Hernia of the abdomen and esophagus

A hernia of the esophageal opening of the diaphragm - why does the pathology arise and how is it treated?

A fixed hernia of the esophageal orifice of the diaphragm (POD) is the pushing of the cardiac (inlet) part of the stomach into the chest cavity, where it resides, without slipping down.

Therefore, the symptoms will be permanent, not transient. This is a rare but more dangerous form of the disease compared to an axial hernia. It is with a fixed hernia that complications are more frequent, which relate to emergency conditions and require immediate medical (including surgical) care. One of these complications is the pinching of a hernia.

A characteristic manifestation of this type of hernia AML is the shortening of the esophagus, with the result that it is completely located in the chest cavity (normally it should be only 2/3) and fixes the stomach constantly above the prescribed level, i.e. over the diaphragm in the mediastinum.

The most common causes of fixed hernia are:

  • continuous increase in intraperitoneal pressure. It is caused by flatulence (increased flatulence in the intestines), weight lifting, overeating, constipation, improper posture during work,
  • mechanical compression of internal organs (including the chest and abdominal cavity) due to improper posture,
  • strong prolonged cough
  • obesity,
  • bad habits,
  • genetic predisposition
  • congenital defects of development.

      1. Heartburn, aggravated by physical exertion and torso. Associated with the ingestion of gastric juice and stomach contents into the esophagus. Especially heartburn bothers while lying down.
      2. Belching - resulting from the discharge of air into the esophagus. It may be mixed with bile, gastric juice, which determines the nature of the smell and taste when belching.
      3. Intense persistent chest pains that mimic heart disease. In this regard, very often patients for a long time believe that they have diseases of the cardiovascular system.
      4. Dysphagia - difficulty swallowing. Initially expressed when swallowing liquid food, and then - solid.
      5. Frequent bouts of hiccups. Associated with the "convulsions" of the diaphragm, which is irritated by the hernial sac.

Complications

      1. Infringement of a hernia - leads to disruption of the blood supply to the part of the stomach that “gets” into the chest cavity and is accompanied by intense pain.
      2. Compression of the branches of the vagus nerve. It may be a consequence of large fixed hernias. At the same time, the patient will experience severe pain, irregularities in the work of the heart (arrhythmias, cases of increased or slow pulse, a sharp decrease in blood pressure).
      3. Esophageal bleeding - manifested by sudden bloody vomiting (acute abundant bleeding) or vomit in the form of coffee grounds (with ingestion and accumulation of blood in the upper part of the stomach). Common manifestations will be pallor, cold sweat, thirst, lowering blood pressure, even fainting.
      4. Perforation of the esophagus - the gap of its walls due to the constant reactive effects of acidic contents of the stomach and a change in their thickness and elasticity.
      5. High risk of developing esophageal cancer.

Diagnostic methods

      1. X-ray examination using radiopaque substance - allows you to detect the presence of a hernia and its type, size.
      2. FGS (fibrogastroendoscopy) - to determine ulceration of the esophageal mucosa, which are a common cause of esophageal bleeding and perforations.
      3. pH-metry - to study the acidity of gastric juice and the contents of the esophagus. The most revealing and informative is its monitoring during the day.
      4. Esophagemanometry - measurement of intra esophageal pressure and identification of areas where it is elevated.
      5. A blood test - detects anemia (with bleeding), inflammatory and infectious diseases of internal organs.
      6. Additional studies to exclude pathology of the respiratory and cardiovascular systems:
      • electrocardiogram,
      • radiography of the chest,
      • ultrasound procedure.

Treatment of fixed hernia of the esophagus

      • medicamentous
      • surgical

With a fixed hernia, conservative therapy is prescribed only to relieve acute symptoms as a preparatory stage for surgical treatment. It includes the appointment of drugs that reduce the amount and acidity of gastric juice, regulating the motility of the digestive organs, reduce belching and heartburn.

Since the manifestations of a fixed hernia AML are permanent and are often complicated by its incarceration, surgical intervention is the most appropriate treatment option. Patients are prescribed an operation during which the lower part of the esophagus and the cardiac part of the stomach descend from the chest into the abdominal cavity. Then the legs of the diaphragm are sutured, which form the esophageal opening in it (krurorafiya) behind the esophagus.

Krurorafiya in modern surgery can be carried out in three ways: through the abdominal access (through the abdominal cavity), thoracic (through the chest cavity) and endoscopically. The latter technique is minimally invasive, because it does not require large cuts and allows you to monitor the progress of the operation with an endoscope.

To prevent reflux, Nissen fundoplication is performed - this is the hemming of the posterior surface of the upper third of the stomach around the esophagus. Fundoplication is performed using both the classical (open) method and the method of laparoscopy (endoscopic surgery method).

On the fixed hernia of the esophageal opening of the diaphragm

Hiatal hernia, also called esophageal hernia, can cause severe pain and discomfort. Although some people may not experience the symptoms of this disease.

A hernia of the esophagus occurs as a result of the weakening of the opening in the diaphragmatic membrane, which separates the chest cavity and the abdominal cavity.

The mechanism of the digestive system is quite simple. A one-way valve at the bottom of the esophagus temporarily opens during food intake. Thus, the food can pass into the stomach. After that, the valve closes again to prevent the contents of the stomach from being ejected into the esophagus.

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Hernia of the esophagus (esophageal opening of the diaphragm) occurs when the upper part of the stomach is pushed through the valve and into the chest cavity. This happens because of both temporary or congenital degenerative changes, as well as the influence of external factors, for example, trauma or a wrong lifestyle.

In gastroenterological practice, more than half of adults aged 60 years have a hernia of the esophagus or esophageal opening of the diaphragm.Therefore, do not relax. It is necessary to take into account any symptoms that may indicate the development of ailment of the digestive system.

Varieties of hernias

Hernia formations differ in numerous factors. It matters, location of the disease, size, origin and type. All these things allow you to more accurately prescribe treatment and monitor the progress. All this is studied during the diagnosis of pathology of the esophagus.

There are two main types of hernia of the esophagus: sliding and fixed.

Sliding hernias are the most common and typical cases for diseases of the digestive tract. But they have their own difficulties. They are more difficult to diagnose, symptoms or does not appear, or signs rarely occur, only at the moments of exacerbation of the disease. Treatment for this type of hernia formation is not always applicable. In most cases, only the symptoms heal to make life easier for the person.

Be careful!

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In simple words, you buy the usual anesthetic, and the disease continues to develop into a more difficult stage.

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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Fixed hernia of the esophagus

Fixed hernia is also called in medicine paraesophageal form of esophageal disease. They occur much less frequently than the sliding type of disease. The fixed type has its own characteristics.

Fixed hernias occur when part of the stomach is pushed through the diaphragm into the chest cavity and remains there without sliding back. If the sliding outfall can be eliminated with the help of a special diet and exercises, then the fixed ones can be eliminated only by medical treatment.

In this form of the disease, the symptoms manifest themselves to a significant degree and may increase with increasing slippage into the sternum of the stuck abdominal organ.

In most cases, the ailment is not serious. However, there is a risk that blood flow in the stomach may be blocked. If this happens, it can cause serious damage and requires emergency medical attention in the form of a surgical procedure. If the sliding type is not threatened with infringement, then the fixed dumping can be infringed at any moment.

Symptoms of fixed hernia

Such a rare type of hernia, like fixed falls, can cause the same symptoms as in the case of a sliding type of disease. The difference will be that when fixing the stomach in the chest cavity, the symptoms will be constant and intensify as the disease develops.

This is because the dumping in the sternum is constantly, without slipping back into place. It constantly provokes acid reflux and irritation of nerve fibers, causing pain.

The most common symptoms of fixed esophageal disease are:

  • acid reflux,
  • throwing bile or air into the esophagus,
  • heartburn, which increases with exercise and stooping,
  • intense chest pains resembling heart,
  • trouble swallowing
  • belching.

Fixed falling out is more susceptible to impairment, therefore, if the symptoms intensify and the pain worsens, one should immediately consult a doctor and be examined.

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If in the case of sliding formations that have no complications, conservative treatment is acceptable, then with a fixed type, conventional treatment will not bring the desired result.

Begin treatment of a fixed ailment with medical methods in order to reduce the patient's symptoms. After that, or in case the medications did not bring any improvement, proceed with the operation.

Surgery looks in such a way as to return the organs from the peritoneum, which fell into the chest cavity. After that, a hole in the diaphragm behind the esophagus and fundoplication is stitched. As a rule, the recurrence of such a disease is unlikely.

Axial hernia of the esophagus (sliding and fixed)

When the organs located below the diaphragm protrude through its natural esophageal opening, this leads to the development of a rather serious pathology of this department - axial hernia. This disease has long been among the ailments of the digestive tract organs, a very important place, since in the absence of timely and adequate treatment it can provoke the development of serious complications. Axial hiatal hernia (HHP) is one of the most common types of deformity, localized in the digestive organs. Among all the pathologies of the gastrointestinal tract, it takes 3rd place. If you do not find it at the earliest stage of development, then therapeutic measures may not give the expected result from them.

Main types and stages of pathology

Such hernias are called hiatus and are pathological protrusions of the peritoneal organs through the natural opening in it. This is mainly the stomach and the lower part of the esophagus. When a person develops this ailment, instead of the abdominal cavity, they find themselves in the sternum. The disease can be both congenital and acquired, and according to morphological features, hiatal hernia AML is divided into 2 types:

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  • Sliding (axial, also called axial). The most common type of pathology. According to statistics, it is diagnosed in 90% of cases. Such a name axial hiatus hernia has received for the reason that when it the upper part of the stomach and the lower food sphincter (LES) freely slip into the chest cavity and come back. This type of disease of the digestive system is divided into several types - total gastric, esophageal, subtotal and cardiac hernia. Most often, this pathological movement occurs when a sick person changes position of the body.
  • Paraesophageal (fixed) hernia is much less common than sliding. It represents the movement into the chest cavity of the cardiac part of the main digestive organ, which does not descend back, but remains there forever. That is why this kind of pathology has unchanged symptoms. Paraesophageal hernia of a fixed type is more dangerous than sliding and more often causes the development of a large number of serious complications, which require urgent treatment to get rid of.

Also, this disease is usually divided into degrees of development. A hernia under the first stage is characterized by the fact that the abdominal esophagus is located directly above the diaphragm, and the stomach is slightly elevated and tightly pressed against it. With grade II, part of the main digestive organ has already been moved to AML, and III, the heaviest, is characterized by being above the diaphragm not only of the cardia of the stomach, but often also of its body, or bottom.

Causes of hiatal hernia

Diaphragmatic hernia, also known as hiatal medicine and, more commonly, hernia of the diaphragm, is characterized by protrusion of the abdominal organs (stomach, lower esophagus, and sometimes the small intestinal loops) through the natural esophageal opening in the diaphragm. The diaphragm is a muscle-tendon septum that separates the chest and abdominal cavity and performs respiratory functions. It has several openings through which the inferior vena cava, aorta, esophageal tube, and nerves pass.

The esophagus, through which food enters from the oral cavity into the stomach, descending from the neck into the chest, is located between the lungs, and, having penetrated through the diaphragm, communicates with the gastric cavity. With the development of this pathology in the esophageal opening of the diaphragm, there are extensions that allow parts of the abdominal organs to pass inward. So, the organs that are part of the protrusion are not in the stomach, but in the chest.

The hernia of the esophageal orifice of the diaphragm may have the following:

  1. Age-related changes in the body, causing weakening, loss of elasticity of the muscular-ligamentous apparatus of the esophagus and diaphragm,
  2. Resorption of the fat layer under the diaphragm, which leads to stretching of tissues.
  3. Congenital weakness of the connective tissue (Marfan syndrome, systemic scleroderma).
  4. Increased intra-abdominal pressure, causing expansion of the opening for the esophagus (due to pregnancy, obesity, ascites with cirrhosis or heart failure, flatulence, internal neoplasms, intense cough in lung and bronchial diseases, chronic constipation, frequent overeating, abrupt physical exercise, recurring vomiting) .
  5. Disturbance of the motor activity of the esophageal tube, accompanied by such pathologies as gastroduodenitis, peptic ulcer, calculous cholecystitis, chronic pancreatitis, and others, in which the motor activity of the stomach increases.
  6. The shortening of the esophagus due to the formation of scars after inflammatory processes, which leads to pulling it up into the chest cavity.
  7. Injuries to the diaphragm (with direct damage to the open or due to a bruise of the abdominal wall).

In many cases, it cannot be unambiguously stated what led to the formation of a hernia of the esophageal opening of the diaphragm, since the development of the disease may be due to a combination of factors. In addition to these reasons, it should be borne in mind that nicotine, caffeine, some medications (including hormonal preparations) can affect the tone of the diaphragm and esophageal canal.

Hiatal hernia - classification

Taking into account the anatomical features and mechanisms by which diaphragmatic hernia is formed, their classification involves the allocation of three main types:

  • sliding (other names - axial, axial or wandering),
  • fixed (fixed, near-esophageal),
  • mixed (combines the mechanisms of formation of sliding and fixed protrusions).

Sliding hiatal hernia

Axial hiatal hernia is diagnosed in 90% of cases. These hernias are considered false due to the absence of a hernial sac. With this pathology, abdominal organs penetrate into the chest cavity, returning to its anatomical position, which often happens when the body position changes. Depending on the organ that forms the sliding hernia, it is divided into the following types:

  • esophageal (when in the chest cavity there is only the esophagus - the abdominal part),
  • cardiofundal (if cardia penetrates the supraphrenic part - the lower valve of the esophagus, as well as the bottom of the stomach),
  • stomach (when the entire stomach or part of it moves into the chest cavity).

What is dangerous diaphragmatic hernia?

Relatively "harmless" is considered sliding axial hernia of the esophageal opening of the diaphragm, which is infringed in very rare cases. At the same time, this variety can be transformed into a fixed one when shortening the esophagus due to scarring. A fixed hernia of the esophageal orifice of the diaphragm is characterized by an increased risk of infringement, at which the normal blood supply to the pinched area stops and tissue necrosis can begin.

In addition, due to the easy penetration of the gastric contents into the esophagus and the compression of organs located in the chest cavity, such negative consequences are possible:

  • peptic ulcer, gastritis,
  • obstruction of the esophagus,
  • hidden bleeding,
  • aspiration pneumonia,
  • cardiovascular pathologies,
  • cancers of the digestive system,
  • perforation of the esophagus,
  • solarium
  • displacement of the gastric mucosa in the esophageal tube and others.

Hiatal hernia - symptoms

Signs of hernia of the esophageal opening of the diaphragm may be absent for a long time or are weakly expressed, especially if the protrusion is small. Clinical manifestations depend on which organ has undergone pathology, what are the sizes of the hernia, what are the associated diseases. Here are the symptoms that a diaphragmatic hernia can have:

  • heartburn that occurs after eating, at night, after stooping,
  • frequent hiccups
  • bitter-sour belching,
  • pains of a different nature, marked in the epigastric, hypochondral and retrosternal areas,
  • feeling of food getting stuck, painful passage of food through the esophagus,
  • dyspnea,
  • cough,
  • nausea,
  • cardiopalmus,
  • cyanosis of the skin after eating.

The degree of hiatal hernia

There are three severity of the disease, on which the signs of diaphragmatic hernia also depend:

  1. First degree - the abdominal esophagus moves into the chest cavity, the size of the opening prevents the elevated stomach from bulging upwards, and the cardia is at the level of the diaphragm.
  2. Second degree - above the diaphragm is the lower esophagus, and part of the stomach penetrates the region of the esophageal opening.
  3. Third degree - sticks out the lower esophagus along with cardia, body or the bottom of the stomach, sometimes with the antrum and loops of the small intestine.

Diaphragmatic hernia - diagnosis

Diaphragmatic hernia, the symptoms and treatment of which require close attention from doctors and patients, is diagnosed using the following basic techniques:

  • fibrogastroduodenoscopy - a study of the esophagus, stomach and duodenum by introducing a flexible tube with an optical system (gastroscope) through the oral cavity,
  • X-ray examination of the thoracic and abdominal cavities in different projections using a contrast agent,
  • Ultrasound and computed tomography of the abdominal cavity,
  • daily pH – metry (determination of acidity) of the esophagus and stomach,
  • esophageal manometry - assessment of the contractile activity of the esophageal tube, coordination of its motility with the work of sphincters.

A relatively new invention is a physical method for the diagnosis of hiatal hernia. Its essence is that when performing auscultation of the chest at certain points in patients after a meal, in a horizontal position on the back, in the presence of a hernia, peristaltic noise is detected, which normally should not be.

Hiatal hernia - treatment without surgery

If symptoms are not expressed, and a small hernia of the esophageal orifice of the diaphragm is diagnosed, treatment is indicated as conservative. Depending on the accompanying pathologies, an individual scheme of drug therapy is prescribed, which may include the administration of drugs from the following groups:

  • antacids (Gastal, Maalox),
  • histamine H2 receptor blockers (Ranitidine),
  • prokinetics (Motilium, Trimebutin),
  • B vitamins,
  • antispasmodics (no-shpa, platifillin).

Diaphragmatic hernia - clinical guidelines

The hernia of the esophageal opening of the diaphragm of the 1 st degree and the 2 nd degree is often treated without surgery, while, in addition to drug therapy, it is necessary to strictly follow these recommendations:

  • rejection of bad habits,
  • sparing diet
  • weight control,
  • eliminating eating and eating before bedtime,
  • preventing constipation
  • elimination of weight lifting and sharp bends,
  • refusal to wear belts, corsets,
  • ensuring sleep on a bed with a raised head.

Exercises for hiatal hernia

An important part of the treatment is gymnastics with hernia of the esophageal opening of the diaphragm, which helps strengthen muscles, normalize the work of the stomach and intestines, and reduce pressure in the abdominal cavity. Patients diagnosed with a hernia of the esophageal opening of the diaphragm, the exercise is recommended by the doctor individually, and the following rules are followed:

  1. Do not perform exercises for the abdominals, sharp bends.
  2. Gymnastics is conducted on an empty stomach in the absence of discomfort, pain.
  3. Clothing during classes is free, breathing is correct.

Diet for hernia of the esophageal orifice

Patients are shown fractional food, eating food in a ground state and heat. The menu for hernia of the esophageal opening of the diaphragm excludes:

  • spicy dishes, spices,
  • salted, smoked, fatty and fried foods,
  • chocolate,
  • citrus,
  • raw tomatoes,
  • legumes.

  • boiled lean meat, fish,
  • boiled vegetables,
  • porridge,
  • jelly,
  • vegetable soups.

Surgery to remove a hiatus hernia

Surgical treatment is indicated, if conservative treatment is inconclusive, diaphragmatic hernia is strangulated, protrusion sizes are large, dysplastic changes of the esophageal mucosa are observed. Often one of three types of operations is performed:

  1. Suturing the hernia gate with the subsequent strengthening of its special mesh.
  2. Restoration of the anatomical position and fixation of the stomach to the anterior wall of the abdomen.
  3. Filing the bottom of the stomach to the wall of the esophagus.

Short description

Protocol name: Hernias of the esophageal opening of the diaphragm

Hiatal hernia - displacement of the contents of the abdominal cavity through the esophageal opening of the diaphragm due to its expansion.

Protocol code:

ICD-10 code (s):
K 44 Diaphragmatic hernia
K 44.0 Diaphragmatic hernia with obstruction without gangrene
K 44.1 Diaphragmatic hernia with gangrene
K 44.9 Diaphragmatic hernia without obstruction and gangrene

Abbreviations used in the protocol:
AlAT - alanine aminotransferase
AsAT - aspartate aminotransferase
HHG - hiatal hernia
GERD - gastroesophageal reflux disease
GER - gastroesophageal reflux
GDZ - hepatoduodenal zone
ECG - electrocardiogram
ELISA - enzyme immunoassay
RCTs - randomized clinical trials
EFGS - endoscopic fibrogastroscopy
CT scan - computed tomography
HIV - human immunodeficiency virus
PTI - prothrombin index
INR - international normalization ratio
Coronary artery disease - coronary heart disease
KFK - KV creatine phosphokinase
LDL - low density lipoprotein
HDL - high density lipoprotein
Myocardial infarction
ME - international units
IPP - proton pump inhibitors
RSE - Republican State Enterprise
AO - joint stock company
iv injection intravenously
intramuscular injection

Date of development / revision of the protocol: 2015

Patient category: adults.

Protocol users: general practitioners, general practitioners, gastroenterologists, surgeons, endoscopists,

Assessment on the degree of evidence given recommendations.

Table - 1. The scale of the level of evidence:

Classification

Clinical classification :

There are three main types of HH:
1. Sliding (axial), occurs in almost 90% of cases, in this case, the cardia lies above the esophageal opening of the diaphragm, and therefore the ratio between the esophagus and the stomach changes, and the switching function of the cardia,
2. Paraesophageal hernia, occurs in approximately 5% of cases, characterized by the fact that Cardia does not change its position, and the bottom and the greater curvature of the stomach go through the expanded hiatus,
3. The short esophagus, as an independent disease, is rare and is either an abnormal development, or occurs in combination with a sliding hernia, and is the result of spasm, inflammatory changes and cicatricial processes in the esophagus wall,

Symptoms, current

Diagnostic criteria:

Complaints and history [5,6]:

Complaints:
· Heartburn (persistent, painful) both after eating and on an empty stomach,
· Pain in the chest (burning character) aggravated by physical exertion and stooping,
· A feeling of discomfort behind the chest,
· Feeling short of breath,
· weight loss,
· Loss of appetite
· Bouts of coughing and choking at night,
· Hoarseness in the morning,
· Belching,
· Hiccup

Anamnesis:
· The patient has been registered with a gastroenterologist with a gastroesophageal reflux disease (GERD) for a long time,
· Barrett's esophagus may be present,
· Constant intake of acid-lowering drugs and antacids.

Physical examination [7,8,9,10]:not.

Diagnostics

The list of main and additional diagnostic measures.

Basic (mandatory) diagnostic examinations conducted at the outpatient level [3,6]:
· Collection of complaints, anamnesis of the disease and life,
· Physical examination,
· ECG (to exclude cardiac pathology),
· X-ray (roentgenoscopy) of the esophagus and stomach with barium (standing and in a horizontal position when the lower limbs are above the head end),
· Endoscopic esophagogastroscopy (EFGS) with biopsy of the mucosa of the lower third of the esophagus,

Additional diagnostic examinations conducted at the outpatient level [4,6]:
· general blood analysis,
· general urine analysis,
· Biochemical blood test (total protein and its fractions, urea, creatinine, bilirubin, ALT, AST, blood glucose),
· Blood test for tumor markers (for suspected cancer),
· Esophagomanometry (to assess the condition of the lower esophageal sphincter),
· Daily pH metrics of the esophagus and stomach (for daily monitoring of acidity in the esophagus and stomach),
· Ultrasound diagnosis (liver, gallbladder, pancreas, spleen, kidney),
· CT scan of the chest and mediastinum (to clarify the size and distribution of HH),

The minimum list of examinations that must be carried out when referring for planned hospitalization: according to the internal regulations of the hospital taking into account the existing order of the authorized body in the field of health.

Basic (mandatory) diagnostic examinations conducted at the hospital levelwith emergency hospitalizationand after the expiration of more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
· Collection of complaints, anamnesis of the disease and life,
· Anthropometry (measuring height and weight),
· Physical examination,
· X-ray (roentgenoscopy) of the esophagus and stomach with barium (standing and in a horizontal position)
· Endoscopic esophagogastroscopy (EFGS) with biopsy of the mucosa of the lower third of the esophagus,
For surgery:
· general blood analysis,
· general urine analysis,
· Biochemical blood test (total protein and its fractions, urea, creatinine, bilirubin, ALT, AST, thymol test, blood glucose),
· Microreaction for syphilis,
· Determination of blood group by ABO system,
· Determination of the Rh blood factor,
· Blood test for HIV by ELISA,
· Determination of HBsAg in serum by the ELISA method,
· Determination of total antibodies to the hepatitis C virus in the serum by the ELISA method,
· Coagulogram (PET, fibrinogen, FA, clotting time, INR),
· Blood to electrolytes,
· ECG (to exclude cardiac pathology),

Additional diagnostic examinations conducted at the hospital levelwith emergency hospitalizationand after the expiration of more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
· Daily pH - metry of the esophagus and stomach,
· Blood test for tumor markers (for suspected cancer),
· Ultrasound diagnosis (liver, gallbladder, pancreas, spleen, kidney),
· CT scan of the chest and mediastinum (to clarify the size and distribution of HH),

Diagnostic measures carried out at the stage of emergency care:
· Collection of complaints, anamnesis of the disease and life,
· Physical examination.

Instrumental studies [6,11,12]:

Table - 2. Typical instrumental signs of HH.

Causes and symptoms

What are the causes of the occurrence of such a disease as a fixed hernia? There are several of them. The most common causes need to be considered in more detail.

Constantly increased pressure inside the abdominal cavity, which can be caused by flatulence, the lifting of heavy objects. Increases pressure in this part of the body, overeating, obesity, and constipation.

The next reason is the wrong body position during any activity. It is equally important to maintain correct posture in order to prevent mechanical compression of the internal organs.

The pressure inside the abdominal cavity may increase due to prolonged strong coughing. A hereditary predisposition to the disease and birth defects and bad habits can lead to the appearance of a fixed hernia.

Experts note that for patients with a fixed hernia, shortening of the esophagus is typical. This leads to the fact that the esophagus fully begins to be located directly in the abdominal cavity. In fact, there should be only 2/3 of the esophagus. Thus, the stomach is constantly above the required level.

It is important that paraesophageal hernia is usually diagnosed by chance when examining a patient for the presence of other diseases. This happens for the reason that most often with a fixed hernia external symptoms are absent. However, in rare cases, there is still a manifestation of certain symptoms. Moreover, if the symptoms are, they will be permanent, and not transient, because they appear only when the problem has reached a large size. Such a picture, as a rule, will provoke esophageal compression.

Appears and has its own characteristics dysphagia. It becomes permanent. When a patient eats a dry food that has a sufficiently dense texture, dysphagia will increase. In addition, the manifestation of dysphagia in a disease such as a fixed hernia will not be treatable by any antispasmodic drugs.

Among the symptoms of paraesophageal hernia, there is heartburn, which is aggravated by bending or performing various physical activities. Especially this symptom manifests itself when the patient lies. Heartburn itself in such cases occurs because the gastric juice and the contents of the stomach enter the esophagus.

In patients with a fixed hernia, there may be such a symptom 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 region of the heart. They are almost certain that they suffer from any disease of the cardiovascular system. This is not surprising, because the pain in the thoracic region, which they feel, really imitates the heart.

Dysphasia, i.e. difficulty swallowing, in such patients may occur first when swallowed liquid food, and over time and solid.

The patient may notice attacks of hiccups. This is due to the fact that irritation of the diaphragm by the hernial sac occurs. And directly the "convulsions" of the diaphragm themselves manifest themselves as attacks of hiccups.

Rehabilitation and prevention of repetition of the disease

A patient who has undergone surgery with a fixed hernia should reconsider his further lifestyle, directing him to a channel that will not only ease his general condition, but will also be a prevention for repeated cases of hernia.

Experts recommend such patients to limit the increase in gravity and not to overstrain physically.

However, it is equally important to maintain a fairly active lifestyle. Morning should begin with the gymnastic exercises, and throughout the day try to maintain the correct working posture, monitor posture. This recommendation applies especially to sitting. It is recommended that such people sleep, raising the head of the bed.

Some recommendations are available regarding nutrition. Such patients should monitor not only the regimen, but also the diet of their food more scrupulously. Foods that stimulate gastric secretion and irritate the mucosa should be excluded from the diet. Portions should be small, i.e. power needs to be fractional.It is also important to control the weight, in no case allowing it to exceed. Another important aspect is the observance of the interval between bedtime and mealtime.

Causes of the disease

Both congenital and acquired conditions can lead to the formation of a hernial orifice in the diaphragm. Among the first, experts distinguish the underdevelopment of the diaphragmatic muscle and the hernial pockets formed during fetal development. Acquired causes include the influence of age-related changes, serious injuries of the sternum, constantly increased intra-abdominal pressure and the occurrence of an inflammatory process near the diaphragm.

There are factors that increase the risk of developing pathology. Among them are such circumstances that provoke a one-time sharp or constant increase in intra-abdominal pressure:

  • last degree of obesity
  • blunt abdominal trauma,
  • excessive weight lifting
  • hard physical work
  • ascites,
  • prolonged indomitable vomiting,
  • persistent constipation.

A hernia can also get sick with AML and a professional heavyweight athlete, especially if he does not follow safety regulations when lifting weights. Also of no small importance in the development of this disease are concomitant chronic gastroduodenitis or pancreatitis, calculous cholecystitis, and gastric or duodenal ulcer hypermotor dispensias of the esophagus, namely the violation of its motor function.

Contributes to the fact that a person has developed an axial hernia of the esophagus and its longitudinal shortening caused by the appearance of scar-inflammatory deformity, the occurrence of which is provoked by thermal or chemical burn, esophageal peptic ulcer and reflux esophagitis.

Signs of disease

In almost half of the cases, the illness is completely asymptomatic or has such minor manifestations that people with a developing disease do not pay attention to them and the pathology continues to progress, carrying the threat of complications. Such hernia AML is diagnosed completely by chance, when an x-ray examination of the esophagus is carried out on a completely different matter.

Still, patients of the gastroenterology department, who are at risk of developing the disease of the digestive organs, should know its main possible symptoms. First of all, it includes pain syndrome, which is localized in the epigastric region and bears a pressing and dull character. It may radiate along the esophagus to the area between the shoulder blades.

Most often, exacerbation of pain occurs in the prone position, with excessive physical exertion or a strong cough, and after a heavy meal. Also characteristic symptoms of pathology can be:

  • Hiccups due to the fact that the hernial sac begins to irritate the phrenic nerve.
  • Heartburn and belching. They are the most frequent negative manifestations of this disease and are provoked by ingestion into the esophagus due to gastroesophageal reflux of the acidic contents of the stomach.
  • Burning pain in the chest and constricting in the intestine. Their appearance most often occurs in the morning and is associated with the movement of the hernial bag through the hole in the diaphragm.
  • Dysphagia (a violation of the swallowing process). Patients with a history of this disease, the most difficult to swallow, no matter how strange it may be, liquid food. This symptom may occur when eating very hot or cold foods, as well as eating too fast.

Very often, the negative symptoms of this pathology are similar to the main symptoms of cardiac diseases, and this can make diagnostics difficult, and can cause the treatment to be prescribed incorrectly and not give the expected effect.

Disease therapy

Treatment of pathological protrusion of the diaphragm is carried out in two ways - surgical and conservative. The second, non-surgical method is indicated in cases where the hernia is small and proceeds without obvious symptoms. An integral part of such therapy is the correction of lifestyle and diet, as well as the appointment of the same medication effects as with gastroesophageal reflux. Patients who have undergone this treatment, only positive. Almost all of them have achieved complete recovery or the transition of the pathology to a state of long-term remission.

But unfortunately, not everyone is conservative therapy. In this case, surgery is prescribed. Indications for it are severe esophagitis, which is not amenable to medical treatment, insufficiency of the lower diaphragmatic sphincter, significant narrowing of the esophagus. This operation has the following objectives:

  • the creation of an anti-reflux mechanism that prevents the acidic gastric enzyme from being thrown into the esophagus,
  • restoration of the anatomical structures of damaged digestive organs, as well as the natural relationship between the stomach and the esophagus.

There are several operations to get rid of this pathology, and each has its own advantages and disadvantages. Accesses to the bulging hernial sac can be performed by laparoscopic or open method.

After surgery, the patient must be prescribed a course of medications, among which are prescribed histamine receptor blockers, proton pump inhibitors, antacids and prokinetics.

Also requires a complete revision of the lifestyle and habits of a sick person:

  • physical activity, if any, must be reduced,
  • put on for long wearing fixing bandage,
  • prescribed a diet for the sparing of the digestive organs, as well as weight loss.

Also, patients after the operation should completely eliminate the situations that contribute to an increase in intra-abdominal pressure, and completely stop smoking. Among the possible complications of pathology, which develop when the recommendations of the attending physician are ignored and the therapeutic course is violated, such pathologies as massive bleeding from the esophagus are noted. peptic ulcer, cicatricial stenosis and reflux esophagitis.

The choice of treatment tactics for this disease is the prerogative of the specialist. In order to cope with negative symptoms and stop the development of a hernia without surgery, the patient must strictly follow all the recommendations of the attending physician. After a course of treatment, visits will be required for a scheduled examination of the gastroenterologist. They are held every six months.

Hernia of the esophageal opening of the diaphragm (HH)

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

In most cases, small hernia of the esophageal opening of the diaphragm does not cause problems. If the hernia is large, the gastric contents are thrown back into the esophagus, resulting in heartburn, belching, as well as dysphagia and chest pain.

A hernia of the esophageal opening of the diaphragm (abbreviated as HH) is diagnosed in about 5% of adults. More than half of the cases occur in the elderly — over 55 years of age, due to age-related changes — in particular, the natural process of weakening the ligamentous apparatus.

Most often, diaphragmatic hernia develops due to the fact that the tissues, the task of which is to limit the esophageal opening of the diaphragm, become much more elastic than necessary. Many do not even know that such a hernia is possible. In the meantime, this is quite a serious problem requiring qualified medical assistance.

  • Injuries to the abdomen and chest,
  • Increased intra-abdominal pressure
  • Bouts of prolonged cough (asthma, chronic bronchitis),
  • Connective tissue diseases: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis,
  • Asthenic physique

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

At risk are those who have the following diseases:

  • Phlebeurysm
  • Flat feet
  • Hemorrhoids
  • Obesity.

Also, the development of a hernia of the esophageal orifice of the diaphragm predisposes a violation of motility of the digestive tract during hypermotor dyskinesia of the esophagus, associated duodenal ulcer and stomach, chronic gastroduodenitis, chronic pancreatitis, calculous cholecystitis.

Symptoms of hiatal hernia

HHOD is a chronic disease affecting the digestive system, which is in 3rd place among other diseases, such as gastric and duodenal ulcers, chronic cholecystitis. A hernia of the esophageal opening of the diaphragm is a pathology in which the stomach slides up to the esophagus.

  1. a sign of diaphragmatic hernia is a pain syndrome, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
  2. chest pain can mistakenly lead a patient to a cardiologist in the diagnosis,
  3. pain may occur after eating or exercising, during intestinal flatulence and after taking a deep breath,
  4. heartburn, burning in the throat, hiccups, nausea, urge to vomit, hoarseness,
  5. cyanosis, vomiting with blood speak about the infringement of a hernia,
  6. in some cases, blood pressure may increase.
  7. at night there are strong bouts of cough, accompanied by suffocation, increased salivation.

Causes of pain during hernia of the diaphragm are squeezing of the nerves and vessels of the stomach at the exit of its cardiac part in the chest cavity, the effect of the acidic contents of the intestine and stomach on the mucosa of the esophagus and stretching its walls.

Pain in hernia of the esophageal section can be differentiated based on the following symptoms:

  • pains appear mainly after eating, exercise, in a horizontal position, with increased gas production,
  • they soften or disappear after a deep breath, belching, taking water, changing poses,
  • pain intensifies as a result of leaning forward.
  • Sometimes the pain may be shingles, resembling pancreatitis.

Typical symptoms of hernia of the esophageal part of the diaphragm are also:

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

Immediately contact an ambulance if:

  • you feel nauseous
  • you had vomiting
  • you cannot empty your bowels or release gases.

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

Sliding (axinal) hernia

Axial hiatus hernia is called the protrusion of organs located below the diaphragm through the natural opening. In the overwhelming majority of cases (approximately 90%), hernia of the diaphragm is axial, or sliding.

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

Axial hiatus hernia begins to develop with reduced elasticity of muscular connective tissue, weakening of their ligaments. Depending on the displaceable area, they can be cardiac, cardiofundal, subtotal or total gastric.

Axial hernia under the esophagus is characterized by a different etiology. There are the following etiological factors:

  • Motility disorders of the digestive system
  • Weakness of the ligament apparatus 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 is in third place, making a serious "competition" for such pathological conditions as peptic ulcer and cholecystitis.

Fixed hcp

A fixed (paraesophageal) hernia of the esophageal opening of the diaphragm is not as common. In this case, part of the stomach is pushed through the diaphragm and remains there. As a rule, such hernias are not considered a serious disease. However, there is a risk that the blood supply to the stomach can be blocked, which can lead to serious injuries and needs urgent medical attention.

In patients with a fixed hernia, there may be such a symptom 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 region of the heart. This is not surprising, because the pain in the thoracic region, which they feel, really imitates the heart.

Degree hod

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

  1. At the first, the easiest degree, the esophagus, which is normally located in the abdominal cavity (abdominal), rises into the chest cavity. The size of the hole does not allow the stomach to rise up, it remains in place,
  2. In the second degree, the abdominal part of the esophagus is located in the chest cavity, and directly in the region of the esophageal opening of the diaphragm is already a part of the stomach,
  3. HHP Grade 3 - a significant part of the stomach, sometimes up to its pylorus, which passes into the duodenum, moves into the chest cavity.

Treatment of hernia of the esophageal opening of the diaphragm: drugs and surgery

Treatment of diaphragmatic hernia begin with conservative measures. Since the clinic has hernia of the esophageal orifice of the diaphragm, the symptoms of gastroesophageal reflux come to the fore, conservative treatment is mainly aimed at eliminating them.

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

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

Drugs for HH

The doctor may prescribe you the following medications:

  • antacids to neutralize gastric acid
  • H2-histamine receptor blockers that reduce acid production
  • proton pump inhibitors (PPIs) - antisecretory drugs for the treatment of acid-related diseases of the stomach.
  • Drugs - proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
  • Prokinetics to improve the condition of the gastric mucosa, esophagus, optimize their motility, get rid of nausea, pain (motilac, motilium, metoclopramide, ganaton, itomed, trimebutin).
  • B vitamins to accelerate the regeneration of gastric tissue.

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

Surgery for hernia of the esophageal orifice

Currently, surgery is the only radical and most effective method of treating a hernia of the esophageal opening of the diaphragm. It is also shown in the absence of a result from the conducted drug therapy.

The operation on the diaphragm for hernias of the esophageal opening is usually planned, carried out after a thorough examination and preparation. Emergency operations are not very often performed for complicated hernias (pinching, perforation, or bleeding from a squeezed organ).

Operations at the HHC are carried out in different ways. The Nissen fundoplication is gaining popularity. In such an operation, a cuff is made from a part of the stomach wall, which is fixed around the opening where the diaphragm expands.

Doctors operate in two ways, such as:

  • removal of the open, abdominal incision of the abdomen,
  • 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 disease in the stage of decompensation.
  • Severe lung disease with respiratory failure.
  • Uncompensated diabetes.
  • Blood disorders with coagulation disorders.
  • Renal and hepatic failure.
  • Pregnancy.
  • Oncological diseases.
  • Recently transferred abdominal operations.

In the postoperative period, antibiotics and anesthetics are prescribed, and in case of violation of the motility of the gastrointestinal tract, prokinetics (cerrucal, motilium) are used. The stitches 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 the physical load associated with active movements of the body.

The most common complications after surgery to remove the hernia of the opening of the esophagus are:

  • disease recurrence
  • cuff slippage,
  • feeling of discomfort in the chest area,
  • pain,
  • difficulty swallowing
  • inflammatory processes
  • seam divergence.

The diet after the operation should be liquid - it will take about 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 be transferred to a soft diet.

A bland diet consists of foods that are easy to chew and swallow such as foods softened by cooking or mashed potatoes, canned or cooked soft fruits and vegetables, or tender meat, fish and poultry. If a mild diet is tolerated for three weeks, then you can go on a regular diet.

Diet and nutrition

Eating should be in small portions. On the day should be 4-5 meals. After eating it is undesirable to rest in a lying position. It is 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.

Diet for hernia of the esophagus and the menu suggest an introduction to the diet:

  • yesterday's bakery products from wheat flour,
  • mucous cereal soups,
  • sour dairy cuisine
  • porridge, pasta,
  • meat, fish, boiled, baked, steamed,
  • oils of plant and animal origin.

It is forbidden to use seasonings and sugar in dishes for patients with hernia of the diaphragmatic orifice, as this provokes the increased acidity of the gastric juice and creates risks for 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 for 1 hour, do not go to bed,
  • dinner should be 2-3 hours before bedtime,
  • you can eat ground fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups,
  • drink 1 tablespoon of sunflower or olive oil before meals,
  • It is forbidden to take fried, fatty, salty foods,
  • Smoking is prohibited.

How to treat a hiatal hernia with folk remedies

In diaphragmatic hernia, herbal therapy with traditional therapy allows to improve the patient’s condition as a whole and remove symptoms. The following recipes speed up 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 amount is 0.5 cups.

  1. The treatment is carried out using a decoction of aspen bark - they take a large spoonful of raw materials and brew 200 ml of boiling water, infuse and filter. Drink 2 large spoons up to 5 times a day before meals.
  2. You can also use the branches of young aspen and cherry. They need to pour a liter of boiling water and cook over low heat for half an hour. Next, allow to cool and take half a glass.
  3. No less effective, according to folk healers, is the most common mint tea. To make it, just 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 during the day in small sips and soon you will forget that you suffered from pain and heartburn.
  4. You can mix in equal shares of flax seed, anise fruits, Althea roots and gentian, fenugreek. The components are ground, mixed, and taken three times a day with a small spoonful of powder. It is permissible to mix with honey.
  5. Chamomile decoction is a good remedy for any manifestations of diaphragmatic hernia. It not only soothes the stomach, but also helps improve digestion. Excellent tool that can be called a panacea for all ills.
  6. Calendula tea is also effective. It can be brewed with chamomile. This tea should be drunk no more than four times a day, certainly not earlier than an hour after a meal.

Recommendations to people with HH

People who have this disease are advised to follow the following guidelines:

  1. Patients need to strictly follow a special diet, which excludes products that cause irritation of the intestines,
  2. Food taken in fractional portions every few hours,
  3. Avoid torso forward, sudden changes in body position - this can cause pain in the sternum and heartburn,
  4. Patients should not lift weights more than 5 — b kg
  5. It is impossible to tighten the belt tightly, wear clothing that is going through the stomach - this creates additional pressure in the abdominal cavity,
  6. Avoid heavy physical exertion, but at the same time regularly perform exercises of physical therapy, strengthening the muscular corset and restoring the tone of the diaphragm,
  7. It is recommended that there is a last time at least 2.5–3 h before going to bed,
  8. Normalize the stool - constipation and diarrhea increase intra-abdominal pressure and contribute to the formation of a hiatus hernia.
  9. Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil,

Prevention

In addition to the basic measures for the prevention of gastroenterological diseases (healthy lifestyle, elimination of stress, proper nutrition), it is necessary to strengthen the muscle wall of the peritoneum - to play sports, therapeutic exercises, to press the press. Patients with diagnosed hiatal hernia are subject to follow-up at a gastroenterologist.

Draw conclusions

We conducted an investigation, examined a bunch of materials, and most importantly, we checked the majority of hernia treatments. The verdict is:

All drugs gave only a temporary result, as soon as the treatment was stopped - the pain immediately returned.

Remember! There is NOT ANY MEANS that will help you to cure a hernia if you do not apply a complex treatment: diet, regimen, physical exertion, etc.

Modern means of hernia, which is replete with the entire Internet, also did not produce results. As it turned out - all this is a deception of marketers who earn huge money on the fact that you are led by their advertising.

The only drug that gave significant
the result is chondrexyl

You ask, why does everyone who suffers from a hernia in a moment did not get rid of it?

The answer is simple, Hondreksil is not sold in pharmacies and is not advertised on the Internet. And if they advertise - then this is a FAKE.

There is good news, we went to the manufacturers and share with you a link to the official site Hondreksil. By the way, manufacturers do not try to profit in public with sore joints; according to the promotion, each resident of the Russian Federation and the CIS can receive one package of the drug IS FREE!

Classification system

A hernia of the esophageal opening of the diaphragm (HHL), also called hiatal hernia, is of several types.

In case of sliding or axial pathology, the part of the esophagus that is under the diaphragm, the cardia (the sphincter between the stomach and the esophagus) and the bottom of the stomach can easily pass into the chest cavity. This happens even with a banal change of posture.

Next comes the axial hernia. It is characterized by weakening of the muscles located around the esophageal opening of the diaphragm. Its symptoms appear with a certain effect on the body. This may be a change of position, food intake or pressure inside the abdominal cavity. This species is diagnosed most often.

Depending on the size and level of protrusion of displaced areas, the disease is divided into several subspecies:

  1. Cardiac hernia.
  2. Cardiofundal. The upper part of the stomach is able to move freely.
  3. Subtotal. The stomach is almost completely beyond the aperture.

Axial cardiac fixed hernia AML occurs more frequently than other species (about 95%). The other two are extremely rare.

As mentioned above, such a hernia can be fixed. What does it mean? The cardiac area of ​​the stomach moves to the chest. It does not slide back, but remains in a new location for itself.

If the pathology is not fixed, organs migrate from the abdominal cavity to the chest and back. In this case, the disease is considered chronic.

Causes of the disease

According to statistics, fixed axial, cardiofundal or other types of hernia appear in 6% of the population. Most of the cases are elderly people.

This disease develops for several reasons:

  1. Pathology of intrauterine development. These include the shortened esophagus and the so-called chest stomach.
  2. Diseases characterized by weak connective tissue.
  3. Increased abdominal pressure. This condition can be triggered by flatulence, incessant vomiting, abdominal trauma, pregnancy, neoplasms, obesity, etc.
  4. Dyskinesia. Violation of the organs of the gastrointestinal tract.
  5. Shortening of the esophageal tube. Occurs due to inflammation, ulcers.

Symptomatology

Very often, a fixed cardiofundal hernia has no symptoms. Especially it concerns cases when protrusion has absolutely small sizes. To detect such a pathology is possible only with a full examination.

Symptoms include the following:

  • Chest pain.
  • Surrounding pain, similar to pancreatitis.
  • Pain on the left side of the chest, which is often considered a sign of angina or even a heart attack.
  • Tachycardia or other abnormal heart rhythms. This symptom can significantly complicate the process of diagnosis.

To avoid having to treat an incorrectly defined disease, you should pay attention to several specific signs of a fixed hernia:

  • Pain occurs after eating, playing sports or hard work.
  • The pain intensifies if you lean forward.
  • The pain goes away if you take a deep breath, change your body position, or drink some water.

If a hernia is pinched, the severity of symptoms increases. Also added to them are other manifestations of the disease:

  • nausea,
  • dyspnea,
  • vomiting with blood,
  • blueness of the skin,
  • pressure reduction.

If these symptoms appear, it is recommended that you immediately consult a doctor to clarify the diagnosis.

How to treat a disease

At the very beginning, conservative therapy is carried out to treat this disease. The most effective medicines can be distinguished:

  • Antacids.
  • Proton pump inhibitors.
  • H2-antihistamines.
  • Prokinetics. These are medicines that heal the mucous membrane of the digestive tract.
  • Vitamins of group B. These substances help to restore the functionality of the stomach.
  • Non-steroidal anti-inflammatory drugs are used to eliminate pain.

Attention! Drugs are given for the purpose of general familiarization, do not prescribe yourself a treatment yourself, consult with your doctor before use.

In order for medicines to bring maximum benefit, you must follow a few simple rules:

  • Adjust diet.
  • If weight is increased, do weight loss.
  • To sleep not lying, but in a semi-sitting position.
  • Protect yourself from hard physical work, as well as limit exercise.

If conservative treatment is not beneficial, the doctor may prescribe surgery. During the operation, the hernial orifice is sutured, the position of the stomach is fixed, or part of the esophagus is removed.

Hernia of the food orifice of the diaphragm is an insidious disease. Its symptoms are often “masked” under other pathologies, therefore, it is rather problematic to diagnose it. Therefore, when any unpleasant symptoms appear, it is recommended to immediately consult a doctor.

A selection of my useful materials on the health of the spine and joints, which I recommend you to look at:

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Denial of responsibility

The information in the articles is intended solely for general information and should not be used for self-diagnosis of health problems or for medical purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know exactly the cause of your health problem.

What are conservative treatments?

The patient himself can do special gymnastic exercises for the muscles of the diaphragm.

These exercises are recommended to perform on an empty stomach or 3 hours after eating.

  1. The patient lies on his right side, his head above the legs by 15 cm. A deep maximum inhale is taken, and the abdomen is bulged out. The exhalation is done calmly, the stomach does not need to be pulled in. Each time try to increase the depth of breathing, exercise up to 4 times a day for 10 minutes.
  2. Exercise, sitting on your lap. Incline the torso alternately in both directions, then do the same exercise, standing on your feet.The main thing in this gymnastics is breathing. Tilt combined with inhalation, return to the starting position with exhalation.
  3. Lying on your back, take turns in both directions in turn. Do not stray from proper breathing.

Photo examples of exercises are presented on the Internet. This gymnastics is performed up to 2 times a day. It is recommended to increase the load over time. The effect of classes is noticeable after a couple of months.

The following physical training is also successfully used for diaphragmatic hernia:

Basically, these exercises help to improve the functions of internal organs.

They are first performed lying down, then sit and stand. Just like the previous complex, these exercises are done on an empty stomach.

  1. The patient lies on his back, a roller or a pillow is placed under his head. The fingers (middle and index) are placed in the middle of the body under the costal arch. Finger skin is slightly shifted up and to the right. While breathing, follow several approaches by gently lowering the fingers deeply in the direction of the spine. The fingers make extensor movements, shifting the stomach up and to the left. These movements are made on the exhale. It is necessary to repeat 5-6 times in one session, as a result, the patient should feel a decrease in pain and a pulling sensation in the throat.
  2. The patient is sitting. The back is bent in the thoracic region, the patient himself is relaxed. The practitioner places his fingers (right hand) under the right costal arch pads down. The fingers of the left hand set parallel to the midline of the abdomen under the left costal arch pads down. The phalanges of both thumbs rest against each other through the skin fold. When inhaling with your thumbs, move the skin of the anterior abdominal wall towards the head. When the patient exhales, the thumbs put pressure in the legs, towards the spine. So repeat from three to six approaches. Photos of exercises can be found in special sources or on the pages of the Internet.

Diaphragmatic hernia obliges the patient to observe a certain diet in order to avoid pain, stress on the internal organs.

In this disease, the diet involves the following items:

  • overeating is not allowed,
  • the patient must try to empty the bowels, avoid constipation,
  • 3-4 hours before bedtime do not eat.

In addition, it is prohibited to wear tight clothing, belts, corsets. It is not allowed to lift heavy objects, work in an inclined position.
Diet for diaphragmatic hernia is a major component of conservative treatment. Meals should be frequent, in small portions. Diet means eating homogenized foods, optimal temperature and consistency. Food should be easily digested, not contain coarse ingredients.

The diet is based on a special culinary treatment of dishes and products, which makes them easily digestible (for example, preparation of minced meat, mashed potatoes, soup).
Due to the risk of increasing intra-abdominal pressure, there should not be included in the menu legumes, many bakery products, kvass and sparkling water. Grapes, dried apricots, cabbage dishes, spicy dishes increase gas formation. Some products lower the tone of the lower esophageal sphincter, which leads to the abandonment of the acidic contents of the stomach. This coffee, fat and roast, strong tea and chocolate.

The diet in this case completely excludes alcoholic beverages, including beer, which increases intestinal swelling due to fermentation processes, tobacco smoking.

After a meal, you need to stay up for a couple of hours; a sitting position is best suited. Do not lift heavy objects after eating.
The physician should review the list of medications that the patient may be taking. It must be remembered that some groups of drugs adversely affect the course of the disease: glucocorticosteroids, nonsteroidal anti-inflammatory drugs, adrenomimetics, xanthine derivatives, calcium channel blockers, anticholinergics, nitrates.

You shouldn’t cancel or prescribe medicines yourself, you should coordinate with their doctor on the appointment of their analogues or use these drugs under protection.

The diet recommended for diaphragmatic hernia is an integral part of successful therapy.As with other diseases of the gastrointestinal tract, the patient's diet should be balanced, fractional, but frequent. Diet means eating porridge, except rice. To porridge is easily digested, it should be boiled. The temperature of food should be equal to the temperature of the body or slightly higher. The diet should also include meat products and fish. Prepare them for a couple or in boiled form. It is desirable to grind meat and fish fillets. The ideal diet for a person with a digestive system disease is based on eating fresh vegetables and fruits. Peaches, plums, pears, bananas are recommended. Apples should be peeled and baked before use in the oven.

Watch the video: How a rolling hiatus hernia is formed (April 2020).

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