Axial hiatal hernia 2. What is an axial hiatal hernia and how is it treated? Types of hernia formations
Hiatal hernia (HHH, hiatal hernia) is a displacement of the stomach and other organs from the abdominal cavity into the chest cavity through an enlarged esophageal opening. The disease occurs quite often. It is found in 2–16% of persons suffering from gastrointestinal disorders and in 5–15% of patients undergoing X-ray examination for diseases of the digestive tract. In old age, the incidence of the disease reaches 50%. Mostly women over 50 years of age are affected. A sliding (axial) hiatal hernia is the most common type of this pathology.
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Causes
The causes and mechanisms of development of hiatal hernia are complex and depend on various aspects. This pathological condition develops with a combination of the following factors:
- increased intra-abdominal pressure;
- changes on the part of the diaphragm.
Some scientists consider another factor involved in the origin of hiatal hernia - dyskinesia (impaired motility) of the esophagus, as well as reflex and symptomatic esophagospasm (narrowing of its lumen).
Reflex esophagospasm is a common disease that occurs against the background of various lesions of the cervical and thoracic spine, esophagus, stomach, gallbladder, and duodenum.
The following conditions lead to increased pressure inside the abdominal cavity:
- obesity;
- binge eating;
- flatulence;
- persistent cough;
- constipation;
- ascites;
- large intra-abdominal tumors;
- pregnancy;
- lifting weights.
The occurrence of congenital hernias is most often caused by embryonic disorders and developmental anomalies of the gastrointestinal tract; their clinical manifestations are detected in childhood. Acquired hiatal hernias develop predominantly in adults, which is most often associated with involutional anatomical changes in the tissues that form the esophageal opening in the diaphragm.
The earlier appearance of regressive changes in the diaphragm is facilitated by insufficient functional load of this powerful muscle in people who lead a predominantly sedentary lifestyle. Pulmonary emphysema has a significant impact on the process of lowering the diaphragm; some authors point to the dependence of age-related involution of the diaphragm and the development of atherosclerosis.
There is a hereditary predisposition to this pathology, which is associated with the characteristics of connective tissue.
Constitutional weakness of connective tissue is important in the origin of hiatal hernia. This is confirmed by the frequent combination of the disease with flat feet, hernias of other localizations, and varicose veins of hemorrhoidal and saphenous veins. With age, the developing expansion of the esophageal opening and relaxation of the fascial fixation of the esophagus create an unfavorable background on the basis of which hiatal hernias form. Also, the difference in pressure in the thoracic and abdominal cavities plays a significant role in the development of hiatal hernia.
In some cases, severe abdominal tension itself can lead to the occurrence of hiatal hernia, as well as other abdominal hernias. This mechanism of hernia formation is observed more often in young patients.
Classification
The basis of all modern typologies is the classification of Akerlud and Sealy. The authors identified 3 main types of this pathology:
- 1. Sliding (axial, axial) hernia. It is observed in almost 90% of patients with hiatal hernia. With this type, the cardia is located above the esophageal opening of the diaphragm, therefore the relationship between the esophagus and the stomach changes and the closing function of the cardiac sphincter is sharply disrupted.
- 2. Paraesophageal hernia. Occurs in approximately 5% of patients. It is characterized by the fact that the cardia does not change its position, and the fundus and greater curvature of the stomach emerge through the enlarged opening.
- 3. Short esophagus. It is rare as an independent disease and represents a developmental anomaly. It is usually observed in combination with a sliding hernia and is a consequence of various changes in the wall of the esophagus.
On the left is the normal location of the stomach and esophagus. In the center and on the right - options for sliding hernias
Short esophagus
There is also a classification depending on the volume of penetration of the stomach into the chest cavity. This division is based on the radiological manifestations of the disease.
There are 3 degrees of hiatal hernia:
- 1. 1st - the abdominal section of the esophagus is located in the chest cavity, and the cardia is at the level of the diaphragm. The stomach is elevated and directly adjacent to the diaphragm.
- 2. 2nd - the abdominal section of the esophagus is located in the chest cavity, and directly in the area of the esophageal opening of the diaphragm is already part of the stomach.
- 3. 3rd - the abdominal section of the esophagus, cardia and part of the stomach (fundus and body, and in severe cases even the antrum) are located above the diaphragm.
Symptoms
The clinical symptoms of sliding (axial) hiatal hernias are caused by insufficiency of the cardiac sphincter, resulting in gastroesophageal reflux (GER) and esophagitis.
The main symptoms are pain, heartburn, regurgitation, belching, dysphagia, and anemia.
The most common and painful symptom is pain. It is usually localized in the lower third of the sternum, in the area of the xiphoid process and radiates to the back, left shoulder, and left arm. The frequency, intensity and duration of pain in the same patient are different. More often it is described as burning.
In some patients, it is difficult to distinguish it from pain due to angina or myocardial infarction, and only an electrocardiogram allows one to differentiate these diseases. Although in some cases, a hiatal hernia can cause spasm of the coronary vessels with the subsequent development of morphological changes in the heart muscle. Bergman described epiphrenal syndrome, characterized by chest pain, disturbance of heart rhythm, caused by compression of the trunks of the vagus nerves in the esophageal opening of the diaphragm by the stomach extending into the chest cavity.
Typically, pain appears after lifting weights, when bending the body forward (the “laces” symptom, as defined by French authors), as well as under the influence of other factors that contribute to an increase in intra-abdominal pressure. In many patients, the pain intensifies after eating, in a horizontal position, or at night.
The consequence of insufficiency of the closing function of the cardiac sphincter is the reflux of acidic gastric contents into the esophagus and the occurrence of heartburn. The latter is persistent and painful in nature and, like pain, most often occurs in a horizontal position of the patient. In some patients it predominates at night. Heartburn decreases after eating, eating dairy products, butter and increases after eating spicy foods. It should be remembered that not all people have heartburn when even very acidic gastric contents are thrown into the esophagus.
In some patients, swallowed food returns to the oral cavity without gagging.
If the gastric contents reach the pharynx and oral cavity, then they speak of regurgitation. The latter is observed in a third of patients. More often, the backflow of sour or bitter liquid occurs suddenly when the patient is in a horizontal position or when the body is tilted and is not accompanied by nausea. Such suddenness can cause aspiration, which leads to a coughing fit and/or an unpleasant feeling of “soreness” in the throat.
A common symptom of hiatal hernia is belching. It may be the only symptom of the disease; in severe cases, patients cannot appear in public places because of this. Regurgitation occurs either with sour contents or with air. Belching often brings relief, reducing the feeling of fullness in the epigastric region, although in some patients this is followed by burning pain in the chest. This symptom in most cases occurs immediately after eating or after 20-30 minutes, which can be explained by an increase in intraluminal pressure due to gastric overfilling. Some patients experience belching when bending their torso forward.
Up to a third of patients with different types of hiatal hernia complain of dysphagia. This symptom in the initial stages of the disease usually occurs as a result of spasm of the lower segment of the esophagus, and in later stages - due to the formation of peptic strictures of the esophagus. Patients localize the sensation of food retention at the level of the xiphoid process. With axial hernias, dysphagia usually does not reach significant severity, appears periodically and often worsens when eating in a hurry and in stressful situations.
Nausea, vomiting, shortness of breath, hiccups, burning tongue are very rare symptoms of a sliding hernia.
A special symptom is episodic aphagia. It occurs suddenly and is caused by eating and drinking liquids. During an attack, the patient is completely unable to swallow. The attack usually lasts several hours. There is pain and a significant amount of mucus is formed. Aphagia stops suddenly or decreases gradually.
Diagnostics
The main method of diagnosis, along with clinical data, are x-ray examination methods.
In case of large fixed hernias, even with a plain radiography of the abdominal organs, clearing and a horizontal fluid level can be observed against the background of the shadow of the heart. A gas bubble with a horizontal liquid level is especially clearly visible in the lateral projection.
A study with a contrast agent makes it possible to definitively detect the part of the stomach with typical folds of the mucous membrane located above the diaphragm. In this case, there is also a gaping of the cardial opening with the throwing of the contrast agent into the esophagus. The movement of the stomach above the level of the diaphragm is especially clearly noticeable.
Insufficiency of the cardiac sphincter is determined in the Trendelenburg position with dosed compression of the abdomen. This technique is mandatory when diagnosing small, unfixed hiatal hernias.
X-ray contrast examination of the gastrointestinal tract. The arrow indicates a sliding hernia (the cardiac part of the stomach is located in the chest)
In rare cases, when performing a chest CT scan for another reason, a hiatal hernia may be accidentally detected.
For complaints indicating reflux esophagitis, FEGDS is performed. The procedure is carried out to assess the condition of the esophageal mucosa and exclude a malignant disease.
Treatment
For small asymptomatic hernias, therapy is not indicated. In the case of hernias that cause minor patient complaints, conservative treatment is recommended aimed at reducing intra-abdominal pressure (eliminating constipation, prolonged cough and combating obesity). Drugs are prescribed to reduce GER, suppress gastric acidity, eliminate esophagitis and esophageal motility disorders.
Contraindicated for hiatal hernia:
- smoking;
- heavy physical activity;
- wearing bandages and tight belts that increase intra-abdominal pressure.
The patient must sleep with the head of the bed elevated. It is recommended to adhere to a certain diet, the main features of which are the following:
- you need to eat in small portions and often (about 5-6 times a day);
- take your last meal 3-4 hours before bedtime;
- food should be mechanically, thermally and chemically gentle.
Drug therapy consists of taking proton pump inhibitors (Omeprazole, etc.), H2-histamine receptor blockers (Ranitidine, Famotidine, etc.) or antacids (Almagel, etc.).
Combinations of these drugs are widely used, taking into account the severity of reflux esophagitis and concomitant diseases. If motility of the esophagus and stomach is impaired, antispasmodics (papaverine hydrochloride, No-spa), as well as Metoclopramide, are used. Additionally, physiotherapeutic procedures are used (Shcherbakov collar, electrophoresis with novocaine).
Surgical treatment is indicated for:
- the presence of large hernias that cannot be treated conservatively;
- peptic painful esophagitis with symptoms of angina pectoris;
- severe dysphagia;
- bleeding;
- peptic stricture of the esophagus;
- severe regurgitation;
- metaplasia;
- pulmonary complications.
Today, the most common operations are Nissen, Hill and Beley.
Complications of hiatal hernia
Complications of hiatal hernias are the following conditions:
1.Reflux esophagitis:
- erosion and ulcer of the esophagus;
- peptic stricture of the esophagus;
- esophageal bleeding (acute or chronic);
- anemia - as a consequence of chronic esophageal bleeding;
- esophageal carcinoma;
- complications from the respiratory system - aphonia (as a result of a chemical “burn” of the vocal cords), cough, bronchitis, asthmatic bronchitis, pneumonia, hemoptysis, shortness of breath, diffuse pulmonary fibrosis.
2. Prolapse of the gastric mucosa into the esophagus.
3. Invagination of the esophagus into the stomach.
4. Strangulated hernia.
5. Perforation of the esophagus.
Sliding hernias are never strangulated, while in paraesophageal hernias this complication is common.
A hiatal hernia appears in the area of the diaphragmatic opening of the esophagus. This is the most common pathology among all diaphragmatic hernias. It is most often diagnosed in women and the risk of its occurrence increases with age. Another name for it.
What is a hiatal hernia? This is a chronic disease of a recurrent nature, in which, through an enlarged diaphragmatic opening, protrusion into the chest cavity of the lower (abdominal) portion of the esophagus, stomach, and less commonly other organs of the abdominal cavity occurs.
Classification
There are several types of hiatal hernia:
- Sliding or axial hernia. With this pathology, the abdominal section of the esophagus and the cardiac part of the stomach move without problems through the diaphragmatic opening of the esophagus into the chest cavity and back. Normally, these organs should be localized in the abdominal cavity.
- A paraesophageal hernia is a rare type of hiatal hernia, in which the stomach seems to turn over and its lower section, sometimes along with other organs, passes through the opening of the diaphragm, while the correct section of the stomach is in the anatomical position.
- Combined hernia. With this pathology, symptoms of sliding and paraesophageal hernia are observed.
Types of hiatal hernia
Depending on the severity of the pathology, axial hernia can be grade 1 or 2.
What is a grade 1 sliding hiatal hernia? With this course of the disease, only the esophagus protrudes into the chest cavity, and the stomach is localized above its anatomical position closer to the diaphragm. If a sliding hernia of the 1st degree is found in patients of an older age group, then it is considered a borderline condition that develops as a result of age-related changes.
With the development of a grade 2 hiatal hernia, the esophagus and stomach simultaneously protrude into the chest cavity.
Causes
The reasons for the formation of a hiatal hernia are varied:
- age-related changes;
- malignant neoplasms;
- injuries;
- surgical interventions;
- gastrointestinal motility disorder;
- chronic diseases of the liver, pancreas and stomach;
- genetic predisposition;
- congenital pathologies, such as underdevelopment of the diaphragm, the appearance of hernias in the prenatal period.
Any factors that increase intra-abdominal pressure also provoke the appearance of a hernia. For example, protrusion of the esophagus is possible during physical activity or coughing.
Important! Wearing tight clothing can provoke the development of the disease.
The period of bearing a child and excess body weight can also cause expansion of the diaphragmatic opening of the esophagus. A hernia often appears in patients suffering from flat feet and Marfan disease.
Clinical picture
The symptoms of a hiatal hernia can vary greatly depending on the extent of the disease.
At the early stage of development of the pathology, the clinical manifestations are mild and most often it is diagnosed accidentally during a medical examination or x-ray.
Depending on the type of hernia and its degree, various signs may be observed.
With a sliding hernia of the 1st degree, the following is noted:
- heartburn after eating, especially if the diet is violated;
- epigastric pain with prolonged stay in a bent position.
One of the signs of a hiatal hernia is the appearance of pain in the epigastric region
Warning! One of the characteristic initial signs of pathology is the appearance of pain that radiates to the back. They intensify with physical activity and when taking a lying position.
When the disease progresses to stage 2, the following is observed:
- constant heartburn that appears regardless of food;
- belching, nausea, dysphagia, hiccups, abdominal pain;
- anemia;
- burning chest pain, similar to attacks of “angina pectoris”;
- painful sensations intensify when bending over and when taking a horizontal position;
- development of bleeding.
Warning! A 2nd degree hernia is dangerous because if left untreated it can cause a heart attack or stroke.
With a paraesophageal hernia, signs caused by gastric prolapse are observed:
- painful sensations after eating, especially if you bend your torso forward;
- burning sensation in the esophagus, belching, nausea;
- disorders of the heart and lungs are observed in cases of their compression by large formations: dyspnea, tachycardia, blue discoloration of the nasolabial triangle, especially after eating.
Warning! A hiatal hernia of the esophagus may be accompanied by bronchoesophageal syndrome, in which respiratory disorders develop: the patient suddenly develops inflammation of the lungs, bronchi and other respiratory tract diseases. The appearance of these symptoms requires emergency hospitalization, as they indicate a severe course of the hiatal hernia.
Diagnostics
Taking a history and examining the patient helps in making a diagnosis. Suspecting the development of a hiatal hernia, the doctor gives a referral for examination. He can assign:
- X-ray of the esophagus, thoracic and abdominal cavity, which is carried out in a lying position; to identify a small hernia, the study is carried out using
X-ray contrast agents (barium salts); - esophageal manometry, which allows assessing the functioning of the organ;
- examination of the gastrointestinal tract using an esophagoscope;
- tissue biopsy, which allows to exclude oncology;
- laboratory tests (stool test for occult blood, complete blood count to detect anemia);
- If chest pain develops, an electrocardiogram is prescribed to rule out angina.
Therapy
The treatment regimen is selected by the doctor depending on the clinical picture. If an asymptomatic course of pathology is observed, then a wait-and-see approach is indicated, that is, the patient should regularly visit the doctor at specific intervals to assess the dynamics of the disease.
If unpleasant symptoms appear, therapy is prescribed, which can be:
- conservative;
- surgical
With the development of a sliding hernia of 1st and 2nd degrees, they usually resort to conservative treatment, which includes diet therapy and medication.
Products that irritate the mucous membranes of the gastrointestinal tract should be excluded from the patient’s diet, namely:
- smoked meats;
- pickles;
- marinades;
- spicy and fermented dishes.
You need to eat little and often. Dishes should be warm and crushed to a homogeneous consistency.
Medicines prescribed:
It must be remembered that self-medication with these drugs is not acceptable, since each of them has its own contraindications and undesirable effects, and only a doctor can choose the right medication and its dosage.
Physiotherapy exercises are also indicated for hiatal hernia.
If conservative therapy is ineffective, surgery is performed.
With the development of paraesophageal and combined hernia, surgical treatment is prescribed more often, since with such development of pathology there is a high risk of complications. During the operation, the diaphragmatic opening is sutured and the stomach is fixed to the abdominal wall.
Consequences and prevention
Complications
Hiatal hernia can provoke pathologies such as:
- gastroesophageal reflux disease;
- peptic ulcer and narrowing of the esophagus;
- internal bleeding;
- strangulated hernia;
- protrusion of the gastric mucosa into the esophagus;
- violation of the integrity of the walls of the esophagus.
Patients with a hiatal hernia should be registered with a gastroenterologist. They need to undergo medical examination at least once every six months.
Axial hiatal hernia is a condition when the cardiac part of the ventricle is located above the esophageal opening of the diaphragm, as a result of which the relationship between the esophagus and the stomach changes, which leads to a sharp disruption of its closing function. This is the most common type of hernia. In clinical practice, you can find another definition of the disease - hiatal hernia (hereinafter referred to as hiatal hernia).
Sliding hiatal hernias got their name due to the fact that the posterior wall of the upper part of the cardiac part of the stomach, which is not covered by the peritoneum, participates in the formation of the hernial sac.
Initially, the disease is asymptomatic and does not bother the patient at all. After some time, a person may notice symptoms similar to diseases of the gastrointestinal tract and heart. If not treated promptly, symptoms can be so severe that they limit normal life activities.
When there is a suspicion of hiatal hernia, it is necessary to contact a surgeon; it is this doctor who deals with the treatment of this pathology. The choice of treatment method for hiatal hernia and subsequently developed reflux esophagitis is determined by the size of the hernia, the severity of the clinical picture and the degree of damage to the mucous membrane of the esophagus. Therefore, it is important to consult a specialist as early as possible and detect the disease at an early stage of development. In this case, simple drug therapy and a special diet may be sufficient.
In medicine, there are three types of hernia:
1. Sliding (A). This type of pathology involves the normal position of the stomach and esophagus. But they can easily move into the esophageal opening. Sliding hernias can be fixed or non-fixed. In the latter case, they are adjusted independently when the patient is in an upright position. Large hernias (cardiofundal and giant), as a rule, are fixed due to the suction effect of the chest cavity and the formation of adhesions in the hernial sac. The scientific name is axial hernia.
2. Paraesophageal (B). It is characterized by the fact that the cardia does not change its position, and the fundus and greater curvature of the stomach emerge through the enlarged opening. With paraesophageal hernias, the cardia remains fixed under the diaphragm, and one or another abdominal organ is displaced into the mediastinum near the esophagus, which is why the hernia has this name. Thus, it seems as if the stomach has turned over.
3. Combined (C). Consists of all the signs of the two types of hernia described above.
Consequently, three degrees of hiatal hernia are determined – I, II and III.
Reference! The grade of the hernia is based on the level of the protrusion into the chest, as well as the size of the mass.
1st degree– in the chest cavity (above the diaphragm) there is the abdominal section of the esophagus, and the cardia is at the level of the diaphragm, the stomach is elevated and directly adjacent to the diaphragm.
II degree– the abdominal section of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of the esophageal opening of the diaphragm.
III degree- above the diaphragm are the abdominal esophagus, cardia and part of the stomach (fundus and body, and in severe cases, the antrum).
The main causes of pathology
The root causes of pathological changes are congenital and acquired. However, all types of hiatal hernia occur under the influence of similar factors.
| Congenital | Purchased |
|---|---|
| During the formation of the chest, the diaphragm was underdeveloped | Injuries and injuries to the chest |
| Hernia pockets formed during embryo development | Insufficient functional load on the diaphragm in people who are predominantly sedentary life |
| Elderly age. As a consequence of age-related changes |
|
| Repeated longitudinal spastic shortening of the esophagus due to esophageal dyskinesia, and also reflex and symptomatic esophagospasm |
|
| Atrophy of the left lobe of the liver, used disappearance of adipose tissue under the diaphragm, which contributes to disruption of the relationships between organs in the area of the esophageal opening of the diaphragm and the formation of its hernia |
|
| Constitutional weakness connective tissue, which is confirmed by their frequent combination with hernias other localizations, flat feet, varicose veins of the subcutaneous and hemorrhoidal veins |
|
| The difference in pressure between the chest and abdominal cavity. The following causes an increase in intra-abdominal pressure: current conditions: obesity, cough, overeating, constipation, flatulence, as- cyt, large intra-abdominal tumors, pregnancy, heavy lifting |
Attention! Sometimes a patient can combine two factors at the same time - acquired and congenital. For example, a heavy smoker suffers from a cough and the abdominal organs protrude through the esophageal opening.
Symptoms of the disease
The initial stages of the disease do not bother the patient in any way and occur in a latent form. As a result, diagnosis becomes difficult, which leads to untimely treatment and possible complications.
However, if you are wary of any discomfort, you can diagnose pathological changes in a timely manner.
The most common symptoms of an axial hernia.
| Symptom | Main features |
|---|---|
| Pain | Burning at the level of the xiphoid process and the lower third of the sternum, worsening after eating and in a horizontal position, accompanied by sharing with other typical signs of gastroesophageal reflux. In some patients, the pain simulates angina pectoris. |
| Heartburn | Usually appears after eating or when a change in body position contributes to the occurrence of reflux. May occur at night. |
| Belching air | Happens or air or acidic contents. Often brings relief by reducing a feeling of fullness in the epigastric region, but in some patients This is followed by burning pain behind the sternum. In most cases it occurs immediately after eating or after 20-30 minutes. |
| Regurgitation | Reflux of sour or bitter liquid occurs suddenly when the patient is in a horizontal position or when the body is tilted and is not accompanied by nausea. |
| Dysphagia | Patients localize the sensation of food retention at the level of the xiphoid sprout. Appears periodically, often intensifies with excitement and hasty eating. |
Nausea, vomiting, shortness of breath, hiccups, burning sensationtongue are relatively rare symptoms of an axial hernia.
How is diagnosis done?
When a patient notices clearly manifesting symptoms, this may be evidence of complications:
- There is slight bleeding resulting from damage to the esophagus or part of the stomach.
- Severe pain or shock occurs when the part of the stomach that is located just above the diaphragm is pinched.
In order to prevent gastric perforation, immediate surgical intervention is necessary. An esophagoscope is used to diagnose pathological changes. The specialist begins an examination of the esophagus as a whole and its individual muscles.
To exclude the possibility of developing cancer, the patient undergoes a biopsy, that is, a small amount of tissue is taken for examination at the cellular level. If the hernia is large, it can be easily detected using x-rays. To diagnose hernial protrusion, barium X-ray examination is used. Thanks to laboratory tests, the presence of internal bleeding (if organs are damaged), gastro-food reflux, the presence of blood in the stool, and insufficient amount of iron in the body are established.
Features of treatment
Axial hiatal hernia can be treated with special medications and following a certain diet.
Two types of pathology treatment
| View | Description |
|---|---|
| Drug therapy | It is necessary to take medications that correct the motor process of the stomach and normalize secretory activity. In general, inhibitors, antacids, and prokinetics are used for such therapy. Drug treatment is used only in the early stages without complications. Thanks to the medications, the patient’s vitality increases and he feels relief. If treatment is applied in a timely manner, the likelihood of complications is significantly reduced |
| Surgical treatment | This method is used extremely rarely, only when drug therapy is ineffective or complications arise. |
The course of treatment for hiatal hernia includes:
- Medicines to strengthen the lower esophageal sphincter.
- Doctor's recommendations for eliminating discomfort in the abdomen and chest during a certain position.
- Avoiding activities and physical activity that lead to high pressure in the abdominal cavity.
- Rejection of bad habits. In particular, from smoking, as a result of which a large amount of stomach acid is produced under the influence of nicotine.
- Taking antiemetic drugs to eliminate symptoms.
- If there is a cough, then remedies against it.
- The use of drugs that help soften the stool.
- If you have problems with excess weight, then you immediately need to lose unnecessary pounds.
Axial hernia, regardless of the degree and severity, is mainly eliminated by conservative treatment methods.
| Treatment with diet | Drug treatment |
|---|---|
| The patient must switch to fractional meals. That is, food intake should occur in small portions, but much more often. In this case, all food should be crushed to a mushy state and consumed only warm. Some foods will need to be excluded from your usual diet, as they can be irritating to the mucous membrane of the digestive tract. These include all pickles and marinades, spicy foods, smoked meats | The use of antacids is indicated, which suppress the activity of gastric juice (Phosphalugel). Take enveloping medications (Vicalin). To eliminate painful sensations, you can use painkillers (Novocaine). Use of antispasmodics (No-spa) |
Attention! If an axial hernia of the second degree does not respond to conservative treatment and no positive dynamics are observed, then the patient requires surgical treatment.
If we talk about paraesophageal and combined types of hernia, treatment with surgery is prescribed much more often. This is explained by the fact that the risk of complications such as bleeding and organ strangulation is very high. As a result, the digestive opening is partially sutured, which prevents the digestive organs from slipping, and the body and fundus of the stomach are fixed.
How does traditional medicine help?
It is extremely difficult to cure pathological changes using non-traditional treatment methods. On the contrary, using folk recipes you can quickly and effectively eliminate unpleasant symptoms.
Recipe No. 1. To eliminate common symptoms
To prepare the remedy you will need gooseberry and mint leaves, cumin, and dry chamomile. So, all the ingredients are placed in a blender and crushed. Then pour boiling water and infuse for ten minutes. It is necessary to take the herbal decoction throughout the day in small quantities. The duration of treatment is determined by the disappearance of uncomfortable symptoms.
Recipe No. 2. Anti-burning
With hiatal hernia, the patient may experience a frequent burning sensation; to eliminate it, you can use chamomile tea. It is recommended to take every time after meals to relieve the condition.
Possible complications
To the extent that axial hiatal hernia can develop asymptomatically for a long time, the likelihood of untimely diagnosis and treatment increases, resulting in complications:
- Bleeding may begin in the esophagus.
- The hernia is strangulated.
- Esophageal perforation is a common occurrence.
- A peptic ulcer of the esophagus develops.
- Cicatricial narrowing of the esophagus occurs.
But, complications are possible even after surgery during the rehabilitation period:
- Abnormal dilatation of the esophagus may occur.
- Recurrences of axial hernia occur.
- The stomach area becomes pathologically enlarged.
Carefully! If an axial hiatal hernia is present, a lung problem in the form of aspiration pneumonia may occur. To eliminate this consequence, antibiotics are required, which are introduced into the body without affecting the digestive tract. It is very important to diagnose the complication in time and begin immediate treatment.
Video - Hiatal hernia
When a diagnosis of axial hiatal hernia is made, the patient is advised to make changes to his usual lifestyle.
- First of all, physical activity is reduced to a minimum.
- The food goes on a special diet.
- Regulate sleep and observe rest times.
- If the disease causes discomfort during sleep, it is recommended to sleep with a high or raised headboard.
- Lose extra pounds.
- After eating food, try not to lie down or bend over.
- Avoid fatty foods.
- The last meal should be at least two hours before bedtime.
- Avoid sweets, white bread and legumes.
- Avoid drinking coffee and alcoholic beverages.
- Review your wardrobe and stop wearing tight clothes.
To prevent pathological changes, it is necessary to strengthen the abdominal muscles, prevent frequent constipation, avoid heavy physical activity, and attend exercise therapy classes.
Diagnostic methods and treatment methods are selected exclusively by the attending physician. Otherwise, the patient may experience complications that will worsen the health condition. Therefore, self-diagnosis and self-medication are excluded.
Hiatal hernia is a pathology that is characterized by protrusion of abdominal organs through the esophageal opening of the diaphragm. As a rule, displacement of the lower part of the esophagus, stomach, and slightly less often other organs occurs.
The pathology is accompanied by the fact that the listed organs are displaced into the chest instead of the abdomen. Another name for this disease is hiatal hernia (abbr.
What is a hiatal hernia? This is a protrusion of the abdominal organs (lower esophagus, stomach, less often other organs) through the natural opening of the diaphragm (esophageal).
That is, the organs included in the protrusion are not in the stomach, but in the chest. Another name for this pathology is hiatal hernia or, for short, hiatal hernia.
In medical practice, axial esophageal hernia is divided into degrees in accordance with the size of the prolapse and the symptoms of the disease.
Not every patient observes manifestations of the pathological process, especially in the initial stages of progression.
Not every patient notices the changes that appear as a result of the development of an axial hernia. In the early stages there are practically no symptoms.
Due to the absence of pronounced symptoms of hiatal hernia, treatment is almost always delayed. The development of the disease necessitates observation by a doctor and professional help.
The use of diets and pills in this case will not help the patient to recover, except perhaps to prevent complications in the form of gastroesophageal reflux disease from developing.
Diet means proper nutrition - in small portions, but often. The patient is prohibited from eating chocolate, flour, consuming animal fats, drinking coffee or soda. The patient should not take a horizontal position for at least 3 hours after eating.
To obtain the greatest effectiveness from non-surgical treatment, the patient must adhere to a healthy lifestyle, eliminating his bad habits. It is necessary to monitor the level of intra-abdominal pressure - it should not increase.
When the organs located below the diaphragm protrude through its natural esophageal opening, this leads to the development of a rather serious pathology of this section - an axial hernia.
This disease has long occupied a very important place among the ailments of the gastrointestinal tract, since in the absence of timely and adequate treatment it can provoke the development of serious complications.
Axial hiatal hernia (HH) is one of the most common types of deformity localized in the digestive organs.
Among all pathologies of the gastrointestinal tract, it ranks 3rd. If it is not detected at the earliest stage of development, then the treatment measures taken may not give the expected result.
A hernia is the exit of one organ from its cavity into the adjacent one through an opening without violating the integrity of the membrane. There are several types of hernias of the digestive system, but the axial one occurs in 90% of cases of disease, that is, in every twentieth.
Axial hiatal hernia
This type of hernia can be congenital or acquired. This disease is associated with pathology of the diaphragmatic opening. With age, the muscles of the diaphragm lose elasticity, so diseases associated with its work most often have an age-related nature.
Diagnosis of a hernia in athletes does not always entail leaving sports. Some types of physical activity will not only not harm the patient, but will also help improve your health. Naturally, we are not talking about professional sports.
The main cause of an axial hernia is large loads on the abdominal muscles if there is a congenital predisposition to weakness of the abdominal wall. Strength sports that require heavy lifting should be abandoned immediately.
You can go swimming and do sports exercises where the main load falls on the biceps and triceps. Not fast cycling and walking also does not cause complications of the disease. The main thing is to do everything in moderation.
Read more about the types and treatment of hiatal hernias here.
Axial hernia in newborns is extremely rare and is considered a pathology of intrauterine development of the fetus. The so-called thoracic gastric defect is characterized by a congenital form of a shortened esophagus.
In this case, the part of the stomach that is located above the diaphragm is not framed by the abdominal cavity.
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The first signs of the disease are manifested by frequent regurgitation of the baby; after six months, when complementary foods are introduced, vomiting may appear. Children with axial hernia suffer from underweight, growth retardation and malnutrition.
When diagnosing a hiatal hernia in newborns, doctors recommend surgical treatment in order to further avoid the progression of the disease and the development of concomitant diseases.
Proper nutrition is one of the most important factors in treating a hernia. Increased secretion of gastric juice and its reflux into the esophagus leads to irritation of the mucous membrane.
Therefore, it is necessary to reduce the acidity of gastric juice as much as possible by excluding the following foods: confectionery, spices, smoked foods, sweet desserts, spicy dishes and seasonings, fried foods.
Special breathing exercises will improve the patient’s general condition and help strengthen muscles. Breathing exercises should be done daily, two or three hours after eating.
While on your knees, bend left and right. While bending over, inhale; in the starting position, exhale. Then repeat the same exercise while standing. Do each exercise ten times. Lie on your right side, your legs should be 15 centimeters below your head. When you inhale, stick your stomach out as much as possible, and when you exhale, relax it. With each subsequent time, the breath becomes deeper. Do gymnastics for 10 minutes four times a day. After seven days of such training, as you exhale, you need to draw in your stomach. Lie on your back and twist from side to side. In this case, breathing should be measured.
By performing such exercises, improvements are observed after three months.
The symptoms of this pathology directly depend on its type and stage. It should be noted that initially the disease occurs with mild symptoms.
This makes diagnosis much more difficult, which leads to certain complications and longer treatment. Therefore, doctors recommend that you be very attentive to your health and, if certain signs occur, consult a specialist in a timely manner.
This will allow you to recognize the disease in the initial stages and begin effective therapy.
Sometimes the presence of the disease may be indicated by regularly occurring hiccups - this symptom is observed in approximately 3% of patients.
With significant sizes of such formations, cardiorespiratory symptoms are often observed. Caused by compression of the lungs and heart. Such signs are rapid heartbeat, cyanosis (blue discoloration of the area around the mouth), shortness of breath and some others..
This pathology refers to internal abdominal hernias, and therefore, when it appears, there are no external manifestations. The symptom complex of diaphragmatic hernia is associated primarily with disruption of the functioning of organs that change their location.
For example, normally the work of the lower esophageal sphincter is ensured by the diaphragm, providing a supporting effect on it. When the cardiac part of the esophagus is displaced upward, insufficiency of this section is observed, which is manifested by gastroesophageal reflux (stomach contents retrogradely enter the esophagus) and is accompanied by irritation of the esophageal mucosa, which is not resistant to the effects of acidic gastric juice.
In severe cases, inflammation may be accompanied by hidden bleeding, which over time may only manifest as anemia.
The main symptom of a diaphragmatic hernia is constant heartburn, the intensity of which increases when changing body position (lying down, while bending the body), as well as after eating and during physical activity.
The second sign of a hiatal hernia, which is observed in approximately half of patients, is chest pain. It should be differentiated from manifestations of cardiovascular diseases.
In the presence of a hiatal hernia, the pain behind the sternum intensifies when bending over or during physical activity. However, when examining a patient, it is worth remembering that a hernia of the diaphragm can be combined with heart disease.
The above symptoms are often accompanied by belching of air or sour, sometimes the patient feels a lump in the throat or pain when swallowing, and there is a sudden increase in blood pressure.
With an axial hernia, characteristic symptoms are often observed.
The video shows an endoscopic analysis of a hiatal hernia. You will become familiar with the structure of this body.
There are two types of sliding hiatal hernia: non-fixed and fixed. An unfixed hernia is a less complex type of pathology, but also requires treatment.
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As for fixed, it is difficult to diagnose, because in the first stages it is almost asymptomatic. As a rule, the patient learns about the disease by chance during an X-ray or medical examination.
Axial hernia of the second degree is manifested by pain in the epigastric region, heartburn, belching, hiccups, and anemia.
In some cases, patients confuse esophageal pain with pancreatic or heart pain. The doctor’s task in this case when diagnosing is to exclude pancreatitis, heart attack, angina pectoris, so you should know the main characteristics of pain symptoms in the disease:
- Moderate intensity of pain, intensifying with physical activity.
- The pain syndrome appears when the patient lies down, stands for a long time, when coughing, flatulence, after eating.
- The pain goes away completely after belching or vomiting.
A hiatal hernia is dangerous because respiratory tract diseases and various inflammations of the lower parts of the esophagus can develop. Prolonged hemorrhages lead to anemia, after which the patient increases the risk of developing esophageal cancer.
In most cases, after the disease develops, people experience reflux esophagitis. If, after the first signs, the disease is not treated for 7-10 years, then in patients, according to gastroenterological studies, the risk of developing esophageal cancer increases by 280%.
The pathology refers to internal hernias, so it does not manifest itself externally. Symptoms are associated with a violation of the position and functioning of internal organs. In addition, it depends on the type and degree of development of the disease.
Therapy of the disease
Symptoms of an axial hernia depend on its stage and the presence of concomitant pathologies. This disease is life-threatening and health-threatening, so it is important to make a timely diagnosis and begin proper treatment.
When the first signs of pathology appear, you should consult a gastroenterologist. With an axial hernia of 1st degree, no symptoms are observed.
The disease is detected during an X-ray examination. In the early stages of development of the pathology, minor pain may be noted.
The intensity of pain increases with physical activity and lying down.
The stomach is one of the key organs, the health of which directly affects the comfort and full functioning of a person. The appearance of a sliding hernia can have a significant negative impact on this organ.
This problem cannot be ignored, so it is important to familiarize yourself with the symptoms of the pathology and treatment methods.
Paraesophageal. We are talking about displacement of only part of the stomach without the participation of other organs in the process.
Sliding hernia, also known as axial hernia. In this case, its cardiac part also moves into the chest cavity.
Mixed. We are talking about the signs of the first two types, which appear simultaneously.
Congenital. This diagnosis is made when a hernia is detected, the formation of which occurs against the background of a small esophagus located in the shape of a “thoracic ventricle”. This situation is anomalous.
1. The stomach is located under the diaphragm, the cardia is at the level with it, and the abdominal segment of the esophagus is above the level of the diaphragm.
2. A hiatal hernia of the 2nd degree is distinguished by the fact that the esophagus is compressed evenly, and the cardinal part of the stomach protrudes into the mediastinum.
3. There is a pronounced contraction of the esophagus, and the entire stomach or its component protrudes into the mediastinum.
The key symptoms can be defined as pain that appears with varying frequency and intensity. At the same time, they can be both dull and burning.
Sometimes painful sensations radiate to the heart area, as a result of which patients begin to suspect heart failure. In some cases, a hiatal hernia can cause pain in the interscapular area.
If the disease is caused by a congenital problem such as an insufficiently wide esophagus, then the symptoms may resemble those of an axial hernia. We are talking about heartburn that appears after eating, pain in the chest, worsening in a horizontal position, and pain in other parts of the body.
Difficulty in swallowing food;
Heartburn after exercise or eating;
Pain in the chest area;
Signs of a hiatal hernia may take the form of belching air or stomach contents.
These symptoms are sometimes misjudged by patients. As reviews show, people think that these are signs of other diseases and self-medicate.
Among diseases of the digestive system, not the least axial hiatal hernia, which According to medical observations, it occurs in 5% of the adult population, has severe symptoms and requires immediate medical attention. In the gastroenterological practice of doctors, such a disease can often be found under the term “axial vital hernia”, “HH” or the simplified name “esophageal hernia”. The disease has a chronic relapsing course, characterized by protrusion of the lower esophagus and displacement of part of the stomach into the chest cavity. What is a hiatal hernia, what are its causes, symptoms, how dangerous is the disease and what treatment methods does modern gastroenterology offer?
Description of the disease
An axial hiatal hernia occurs when the muscles of the diaphragm around the hiatus hiatus weaken. This pathological condition leads to the fact that part of the stomach, after eating or exercising, enters the chest cavity, but after a while returns to its previous state. At the initial stages of the development of the disease, the clinic may be absent or manifest minor signs, but as it progresses, the symptoms become pronounced and require immediate medical intervention.
As practice shows, hernia most often occurs in women, less often in men. It can be congenital or acquired.
Based on morphological characteristics, esophageal hernia is divided into several stages and classifications, each of which has its own characteristic features. In practice, the most common type is a sliding (axial) hernia, which is diagnosed in 90% of patients. It received its name, a sliding axial hernia, because it is able to slip into the upper stomach and lower alimentary sphincter, penetrate the sternum and return freely.
Causes
There are several causes and predisposing factors that can provoke the development of a hiatal hernia, but in 50% of cases the disease is not an independent disease, but manifests itself against the background of progressive degenerative changes in the esophagus and connective tissue. The following causes and factors can be the trigger for the development of the disease:
- Sedentary lifestyle.
- Asthenic physique of a person.
- Flat feet.
- Scoliosis.
- Haemorrhoids.
- Increased intra-abdominal pressure.
- Hurting cough.
- Obesity.
- Hard physical labor.
- Pregnancy period.
- Reflux esophagitis.
In addition to the above reasons, gastritis, stomach ulcers, cholecystitis, pancreatitis and other diseases can provoke the development of a hernia. Regardless of the etiology of the disease, treatment should be started as quickly as possible, this will help reduce the risk of complications and surgery.
Classifications and stages of development
Axial hiatal hernia is divided into three main types:
- Sliding (not fixed)– able to move from the lower part of the esophagus to the upper and sternum;
- Paraesophageal (fixed)– only the cardiac part of the organ moves into the chest cavity, which does not descend back. This type of disease is much less common, but fixed hernias are more dangerous and often require immediate surgical intervention.
- Combined– accompanied by two signs of the first two options.
Depending on the spread of the hernia into the chest I distinguish three stages:
First degree– the abdominal section of the esophagus is located above the diaphragm, the stomach is raised and pressed tightly against it. At grade 1, clinical signs are invisible, and minor disturbances in the gastrointestinal tract often go unnoticed.
Second– the esophagus is present in the sternum, the stomach is located at the level of the diaphragmatic septum. When diagnosing stage 2 of the disease, the symptoms are severe and require medical intervention.
Third stage– there is part of the esophagus above the diaphragm. This is the most severe degree of the disease, requiring surgery.
It is known that the first degree of the disease is often accompanied by other concomitant diseases of the gastrointestinal tract, so at this stage it is difficult to recognize a hernia. Most often, the underlying disease is treated.
Clinical signs
In almost 30% of cases, an axial hernia does not cause any symptoms, but only until it reaches more serious stages of development. Often the symptoms can resemble other diseases, which makes diagnosis very difficult. Clinical manifestations intensify as the hernial sac enlarges.
The main symptom of the disease is pain in the chest, back, and abdomen. The intensity of the pain syndrome is quite different, from weak and aching pain to acute and unbearable. The pain often intensifies after eating, exercising, coughing, turning or bending the body.
In addition to pain, there are other symptoms, including:
- Unpleasant belching.
- Nausea, vomiting.
- Difficulty swallowing food and liquids.
- Severe heartburn.
- Hoarseness of voice.
- Sore throat.
- Discomfort in the epigastrium.
- Dyspeptic disorders.
- Increased fatigue.
- Frequent headaches.
- Low blood pressure.
When the hernial sacs are strangulated, the symptoms become more pronounced, the patient’s condition worsens sharply, and the risk of internal bleeding increases. Such symptoms require immediate hospitalization of the patient in a hospital where he will receive proper medical care.
Possible complications
Lack of timely treatment can lead to unpleasant and sometimes irreversible processes. Among the complications, the most common are:
- aspiration pneumonia;
- chronic tracheobronchitis;
- strangulated hernia;
- reflex angina;
- the risk of myocardial infarction increases;
- stomach bleeding;
- perforation of the esophagus;
With a long-term disease, the risk of developing malignant tumors increases. Considering the complexity of the disease and its possible consequences, the only way to prevent complications is timely diagnosis and properly administered therapy.
Diagnostics
If an axial hiatal hernia is suspected, the doctor prescribes a number of laboratory and instrumental research methods, including:
- X-ray examination.
- Computed tomography of the chest organs.
- Laboratory analysis of urine and blood.
- Endoscopic examination (esophagogastroscopy).
- Esophagomanometry.
The results of the examinations will allow the doctor to obtain a complete picture of the disease, assess the patient’s condition, the stage of the disease, make the correct diagnosis, and prescribe the necessary treatment. In addition, the patient will be prescribed a consultation with other specialists, in particular a pulmonologist, cardiologist, and otolaryngologist.
Treatment methods
Treatment of an axial hernia can be carried out conservatively or surgically. The doctor determines the treatment tactics based on the diagnostic results and the general condition of the patient. Conservative therapy consists of taking several groups of medications with symptomatic action, as well as following a strict diet.
Drug treatment cannot eliminate the problem, but only relieves the severe symptoms of the disease. Your doctor may prescribe the following medications:
- Enzymes – Mezim, Pancreatin, Creon.
- Antacids - Rennie, Phosphalugel, Maalox.
- Drugs that normalize peristalsis - Domperidone.
- Proton pump inhibitors - Omeprazole, Rabeprazole.
If necessary, the doctor can prescribe other medications, the dose of which, as well as the duration of administration, is determined individually for each patient.
When the disease is advanced or conservative treatment does not bring the desired results, the doctor will prescribe a planned or unscheduled operation. Surgical treatment will help restore the natural anatomical structure and location of organs, reduce the risk of relapse, and improve the patient’s quality of life.
The choice of surgery directly depends on the capabilities of the clinic and the degree of the axial hernia.
Nutritional therapy is considered important in treatment and must be adhered to at any stage of treatment. The patient is prescribed fractional meals, up to 6 times a day. Portions should be small, food only at medium temperature. Fried, spicy, fatty and smoked foods, as well as alcohol, coffee, and strong tea should be excluded from the diet. An approximate menu for the patient will be drawn up by the attending physician or nutritionist.
Prevention
To reduce the risk of developing a hiatal hernia, prevention should be carried out far before the first manifestations of the disease. It includes compliance with the following rules and recommendations:
- rejection of bad habits;
- rational and balanced nutrition;
- healthy lifestyle;
- moderate physical activity;
- body weight control;
- timely and correct treatment of all concomitant diseases.
By following basic rules, you can not only reduce the risk of developing a hernia, but also other diseases of the gastrointestinal tract. In any case, self-medication should be excluded. The sooner a person seeks medical help, the greater the chance of a successful prognosis.
