Hernia of the esophagus - recurrent displacement of the abdominal end of the esophagus, cardiac stomach, and sometimes intestinal loops in the posterior mediastinum through the esophageal opening of the diaphragm. Manifested by pain in the epigastric region and chest, cough, vomiting with streaks of blood, hiccups. Diagnosis is based on radiography of the abdominal and chest region, endoscopy. In the initial stages, hernia of the esophagus requires adherence to some conservative measures (weight reduction, rejection of tight belts and belts, sleep with a raised head end, etc.), with their ineffectiveness and the development of severe gastroesophageal reflux disease, surgical treatment is necessary.
Causes of esophageal hernia
The appearance of a hernia of the esophagus is based on two pathogenetic factors: the weakening of the ligamentous apparatus, fixing the cardiac section of the stomach, and the increase in intra-abdominal pressure. If the first factor is most often associated with congenital features, then an increase in pressure in the abdominal cavity can lead to constipation, increased flatulence, ascites. overweight, pregnancy, excessive exercise. There are also a number of factors leading to shortening of the esophagus and the subsequent tightening of its abdominal end and cardial section of the stomach into the mediastinum. These factors include some diseases of the esophagus, heart defects.
The displacement of the lower esophagus and the cardia of the stomach in the chest occurs without the participation of the peritoneum, so the hernia of the esophagus does not have a hernia sac. After the formation of a hernia of the esophagus, the vagus nerve significantly relaxes, the His angle disappears (the acute angle at which the esophagus flows into the stomach, prevents the food from being thrown back into the esophagus), the valve mechanism of the cardia stops functioning (it also prevents gastroesophageal reflux). Because of the listed mechanisms, the blood circulation in the cardiac part of the stomach is disturbed, which leads to aggravation of gastroesophageal reflux disease. and therefore to the progression of hernia of the esophagus.
Depending on exactly which parts of the digestive tube penetrate the esophageal opening of the diaphragm, three types of hernia of the esophagus are distinguished: sliding, or axial (esophagus, cardia of the stomach move to the posterior mediastinum), paraesophageal (the lower part of the esophagus and cardia of the stomach remain under the diaphragm, and only the bottom of the stomach is displaced into the chest cavity and mixed (combines both axial and paraesophageal hernia properties).
The risk factors for the development of hernia of the esophagus include obesity. chronic obstructive pulmonary disease. constipation, flatulence, frequent vomiting, pregnancy, old age, various connective tissue dysplasia. ascites
Symptoms of hernia of the esophagus
Often, even large hernia of the esophagus does not appear. Huge hernias with most of the stomach and intestines penetrating into the posterior mediastinum have the most severe course. Detection of a hernia of the esophagus is closely related to the diagnosis of gastroesophageal reflux, however, it is noted that the progression of the hernia most often does not worsen the course of GERD.
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A common hernia can be a symptom of more serious diseases:
- Muscular dystrophy of the buttocks, thigh and lower leg,
- Pinch of the sciatic nerve,
- Seps - blood poisoning,
- Violation of the tone of the muscular wall of the blood vessels of the lower extremities,
- Horsetail syndrome, often resulting in paralysis of the lower limbs.
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The most frequent manifestation of a hernia of the esophagus is pain. Pain may occur in the epigastric region, left hypochondrium, in the region of the heart. The intensity of the pain syndrome is usually closely related to the time of eating and its volume - severe pain occurs immediately after eating, and the more abundant the meal, the more intense the pain. The pain is aggravated by bending, bending the body, and physical exertion. You can reduce the manifestations of pain syndrome by taking antacids. Sometimes the pain of a hernia of the esophagus may resemble an attack of angina.
Other, more rare, symptoms of hernia of the esophagus include vomiting (often streaked with blood), episodes of cyanosis, breath holding in a dream, protrusion of the left half of the chest, heartburn, sour belching, cough, impaired swallowing, and hiccups.
Hernia of the esophagus is often complicated by the development of esophagitis of reflux origin, ulcers of the esophagus, cicatricial strictures with shortening of the esophagus. A peptic ulcer can form in the stomach, persistently resistant to treatment, often complicated by bleeding. perforation. In the presence of paraesophageal hernia in the mediastinum, the intestine may shift with the development of its incarceration and intestinal obstruction. Because of the severe pain that occurs immediately after a meal, patients may have an aversion to food, which leads to significant weight loss and exhaustion. On the part of the respiratory system, episodes of respiratory arrest during sleep are possible, aspiration pneumonia develops due to regurgitation of the stomach contents.
Diagnosis of hernia of the esophagus
Consultation with a gastroenterologist is required for all patients with hernia of the esophagus for differential diagnosis with another pathology. The two main methods of diagnosis of hernia of the esophagus - x-ray and endoscopic combined provide only 85% of the reliability of the result. Consultation with an endoscopist is required for esophagogastroduodenoscopy. During the endoscopy, the unchanged esophagus is visualized, around the lower part of which the diaphragm closes rhythmically (in time with respiratory movements), or the cardial section of the stomach that is circularly protruding into the lumen of the esophagus is seen - this is the most reliable criteria for esophageal hernia. However, it should be remembered that these signs can also be observed due to vomiting movements that often occur during the endoscope through the pharynx, which causes a high frequency of overdiagnosis of the hernia of the esophagus. In most cases, an EGD can only diagnose reflux of the stomach contents into the esophagus.
X-ray diagnosis of hernia of the esophagus is carried out in several stages. First carry out a survey radiography of the abdominal cavity. on which they register the shadow of the esophagus, the location of the domes of the diaphragm and the gas bubble of the stomach. At the next stage, the X-ray of the esophagus and the X-ray of the stomach with the introduction of contrast in a vertical position. Evaluated the passage of contrast through the digestive tube, the rate of gastric emptying. At the third stage, images are taken in a horizontal position and with the head end lowered. Normally, the locking mechanism of the cardia and the angle of the His prevents the backward movement of barium suspension into the esophagus. With a hernia of the esophagus, these mechanisms do not work, so gastroesophageal reflux is noted. After that, the patient returns to an upright position, and the position of the gas bubble of the stomach, the presence or absence of contrast in the esophagus is examined.
With a small hernia, with no clinical symptoms, a hernia of the esophagus after such a study is diagnosed only in a third of patients. Some gastroenterologists recommend supplementing X-ray examination with special techniques that increase the pressure in the abdominal cavity. However, most authors agree that such methods only worsen the patient's condition with hernia of the esophagus and lead to overdiagnosis of this pathology.
Esophageal manometry may also help in the diagnosis. In conducting this study, the functional state of the lower esophageal sphincter, its length and ability to relax during swallowing are evaluated, and episodes of its relaxation beyond periods of swallowing are detected. This method is not widely used.
Other techniques, such as ultrasound of the abdominal organs. CT and MSCT. do not provide reliable data for the diagnosis of hernia of the esophagus, however, allow for differential diagnosis with other diseases of the digestive tract. Differentiate a hernia of the esophagus should be to diseases accompanied by esophagitis, angina, nerve damage thoracic spinal cord, the relaxation of the dome of the diaphragm, the syndrome Kasten (hiatal hernia, cholecystitis. Duodenal ulcer), the triad Sainty (hiatal hernia, diverticula of the colon. GSD) .
Treatment of hernia of the esophagus
Begin treatment of hernia of the esophagus always with conservative measures. The patient is recommended to normalize the weight, to abandon the use of tight belts and belts. Sleep should be with a raised head end. It is necessary to eat often, in small portions, to include in the diet a sufficient amount of fiber.
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Drug therapy is aimed at preventing and treating the main complication - GERD. For this purpose, proton pump inhibitors are used in gradually decreasing doses in a course of up to two months, followed by a transition to a short course of antacids. Prokinetics (domperidone) must be included in the treatment.
Surgical treatment of hernia of the esophagus is indicated in the development of severe forms of gastroesophageal reflux disease, torpid reflux esophagitis, which is not amenable to conservative treatment, Barrett's esophagus (a precancerous condition that appears on the background of GERD). Tactically, both open and laparoscopic surgery can be performed. To eliminate a hernia of the esophagus, endoscopic fundoplication is used. gastrocardiopexy. Belci operation.
Prognosis and prevention of hernia of the esophagus
The prognosis for hernia of the esophagus is favorable, provided timely prevention of serious complications. Self-healing with this pathology is impossible, but if the recommendations of the gastroenterologist are observed, the course of the disease is observed with minimal clinical manifestations and even without them. Prevention includes regular endoscopic examination of patients at risk, especially of the gastroenterological profile. Be sure to conduct anti-relapse treatment of diseases of the digestive tract.
Causes and mechanism of development of hernia of the esophagus
Such a hernia may be due to congenital abnormalities. The reason lies in the small length of the esophagus, which leads to the initial localization of the stomach in the chest region.
However, in most cases, this pathology develops under the influence of a number of factors:
- the weakening of the muscular ligaments of the esophagus under the influence of age-related changes,
- atrophy of the liver, leading to a decrease in the volume and weight of this organ, which affects its functionality,
- sudden weight loss, which reduces the fatty layer under the diaphragm,
- surgical interventions on the organs of the digestive tract,
- ascites (the appearance of excess fluid in the peritoneal region),
- intestinal obstruction syndrome,
- high level of physical activity
- burns of the digestive organs when acids or alkalis enter into them,
- different types of diseases of the digestive tract,
- internal abdominal trauma.
Pathology has several types:
- Esophageal. In this form of the disease, the bottom of the stomach, the intestinal loop and part of the adipose tissue that is on the surface of the intestine fall into the diaphragm.
- Axial. The stomach moves to the chest area along the vertical axis. Often there is the whole body or its main part.
- Sliding. The esophagus changes its location, alternately getting in the region of the diaphragm, then in the part of the peritoneum.
Despite the classification of the disease, the symptoms of hernia of the esophagus are similar in nature.
Symptoms and diagnosis of pathology
In half of the patients, esophageal hernia may not manifest itself, i.e. have hidden symptoms. In 10-50% of cases, it is diagnosed during an ultrasound or x-ray of the peritoneum or chest.
But there are a number of signs that often indicate the development of the pathology of this organ of the gastrointestinal tract. Such manifestations include pain in the abdomen, which may be of a different nature, starting with the aching sensations under the ribs and ending with the girdles that spread to the back. After eating or moving the body to a horizontal position, the pain intensifies. Deep breaths, vomiting or belching with a bitter or acid aftertaste may bring relief.
If after eating, regurgitation of pieces of food and the appearance of a burning sensation are observed, then this may also indicate a lump in the esophagus.
Heartburn with a sour taste in the mouth, appearing at night or in certain body positions, is a sign of the pathology of the digestive tract.
Sometimes hernia is accompanied by frequent hiccups, a feeling of tightness in the chest after eating solid food, pain in the tongue and the appearance of hoarseness.
A gastroenterologist or surgeon diagnoses a hernia of the esophagus, the symptoms and treatment are also determined by these specialists. For the diagnosis are assigned 4 types of research:
- X-ray At the same time, barium is injected into the body through the oral cavity.
- Fibrogastroscopy. Examination of the stomach through the introduction of a probe with a built-in video camera.
- Ultrasound. An examination of the chest and abdominal cavity.
- pH-metry. With this type of analysis, the acidity level in the digestive tract organs is measured.
Each type of research involves preparation, instructions for which are given by the attending specialist.
Symptoms of the disease
Symptoms of hernia of the esophagus manifest themselves with the progression of the pathological process. This pathology requires competent treatment. In the absence of such, bile from the stomach will begin to freely enter the esophagus. Treatment of hernia of the esophagus depends on the stage and the clinical picture. If the pathology is not treated in time, it will lead to inflammation of the esophageal mucosa. It is worth noting that the esophagus is sensitive to gastric bile: it is not able to defend against it. Symptoms of the disease make themselves felt when there is a regular reflux of bile into the esophagus. With this phenomenon, esophageal hernia develops.
- Throwing bile into the esophagus leads to pain. If a person develops a small hernia of the esophagus, the symptoms may not appear. It is important to say that the hernia of the esophageal opening of the diaphragm often proceeds hidden. Despite the hidden course, the disease is dangerous to health. If there are no manifestations of pathology, it can be detected in the process of ultrasound. Hernia of the esophagus can grow: in this case, symptoms appear. Hernias of the esophageal orifice symptoms are different. Their severity depends on what size education has reached, the addition of complications plays an important role. So, we know what a hiatal hernia is. We now turn to the symptoms.
- Hernia of the esophagus causes heartburn. Symptoms are associated with the fact that the gastrointestinal tract is disturbed. Heartburn can manifest itself in a calm state. Sometimes it occurs when bending, turning. A hernia of the esophageal opening of the diaphragm manifests heartburn during physical exertion. A symptom arises in those who had consumed alcohol on the eve and ate heavy food. Heartburn varies in severity. But regardless of its manifestations, the patient feels discomfort in the chest. There can be bitterness in the mouth. Hernia of the esophagus with its manifestations affects the performance In some patients, sleep is disturbed.
- Pain syndrome with HHD manifests itself when a person bends down, assumes a prone position. Some people feel pain in the chest, in the hypochondrium. Aching pain may appear in the stomach. After eating, they intensify. Pain in the side aggravated by inspiration.
- Symptoms of the disease deliver severe discomfort. Manifestations of a hernia of the esophageal part of the diaphragm are shortness of breath and regurgitation. Belching occurs as a result of a spasm of the alimentary canal. A hernia of the food opening of the diaphragm leads to an increase in intra-abdominal pressure. When belching occurs, the mouth tastes like stomach contents. Hernia of the esophagus treatment is always complex. Acceptance of spasmalgate alone will not help. Belching delivers discomfort, however, leads to improved well-being.
- If the hiatus hernia has reached medium size, regurgitation appears. This symptom affects the quality of life. The patient has to carry containers for vomit.
- Pathology leads to dysphagia, a symptom characterized by swallowing disorder. Hernias of the food opening of the diaphragm appear when a person tries to eat something cold or hot. Swallowing disorder occurs infrequently. There are cases when it indicates complications. If the hernia of a diaphragm becomes aggravated, the food badly passes inside (some patients have heartburn). Sometimes the patient can not swallow food: this is due to the fullness of the esophagus. Dysphagia causes discomfort. It leads to the fact that a person refuses to eat.
- The clinical picture depends on the type of pathology. If a sliding hernial formation is diagnosed, a protrusion into the hernial sac occurs.
- Symptoms of the disease occur if there is gastric contents in the esophagus. Esophageal hernia type is characterized by chest discomfort. To avoid pain, a person refuses to eat.
Radiography of the chest
This type of diagnosis is used in most cases when a person is worried about pain in the solar plexus. When conducting radiography, you can find signs indicating the development of a hernia of the esophageal part of the diaphragm. The following factors indicate the presence of the disease:
- overestimate of the esophageal sphincter,
- lack of subphrenic esophageal,
- placement of the cardia over the diaphragm,
- expansion of the esophagus,
- retention of barium suspension in the hernia.
X-ray of the esophagus and stomach
This diagnostic technique makes it possible to identify a hernia of the esophageal part of the diaphragm due to the fact that the person being examined is placed in the Trendelenburg position, in which the pelvic region and the body are above the head. With such a position of the patient's body, intra-abdominal pressure rises and this contributes to obtaining more reliable information during x-rays. Before performing fluoroscopy, the patient is given to take a solution of barium sulphate.
Most often, the hernial phenomenon of the esophagus is signaled by the following symptoms.
- difficulty in swallowing,
- pain in the sternum
- unpleasant belching,
- shortness of breath, asthma.
The most common symptom of hernia formation of the esophagus is prolonged and painful heartburn. It may occur after eating and on an empty stomach. Heartburn is particularly evident in the supine position or during physical exertion, especially when bending forward.
Unpleasant release of air in the form of belching can also torment the patient. At the same time the part of food which is not digested by a stomach can belch. There may be an unpleasant smell from the mouth.
As for pain, it is common with a similar diagnosis. It is felt in the region of the sternum, closer to the left side. Burning pains under the ribs often frighten patients, referring them to heart disease symptoms. In fact - the pain comes from the hernial formation of the esophageal opening of the diaphragm and give to the heart. May increase after exercise.
Difficulty in swallowing feels like a lump in the throat, which prevents normal passage of food through the esophagus. This syndrome also develops pain. They give in the left shoulder blade and shoulder. Similar symptoms occur with angina. Pain does not necessarily appear, it may just be an unpleasant pressing feeling behind the sternum.
Asthma and shortness of breath most often torments the patient at night. From this, a voice can sit down, coughing and active salivation can begin. Thus, a person begins to panic, blood pressure rises. If the patient did not consult a doctor in time, a syndrome of an obsessive state may even develop.
Signs of hernial collapse during complications are most pronounced.
In surgery, such formations of the esophageal opening of the diaphragm for convenience of diagnosis are divided into subcategories:
- formations that are asymptomatic,
- falling out of the esophagus without cardia failure syndrome,
- hernial protrusion with the presence of cardia insufficiency syndrome,
- hernias that have developed with other diseases of the gastrointestinal tract,
- presence of congenital shortened esophagus,
- paraesophageal falls.
All of them can show signals that prompt the attending physician about the presence of such a disease as a diaphragmatic hernia. The formation of the esophageal opening of the diaphragm, abbreviated as AML, is most often manifested.
Why did you choose such a division of the manifestation of education? The fact is that since the hernial esophageal dumping into the sternum does not have its own pronounced symptoms, it was assigned to the accompanying problems, the presence of which aggravates the symptoms. Then the doctor will be easier to navigate what ailment should be sought.
Asymptomatic hiatal hernia occurs very often, as they are characteristic of a new formation. Nearly 40% of the esophagus bulging has no sign. This is exactly the case when doctors can diagnose an ailment when examining a patient for another illness. This allows modern medicine and new technical devices.
Cardiac insufficiency syndrome occurs in almost 90% of cases of ejection of parts of the esophagus into the chest cavity. As a rule, it is manifested by heartburn, which can torment the patient at night or after eating. Attacks of heartburn can be as fleeting, and cause real torment. Sometimes, it can even affect human performance.
A hernia of the esophageal opening of the diaphragm is often accompanied by pain. This is also part of the symptoms encountered in cardiac insufficiency syndrome. Pain can be, as clearly expressed, and mixed by feeling with heartburn. Then it is difficult for the patient to distinguish one from the second and there is a feeling of simply strong heartburn.
Since hernia of the esophagus is most common in elderly people, it should be understood that the pain in the sternum and the heart may not be associated with a hernia of the esophageal opening of the diaphragm, but to have an individual character. In this case, the doctor is hard to determine what was the primary source of pain. Give pain can not only in the sternum, but also in the neck, lower jaw.
Esophageal hernia of the orifice of the diaphragm sometimes causes difficulties in the passage of food through the esophagus. This may be one of the symptoms of hernial formation, and it is alarming about the possibility of developing a cancer on this background.
If cardia deficiency syndrome is absent, signs of protrusion are not so pronounced. For example, pain can only be disturbed after the patient eats. Belching and heartburn can stop if you eat a little food.
Cases when the esophageal opening of the diaphragm is accompanied by accompanying ailments of the gastrointestinal tract are not uncommon. These can be diseases such as gastric and duodenal ulcers, cholecystitis, pancreatitis and other ailments.
As for the congenital short esophagus, this disease refers to a congenital disease and is diagnosed, as a rule, by chance.
It is used in conjunction with impedancemetry and intragastric and intraesophageal pH-meter. The main task of such diagnostic procedures is the study of the gastrointestinal tract environment.
If a gastroesophageal reflux disease (paraesophageal hernia) is suspected, the patient is prescribed daily pH monitoring to assess the frequency of gastric gastrosis casts into the esophagus and their characteristics.
If a patient has a history of gastric or duodenal ulcers, an additional fractional diagnosis of gastric juice is made.
In each case, if you suspect a hernia of the esophageal orifice of the diaphragm, the doctor individually can prescribe a certain set of diagnostic measures, including only some of the techniques listed above.
Types of esophageal hernia
Such a disease as a hernia of the esophagus has several types:
- Congenital hernia. which is formed due to an underdeveloped and short esophagus, in connection with this, part of the stomach will initially be located in the chest cavity,
- Acquired. As a rule, this type of hernia is typical for people over 60 years of age, but there are younger patients.
- Unfixed and fixed. this is characteristic of axial and paraesophageal, sliding hernias.
• Axial hernia - refers to total-gastric, sublethal and cardiac. It is formed by independent movement from one cavity to another.
• Paraesophageal - this is the origin of the hernia, when the part of the stomach that forms it is under the diaphragm, it is close to the digestive tract.
• A sliding hernia is the passage of a hernia into a hernial pouch formed by the peritoneum lined.
- Small intestinal and epiploic hernia with thinning of the walls.
Causes of esophageal hernia
What can cause a hernia?
There are several reasons why this pathology may develop. It:
- surgery on the esophagus,
- age-related changes in the ligaments of the digestive tract,
- changing the location of internal organs during multiple pregnancies,
- decrease in the functions of the liver and its change in volume - atrophy,
- accumulation of fluid in the peritoneal cavity - ascites,
- a sharp decrease in body weight and the absorption of fat under the diaphragm,
- chemical burns or burns from hot food,
- excessive exercise and weight lifting
- disruption of the digestive system,
- chronic constipation, frequent flatulence,
- abdominal injuries that do not violate the integrity of the skin,
- diseases that prevent the proper functioning of the stomach, gastric bladder and the initial sections of the small intestine (chronic).
Esophageal hernia complications
What can be dangerous this pathology?
The disease sometimes leads to a number of complications, and this will not depend on the classifications and the reasons for its origin. This hernia may be accompanied by esophageal bleeding, the passage of the esophagus into the so-called "hernia sac" or gastric mucosa, inflammation of the gastric mucosa, shortening of the esophagus, incarceration of the hernia (here the surgery will be inevitable).
A strangulated hernia of the esophagus is characterized by increased pain, bloating and a strong tension of the abdominal walls, the appearance of a prolonged, intractable vomiting.
In this case, emergency suturing of the diaphragmatic opening to normal size is performed after reposition of the esophagus into the abdominal cavity.
Folk remedies for hernia of the esophagus
There are also popular ways to get rid of the symptoms of this pathology, such as heartburn, constipation, abdominal distension, belching. Traditional medicine in this case only alleviates the condition, it is not able to cure a hernia.
A number of the following herbal remedies help:
- For heartburn - mix licorice root with orange peels and dissolve for a few minutes, grate raw potatoes and carrots on a coarse grater, take inside or dissolve for 10-15 minutes.
- When constipation - you can drink compote of dried fruit, take infusions of rhubarb root and senna leaves, steamed licorice root.
- When abdominal distension - insist cumin seeds or chamomile flowers, drink several times a day, steam up yarrow and St. John's wort, also take orally, steam peppermint with valerian root and fennel fruits. A similar result will give an infusion of carrot seeds (a couple of grams per 3 cups boiling water).
- Belching - well help infusion of the fruits of mountain ash or cranberry. in which you can add honey or aloe juice.
- Pain will reduce Althea infusion. its roots are taken as a painkiller (1 tablespoon per cup of boiling water). Another tool is based on an alcohol solution of propolis (30 drops) and a quarter cup of milk.
There is also a method of treatment with the help of massage, this method is suitable for all types of hernias. First you need to consult with your doctor. Of course, it is better if the specialist will do the massage, but you can resort to the help of relatives, but only with the permission of a specialist. Massage will help strengthen the muscles of the peritoneum.
It is worth knowing that in a small percentage of cases the disease proceeds without any symptoms. Many people learn about the disease by chance, passing any examination associated with the abdominal cavity.
Posted in Selected diseases
How is the diagnosis of hernia of the esophageal orifice of the diaphragm
Diagnostics of hernia of the esophageal part of the diaphragm is a whole complex of procedures that are necessary to identify violations and related factors. At the first stage, the doctor examines the patient and studies the symptoms of the disease, which is expressed in certain signs. If there are complaints to the patient about the symptoms characteristic of this pathology, the specialist will prescribe a comprehensive examination based on a history.
Factors such as pain in the solar plexus, which is also accompanied by cardiovascular and bronchopulmonary diseases, indicate the formation of a hernia of the esophageal part of the diaphragm. There may be phenomena peculiar to gastroesophageal reflex ailments. In this regard, the diagnosis of hernia of the esophageal part of the diaphragm is very difficult, since it is impossible to make a diagnosis according to some signs that are troubling the patient. Given this fact, to confirm suspicion of a hernia, the patient is prescribed such procedures as:
- Radiography of the chest.
- X-ray of the esophagus and stomach.
- Endoscopic mucosal biopsy.
- Morphological study of biopsy.
- Analysis of fecal occult blood.
- Esophageal manometry.
- Intragastric and intraesophageal pH-metry.
Let us take a closer look at why each type of research is needed and what information it provides.
We conducted an investigation, examined a bunch of materials, and most importantly, we checked the majority of hernia treatments. The verdict is:
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What is a hernia of the esophagus
Hernia of the esophagus is also called hernia of the esophageal opening of the diaphragm (HHL). Pathology is accompanied by displacement of the abdominal organs through the esophageal opening to the sternum. The diaphragm is a muscle that separates the abdominal and thoracic cavities. Normally, the organs located under the diaphragm do not fall into the upper sections. However, with an increase in intra-abdominal pressure and weakening of the connective tissues, the digestive organs shift, which leads to deformation in the esophagus - hernia. In the case of hiatal hernia, the cardial section of the stomach or the abdominal end of the esophagus is shifted.
The development of the disease leads to bile entering the esophagus and reflux of the stomach contents. Continuous ingestion of gastric acid provokes inflammation of the esophageal mucosa. As a result, it is easily damaged, and the patient feels painful.
Symptoms of hernia of the esophagus often coincide with signs of other diseases. Therefore, pathology is difficult to determine.
For hiatal hernia characteristic:
- Abdominal pain. Localized in the sternum, hypochondrium, abdomen, heart area. Sometimes can give in the back. As a rule, pain whining character, only occasionally accompanied by burning sensation. Occurs after eating or when the body is horizontal. It dies out with a deep sigh, belching, vomiting.
- Involuntary belching. Appears not only after eating, but also when talking, yawning. Accompanied by sour or bitter odor.
- Regurgitation Uncontrolled appearance of vomitus in the mouth after eating. Observed in 35% of patients. Occurs without prior nausea, after regurgitation abdominal pain subsides.
- Heartburn. Appears after eating, physical exertion, weight lifting. Strengthens when the torso is tilted or horizontal. Often goes along with flatulence, nausea and bitter-sour taste in the mouth.
- Sensation in the chest of a foreign body - coma. Appears only with food when swallowed.
- Prolonged frequent hiccups.
- Heartache. Observed in 30% of patients, which is why patients often confuse hernia of the esophagus with cardiovascular diseases. Accompanied by tachycardia, cardiac arrhythmias, difficulty breathing.
- Difficulty breathing and trouble swallowing food or drink. In advanced cases, the patient cannot eat at all.
- Pain in the tongue.
- Hoarse voice.
Almost half of the patients are unaware of the pathology, since a hiatus hernia in 50% is asymptomatic. The disease is detected by chance during x-ray or ultrasound.
There are two causes of esophageal hernia - congenital and acquired. Congenital hernia is a consequence of a short esophagus, due to which part of the stomach from birth is located in the chest cavity. It occurs in one of 1700 newborns. Acquired hernia usually appears after 60 years.
At an earlier age is much less common. The causes of hernia of the esophagus include:
- Hereditary predisposition.
- Increased abdominal pressure.
- The esophageal tube shortening and esophageal upward shift as a result of diseases of the gastrointestinal tract: ulcers, cholecystitis, pancreatitis.
- Injuries to the diaphragm and abdominal cavity.
- The weakening of muscle tissue.
- Liver atrophy.
- Operations of the esophagus.
- Accumulation of excess fluid in the abdominal cavity.
- Pregnancy, especially multiple pregnancy.
- Permanent constipation.
- Frequent and excessive exercise of abdominal muscles.
- Sharp weight loss.
- Burns of the mucous membrane of the esophagus (chemical, thermal).
Also, provoking factors that may cause a hernia include: overweight, excessive drinking, smoking, a sedentary lifestyle, in which the muscles of the abdominal and thoracic cavity weaken.
Varieties of pathology
Symptoms and treatment of hiatal hernia are directly related to the type of disease.
There are several types of hiatus hernia, depending on which parts of the esophagus penetrate into the chest cavity:
- Parietal esophageal (paraesophageal). Through the esophageal opening of the diaphragm, the bottom of the stomach, intestinal loops and the omentum (layer of fatty tissue covering the intestines) exit.
- Sliding. Displaced esophagus and cardia of the stomach. This type of hernia was named after the shifted organs literally “walk” from one cavity to another. Periodically, the stomach and esophagus return to their normal position, and the symptoms disappear. Discomfort resumed when the organs are again shifted to the sternum.
- Axial (axial). The stomach is fully or partially shifted vertically.
What is dangerous hernia of the esophagus? In advanced cases, it leads to:
- inflammation of the lining of the stomach and its erosion,
- shortening the esophageal tube,
- infringement of a hernia,
- gastric ulcer, chronic gastritis,
- esophageal cancer.
Features of treatment
Treatments for esophageal hernia include:
- Reception of medicines.
- Treated physical culture.
It is possible to treat hiatal hernia only by a medical method. Surgical intervention is resorted to in extreme cases.
For hernia of the esophagus, the following drugs are prescribed:
- Antacids are aimed at neutralizing the high acidity ("Almagel", "Maalox", "Phosphalugel").
- Prokinetics - normalize the passage of food ("Zeercal", "Motilium", "Domyrid").
- Histamine blockers and inhibitors - reduce the production of gastric acid ("Ranitidine", "Nolpaza", "Roxatidine", "Omeprazole", "Famotidin", "Contalok").
- Bile acids - neutralize the acid that has got into the esophagus ("Ursofalk", "Urokhol").
As an additional tool, decoctions from licorice root, yarrow, St. John's wort, gentian, cold mint, buckthorn, rhubarb root, flax seeds, cumin, rowan flowers, chamomile, work well.
Surgery is carried out with the following complications:
- infringement of a hernia,
- bleeding, ulcers, erosion,
- squeezing of the heart muscle when most organs enter the chest cavity,
- the introduction of the organs of the gastrointestinal tract into each other.
Patients with hernia of the esophagus surgery is also prescribed for the ineffectiveness of drug treatment. A cavity incision or laparoscopy is used as a surgical method. Contraindicated surgery during pregnancy, with cardiovascular diseases, oncology, diabetes. After the examination, determine the type of operation:
- Gastrocardiopeksiya. The esophagus and cardia of the stomach are literally sutured to the sub-diaphragm structures.
- Fundoplication over Nissen. Conducted using band or laparoscopic method. During the operation, the size of the diaphragm opening is reduced with a special cuff.
- Operation Belcy. The bottom of the stomach is stitched to the front wall of the esophagus, and the esophagus and its valve - to the diaphragm.
- Allison technique. Apply only in the complex surgical procedures. During the operation, the hernial openings are sutured.
With hiatus hernia, the diet is not strict. Exclude only products that increase gas formation, as well as increasing acidity. It is forbidden to drink alcohol, juice, fatty, spicy, pepper, pickled food, lard, mushrooms, beans, peas, cabbage, citrus, pastries, chocolate, carbonated drinks, coarse cereals, black bread.
The diet with the use of dairy products, mucous porridges, mashed soups, baked lean meat and fish, fresh soft vegetables and fruits has a positive effect on the treatment process.
Patients who have found esophageal hernia are prescribed physiotherapy exercises aimed at strengthening the abdominal muscles. The complex includes the following exercises:
- Lie on your side, put your head and shoulders on a stiff pillow. While inhaling, push out the belly, while exhaling, relax first, then draw.
- Get on your knees. While inhaling, make a slope, with an exhalation return to the starting position.
- Get down on your back. Make turns corps on the inhale, on the exhale return to the center.
With hiatus hernia self-healing is excluded. It is possible to get rid of the pathology only by fulfilling in full all the doctor's prescriptions. Prevention of the disease is to strengthen the muscles of the abdominal cavity, the normalization of weight, regular examinations by a gastroenterologist.
There are congenital and acquired hernia of the esophagus. Congenital is caused by the abnormal structure of the esophagus. The body can be short. Acquired food hernias are more common.
- One of the causes of pathology is muscular weakness of the diaphragm. As the body ages, organs function worse. Tissues and muscles become less elastic. Failures in the internal organs have a negative impact on health. Some people have impaired functions of the digestive tract. The cause of the development of a hernia is muscular weakness of the diaphragm, due to age-related changes. The disease leads to hernia formations. In order to avoid hernia of the esophagus, you need to lead an active lifestyle. It is necessary to refuse overeating and other bad habits.
- Symptoms of pathology may be due to hereditary tendency. If a hernia a hernia of intra-abdominal pressure occurs when fluid accumulates in the abdominal cavity.
- People who overeat, are more prone to hernia of the esophagus. To avoid illness, you need to clean the intestines. It is necessary to ensure the prevention of constipation, obesity.
- If a person has impaired motor activity, he is also prone to pathology. If the digestive organs develop abnormally, the esophagus is pulled upwards. The result - the emergence of diseases, among which is a hernia of the esophagus, pancreatitis, a stomach ulcer.
- If the esophagus is naturally shortened, scarring occurs in it. Changes of this nature may be associated with thermal, chemical effects. Hernia of the esophagus may occur against the background of intestinal pathologies. It is necessary to treat diseases of the gastrointestinal tract in time. Do not forget that they lead to dangerous consequences (oncology).
- Damage to the diaphragm leads to the development of hernia of the esophagus. Closed injuries - bruises, injuries, fluctuations of intra-abdominal pressure. As for open injuries, they can be associated with exposure to heavy objects, such as a knife. If the diaphragm is damaged, a hernia of the esophagus develops. It is important to note that the tone of the diaphragm is affected by nicotine, alcohol, caffeinated beverages, hormonal drugs.
- Comorbidities play an important role. Hernia of the esophagus is heavier due to gastritis and other gastrointestinal diseases. In the process of diagnosis, a distinction is also made between hernia of the esophagus and other diseases of the gastrointestinal tract. Differential diagnosis helps to make a reliable diagnosis and prescribe the appropriate means of treatment.
Diagnosis of the disease
Symptoms and treatment of the disease go hand in hand. Diagnostics of hernia of the esophageal orifice of the diaphragm involves the use of highly informative examination techniques. The diagnosis is made by a gastroenterologist.
- The doctor prescribes fibrogastroduodenoscopy (FGDS). A fibrogastroscope is used for the procedure. With the help of this device are investigated: the esophagus, stomach, duodenum.
- X-ray helps in making an accurate diagnosis. It is necessary in case of suspected ulcer, inflammation in the digestive tract. X-ray - a highly accurate method of examination.
- If necessary, carried out PH-metry. The procedure is necessary if the contents of the stomach is thrown into the esophagus. In the process, the doctor uses special equipment.
How to treat a hernia of the esophagus? Much depends on the stage of the disease. The goal of conservative therapy is to restore the activity of the esophagus and the digestive tract organs, and also to relieve a person of uncomfortable symptoms. In most cases, the doctor prescribes a diet. It involves the rejection of fried, spicy, salty foods. The diet includes food that improves the functioning of the stomach (boiled vegetables, cereals). Medicines are taken to reduce the harmful effects of gastric juice on the esophagus. It is important to cure concomitant diseases. It is worth saying that the treatment is not complete without a diet and a healthy lifestyle. If conservative measures fail, a hernia is prescribed.
Indications for surgery:
- increased inflammation in the esophagus,
- the appearance of erosions, bleeding,
- disorders affecting the esophageal mucosa.
Surgical intervention is not performed:
- during pregnancy
- Diabetes mellitus,
- oncological process
- severe pathologies associated with the heart.
It is important to treat pathology in time. Improper therapy leads to dangerous consequences. On the background of a hernia of the esophagus, gastric ulcer may occur. Signs of a hernia should not be overlooked. Late treatment leads to internal bleeding. If the body is constantly losing blood, anemia develops. It is accompanied by weakness, loss of sleep and appetite. Among the complications is to identify the invagination, in which the esophagus spontaneously wraps itself.
The consequence of improper treatment may be a pinching of the hernia. Finally, the most dangerous complication is esophageal cancer. Oncology is dangerous because metastases spread to the gastrointestinal tract and ultimately lead to death.
- Timely treatment of gastrointestinal tract pathologies.
- Rejection of bad habits.
- Timely rest and proper sleep.
- Active lifestyle (charging, swimming, walking in the fresh air).
- Refusal from heavy and unhealthy food.
- Stress relief.