdominal organs into the chest cavity. The disease is detected in 5% of the adult population. However, about half of the patients do not note any manifestations. This course of the pathology is due to the fact that the sliding one has erased signs of a typical form, since the protrusion is located inside the body and cannot be detected during a routine examination. The disease affects women more often than men. In children, the pathology is predominantly congenital.

Forms of the disease

A sliding hiatal hernia is divided into:

Cardiofundal.
Total gastric.
Cardiac.
Subtotal gastric.

Paraesophageal hernias are classified into:

Gastrointestinal.
Omental.
Intestinal.
Antral.
Fundamental.

Stages of pathology

A sliding hiatal hernia can be classified according to the volume of the stomach penetrating into the chest cavity:

Clinical picture

The symptoms of the pathology are very similar to the manifestations of diseases of the gastrointestinal tract associated with dysfunction. Against the background of deterioration in the activity of the esophageal (lower) sphincter, catarrhal reflux (reverse reflux of gastric contents) is noted. Over time, due to the aggressive influence of the masses, an inflammatory process develops in the lower part of the esophagus. The patient begins to complain of heartburn after eating and gets worse with physical strain or in a horizontal position. Often appears Pain may appear after eating. They have different characters. The pain can spread to the shoulder blade, radiate to the neck, behind the sternum, to the heart area or lower jaw. These manifestations are similar to those of angina pectoris, which is the differential diagnosis. In some cases, pain appears at a certain position of the body. The patient may complain of bloating in the upper abdomen and a feeling of the presence of a foreign body.

Consequences

More severe cases are characterized by a number of complications. One of them is bleeding from the esophageal vessels. As a rule, it occurs in a latent form and manifests itself in the form of progressive anemia. Bleeding can be chronic or acute. In some cases, even strangulation of protrusions in the esophageal opening and perforation of the esophagus are detected. The most common consequence of the pathology is reflux esophagitis. It can develop into a peptic ulcer in the esophagus. With prolonged therapy, this condition provokes an even more serious complication - organ scarring.

Diagnostics

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

Treatment of pathology

Various measures are being taken to alleviate the symptoms that accompany a sliding hiatal hernia: diet, medications. Conservative methods are aimed at eliminating the symptoms of pathology: relieving pain, heartburn, nausea. In this case, medications are prescribed to reduce the acidity of gastric juice. Such drugs, for example, include the drug "Kvamatel". One of the conditions for effective treatment of patients diagnosed with a hiatal hernia is diet. The diet limits the presence of fatty, spicy, fried foods, alcohol, chocolate, coffee, and foods that promote the production of gastric juice. You should eat food in small portions, often. To prevent reflux, it is recommended that the patient sleep with the upper body elevated and avoid lifting heavy objects.

Surgical intervention: general information

It should be said that the above measures do not eliminate the reason why a sliding hiatal hernia occurs. Surgery is the only way to restore the anatomical relationship between the parts of the gastrointestinal tract. During the intervention, an antireflux mechanism is created that prevents the reverse reflux of stomach contents. During the operation, the hernial orifice is eliminated by suturing the enlarged opening of the diaphragm to normal size.

Surgical techniques used

Today, specialists use two methods of intervention:

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

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