Esophageal hernia causes and treatment methods. Causes of hiatal hernia and methods of treatment at home. Instrumental diagnosis of hiatal hernia

A hiatal hernia is a chronic disease in which the position of the esophagus and stomach changes within the body. Pathological hernial protrusions form from their walls.

The process is caused by relaxation of the muscular and ligamentous apparatus, expansion of the diaphragmatic ring. An esophageal hernia consists of the following parts: the hernia gate, the hernial sac, and the hernial contents.

The gate is most often the diaphragm ring. The hernial sac is formed from the wall of the organ. Hernial contents are everything that gets into the hernial sac: food, adjacent walls.

The disease appears and progresses in old age. It is extremely rare in young people, only when congenital pathologies. Risk of development in people over 60 years of age.

The following reasons are identified:

Congenital anomaly of the esophagus. A hernia is diagnosed immediately after birth or in young children. The percentage of its development is not significant.
Age-related relaxation and sprain of the esophagus and diaphragm.
Obesity, overweight. At the same time, intra-abdominal pressure increases, internal organs are displaced, which causes hernial protrusions.
Dramatic weight loss. Over 20 kg per month is considered critical.
Chronic processes in the liver with changes in its size: hepatitis, cirrhosis.
Excessive overeating.
Strength physical activity.
Surgical interventions on internal organs, especially the esophagus, stomach, trachea, heart.
The accumulation of fluid in the abdominal cavity is ascites.
Sometimes during pregnancy.
Constipation.
Organic lesions of the esophagus.
Burns of the insides with salts and acids.
Post-stroke condition.
Blunt abdominal injuries.

Symptoms and signs of the disease

If the pathological focus is not large in size and is located on early stages, then the disease may practically not manifest itself. When the hernial protrusion becomes larger, functions, innervation, and blood supply are disrupted, and patients begin to complain.

What can be the symptoms of a hiatal hernia:

Pain syndrome.

Each patient's hernia manifests itself individually, but there are still General characteristics. The pain is sudden, severe, pulling or aching character, sometimes tingling sensations are felt.

Localized in the epigastric region, “under the stomach” or in the left hypochondrium. Gives to left hand, back, intercostal spaces. Intensifies with physical activity, rapid breathing, during or after eating.

The pain may go away with changing body position or swallowing cold water.

Difficulty swallowing. The patient has difficulty swallowing a bolus of food.
Severe heartburn.

It is a burning sensation in the esophagus. It occurs due to impaired motility of the esophagus and the reverse flow of hydrochloric acid from the stomach into the esophagus. The symptom is constant and bothers patients even at night. Medicines eliminate it for several hours.

Belching food recently eaten.

There may be belching of sour air.

Cough.

It appears not because of problems in the lungs, but because of compression of the trachea by a displaced esophagus or hernial formation. It is dry and constant in nature, comes from the throat, but there is no phlegm with it, so it is quite difficult to cough up.

Cannot be treated with antitussive drugs. If such a cough lasts for a long time, more than 2 months, a doctor’s consultation is necessary.

Bitterness in the mouth, bad breath.
Hiccups.

Appears due to infringement vagus nerve. At the same time, the diaphragm begins to contract chaotically.

Nausea.

To relieve symptoms, patients often induce vomiting.

Dyspeptic disorders.

Most often this is stool in the form of diarrhea.

Dysphagia.

Difficulty passing food through the esophagus.

Hoarseness of voice.

If several symptoms appear, you should consult a specialist for diagnosis and prescribing the necessary treatment.

Classification

Doctors distinguish 3 degrees of hiatal hernia.

1st degree.

It is characterized by a small protrusion, a minor affected area. The functions of the organs are practically not impaired. The innervation and blood supply are not affected, there may be no symptoms. They are discovered by chance during routine examinations.

If you have a 1st degree hernia, you should definitely see a doctor, he will prescribe necessary treatment. This includes adherence to daily routine and nutrition, diet, and prescription of drug therapy. Does not require surgical intervention.

2nd degree.

Education bigger size, appears characteristic symptoms: complaints of pain, discomfort, heartburn, belching. The functions of the esophagus and stomach begin to suffer. Treatment is prescribed only by a doctor based on the results of diagnostic procedures.

3rd degree.

Advanced and late form of the disease. Manifests itself with severe symptoms. The patient is tormented severe pain acute, severe heartburn and belching, refusal to eat.

suffer digestive features gastrointestinal tract. This condition requires emergency treatment and hospitalization, complex treatment.

First they carry out surgery to eliminate a hernia. The stretched ligaments are sutured, a retaining mesh is applied, and then drug treatment is prescribed.

The drugs of choice are antispasmodics, proton pump inhibitors, antacids, and prokinetics. A strict gentle diet must be followed: exclude hot, fatty, fried and spicy foods.

It is allowed to eat liquid or mushy food, boiled, steamed, or grated.

How dangerous is the disease?

The most dangerous complication of a hiatal hernia is strangulation. It is detected after a long process without the necessary therapy or acutely, suddenly, as the first manifestation of pathology.

How does this manifest itself:

Sudden acute sharp pain V upper sections belly or middle chest. Reminds the nature of angina or heart attack. It always radiates to the shoulder blade, collarbone, neck, tongue on the left. The attack worsens after eating or physical activity, the pain becomes unbearable, and patients may lose consciousness. Cannot be eliminated by medications.
At the height of pain, vomiting occurs. Doesn't work for a long time, up to several days, does not bring relief. There may be blood impurities. If these signs occur, consult a doctor immediately.
Bloating and distension in the abdomen.
Increased heart rate, high blood pressure.

If these signs appear, the patient should be taken to the hospital immediately.

In addition to infringement, the following dangerous conditions are distinguished:

Formation of erosive or ulcerative esophagitis.
Peptic ulcers of the esophagus.
Stenosis and cicatricial changes in the esophagus, narrowing of its lumen.
Internal bleeding.
Malignancy.
Perforation of the organ wall.
Attachment of a secondary infection, peritonitis.

Diagnostics

In order to determine the required range of studies and deliver accurate diagnosis, you should contact a qualified professional. First, the doctor questions the patient and examines him. This helps to detail complaints and collect the necessary information.

When palpating the abdomen, a protrusion of the hernia can be immediately detected. After this, general clinical tests are prescribed: general urine test, general blood test, stool test for coprogram.

There may be anemia and minor inflammatory changes in the blood. In the coprogram, the digestive and enzymatic functions of the organs are assessed. Next, we begin instrumental research methods.

X-ray with introduction contrast agent. An x-ray allows you to evaluate the location of structures and detect a hernia.

Signs of a hernia will be:

Displacement of the abdominal esophagus.
High diaphragm dome.
Presence of a hernial sac.
Expansion of the diaphragmatic ring.

To detail the signs, they are prescribed endoscopic methods. in the case of a hiatal hernia, it allows one to assess the condition of the mucous membranes, the movement of organs, the size of the protrusion, the expansion of folds and openings. Based on this, a final diagnosis can be made.

Laparoscopy

Applies to both diagnostic and therapeutic methods. It is prescribed when there is insufficient collection of information about the patient’s health status.

Laparoscopy is a type of surgical technique that involves making small punctures in the abdomen. Cameras are inserted through these punctures and necessary tools, all this in the form of metal tubes.

The image from the cameras is displayed on a computer monitor. If a hernia is detected, it is dissected, examined and sutured. The operation is not long, minimally invasive, non-traumatic.

After it there are no complications or huge scars, the recovery period is short. This method actively used in surgery.

How and with what to treat the disease

Treatment of a hiatal hernia comes down to several options:

Diet therapy.
Conservative medication;
Surgical operative;
Mixed combined.

Is it possible to cure a hernia without surgery?

Treatment without surgery is possible. In this case, the following conditions are met:

The hernial protrusion should be small in size.
It should not interfere with the functioning of internal systems.
Blood flow is not impaired.
The patient is bothered by minor symptoms.
The severity of symptoms is not acute.
The patency of the esophagus is preserved.
Conservative therapy is carried out at 1-2 degrees of the disease.
Stage 3 hernia is treated only surgically or in a mixed way.

How to treat a hernia without surgery

In order to treat the disease without surgery, it is necessary to follow a diet, take medications regularly, and do gymnastics.

Nutrition, diet and menu for hiatal hernia:

Complete abstinence from spicy foods. The list of products includes: onions, peppers, garlic, seasonings, sauce, mayonnaise, ketchup.
Avoid eating fried, salty, sour, smoked foods.
Prohibition of alcohol, smoking, carbonated drinks, juices, coffee, energy drinks.
Limit on fruits. Eliminate lemon, cranberries, pomegranate, kiwi, grapes, and citrus fruits from your diet.
Vegetables and fruits should be consumed in grated form.

The diet involves split meals up to 6 times a day, portions should be small. Don't engage physical activity within an hour after eating, sleep with the head of the bed raised. After eating, do not lie down.

Menu options

In case of pathology, the following products should be observed:

Dried fruits: dried apricots, prunes, raisins. They are best taken as an afternoon snack or for dessert.
Low-fat dairy products. Can serve as breakfast and last meal.
Vegetable soups without frying for lunch as a first course.
Boiled fish, poultry. For a side dish or dinner. They prepare meatballs, steamed cutlets, and soufflé.
Porridge with water for breakfast.
Compote, tea and fruit salad for dessert. It is recommended to drink 1.5 liters of fluid per day.

From medications medicines prescribe:

Proton pump inhibitors - Omez, Lansoprazole.
Antacids – Maalox, Almagel.
Prokinetics – Cerucal.
Antispasmodics – Duspatalin, Drotaverine.
Probiotics – Linex, Enterol.

Exercises and gymnastics

The patient's position is lying on the right side. Place a hard pillow under your head and shoulders so that they are raised at an angle of 45 degrees. While inhaling, we strain the abdominal wall and gradually protrude the stomach. Exhale sharply. At this moment we relax the abdominal wall. Do it 2 times a day for 10-15 minutes.
The patient stands on bent knees. The body is straight. We take a slow breath. At this time, tilt the body to the left as much as possible, then to the right. Exhale while straightening. Perform once for 10 minutes.
Position the patient lying on his back. As you inhale, turn your body to one side. As you exhale, return to the starting position. The next breath is a turn in the other direction. And so do 10 alternations 2-3 times a day.

Hernia surgery

During surgery, the hernial orifice is excised, the condition of the organ is examined, and it is returned to its place. The hernial sac and gate are sutured. A retaining mesh is applied to vulnerable areas.

Perform the following tactics:

Fundoplication according to Nissen - using a special mesh, the transfer is demarcated from the stomach so that there is no displacement of the organs.
Belsey operation. The lower part of the esophagus is sutured to the diaphragm and ligamentous apparatus. A hernia in this position will not be able to form again.

Diet after surgery

After surgery, the following principles apply for the first 24 hours: cold, hunger and rest. This means that for 24 hours after surgery the patient only takes bed rest, it is forbidden to stand up.

Cold in the form of ice or heating pads is applied to the surgical area. You cannot eat, you can drink water in small sips.

After 24 hours, you can take a half-sitting position without standing up abruptly. Avoid all physical activity. Consume cold, mushy and water-based foods: mashed bananas, oatmeal, jelly.

On the 3rd day a gentle diet is prescribed. Everything is boiled and ground. Once the patient's condition improves, he returns to his normal diet.

Treatment with folk remedies

Decoction of aspen bark.

Grind the dried preparation. Pour 1 tablespoon into 250 ml of water and simmer over low heat. Cook for 30 minutes without active boiling.

Then cool, strain, and can be diluted with chilled water. Drink 50 ml 3 times a day. Relieves inflammation pain symptom, heartburn.

Decoction of goose cinquefoil.

Pour 300 ml of boiling water over two tablespoons of the dry, crushed mixture, cover and leave for 2 hours. Strain, cool. Drink half a glass 2 times a day for 1 month.

Chamomile tea

Relieves pain, inflammation, muscle spasms. Pour 200 ml of boiling water over 2 tea bags. Infuse, cool. Take as tea.

Any person knows that hernial formation is dangerous thing, as it can lead to pinching of the organs included in it and provoke dangerous conditions, including tissue death. Among gastroenterological problems, diaphragmatic formation of the esophageal opening of the muscular plate is very common. This problem manifests itself in different ways, but it definitely needs to be treated. In order for treatment to be prescribed correctly, it is extremely important to establish the original cause of the disease.

Hiatal hernia: description of the problem

A hiatal hernia is an abnormal condition in which part of the digestive system organs moves from the abdominal cavity to the thoracic cavity through an enlarged esophageal opening in the diaphragmatic plate. As a rule, this concerns parts of the esophagus and stomach itself, but even loops can be subject to displacement small intestine. This phenomenon called a hiatal hernia.

Doctor's note: in many patients, the hernia does not make itself felt at all for a long time, being asymptomatic. However, you should not assume that this condition is harmless, because, like any other hernial formation, the esophageal hernia can also shrink, pinching the organs passing through the opening. The condition threatens to cause anemia, bleeding and other unpleasant consequences.

Esophageal hernia is a common disease; statistics show that every fifth adult suffers from this problem. The risk group includes people who have chronic diseases of the digestive system and (or) are over 50 years of age.

What does a hiatal hernia look like?

Types of hernias

Depending on the specific situation and location of the hernial formation, experts distinguish several types of this disease.

Type of hiatal hernia	Description
Sliding (fixed and not fixed)	The upper part of the stomach moves to the area above the diaphragmatic plate (in chest cavity), thereby participating in the formation of the hernial sac. The main feature of the condition is that the stomach is displaced not near the esophageal tube, but along its axis. Non-fixed “dumping out” is not permanent; it appears only under certain circumstances, often without provoking specific symptoms, which greatly complicates diagnosis. The concept fixed means that the location of the hernia does not depend on changes in body position, but a non-permanent hernia changes its location, for example, when a person assumes a vertical position.
Constant (perioesophageal)	In this situation, the lower section of the esophageal tube and cardia (the muscular ring connecting the esophagus and stomach) remain in their normal position, and through the hole in the diaphragm, strongly curving, part of the stomach emerges into the chest cavity, as if parallel to the esophagus itself. This condition is accompanied by obvious symptoms associated with difficulties in passing food.
Mixed type	A mixed type is diagnosed when the formation mechanism cannot be attributed to one or another variety.

Causes

To prescribe the correct treatment, it is of great importance to establish the mechanism of formation of a hiatal hernia. Experts say there are two main groups of reasons - weakness of the diaphragm muscles and too much high pressure inside the abdominal cavity. Such conditions can provoke both sliding and permanent hernia formation. Let's look at the common reasons in more detail:

changes in the muscles that form the esophageal opening itself - they relax, stretch and form a hernial orifice. Relaxation may occur due to nerve entrapment or traumatic injury;
under the diaphragmatic plate resolves with age adipose tissue which causes muscle weakening;
genetic predisposition;
atypical pulling up of the esophageal tube (due to a violation of its motor function, shortening due to scarring against the background of chemical and thermal burns);
closed and open injuries;
congenital pathological feature the structure of the diaphragmatic plate or esophageal tube;
a significant increase in pressure in the abdominal cavity of the body. Due to the fact that the pressure in the chest cavity is already lower than in the abdominal cavity, when it increases, pressure is exerted on the diaphragm, and it bends, during which the hole expands. If this happens on an ongoing basis, then the organs can easily form a hernial sac. The direct cause of this condition may be: pregnancy, strong due to chronic diseases respiratory system, heavy lifting, severe obesity, overeating and frequent violations stool, namely constipation;
a decrease in sphincter tone can be triggered by abuse of nicotine and alcohol, taking certain hormonal and medicines, which also creates favorable conditions for the appearance of a hernia.

One can also say about specific reasons, provoking a certain type of hiatal hernia. Thus, a congenital sliding hernia can form during intrauterine development due to a slowdown in the movement of the stomach into abdominal cavity. There may also be a pre-formed “bag” (a place where organs may descend in the future), which is formed due to untimely or incomplete fusion of the diaphragmatic plate during the period when the stomach has already descended. It happens that acquired causes that can be at the origin of the appearance of a sliding hiatal hernia include the presence of strong reflex contractions of the esophageal tube due to peptic ulcer or cholecystitis.

Constant about hiatal hernia is considered more dangerous, since it is precisely this formation that is most often pinched. Besides common reasons, this condition can be provoked by dyskinesia of the esophageal tube - a violation motor function without lesions organic character. The formation can be pinched either immediately after the stomach is displaced or after some time due to the influence of certain factors:

strong laughter;
eating large amounts of food;
physical stress due to heavy lifting;
falling from height;
overflow of the intestines with feces, etc.

Video about hiatal hernia

It is impossible to avoid all possible causes of a hernia, but you can significantly reduce the risk of its occurrence: healthy image life, treat diseases of the digestive system in a timely manner, avoid injury. There are many factors that provoke the problem, and most of them are congenital. It is extremely important to monitor your own health and the health of your child so that if symptoms of the disease are detected, you can get medical help in a timely manner.

Therapeutic measures must be carried out comprehensively. It is very important to diagnose diseases in a timely manner and select appropriate therapy. An esophageal hernia, the treatment of which will be discussed in detail below, is formed when the organs of the abdominal cavity are displaced into the chest cavity.

This happens when the esophageal ring is stretched and a difference in pressure is formed in the cavities. To prevent complications in the form of strangulation, it is necessary to carry out timely treatment. Let's find out how a hiatal hernia is treated.

Treatment of hiatal hernia is complex. It consists of various directions. These include:

conservative therapy;
surgery.

The first, in turn, consists of a diverse set of directions. The following treatment methods are of particular importance for hiatal hernia:

appointment of the appropriate diets;
physiotherapy;
complex therapeutic exercises.

This is the treatment for a diagnosis of hiatal hernia. The operation is recommended in case of huge hernias and lack of effect. conservative therapy. But it is important to understand that treatment with pills does not remove the hernia itself, but only eliminates the symptoms.

Conservative methods as a method of treatment

When a hiatal hernia is diagnosed, treatment is complex. Patients with this pathology should change their lifestyle. If we look at the factors that contribute to the occurrence of a hernia, the first thing that needs to be changed is the diet. It is important to understand that conservative methods are effective for small sizes and in cases of mild symptoms.

When diagnosing a hiatal hernia, the causes and methods of treating this disease are different, so we consider them further.

Diet and lifestyle

Treatment of hiatal hernia consists of using a gentle regimen. All products are thoroughly crushed, excluding coarse mechanical food. Products should be added increased content fiber. These are all possible cereals, vegetables And fruits. Limit legumes and pasta. A prerequisite is to eat three hours before bedtime. It is recommended to sleep with the headrest raised 30 degrees. It is especially important for those who have GERD in combination with a hernia. It is advisable to limit your intake of coffee and carbonated drinks. Try to avoid bad habits.

Details about correct mode nutrition, healthy and harmful products we tell.

Your lifestyle should be replaced with a more active one. Excess body weight is an aggravating circumstance. Sports with a hiatal hernia are recommended to be limited in terms of performing exercises with high physical activity. You should adhere to exercise therapy.

Medication methods

How to treat a hiatal hernia? Treatment is similar to. Therefore, medications are prescribed to reduce the aggression of hydrochloric acid and improve digestion.

How to treat a hiatal hernia? Assign the following medications for hiatal hernia:

Taking certain medications directly depends on the severe symptoms of the hernia itself and concomitant diseases in the form of GERD. This is the most important thing in the matter of treating a hiatal hernia with medications.

Exercise therapy

Therapeutic gymnastics is aimed at strengthening the muscles of the anterior abdominal wall. The exercises are built on the same principle. All movements must be done while inhaling or exhaling. For example, the starting position is standing. Hands to the sides. The width of the legs is arbitrary. As you inhale, you should stick your stomach out. Don't overdo it. As you exhale, relax the front wall of the abdomen.

One more example. Lying position. As you inhale, turn your torso in one direction, and as you exhale, turn your body to the other. It is advisable to carry out such exercises every day. Respectively, with severe symptoms, exercise therapy alone will not have the desired effect. Therefore, it is important to seek specialized medical help.

Surgical intervention

When a hiatal hernia is diagnosed, treatment should include surgery. It is indicated for any type of hernia.

There are indications for surgery:

pronounced clinical picture in the form of pain;
in case of complications development;
if in combination with a hernia the patient has reflux that cannot be treated;
for hernias with complications on the pulmonary system and heart;
if the place of transition of the esophagus into the stomach does not become clear during biopsy characteristic appearance epithelium. That is, dysplasia develops, with subsequent metaplasia and cancer.

All operations are divided into 4 types.

Useful video

How to cure a hiatal hernia? You can learn more about this issue using this interesting video.

How to identify a hiatus hernia? — you will learn what the degrees of hernia are, how to distinguish the symptoms of a hernia from heart pain, get acquainted with the characteristic and less clear signs hiatal hernia and its strangulation.

A small esophageal hernia usually does not manifest itself in any way at the initial stage, so a person does not feel any suspicious signs.

With further increase in the size of the hernia, the following symptoms appear.

Heartburn- the most common and characteristic sign of this disease. As a rule, heartburn occurs after eating, as well as at night, when the patient is in a horizontal position for a long time. Unpleasant symptoms may intensify with sudden bending of the body forward. The intensity of heartburn can vary widely: from episodic cases to painful attacks and even loss of ability to work.
Pain- occurs in most patients. Most often, pain appears in the retrosternal region or in the hypochondrium. In some cases, the pain is localized in the epigastrium (closer to the upper abdomen). Sometimes patients feel pain in the heart, although there are no problems with this organ. The main reason for the appearance pain with a hiatal hernia, there is compression of the branches of the vagus nerve passing through the diaphragmatic opening. If a protrusion is suddenly pinched, the pain can be very sharp - in this case it is recommended to call ambulance.
Dysphagia- difficulties in moving food through the esophagus. This symptom occurs in 40% of all cases of the disease. Dysphagia can occur even with liquid or semi-liquid foods, and patients may complain of bolus or liquid getting stuck. So-called paradoxical dysphagia often occurs. In this case, solid food passes through the esophagus much more easily than liquid food. This symptom intensifies when eating too hot or cold food, as well as when eating too quickly.
Belching- occurs in approximately half of all cases of the disease. The patient may feel belching of air or food. In this case, there is often a feeling of significant distension in the epigastric region. After belching, the patient's condition improves somewhat.
Hoarseness of voice- occurs due to the reflux of stomach contents into the larynx and oral cavity, resulting in a peptic burn. In order to prevent the appearance unpleasant consequences It is recommended to drink one or two sips clean water after each episode of regurgitation.
Hiccups- can be persistent and cause considerable discomfort to the patient. The main cause of prolonged hiccups is irritation of the branches of the vagus nerve and, as a result, convulsive contraction of the diaphragm.
Cough- also occurs due to infringement of the vagus nerve. This symptom may be accompanied by attacks of suffocation and disorders heart rate.

In the presence of a hiatal hernia, the above symptoms do not occur in all cases.

The likelihood of their occurrence largely depends on the type of hernia, its size and a number of other factors.

What is the difference between a sliding hernia?

Diaphragmatic hernias include sliding hernial protrusion. It is characterized by the penetration of part of the esophagus or stomach into the chest cavity through a weakened opening of the diaphragm. Sometimes the organs return to where they should be, causing symptoms to disappear for a time. Frequent tension of the abdominal muscles and excessive physical activity lead to the disease reoccurring.

For sliding hernias Characterized by a burning pain that is felt in the chest or upper abdomen.

It is felt especially strongly in a lying position and with slight bends.

In addition to pain, the following are observed:

nausea;
belching;
heartburn.

Symptoms characteristic of certain types of disease

Depending on the type of diaphragmatic hernia, the clinical picture of the disease may differ in the appearance various symptoms. Let's look at the most characteristic signs individual species hiatal hernia.

A sliding hernia is manifested by a protrusion emerging into the hernial sac, lined with peritoneum. With this form of the disease, symptoms appear when the contents of the stomach are refluxed towards the esophagus, i.e. gastroesophageal reflux occurs. In this case, the patient usually complains of such characteristic symptoms as belching, heartburn, pain in the epigastric region or between the ribs, and frequent regurgitation of gastric contents. Subsequently, dysphagia often occurs, which makes it difficult for food to pass through the esophagus.

A paraesophageal hernia differs from other types of disease in that when it is present, food stagnates in the stomach. In this case, the stomach is partially located near the chest cavity, which causes the appearance of characteristic symptoms.

In the presence of a paraesophageal hernia, the patient feels pressing pain in the retrosternal region, which often intensifies after eating.

The danger of the disease is that as symptoms progress, patients reduce the amount of food they eat, and in some cases, even stop eating altogether.

When a paraesophageal and sliding hernia are combined, symptoms of heartburn and difficulty moving food through the esophagus are also observed.

A strangulated hernia is characterized by the appearance of sharp pain in the epigastric or retrosternal region.

If the infringement occurs in the area of the lower sphincter of the esophagus, then painful vomiting often occurs, but the process of vomiting itself does not occur due to compression of the upper third part of the stomach or the lower part of the esophagus. Also, it becomes almost impossible for food to move through the esophagus into the stomach.

If the upper third of the stomach is pinched, the patient experiences severe vomiting of gastric contents. Bile or blood components may be visible in the vomit. Signs of sepsis and intoxication are often observed: cold sweat, pale skin, increased heart rate, shortness of breath, increased body temperature.

Since strangulation of a diaphragmatic hernia is very dangerous condition, then if the above symptoms appear, you must urgently call an ambulance. In the absence of any action to save the patient, it may accumulate in the chest cavity. free liquid, and the pinched organ can stretch unnecessarily and even rupture.

An axial hernia is characterized by the displacement of part of the stomach into the chest cavity through the esophageal diaphragmatic opening. When it appears, the patient experiences pain in the chest, esophagus or heart. The pain may also radiate to the back or neck. Intensity pain syndrome can be different and depends on the size of the hernial protrusion, the degree of nerve entrapment and other factors.

The pain may be worse after eating, coughing, or lifting heavy objects.

Other symptoms also appear: vomiting, belching, nausea, regurgitation, heartburn. In some cases, increased salivation and difficulty swallowing food occur.

Often due to the appearance axial hernia other diseases arise: colitis, cholecystitis, ulcerative disease - and symptoms characteristic of these ailments arise.

A paraesophageal hernia is characterized by the location of part of the stomach next to the esophagus above the diaphragm. This condition is characterized by the fact that at the initial stage there may be no symptoms. In some cases, this disorder is discovered by chance during an examination for another disease.

With a significant increase in the size of the diaphragmatic hernia, esophageal compression occurs, which leads to dysphagia (impaired swallowing of food) in patients.

Incarcerated paraesophageal hernia is manifested by severe pain localized in the epigastric or retrosternal region.

A hernia caused by a congenital short esophagus is characterized by symptoms similar to those of axial diaphragmatic hernias. The final diagnosis can be established only according to the anamnesis.

Esophageal hernia in combination with cardiac insufficiency. For this type of diaphragmatic hernia, the main characteristic symptom is heartburn. Manifestations of heartburn can occur both after eating and as a result of a sudden change in body position. This symptom often appears at night, which is due to an increase in the tone of the vagus nerve during rest in a horizontal position of the body, which leads to relaxation of the lower esophageal sphincter.

Heartburn can be mild or quite debilitating.

The intensity of this symptom depends on the acidity gastric juice, degree of stretching of the esophagus and other factors.

Another characteristic symptom is the appearance of pain in the chest area. The pain, as a rule, intensifies both when taking a horizontal position of the body and when bending the body forward. Character of pain: prickly, burning, sharp.

Other symptoms characteristic of this form of the disease are belching, pain in the interscapular region, and some difficulty in passing food through the esophagus. Belching is observed in half of all patients, and relief does not occur even as a result of taking prescribed medications.

Esophageal hernia in combination with other pathologies of the gastrointestinal tract (GIT). Distinctive feature This type of disease is that the symptoms of a hernia may remain unrecognized for a long time due to the presence of signs characteristic of disorders in the gastrointestinal tract.

Most often, diaphragmatic hernia is combined with duodenal ulcer, as well as with stomach ulcers. In such cases, patients complain that pain in the epigastric region occurs regardless of the fact of eating, but the pain increases significantly with any change in body position.

Signs characteristic of cardiac failure may also be observed, even with complete absence pathological changes from the cardiovascular system.

In general, the main signs characteristic of diaphragmatic hernias various types, have some general features, for example, the presence of pain or heartburn, but differ in other distinctive features. In order to accurately establish a diagnosis, when any of the above symptoms appear, it is necessary to undergo a detailed examination by a gastroenterologist using modern diagnostic methods.

Signs of a strangulated hernia

Strangulated hernia - serious complication. Occurs after long treatment or is the first manifestation of the disease. The following symptoms occur:

Sharp, sudden pain in the lower chest or upper abdomen. Then it manifests itself in the scapula or in the fossa above the collarbone. Poor diet, medications, or fluids may make the pain worse. The intensity is high, sometimes leading to a state of shock.
Continuous vomiting for several hours or even days. The more intense the pain, the stronger the vomiting.
Severe bloating, discomfort.

Any of the above symptoms is a signal that you need to immediately visit a doctor.

Self-medication is unacceptable.

Degrees of hiatal hernia

Depending on how strongly the stomach is displaced into the thoracic region, there are 3 degrees of hernia:

The abdominal part of the esophagus is located above the diaphragm, the cardia is at the level of the diaphragm, and the stomach is adjacent to it.
The abdominal part of the esophagus is displaced into the thoracic region, the stomach is located at the site of the esophageal opening of the diaphragm.
The abdominal part of the esophagus, cardia and the entire stomach are shifted to the thoracic region.

How to distinguish chest pain with hiatus hernia from heart pain?

First you need to note the similarity of symptoms:

Aching or burning pain.
Pain is felt behind the shoulder blades and in the thoracic region.
Intensifies during and after physical activity.

Differences between pain in hiatal hernia and heart disease:

Pain with hiatal hernia	Heart pain
Increases after consumption large quantity food.	It is not related to what food you ate the day before and in what quantities.
May occur when lying down or leaning forward.	Does not depend on body position.
It is associated with intra-abdominal pressure: appears with coughing, constipation and problems with urination.	There is no association with cough, constipation or urinary problems.
May appear due to increased gas formation.	Increased gas formation has no effect.
Disappears or decreases after belching, vomiting. Becomes less pronounced with deep breathing.	Belching or vomiting does not make it better.
Disappears or weakens after drinking liquids, especially alkaline ones.	There is no relief after taking any liquid.
Sometimes it seems to “encircle” the body.	No pain is felt in the upper abdomen.
Taking nitrates has no effect on pain relief.	Taking nitrates leads to relief.
	Physical exercise have an impact.

It is worth comparing the symptoms separately strangulated hernia with myocardial infarction, as they are most often confused.

Cough and lung diseases

A strong cough awakens you from sleep and leads to pain in the chest area. It intensifies if dinner was immediately before going to bed.

The reason for this is the flow of eaten food into the esophagus, and from there into the larynx, trachea and bronchi.

The result is the appearance of bronchitis and asthma attacks.

Tongue pain and hoarseness

Anemia

This disease is characterized by dizziness, pallor skin, causeless lack of strength and energy, darkening of the eyes.

When taking tests, it may turn out that the level of hemoglobin and/or red blood cells is below normal. This speaks of internal bleeding, which can be caused by damage to the walls of the esophagus from gastric juice.

At the appointment, the doctor will ask the patient if he has black diarrhea.

Swallowing disorder

Difficulty swallowing food is a common symptom of a hiatal hernia. You constantly feel a lump in your throat, especially after eating liquid food. Violations are variable in nature.

Patient Reminder

A sliding hernia has variable symptoms; it is characterized by vomiting, heartburn, belching and burning pain.
There are 3 degrees of hiatal hernia depending on how much the stomach is displaced into the chest cavity.
Pain with hiatal hernia, unlike heart pain, depends on the amount of food consumed, body position, intra-abdominal pressure and is significantly relieved after vomiting or belching. Taking nitrates does not relieve symptoms.
Pain with hiatal hernia differs from pain with myocardial infarction in that it is burning and stabbing in nature. The pressure drops, and vomiting may be bloody.
Other signs of a hiatal hernia include difficulty swallowing, tongue pain, hoarseness, anemia, cough and lung disease.

Update: November 2018

Today, according to many experts, hiatal hernia is a very common disease of the gastrointestinal tract, ranking third after gastric ulcer and cholecystitis.

Moreover, in 50% of cases, a diaphragmatic hernia occurs latently, either asymptomatically or with minimal symptoms and discomfort. It is usually discovered by chance while passing through endoscopic examination or x-ray examination of the stomach and esophagus.

In 30% of patients with a hiatal hernia, the primary complaints with which patients go to the doctor are pain in the heart - non-coronarogenic cardialgia and heart rhythm disturbances - paroxysmal tachycardia and extrasystole. This most often leads to diagnostic errors and ineffective therapy by a cardiologist, since a hernia is a possible cause of cardiac disorders.

This disease, as a rule, is combined with gastroesophageal reflux disease, which leads not only to cardiac disorders, but also to a whole complex of pulmonary and dyspeptic disorders in the human body.

A diaphragmatic hernia is an enlargement of the esophageal opening of the diaphragm, in which the ligaments connecting the stomach and esophagus are stretched.

Such a violation leads to the reflux of bile and gastric juice into the esophagus, gradually inflammation and changes in its mucous membrane occur, which over time provokes the formation of malignant tumors.

According to research by world gastroenterological associations, in the absence of adequate timely treatment for a hernia, after 7-10 years the patient’s risk of developing esophageal cancer increases. If there is no treatment for 7 years, then the risk of developing cancer increases by 280%; if the disease is more than 10 years old, then the risk increases to 400%.

Hernia symptoms

Painful sensations

Pain when diaphragmatic hernia esophagus are very diverse and depend on its type, duration of the disease, and age of the patient:
The most common localization of pain is in the epigastric region; it appears when changing body position, after eating.
Sometimes the pain can radiate to the area between the shoulder blades or to the back.
It is also possible to experience girdling pain, which may resemble the symptoms characteristic of a disease such as pancreatitis.
A fifth of patients, especially the elderly, experience pain in the heart area; this may also be associated with concomitant diseases - coronary heart disease, angina pectoris.
When a hernia leads to various complications, the direction, nature, and intensity of pain changes. With solarium, the pain becomes unbearably burning, and its intensity increases with pressure in the epigastric region, and when the patient bends forward, it becomes easier. When perivisceritis occurs, the pain is aching, dull, continuous and concentrated high in the epigastric region. In case of infringement hernial sac, piercing, tingling pain appears behind the sternum, radiating to the area between the shoulder blades (see)

Belching sour

When belching, a taste of bitterness or bile remains in the mouth, or the patient experiences very frequent belchings of air, most often they occur after eating.

Regurgitation, vomiting

This symptom most often occurs at night, after eating or while lying down, and is not accompanied by nausea. If the amount of regurgitation is significant, it can cause aspiration pneumonia.

Dysphagia

This is not a permanent symptom of a hiatal hernia; it may come and go. If you eat hot or too cold liquid food or swallow it very quickly, it may be difficult for the food to pass through the esophagus. As for solid food, it moves through the esophagus easier and faster. If this sign of an esophageal hernia begins to be permanent, this is a reason to diagnose oncology, stricture, esophageal ulcer, or strangulated hernia.

Heartburn

The most characteristic, pronounced and frequent sign of a hiatal hernia. It happens after eating, at night and in a lying position. In most patients it is constant symptom and plays a decisive role in the diagnosis of diaphragmatic hernia.

Hiccups

Not the most characteristic symptom, since it occurs only in 4% of patients. if it occurs, it is characterized by a long period; the patient can hiccup from several hours to several days.

Pain, burning tongue

A rare symptom, it appears only if gastric contents are thrown into the mouth or larynx, and hoarseness may occur.

Combination of hiatal hernia with disorders in the respiratory system

Most often, a hiatal hernia is accompanied by bronchial asthma, obstructive bronchitis, aspiration pneumonia. The most dangerous of these pathologies is the aspiration of gastric masses into the respiratory tract. In this case, the patient experiences suffocation, persistent cough and chest pain.

To differentiate pain in the esophagus due to a hernia, the symptoms of which are similar and characteristic of other diseases, the following factors characterizing the presence of a diaphragmatic hernia in a patient should be taken into account:

After eating, in most cases, the pain intensifies, and the intensity of pain increases with coughing, physical activity, any tension, even just in a horizontal position.
After vomiting, belching or regurgitation, take a deep breath pain subsides or stops. Taking soda, water, and lying down also help reduce pain.
The nature of the pain is rather moderate, aching, dull, only in rare cases can there be extremely strong pain.

What is the difference between a sliding hernia?

One type of diaphragmatic hernia is a sliding hernial protrusion. In this case, through weakness The diaphragm allows part of the esophagus or stomach to enter the chest cavity. Periodically, they return to their normal location (in the abdominal cavity), which leads to the disappearance of symptoms. Physical activity, tension in the abdominal muscles and a number of other factors lead to the re-formation of a hiatal hernia.

A characteristic symptom of sliding hernias is burning pain, which is located behind the sternum or in the upper abdomen. It intensifies in the “lying down” position and with strong bends, and is often accompanied by belching, heartburn or nausea.

What are the signs of a strangulated hernia?

One of the most dangerous complications of diaphragmatic hernia is strangulation. It can occur either after a long course of the disease or be the first manifestation of the disease. In order to promptly identify infringement, the patient should be assessed for the following symptoms:

Sudden sharp or shooting pain in the lower half of the chest/upper third of the abdomen. Often, it radiates to the scapula or supraclavicular fossa. Increased pain is provoked by increased intestinal motility (due to food intake, liquids, certain medications, etc.). The intensity of the pain is extremely high, in rare cases it can lead to shock;
Vomiting that does not stop for a long time (from several hours to days). As a rule, it intensifies at a height of pain;
Severe abdominal bloating with increased pain.

The presence of one of these signs requires urgent medical care for the patient.

Main causes of hiatal hernia

Signs of a diaphragmatic hernia most often appear in older people, when the body wears out for natural reasons, and tissues, muscles, and internal organs lose their elasticity. As the hernia progresses, in some patients by the age of 60, the so-called “hernial orifice” may form, when the esophageal opening can increase by several centimeters.

Causes of hiatus hernia:

Age-related weakening of muscles and ligaments of the esophagus
Resorption of fatty tissue under the diaphragm
Changes in the position of internal organs, for example, during pregnancy
Atrophy of the left side of the liver
Esophageal dyskinesia
, abdominal muscle tension
Increased intra-abdominal pressure
Congenital malformations - shortened esophagus
Surgery on the esophagus
Thermal burns from hot food cause contraction of the esophagus and provoke the formation of a hernia.

There is both an asymptomatic course of the disease, and vice versa, in patients in combination with various diseases gastrointestinal tract, a hiatal hernia is also detected. Thus, according to some data, 40-60% of patients with gastric or duodenal ulcers, 50% of patients with chronic gastroduodenitis, 20-40% of people with cholecystitis (see and pancreatitis (see) are diagnosed with a diaphragmatic hernia.

Diagnostics

The first step in detecting a diaphragmatic hernia is to look for the patient's characteristic symptoms and possible causes. After this, it is necessary to proceed with a direct examination, during which it is possible to detect following signs diseases:

Inspection - with a hiatal hernia, the chest practically does not move during breathing, due to dysfunction of the diaphragm. If a person suffers from this pathology for a long time, the stomach becomes “sunken”. This symptom may not be observed in people who are overweight;
Feeling the abdomen (palpation)– it becomes dense in the upper parts of the abdominal wall, due to strong muscle tension. Pain on palpation is also possible;
Auscultation (listening with a phonendoscope)– a characteristic sign of a diaphragmatic hernia is the appearance of bowel sounds in the chest cavity. The normal sound of breathing is usually absent or significantly reduced.

The above signs are enough to suggest a diagnosis. However, the presence of a hiatal hernia can only be reliably confirmed using instrumental diagnostic methods.

Plain chest x-ray/fluorography

This is not enough informative method, however, it is necessary to distinguish the pathology of the diaphragm from diseases of the chest cavity (pneumothorax, pleurisy, pneumonia, etc.). You can also find some indirect signs hiatal hernia:

The dome of the diaphragm is located above normal;
The presence of intestinal loops/gastric gas bubble in the chest cavity;
Displacement of the mediastinal shadow (section white between the lungs x-ray) away from the midline.

It is quite difficult to detect these changes on an x-ray/fluorography without appropriate experience. Therefore, it is important that the image is examined by a qualified doctor.

X-ray of the esophagus and stomach with contrast

In the absence of CT, X-ray contrast diagnostics is the best way confirm diaphragmatic hernia. For this purpose, the patient is given a solution of a contrast agent (about 200 ml of Barium sulfate) to drink, after which an X-ray is taken. A reliable sign of a diaphragmatic hernia is the presence of a stomach or small intestine.

How to prepare for research?

For optimal X-ray quality, preparation should begin 3 days before the procedure:

During this period, the patient is prescribed a diet with a minimal amount of fiber. Should be excluded: Rye bread, pearl barley and corn grits, dairy products, fruits, vegetables and their derivatives (juices, jam, etc.);
12 hours before contrast radiography, you must adhere to a “starvation” diet;
In the evening and morning before the procedure, the patient is given one cleansing enema.

It should be noted that taking laxatives is not recommended, as they increase the amount of free gas in the intestines and reduce the quality of diagnosis.

Ultrasound of the pleural cavity

An additional method that is used when X-ray results are questionable. Using ultrasound, loops of the small intestine or stomach are distinguished from other pathological processes in the chest. The procedure does not require any preparation and takes 7-10 minutes.

CT scan of the chest and abdomen

Using this expensive X-ray examination, a diaphragmatic hernia is detected in 100% of cases. The presence of false results is excluded due to excellent visualization. Unfortunately, computed tomographs Only large cities have hospitals and regional centers. The study, as a rule, is carried out for a fee (the average price is about 2000 rubles). This explains its rare use.

Laparoscopy/Thoracoscopy

This is not just a way to diagnose a diaphragmatic hernia, but a full-fledged surgical intervention. Its principle is simple - in a certain anatomical area (abdomen or chest, respectively), two incisions 1-2 cm long are made. Through them, an endoscopic instrument made in the form of narrow metal tubes with some kind of working tip (branches) is inserted into the cavity. One of them must have a video camera with a light source. Thus, the surgeon can directly examine the diaphragm and choose further tactics.

It should be noted that these procedures are most often used when severe injuries belly or chest. As a diagnostic method, laparoscopy and thoracoscopy are rarely used.

Treatment of diaphragmatic hernia

First of all, it must be emphasized that treating a hiatal hernia without surgery is impossible. The only way to get rid of this disease is surgery. This should be done as soon as possible, as waiting a long time may lead to the following complications: strangulated hernia, obstruction digestive tract, respiratory failure etc.

This operation does not have absolute contraindications for carrying out, therefore it can be performed on all patients. Depending on the severity of their condition, it is carried out either urgently (within 2 hours) or planned. Emergency intervention is indicated for the following patients:

With strangulation of a hiatal hernia;
With severe respiratory failure;
For disturbances in the functioning of the heart caused by a hernia;
WITH severe symptoms(uncontrollable vomiting, intense acute pain, etc.).

In other cases, the operation is carried out as planned (the duration is not limited, but it is recommended within several weeks) in a specialized department of “thoracic surgery”.

Preparing for planned surgery

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

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

How to treat a hiatal hernia?

The main goal of the operation is to reduce the hernial protrusion back into the abdominal cavity and suture the damaged area of the diaphragm. To do this, the surgeon can perform one of two approaches: cut the anterior wall of the abdomen along the midline or perform a thoracotomy (open the lower parts of the chest). For a strangulated diaphragmatic hernia, the doctor needs both of these approaches.

If the operation is performed as planned in the thoracic surgery department, the doctor can use a more modern method of treating a hernia - video endoscopic surgery. As with diagnostic laparoscopy, two 1-2 cm incisions are made, through which special instruments are inserted into the chest cavity. One of them is necessarily equipped with a video camera with a flashlight, through which the surgeon controls his actions. The second one can perform the function of tweezers, electric/plasma knife, liquid suction, etc.

After the organs are repositioned into the abdominal cavity, the diaphragm is sutured and strengthened with body tissue (most often a tendon or aponeurosis) to prevent the reoccurrence of a hiatal hernia.

Rehabilitation after surgery

Surgical treatment of an esophageal hernia is quite traumatic. Therefore, in the postoperative phase, the patient may experience pain, digestion problems, or infectious complications. To avoid this, clinicians recommend the following measures:

Adequate pain relief

As a rule, NSAIDs are sufficient for this, which are administered by intramuscular injections(in the buttock). Most often - Ketorolac/Ketorol. In case of severe pain, it is possible to administer local anesthetics(Lidocaine or Novocaine) into the surgical incision or using epidural anesthesia.

How is epidural anesthesia (pain relief) done? The doctor uses a blunt needle to inject the drug (Lidocaine, Novocaine) into the spinal canal, into the space between spinal cord And inner surface vertebrae If necessary, epidural analgesia can be maintained continuously if a tube is installed in the indicated space through which the anesthetic is constantly supplied.

Diet

Dietary treatment: A hiatal hernia often disrupts the normal movement of food through the intestines. Therefore, in the postoperative phase it is important to gradually restore its function. Patients are recommended to eat a diet that excludes flour, salty, spicy and fatty foods. The diet should include porridges (rice, buckwheat, corn), which contain moderate amount fiber; boiled meat (chicken or beef); soups made with chicken broth;

Prevention of thromboembolic complications

After most operations there is a risk of developing these complications. In this case, a blood clot grows on the wall of a vessel in the patient, which can break off and close the lumen of vital arteries (pulmonary, coronary, vertebral, etc.) or enter the heart cavity. To prevent this from happening, patients are advised to wear compression stockings and perform injections with heparin preparations (if there is no significant bleeding).

A hiatal hernia can become a life-threatening condition if you wait or treat it folk remedies. Therefore, after making a diagnosis, it is necessary to decide on the date of the operation and the technique for its implementation. If surgery was performed in a timely manner, the prognosis for the patient is, in most cases, favorable. Proper rehabilitation and prevention postoperative complications allow the patient to return to their previous quality of life within a short period of time.