Sliding unfixed hiatal hernia. How does KS manifest? Causes of axial hernia

sliding hernia hiatus diaphragm involves the process of moving the stomach through the dilated canal of the esophagus into the area chest. According to statistics, about 4.9% of people suffer from this type of illness. As a rule, half of the patients sliding hernia the esophagus proceeds completely unnoticed, that is, asymptomatic. The lesion site plays a huge role. It may be completely unnoticeable during external examination, since its progression occurs deep inside the body. Doctors say that a disease such as sliding hernia is often detected in women. Men suffer from this disease much less frequently. Regarding this disease in children, we can say that it is congenital.

Types of disease

One of the most common variations of the disease that most often affects humans is axial hiatal hernia. Sliding hiatal hernia (axial) in turn is divided into the following types:

total gastric hernia;
cardiac;
subtotal;
cardio-fundal.

In medicine, it is customary to distinguish between other types of hernias that are similar. They are usually designated general term"paraesophageal hernia". It, in turn, is divided into the following types:

In view of the fact that the main place where the formation of the hiatal hernia actually occurs is the stomach, it is customary in medicine to classify similar diseases in terms of the volume of parts that penetrated into the chest cavity through the esophageal canal of this body, namely:

in the case of the development of a sliding hernia, which occurs in the first stage, the stomach rises and further adheres directly to the diaphragm. Penetration occurs in the chest area abdominal region esophagus;
at the second stage of the disease, the position of the stomach is fixed directly in the opening of the diaphragm. Abdominal part the esophagus, in turn, moves into the chest cavity;
at the time of detection of the disease, which most often occurs in the third stage of its course, almost the entire volume of the stomach, as well as the lower part of the esophagus, is located at the top of the diaphragm.

Symptoms and causes of hiatal hernia

It is clear that a completely natural question is as to what exactly causes a hiatal hernia, as well as what are its symptoms and treatment? The main reason is the process of the apparatus connecting the esophagus and stomach. Based on statistics, it was possible to conclude that often this disease occurs in that category of people who practically do not engage in any kind of sports and at the same time lead sedentary lifestyle life. In addition, people who eat poorly and have a very thin physique fall into the risk category.

The following reasons can also be identified:

regular flatulence;
pregnancy with complications;
frequent vomiting;
coughing;
neoplasms in the abdominal cavity.

The manifestation of this disease has signs that are very similar to the signs characteristic of gastrointestinal lesions. As a rule, these symptoms are reflected in the disruption of the stomach. Often there is a significant deterioration in the functioning of the sphincter located in the lower part of the esophagus. As a result, the contents of the stomach are sucked directly into the trunk of the tube, which is responsible for carrying food. Gradually, gastric juices accumulate in the esophagus, which are quite aggressive in nature. In the future, this leads to the beginning of the inflammatory process.

As a rule, this inflammatory process begins to manifest itself as soon as a person eats, that is, he develops heartburn. Painful sensations may increase significantly if the patient lies down or performs physical work with loads. Some patients claim that they have a lump in their throat. After eating food, a wide variety of pain may occur. It may occur in the area lower jaw, chest, shoulder blades, as well as in cervical spine. Often, patients go to the hospital complaining of pain in the heart area, as it is very similar to angina pectoris. To determine the cause of this condition as accurately as possible, specialists usually prescribe differential diagnostics.

A hernia is dangerous because it can lead to Negative consequences in the form of reflux - esophagitis, as well as other serious complications.

If the disease has been going on for a long time, that is, it is in a fairly advanced state, then the following may additionally occur. unpleasant sign like bleeding from blood vessels which are located in the esophagus. It is not always possible to determine this phenomenon, since it is hidden.
Often the main symptom of a sliding hernia is progressive anemia. These bleedings, in turn, can be divided into the following types:

spicy;
chronic;
strangulating a hernia in the opening of the diaphragm;
complicated.

As a result of this disease an ulcer develops, which in medicine is called “ peptic ulcer" It develops in the cavity of the tube through which food enters the stomach. If you don't provide timely treatment, this in turn can lead to narrowing of the esophagus. Symptoms of cicatricial stenosis occur.

Basic methods for diagnosing the disease

In order to determine the stage of the disease, they use following methods diagnostics:

determination of the patient's main complaints;
comprehensive x-ray examination esophagus, as well as the patient’s stomach;
Esophagogastroduodenoscopy;
CT scan.

The highest degree of effectiveness in determining the extent of the disease is X-ray equipment. By using ultrasound examination it is possible to determine the main lesion, but the degree of accuracy is quite low.

Treatment of sliding hernia

Initially, they try to treat this disease more conservative method. Its main purpose is to relieve underlying symptoms such as heartburn and pain. Medicines are often used to reduce the degree of acidity. The patient is advised to adhere to special diet, namely, exclude or limit as much as possible the following dishes in the diet:

spicy;
fried;
fat;
activating production gastric juice;
alcoholic drinks;
drinks with high caffeine content;
chocolate.

The patient should sleep in such a position that top part the body was slightly raised. It is highly undesirable to lift heavy objects.

It should be noted that even the most effective conservative treatment, and strict adherence to a diet will not be able to eliminate the main cause of the disease, it can only slightly alleviate general state patient, but this usually does not last long. To completely cure a hiatal hernia, you need cardinal methods, that is surgery.

The grounds for the operation are:

development of anemia;
strong blood flow;
ulcer formation;
esophageal erosion;
esophagitis;
lack of positive results of conservative treatment;
an increase in the size of the hernia, as well as its fixation in the “gate”;
high risk of injury;
dysplasia of the esophageal mucosa.

A sliding hiatal hernia (HHH) is a conglomerate of abdominal organs that passes through the muscle fibers of the diaphragm and penetrates the mediastinum, while being in constant dynamics. Due to regular friction, the fibers of the main respiratory muscle diverge even more, creating favorable conditions for further advancement and enlargement of the hernial sac. Timely diagnosis and timely initiation of therapy can save a person from surgery.

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Description of the disease

Aperture is the main thing respiratory muscle person. Due to its anatomical location, another function of the muscle is to delimit the mediastinum, in which the vital important organs- lungs and heart, - from the abdominal organs. In the plane of the diaphragm there are openings through which internal organs pass. One of them is the esophagus, through which the respiratory tract passes.

The formation of a hernia occurs due to the expansion of the ring of the esophageal opening. As a result, the stomach, and sometimes parts of the intestine, enter the mediastinal cavity. A hernia becomes sliding if the contents of the hernial sac can return back into abdominal cavity.

The reasons for the expansion of the diaphragm opening may be:

Connective tissue dysplasia. Reduced strength and elasticity of the tissue that is part of the fibrous ring of the hole itself, as well as ligamentous apparatus esophagus (Morozov-Savvin ligament, which should fix the esophagus to the diaphragmatic muscle).
Sedentary oway of life. Leads to a decrease in the load on the diaphragm and a weakening of the tone of muscle fibers, which provokes fiber disintegration and expansion of the esophageal opening ring.
Chronic lung diseases. Shape volume changes lung tissue, which leads to forced lowering of the diaphragmatic muscle, its relaxation, and expansion of the ring, which becomes a hernial orifice.
Increased intra-abdominal pressure. May be the result of intestinal pathology, flatulence, volumetric formations abdominal cavity. Coughing, obesity and overeating, pregnancy, and heavy lifting can cause a rise in blood pressure.
Hiatal contraction of the esophagus. It occurs as a result of spastic contractions, clinically manifested by hiccups and symptoms of reflux esophagitis. The cardia is pulled towards the mediastinum, the esophageal opening gradually expands, and a hernia is formed.

Types of sliding hiatal hernias

The main symptom of sliding hernias is the possibility of the contents of the hernial sac returning to the abdominal cavity. This happens most often when the patient’s body position changes under the influence of gravity. However, when long term diseases, the formation of adhesions in the mediastinum and fixation of the hernial sac are possible.

The prognosis depends on the stage of the diaphragmatic hernia:

Signs	HMS 1st degree	HMS 2nd degree	HMS 3rd degree
Location of organs in relation to the diaphragm	The cardia of the stomach is raised to the diaphragm from below, the position of the abdominal part of the esophagus is no more than 4 cm below the diaphragmatic muscle	The abdominal part of the esophagus penetrates into chest cavity, the cardia of the stomach enters the mediastinum	The antrum of the stomach, the fundus, and sometimes the entire organ extend into the chest cavity. In severe cases, “slipping” into the sternum is possible
Pathogenesis	Functional contraction of the esophagus due to increased intra-abdominal pressure or dyskinesia	Shortening of the esophagus due to the appearance of cicatricial changes in the mucosa due to reflux esophagitis	Critical expansion of the diaphragmatic esophageal opening as a result of constant movement of hernial contents
Forecast	Timely initiation of therapy will eliminate symptoms and normalize the tone of the diaphragmatic muscle	Infringement of the hernial sac is possible, which requires emergency surgical assistance. Often mimics acute coronary syndrome	Surgical correction and fixation of the hiatal ring is required. Signs of cardiac and respiratory failure

A diaphragmatic hernia of the 2nd-3rd degree is dangerous due to strangulation, since, together with the abdominal organs, vascular and nerve plexuses pass through the hole, damage to which can lead to major changes. Required timely diagnosis and correct therapy of pathology to prevent complications.

Clinical manifestations

Most often, a sliding hiatal hernia is accompanied by symptoms of reflux disease. Pathology can imitate many somatic pathologies:

acute coronary syndrome;
gastropathy;
obstructive syndrome.

The main symptoms of the pathology are:

Pain- wears burning character, sometimes accompanied by peristaltic spasms (during contraction of the esophagus). Due to its close location to the heart muscle, the patient most often ends up in cardiology department with suspicion ischemic disease hearts. The pain is triggered by eating and worsens when sitting or lying down. When going to vertical position with an unfixed hernia they subside.
Heaviness in epigastric region - appears 20-30 minutes after eating.
Heartburn- is the result of reflux (backflow of food from the stomach into the esophagus). Occurs at night or during the day if the patient lies down after eating.
Belching- most often with air, in exceptional cases - with food eaten during overeating. Caused by insufficiency of the sphincter of the gastric cardia. Occurs 20-30 minutes after eating. The heaviness in the epigastric region decreases, but burning spasms appear in the chest cavity.
Hiccups- spasm of the esophagus, provokes an increase in hernial contents, as contraction of muscle fibers pulls the organs of the abdominal cavity towards the mediastinum.
Dysphagia- manifests itself as nausea possible vomiting, burning of the tongue due to the backflow of the contents of the esophagus into the oral cavity.

The disease is often accompanied by other disorders digestive tract. The stomach suffers the most. The peristaltic wave is disrupted, since nerve plexuses pass through the hernial orifice in the esophageal opening.

The disease may be accompanied by general somatic disorders. Signs of respiratory failure appear with fixed hernias of the 2nd-3rd degree, when due to invagination of the hernial sac into the chest, the volume of the lungs decreases. This leads to symptoms that mimic obstructive syndrome: attacks of shortness of breath, suffocation, severe coughing, which further intensifies the hernia clinic (as it contributes to an increase in intra-abdominal pressure).

Also one of the complications is heart failure, which can be the result of compression of the myocardium or a consequence of severe pain.

Therapy

The main goal of conservative treatment is to relieve symptoms, which reduces the risk of complications. Appointed the following groups drugs:

Group	Name	Purpose
Antacids	Almagel. Phosphalugel	Form a film on the surface of the mucous membrane, allow you to activate the regenerative processes of the mucous membrane, reduce acidity
Prokinetics	Metoclopramide. Motilium	Normalize peristalsis and can reduce the manifestations of spasmodic pain
Alginates	Gaviscon. Laminal	A film is formed covering the mucous membrane of the stomach and esophagus. This reduces the risk of developing Barrett's esophagus due to reflux esophagitis, reduces burning and pain
H2 receptor blockers	Famotidine. Ranitidine	Allows you to reduce the acidity of gastric juice, effective for the treatment of reflux esophagitis, erosions, ulcers of the stomach and esophagus
Inhibitors proton pump	Omeprazole. Pantoprazole	Reduces gastric juice secretion and acidity. Significantly reduce pain

Surgical treatment

To perform an operation for plasty of the esophageal opening, it is necessary to have strict testimony, such as:

resistant course of the pathology (the disease does not respond to therapy, the patient’s condition does not improve);
the addition of complications (respiratory and heart failure, the formation of Barrett's esophagus, manifestations of angina pectoris, bleeding);
strangulation of the hernial orifice (emergency surgical intervention is performed);
recurrent diseases gastrointestinal tract (peptic ulcer stomach and duodenum, cholecystitis, pancreatitis, hepatitis and so on).

The most gentle is endoscopic technique, but for large hernias, open repair of the diaphragmatic opening is recommended.

Preventive measures

A sliding hiatal hernia is a common pathology, as many people have sedentary image life, eat surrogates and low-quality products. Therefore, the main measure to prevent the development of the disease is management healthy image life. Necessary:

Exercise. Physical education allows you to strengthen the muscle corset; the respiratory muscles are trained with the help of cardio exercises and breathing exercises.
Eat properly. Shown fractional meals in small portions 4-5 times a day, the last meal before bedtime - no later than 3 hours.
To walk outside. Walking helps prevent the development of lung diseases.
Stop smoking. This will ensure the prevention of lung diseases, reflux disease, and burns of the esophagus from tobacco smoke.
Sleep on a hard surface with an elevated head end. This position can reduce the likelihood of developing reflux disease.

Sliding hernia (abbreviated SC) of the food opening of the diaphragm common disease among patients. The main problem for doctors is to diagnose it. Detection of the disease early stages will help cure the patient without surgery, provided that he follows certain rules.

Symptoms

The anomaly itself may not have pronounced symptoms, as they may be similar to other diseases of the digestive system.

A hernia is usually diagnosed if full examination internal organs, sometimes discovered by chance . Among the clinical manifestations observed in patients:

pain near the stomach, possibly the chest, they increase after eating, as well as taking a lying position;
regular heartburn;
regurgitation of gastric contents;
bad breath;
vomiting (usually in the morning);
discomfort during swallowing;
increased blood pressure;
hard breath.

Important! The result of late detection of a hernia leads to the formation of ulcers of the alimentary canal.

How does KS manifest?

The hernia is divided:

to fixed;
not fixed.

The first case involves a protruding stomach, the latter does not change its position due to pressure surges or changes in the patient’s posture.

The figure shows penetration of the gastric diaphragm (GHD)

In the picture, the hernia no longer returns to its normal state

Locations not fixed hernia are changing, because of this reason it is sometimes called wandering. It is characterized by the fact that when a person changes his posture to a horizontal one, the stomach returns. This form of the disease also needs treatment.

The disease is expressed by increased pain during changes in body position or physical activity. It is possible that internal bleeding may occur, which comes out with vomit or stool. This happens more often when the esophagus is injured and ulcers have formed.

Causes of hernia formation

The disease is acquired as a result of other factors or can be congenital, the reasons for this are as follows.

Acquired	Congenital
Damage nerve trunk cervical plexus or inflammation relaxes the diaphragm muscles.	The disease can develop during intrauterine pregnancy, when digestive organ slowly descends to the peritoneal region.
An enlargement of the diaphragm can be caused by: ulcers, cholecystitis, gastritis.	An incomplete stage of formation of the muscles of the diaphragm, as a result of which its opening is expanded.
The following may be involved in the formation of the disease: pregnancy, constipation, smoking, stress, due to lifting heavy objects.	Late formation of the canals, after prolapse of the stomach, leads to the formation of a hernia sac.
Age-related changes.

More often, this pathology is treated without surgery; for this you need to change some habits, and then follow the recommendations of doctors.

The first thing that is eliminated is weight, which becomes a disease-provoking factor.
Incorrect posture and lack of tone in the diaphragm muscles lead to deformation.
If a hernia is suspected or diagnosed, it is extremely important to avoid overexertion due to lifting heavy objects.
Prolonged stay in an inclined position can provoke displacement of the stomach.
To identify a hernia, if symptoms arise, it is necessary to conduct an examination of the gastrointestinal tract, promptly treat gastritis, GERD (gastroesophageal reflux disease) if they are detected.
Physiotherapy, proper nutrition reduce the risk of disease progression.
The pain of heartburn is reduced if you place a hard pillow under your chest before going to bed, while at the same time reducing the size of your food portions.
Swimming has a positive effect on respiratory organs, which help strengthen the muscles of the diaphragm and prevent the development of hernial formations. Therefore, it is recommended to visit the pool 4 times a week, taking into account a 30-minute session.

When surgery is required according to surgeons

Doctors have come to the conclusion that surgical intervention for diaphragmatic hernia is indicated only in the most extreme cases when the results of other methods are powerless. The danger of surgical intervention is provided by postoperative complications:

seam divergence;
inflammation;
discomfort when swallowing
formation of relapses;
displacement of the compression mesh;
discomfort in the chest area;
bleeding;
infection;
lack of belching;
damage to nearby organs.

Of the patients, at least 5% return to operating table again.

The use of anesthesia also carries risks, among which are:

a sharp decrease in heart rate, drop in blood pressure;
damage to teeth or vocal cords due to the tubes used;
deterioration of airway patency;
allergies.

In 60-70% of cases, surgery is not prescribed. Surgeons refer patients to general practitioners for supportive care.

This video, from a popular program, discusses nutrition and treatment for hiatal hernia.

If surgery is vital for a patient, then, despite warnings, 95% of cases give a successful result.

In what cases is surgery indicated?

A hernia of the diaphragm is often eliminated without surgical intervention; it is indicated only in severe forms of esophagitis ( inflammatory lesion esophageal mucosa), which is not supplied drug treatment. Otherwise, neoplasms appear in the esophagus.

Period after surgery

After the procedure, which lasts 2 hours, the person remains for some time under the supervision of doctors. If there are no complications, the patient is discharged, sometimes within a day.

Parting words from doctors during recovery period the following:

Physical activity is contraindicated for a person.
It is important for the patient to comply dietary rules nutrition.

Operated people, after 4 hours of the operation, make light movements without getting out of bed - roll over, rise, bend their limbs. The second day involves taking liquid food, followed by strict diet at least 60 days. Then, the diet is allowed to be varied, but the gentle regime cannot be violated for six months. Compliance with the recommendations will help the patient return to health sooner usual life, without diets or medications.

Advantages and disadvantages of Nissen and Toupet surgery

Nissen and Toupet operations are considered popular methods of treating hernia. The basis is to create a cuff around lower section esophagus using the fundus of the stomach.

The advantage of the latter type of plastic surgery is considered to be a lower number of complications compared to the Nissen method, after which the following may occur:

dysphagia (impaired swallowing function);
small ventricle syndrome;
cascade stomach.

It is believed that the Nissen operation, the cuff of which wraps the stomach around the esophagus 360°, is suitable for patients with normal or increased peristalsis of the esophagus. People at sluggish or weak peristalsis, a Toupet fundoplication is indicated, surrounding the organ by 270 degrees.

Price surgical intervention For individual regions For example, some clinics are different Sverdlovsk region They offer to perform a fundoplication for 40 thousand rubles. Complications during operations often depend on the professionalism of the surgeon. For this reason, you need to choose a surgeon and a clinic after first studying the experience of performing such procedures.

A hiatal hernia, with careful and careful attention to regimen, nutrition, and exercise, does not require surgery. The restrictions that the hiatal hernia imposes on a person are aimed at improving well-being, getting rid of bad habits and give joy from simple and, sometimes, undervalued things and surroundings. A minimum of observation of the body’s peculiarities and care will return joy and everyday comfort.

Bottom line: the article examines the causes of the disease and gives recommendations to help treat it without surgery. The opinion of surgeons about the reasons for undergoing surgery is given. The methods used by surgeons are reviewed. We hope this information will be enough for you to avoid surgical intervention, or, in difficult circumstances, to choose the most gentle option.

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

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

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

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

General characteristics of the sliding hiatal hernia

A sliding hiatal hernia is predominantly asymptomatic, which complicates diagnosis. 75% of patients have no symptoms and no treatment for this reason for a long time is not carried out. Ignoring the problem leads to the fact that the hernia progresses, and more and more of the stomach penetrates through the diaphragm.

The main cause of the disease is muscle weakness.

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

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

Etiology of the disease

Causes of hiatal hernia:

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

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

On last stage When a hernia forms in the chest area, most of the stomach or the entire organ is located. In this case, it is necessary to treat the disease not only conservative methods, but also surgical intervention.

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

How does hiatal hernia manifest itself?

Basic clinical manifestations sliding hiatal hernia:

Dyspeptic phenomena. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient takes horizontal position after the stomach is full. Such manifestations can occur without apparent reason, for example, at night and in the morning.
Dysphagia or difficulty swallowing. Such a phenomenon with a hiatal hernia will be more psychological, because while swallowing food, the patient may feel discomfort and pain associated with inflammation of the esophagus, which creates a fear of recurrence discomfort. As a result, food intake begins to be accompanied by a lack of swallowing reflex. The patient switches to eating exclusively liquid and semi-liquid foods. This, in turn, leads to weight loss. In this regard, the patient is prescribed a therapeutic diet.
Frequent pathologies respiratory system . Bronchitis, aspiration pneumonia appear as a result of falling into Airways particles of poorly chewed food. It's threatening purulent inflammation lungs and chronic respiratory diseases, which only aggravate the situation serious condition sick.
Regulation. This phenomenon is associated with the backflow of stomach contents into the oral cavity. Long-term exposure to stomach acid leads to dental diseases. A patient with a hiatal hernia faces hypersensitivity enamel, papillitis, various stomatitis and gingivitis. Treatment local problem in the oral cavity does not lead to positive results, and until the main problem is eliminated, dental pathologies will only progress, and constant irritation of the mucous membrane may end precancerous conditions and even oncology.

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

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

Principles of treatment

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

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

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

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

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

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

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

Hiatal hernias can be congenital or acquired, among which sliding hernias are classified as a separate group. With this type of hernia upper section the stomach moves above the diaphragm, thus participating in the formation of the hernial sac. Sliding hernias are also classified into fixed and non-fixed. In addition, congenital and acquired short esophagus are distinguished separately.

If the development of sliding hernias is based on traction (occurs during contractions of the esophageal muscles), then such hernias are called traction. Accordingly, pulsion hernias are distinguished, which are caused by weakness of the intermediate tissue, for example, with obesity, pregnancy, as well as conditions and diseases that increase intra-abdominal pressure. Another group is sliding hernias, which develop when functional failure esophageal sphincter. There are hernias of adjacent areas, for example a diaphragmatic hernia in the fetus.

Clinical picture.

The clinical picture of the disease is due to developing reflux esophagitis. This condition is the reflux of gastric contents back into the esophagus. Because of high content hydrochloric acid, gastric contents have an irritating and damaging effect on the esophageal mucosa, leading to the development of ulcerative and erosive changes.

Patients complain of pain in the chest, in the epigastrium, in the hypochondrium of a burning or dull nature. Radiation of pain into the scapula is often observed, left shoulder. This clinical symptoms similar to the manifestations of angina pectoris, so these patients long time may be mistakenly observed by cardiologists for angina pectoris.

When bending the body, changing position to horizontal, as well as when physical activity pain intensifies. The pain is accompanied by regurgitation, belching, and heartburn. Subsequently, patients develop dysphagia - difficulty swallowing. Hidden bleeding may occur, manifested as bloody vomit the color of coffee grounds or scarlet, as well as dark-colored stools. The source of bleeding is ulcers and erosions of the esophagus. In this case, the only sign indicating hidden bleeding is anemia.

Diagnostics.

To confirm the diagnosis, X-ray and endoscopic method(fibrogastroduadenoscopy). When carrying out these methods, shortening of the esophagus, damage to the folds of the mucous membrane, and confluence of the esophagus into the stomach are revealed. high level, expansion of the esophagus.

Treatment.

If sliding hiatal hernias are not complicated, then conservative treatment is carried out. This treatment includes taking proton pump inhibitors (omeprozole), antacids (Almagel), prokinetics (domperidone, ranitidine).

Surgical treatment is used in the event of bleeding, as well as in the event that there is no effect from long-term conservative therapy. To eliminate this type of hernia, a surgical intervention called Nissen fundoplication is used. The essence this method is to create from the front and rear walls the fundus of the stomach; a circular (that is, encircling in a circle) cuff around the esophagus. This operation helps prevent gastroesophageal reflux and eliminate the traumatic effect of gastric contents on the esophageal mucosa. This operation is performed laparoscopically, that is, with minimal trauma. The prognosis for this disease is quite favorable.

Prevention includes following a diet and taking medications that normalize the acidity of gastric juice. The diet for diaphragmatic hernia has many common principles.