Sliding hernias. Reasons for development

The chest cavity is separated from the abdominal cavity by a strong muscular organ called the diaphragm. Its central part consists of natural holes. Large vessels pass through them, as well as the esophagus.

It is in this place that many people find hernial protrusions. Almost 90% of cases involve the formation of a sliding cardiac hernia with corresponding symptoms.

Features of pathology formation

One of the common diseases is a hiatal hernia. The older a person gets, the higher the likelihood of its occurrence.

The specificity of the disease is that it can develop in the body for years, while the patient takes medications for concomitant disorders that have similar symptoms. In other words, a hernial protrusion often remains asymptomatic for a long period.

A POD hernia is formed as a result of the following moving into the chest cavity:

upper parts of the stomach;
lower part of the esophagus;
intestines.

There are protrusions:

Sliding (axial). Penetration of the abdominal part of the esophagus and gastric fundus into the chest is noted. It is diagnosed most often, and infringement almost never occurs.
Paraesophageal. The fundus of the stomach and other organs move, but the esophagus maintains its location. Due to the high probability of strangulation, urgent surgery is indicated.
Mixed.

A sliding formation is otherwise called unfixed, since it can change its location. In a fixed protrusion, the position is always stable.

Any form is provoked by various factors:

age-related changes;
abnormal development of the ligamentous apparatus;
diseases of the gastrointestinal tract of an inflammatory nature;
abdominal injuries;
prolonged high pressure in the abdominal cavity;
diseases of the esophagus.

Stages and characteristic signs

Patients who have been diagnosed with an axial cardiac hernia will be wondering what it is. In medicine, it is customary to distinguish between several degrees of protrusion, depending on how large the hernia has formed. Therefore, treatment is prescribed only after an accurate determination of the stage of the disease.

Usually, with a pathological formation at the initial stage, the patient feels almost no discomfort. This explains why complications arise that require surgery to eliminate.

A sliding hernia occurs:

esophageal (1st degree);
cardiac (2nd degree);
cardiofundic (grade 3);
giant (grade 4).

The esophageal form is characterized by the location of the abdominal segment under the diaphragm. The patient complains of:

heartburn;
discomfort in the epigastric region after a long stay in a bent position.

The state of health worsens when the diet is disrupted.

Axial, that is, sliding, cardiac hernia of the POD develops as a result of the location of the lower alimentary sphincter over the anatomical septum, while the gastric mucosa is partially present in the esophageal opening.

Due to a sliding cardiac hernia, a person feels heartburn regardless of whether he has eaten or not. The status is also supplemented:

severe painful discomfort in the abdomen;
constant belching;
nausea;
chest pain that resembles symptoms of angina pectoris;
problematic swallowing;
increased pain when lying down or bending over.

If the stomach partially protrudes into the chest cavity, a cardiofundic hernia is diagnosed. The pathology is quite rare and is accompanied by:

acute pain in the abdomen after eating;
shortness of breath;
cyanosis;
rapid heartbeat.

The most severe degree is the fourth. In this case, the patient is urgently prepared for surgery.

Possible complications

When a patient does not consult a doctor for help in a timely manner, a sliding cardiac hernia of the PAD can result in serious consequences:

hemorrhages in the esophagus;
gastroesophageal reflux disease;
infringement;
cicatricial narrowing;
peptic ulcer;
perforation of the esophagus.

After the operation, complications such as:

pathological expansion of the esophagus;
re-formation of protrusion;
enlargement of a specific gastric area.

Treatment methods

In the absence of the listed complications, an unfixed cardiac hernia is eliminated using:

antacids that help normalize acidity and eliminate pain;
antispasmodics;
agents that enhance the protective function of the gastric mucosa;
drugs that help cope with belching and heartburn.

For treatment to be effective, you will need:

Follow a diet.
Review your daily routine.
Reduce the number of loads.
Stop smoking.
Make time for gymnastic exercises.

It is important to always remember that successful recovery depends on early diagnosis. You should not choose medications at your own discretion. Any medications should be taken only as prescribed by a doctor.

Denial of responsibility

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

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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 of the 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 therefore no treatment is carried out for a long time. 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 is more likely to 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 esophageal hernia of the first and second degrees requires only dietary nutrition and medication. At the third stage, specific treatment is already selected. A fourth degree axial hiatal hernia 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 of death 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 the general prevention of pathologies of the musculo-ligamentous system, which includes physical therapy, dietary nutrition, and the elimination of bad habits.
Increased intra-abdominal pressure. This factor is associated with frequent constipation, bloating, overeating, excess weight, and pregnancy. 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.

At the last stage of the formation of a hernia in the chest area, most of the stomach or the entire organ is located. In this case, the disease must be treated not only with conservative methods, but also with surgical intervention.

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

How does hiatal hernia manifest itself?

The main clinical manifestations of a sliding diaphragmatic hernia:

Dyspeptic phenomena. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient assumes a horizontal position after filling the stomach. Such manifestations can occur for no 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 repetition of the unpleasant sensations. 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 of the respiratory system. Bronchitis and aspiration pneumonia appear as a result of particles of poorly chewed food entering the respiratory tract. This threatens purulent pneumonia and chronic respiratory diseases, which only aggravate the patient’s already serious condition.
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 an esophageal hernia is faced with increased sensitivity of the enamel, papillitis, various stomatitis and gingivitis. Treatment of a 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 can result in precancerous conditions and even oncology.

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

Additionally, the patient is prescribed laboratory 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 associated problems be detected that need to 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 the acute period, but also the prevention of complications and relapse throughout life. Additional measures will include therapeutic exercises, swimming, and 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 complex of disorders. An additional symptomatic complex with esophagitis requires separate treatment.

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

Antacids. Indicated to reduce the negative impact of acidic contents on 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 a sliding diaphragmatic hernia is accompanied by a peptic ulcer of the stomach and duodenum.
De-Nol. Indicated for inflammatory and ulcerative diseases of the gastric mucosa and esophageal tube.
Motilium. Prescribed to improve digestion processes.
Proton pump inhibitors. They inhibit the 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 include 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, a long period of rehabilitation begins. It includes following a diet, eliminating physical activity, and performing a set of therapeutic exercises.

With age, the muscle septum loses elasticity and flexibility. The esophagus protrudes into the sternum through a hole in the diaphragm. hiatal hiatus most often occurs in adulthood.

Esophageal hernia most often occurs in adulthood.

Depending on the location of the defect, there are:

axial hernia;
cardiac prolapse.

There are several types of pathology:

shortened (identified in people with a birth defect);
paraesophageal hernia;
sliding hernia.

A feature of a sliding hernia is the difficulty of diagnosis. The reason is that the symptoms of this disease are quite mild. The fallout itself can only be determined under certain conditions.

A distinctive feature of this defect is that the displacement into the sternum occurs along the axis of the esophagus. The location of the hernia affects the position of the upper part. In this case, the prolapse leads to the fact that the upper part of the patient’s stomach is above the level of the diaphragm.

The stomach takes part in the formation of hernial formation. There are 2 types of sliding hernia: fixed and non-fixed. The position of the patient does not affect the location of the hernial sac. If a person assumes an upright position, the fixed hernia will remain in the sternum. The formation is held in place by adhesions that form in the hernia area.

Experts distinguish between sliding hernias with congenital and acquired defects. There is a difference in pressure between the sternum and. Thanks to this difference, the contents of the stomach enter the esophagus.

The esophageal mucosa is quite sensitive to such substances. This causes erosions and ulcers. The patient experiences discomfort, discomfort and severe pain. The inflammatory process in the esophagus develops gradually. In this case, the mucous membrane bleeds and is constantly injured.

The patient begins to develop anemia due to iron deficiency due to tissue ulceration.

This video will tell you what a hiatal hernia is:

Reasons for the formation of a sliding hernia

Increased salivation is a sign of a sliding hernia.

The condition of the ligaments affects the formation of the esophageal opening of the diaphragm.

With this disease, the upper part of the stomach moves upward. This causes the muscle ligament to become much thinner.

Stretching the ligament provokes an increase in the diameter of the esophageal opening. The patient develops a complication due to regular overeating. If such a defect is detected, doctors refer the patient for surgery.

There are several methods for removing hernias. Through fundoplication, the surgeon creates a special cuff around the esophagus. It prevents stomach contents from refluxing into the esophagus. During the operation, the laparoscopic method is used. With its help, doctors manage to reduce trauma to a minimum. This shortens the patient's recovery time.

However, the possibility of the cuff slipping cannot be ruled out. This increases the risk of complications after surgery. Surgery in most cases helps to achieve positive results. Success largely depends on undergoing physical therapy procedures during rehabilitation.

Sometimes the hernial prolapse is fixed in one position. This occurs due to the narrowing of the scars in the hernial sac. In this case, the patient is diagnosed with acquired shortening of the esophagus. The esophagogastric canal is located above the diaphragm.

In severe cases, a person may experience fibrous stenosis. A complication of a sliding hernia is also reflux esophagitis. The sliding dump cannot be pinched. If the opening narrows, the cardia is compressed and enters the sternum. This condition does not lead to circulatory problems.

What are the signs by which the disease can be identified?

Heartburn is a symptom of a sliding hernia.

A sliding hiatal hernia does not have any obvious manifestations. The patient's symptoms appear only when various complications of the disease occur.

There are several characteristic signs of a sliding hiatal hernia:

the patient begins to complain about;
he suffers from bouts of belching;
pain appears in the esophagus;
regurgitation occurs after eating;
people experience a burning sensation in the chest;
a lump appears in the throat;
increased secretion of saliva occurs;
Some patients have increased blood pressure.

Symptoms of the disease depend on the position of the patient's body. A burning sensation occurs in almost every person with this pathology. A person with a stomach ulcer experiences severe pain. A large amount of food can trigger the appearance in the esophagus.

By taking acid-reducing agents, you can get rid of discomfort.

How is diagnostics carried out?

To identify a sliding formation, experts use several methods:

during gastroscopy, doctors use endoscopic equipment to determine inflamed areas, the presence of ulcers and erosions;
X-ray of the stomach is intended to assess the condition of hernial formations;
A study of changes in daily pH in the esophagus is intended to determine which leads to pain.

Features of treatment

Maalox will help reduce the acidity of the esophagus.

To eliminate the defect, doctors use traditional methods. The complex of treatment measures includes a special diet, therapeutic exercises, and medication.

To reduce acidity, doctors prescribe patients to take antacids (Phosphalugel,). Patients suffering from belching attacks can be helped with Motilium. The dosage is indicated by the doctor taking into account the patient's condition.

However, in case of serious complications, these methods do not achieve positive results. In this case, the patient is sent for surgery.

Sometimes patients experience a slipping of the cuff, and the disease occurs again. Repeated surgery can help such patients.

Patients need to adhere to. During your illness you will have to stop eating fatty and spicy foods. Eliminate smoked meats and marinades from your diet. You need to eat food in small portions to speed up the digestion process.

After surgery, patients should not engage in intense physical labor. It is forbidden to do exercises that provoke an increase in pressure in the abdominal cavity.

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Classification, treatment and symptoms of hiatal hernia. Details about...

A hiatal hernia is essentially a defect in the septum between the abdominal cavity and the sternum. This septum consists of muscles that tend to lose their elasticity and flexibility with age. Therefore, the prolapse of the esophagus into the sternum through the openings of the diaphragm is often attributed to age-related diseases. It is older people who are most vulnerable to such illnesses.

An important factor is also that the pressure in the chest cavity is much lower than in the peritoneum. This often causes a hiatal hernia after heavy physical exertion, prolonged coughing and other similar phenomena that increase internal pressure.

Depending on the place of origin of the formation, there are:

axial fallout;
cardiac hernia.

In modern medicine, hiatal hernia is divided into several types:

shortened esophagus (congenital hiatal hernia);
paraesophageal hernia;
sliding hernia.

A sliding hernia is quite common, but has a number of complications. In particular, with this form of esophageal disease, it is more difficult to establish a diagnosis, since the symptoms do not manifest themselves properly, and the prolapse itself is visible only under certain conditions.

This hiatal hernia differs in that the displacement into the sternum does not occur near the esophagus, but along its axis.

When diagnosing a sliding hernia of the esophagus, the location of the hernia will be slightly different than in the case of other subtypes of esophageal hernia. Sliding prolapse involves placing the upper part of the stomach above the level of the diaphragm. It turns out that the stomach takes part in the formation of the hernial sac.

A sliding hernia can be fixed or not fixed. With a fixed formation of the esophageal opening of the diaphragm, the location of the hernia does not change depending on the position of the patient’s body. This means that when the patient takes a vertical position, a sliding fixed hernia will remain in the sternum. This occurs because the hernial phenomenon is held in place by adhesions in the hernial sac.

Modern medicine also distinguishes sliding hernias from congenital or acquired shortened esophagus.

Since there is a large difference in pressure between the sternum and the abdominal cavity, this promotes the passage of stomach contents into the esophagus. As you know, the esophagus is sensitive to such things. This can cause erosions and ulcers, causing patients not only inconvenience and discomfort, but also severe pain. If this inflammatory process occurs constantly, the mucous membrane is easily injured and bleeds. This in turn can cause tissue anemia.

Reasons for the formation of a sliding hernia

The reason why a sliding formation of the esophageal opening of the diaphragm is formed is the pathology of the ligament that holds the gastroesophageal canal inside the esophageal opening of the diaphragm.

As the upper part of the stomach moves upward during a sliding hernia, this muscle ligament becomes exhausted and stretched. The esophageal opening becomes larger in diameter. Therefore, depending on the amount of contents in the stomach and the position of the person’s body, the hernial phenomenon (including part of the gastroesophageal canal) may first move into the sternum from the abdominal cavity and then return back.

In this case, a hernial formation of the esophagus can be both large in size and small in size. As a rule, a large hernial prolapse is observed in patients who have been suffering from a similar illness for a long time.

If the prolapse is fixed and narrowed by scars in the hernial sac, acquired shortening of the esophagus may occur. In this case, the esophageal-gastric canal, or anastomosis, as it is called, will constantly be located above the diaphragm.

The advantage of a sliding hernia is that it cannot become pinched. But with advanced variants, fibrous stenosis may occur. Also a concomitant disease of a sliding hiatal hernia is reflux esophagitis.

Strangulation of a sliding hernia

As already stated, the sliding fallout cannot be pinched. Even if the hole narrows and the cardia that has entered the sternum is compressed, this does not threaten circulatory problems. Because the contents are emptied through the esophagus, and the outflow of blood occurs through the veins of the esophagus.

Symptoms

As a rule, a sliding formation occurs without pronounced symptoms. Serious symptoms appear when concomitant diseases are added to the sliding prolapse or complications begin.

Then, the patient may complain of:

heartburn;
regurgitation;
burping;
pain;
burning effect behind the sternum;
lump in throat;
increased salivation;
sometimes increased blood pressure.

Symptoms may vary depending on the position of the patient’s body. A burning sensation occurs in almost every patient with a sliding hiatal hernia.

The pain is not like what a person with an ulcer might feel. With hernia formation, pain appears after eating and is proportional to the amount of food taken. When taking drugs that reduce acidity, the pain disappears almost instantly.

Diagnostics

You can diagnose a sliding formation in the following ways:

gastroscopy;
X-ray of the stomach, including functionality analysis;
changes in daily pH in the esophagus.

Treatment

Sliding hernias are first treated with the traditional method, which involves a special diet, physical exercises and medication. If this does not help, and the patient begins to develop complications, surgery may become a question. Surgery is also indicated for bleeding.

Hello! Please tell me. I started having very strong heart palpitations. First a jolt, then as if my heart had turned over, and then a strong heartbeat. I turned to a cardiologist. We did a Holter examination. Nothing bad was found. I told him that I was diagnosed with a sliding hernia. The doctor said that most likely this is a sliding hernia making itself felt. Please tell me. Can a sliding hernia act like this? And what morning exercises can be done with a sliding hernia (I mean morning exercises), as well as what medications are used to treat a sliding hernia. Best regards, Alla.

There are two types of sliding hernias: fixed and non-fixed. There are also three main subtypes of sliding hernias:

traction;
pulsion;
mixed.

Normally, even if a person stands on his head, food does not enter the esophagus from the stomach because:

The fundus of the stomach (upper third) is located above its connection with the esophagus, which enters the stomach at an acute angle (the angle of His). Therefore, when the stomach is filled with food, the pressure in it increases. As a result, the bottom of the stomach seems to press down on the place where the stomach and esophagus connect (cardiac region), blocking it.
In the area where the esophagus flows into the stomach there are folds of the stomach (Gubarev valve), which, like doors to one side, prevent aggressive gastric contents from entering the esophagus.
There is increased pressure in the lower third of the esophagus, preventing stomach contents from rising into the esophagus.
The lower esophageal sphincter (cardia) prevents food from entering the esophagus from the stomach.
The diaphragm muscle, which surrounds the esophagus, creates a valve that prevents stomach contents from flowing back into the esophagus.

Each of these moments plays an ambiguous role, and under certain conditions can become a leading one.

The structure of the human body is formed in such a way that the thoracic and abdominal sections are separated from each other by the diaphragm, which has an opening through which the esophagus passes.

In a healthy person, the muscles and connective fibers of the diaphragm block the abdominal organs from entering the chest. A disease in which part of the stomach extends beyond the peritoneum into the chest cavity is called a hiatal hernia (HH) or gastric hernia.

In the initial stages, the disease can be easily cured, but in advanced cases it will be necessary to resort to surgical intervention.

1 According to the origin of the hernia. There are congenital and acquired.

2 According to the development of the clinical picture. There are primary at the initial stage, recurrent and developing as a result of injury or surgery.

3 By stage of development. There are initial ones, in which the esophagus is not squeezed out, within the hernial canal, and external ones. In turn, they are divided according to the location of the hernial tumor.

A gastric hernia manifests itself in the form of different symptoms and is diagnosed using various methods that make it possible to determine the degree of the disease, possible complications, and confirm the presence or absence of neoplasms.

Determining the cause of pathological manifestations will help the doctor choose the right treatment and determine which methods of therapy should be used (folk or traditional).

In some cases, surgery is performed to remove the hernia.

Elderly people suffer most from stomach deformation.

A type of hiatal hernia is defined in medicine as a gastric hernia. In this case, the stomach completely or partially falls into the chest cavity. The method of treating the disease depends on the size of the tumor.

A gastric hernia is often asymptomatic; in this case, it is discovered by chance during an examination for another reason.

In most cases (about 95%), gastric hernia is treated using conservative methods.

A diet is recommended for patients with gastric hernia. Alcohol, carbonated drinks, coffee, cocoa, chocolate, spices, ketchup, mayonnaise, mushrooms, legumes, cabbage, fatty and fried foods should be excluded from the diet.

Food should be taken in small portions 4-6 times a day, chewing thoroughly, the last meal should occur no later than three hours before going to bed.

In order to protect the mucous membrane of the esophagus from the action of gastric contents, antacids are used. In addition, proton pump inhibitors, H2-histamine receptor blockers, and antispasmodics are prescribed.

As a surgical treatment for a gastric hernia, operations are performed that consist of suturing the hernial orifice and strengthening the esophageal-diaphragmatic ligament, as well as surgical interventions during which the stomach is fixed.

The Nissen fundoplication method is popular. The method refers to anti-reflux operations and involves wrapping the fundus of the stomach around the esophagus to form a cuff, which prevents the stomach contents from refluxing into the esophagus.

During surgery, the anatomically correct location of the lower esophageal sphincter is restored, which, when intra-abdominal pressure increases, should be below the diaphragm, which allows for the restoration of its functions.

Typically, the operation is performed laparoscopically, the advantage of which is minimal tissue trauma and a shorter rehabilitation period.

If there are contraindications to laparoscopy, open surgery is used.

Patients with a gastric hernia are advised to undergo clinical observation by a gastroenterologist.

The main visible symptom of the presence of an external gastric hernia is protrusion of the anterior abdominal wall in the epigastric, central or periumbilical region (with significant prolapse of the stomach); sometimes visible peristalsis and rumbling of the stomach through the skin are observed.

Internal hernias (sliding gastric hernia or permanent paraesophageal hernia) have only general clinical manifestations, and can be asymptomatic for a certain period of time.

The symptoms are rather similar to diseases of the gastrointestinal tract, due to disruption of its functioning. When the activity of the lower esophageal sphincter deteriorates, gastroesophageal catarrhal reflux is observed (reflux of gastric contents into the esophagus).

After a certain time, due to exposure to aggressive stomach contents, inflammatory changes appear in the lower part of the esophagus.

For a sliding gastric hernia, conservative treatment is initially recommended; it is aimed more at alleviating the symptoms of reflux esophagitis: heartburn, nausea, pain. Drugs that reduce the acidity (PH) of gastric juice are used (such as the drug Kvamatel from Gedeon Richter).

The patient must follow a diet limiting spicy, fatty, fried foods, chocolate, coffee, alcohol, and all foods that promote the production of gastric juice.

You need to eat often, in small portions. To avoid reflux, it is recommended to sleep with your upper body elevated and avoid lifting heavy objects.

But, unfortunately, conservative therapy for a sliding hiatal hernia, which was treated with medications and diet, does not eliminate the cause of the disease (the hernia itself) and brings only a temporary effect. Therefore, elective surgery is recommended.

Reasons for education

A hernia is formed in such a way that one of its walls is an organ partially covered by the abdominal cavity. We can say that this type of hernia is a defect in the obstructive tissue between the peritoneum and the chest.

The main component of this tissue is muscles, which become less elastic and elastic over time. Such changes are classified as age-related, so the disease is typical for older people.

The creation of the esophageal opening occurs thanks to its internal right leg, formed from the circular muscle tissue of Gubarev. The ligament created from the diaphragm immobilizes the digestive tract and does not allow the cardiac section to pass through.

Despite the fixed mechanism, this ligament is also characterized by flexibility, due to which, during the urge to vomit, the movement of the digestive tract and esophageal motility functions in a calm mode.

Also, a special membrane takes part in the staticity of the esophagus, which supports the muscle tissue that lifts the esophageal organ.

Not least important is the fat layer, as well as the correct location of the peritoneal organs. Thus, atrophic processes in the left side of the liver and incorrect location of the internal organs can lead to the formation of a sliding hernia of the pancreas.

The causes leading to a sliding hernia can be classified as follows:

Congenital factors:

Slower process of lowering the stomach into the abdominal cavity in the fetus.
Untimely fusion of the diaphragm after gastric prolapse. This pathology can occur not only in the fetus, but also in an adult patient.
Dystrophy of the muscle tissue of the legs, leading to a partial opening of the esophageal opening. The development of dystrophy is possible not only during the period of intrauterine development. It can also be purchased in old age.

Acquired factors:

People who are at risk of increased pressure in the peritoneum due to heavy physical activity, long-term persistent cough, constipation, excess weight, pregnancy.
Age-related changes in the body in general and the diaphragmatic organ in particular.
Ulcers and cholecystitis, causing increased contractions of the digestive tract.
Injury or inflammation of the nerve fibers of the diaphragm.

Symptoms of a sliding hiatal hernia may be completely absent or mild. There is a certain percentage of patients for whom such a disease turns out to be a surprise, discovered as a result of an x-ray for other reasons.

It is impossible to see the hernia, since its peculiarity is that it protrudes into the body and not onto the surface, which complicates the diagnosis even with its large size.

Despite certain diagnostic difficulties, there are a number of symptoms indicating this disease:

Attacks of heartburn after eating and after taking a horizontal position.
A painful burning sensation in the pit of the stomach and behind the chest cavity.
Belching and passing food back without gagging.
Swallowing reflex disorder. At the very beginning, this symptom is apparent, that is, there are no problems with swallowing, since the esophagus is not yet narrowed. Subsequently, as a result of the inflammatory process, scars form in the esophagus, leading to its narrowing and creating difficulties for the passage of food.
Frequent diseases of the respiratory organs: bronchitis, tracheitis, pneumonia. This is due to the fact that gastric juice or acidic contents of the organ enter the respiratory system due to belching.

If treatment is not carried out in time, the disease has a number of complications: inflammation of the esophageal mucosa, even bleeding from wounds and ulcers of the organ, the development of anemia due to frequent bleeding.

In parallel with taking medications, the patient is prescribed a natural method of combating the disease - diet. If you follow it, you can not only alleviate your condition, but also speed up the healing process.

Divided food. Eating should occur every 3-4 hours, the amount of food should be small, maximum 300 g at a time.
Exclusion of fatty, fried, salty, spicy, pickled, smoked foods. This also includes fast foods and other foods that provoke irritation of the mucous membrane and produce excessive stimulation of the secretion of gastric juice.
Increasing consumption of fresh food and steamed food. It is allowed to eat stewed and boiled vegetables and cereals. There are no contraindications for milk and lean meats.
In the case of a narrowed esophagus, all food must be ground to a semi-liquid state.
Eating should occur no later than an hour before going to bed.
After eating, you need to sit (you can take a reclining position) for about half an hour. It is prohibited to lie down during this time.

In addition to dietary nutrition, the most important factor is a healthy lifestyle. It includes giving up bad habits, proper rest, physical activity and physical education.

You should not perform exercises that provoke an increase in pressure in the peritoneum. These may include abdominal exercises, bending and twisting exercises.

A sliding or axial hernia is formed after part of the stomach and lower esophagus are displaced from the abdominal cavity into the chest. This type differs from a regular hernia in that it does not have a hernial sac.

This disease does not critically affect a person’s normal life activities. A long asymptomatic course and unhurried progress often prevent the patient from knowing about his illness for a long time.

Sometimes signs of a sliding hiatal hernia become visible during a visual examination of the abdominal cavity for a completely different reason.

Congenital and acquired factors can provoke hair loss. Congenital causes include the following:

the diaphragm has grown at the wrong time;
the embryo's stomach did not drop quickly enough;
the muscles of the legs of the diaphragm have not fully developed;
the opening of the esophagus is dilated.

Acquired causes of the formation of a floating hiatal hernia:

high intra-abdominal pressure;
relaxation of the diaphragm, injury or inflammation of its nerve;
cholecystitis, ulcers and other increased contractions of the esophagus.

In addition, an axial hernia can occur after pregnancy, as a consequence of childbirth, due to obesity, and it also appears along with some stomach diseases that increase intra-abdominal pressure.

The wide range of triggers means that the disease is common and can affect almost anyone. But having studied the symptoms and treatment, it is worth arming yourself and preventing the formation and progression of a hernia.

The clinical picture of sliding gastric hernias has some differences. It is mainly caused by progressive reflux esophagitis, which is the reflux of the contents of the gastric chamber back into the esophagus.

1. A high content of hydrochloric acid and enzymes leads to irritation and significant damage to the mucous membrane of the esophagus, which results in ulcerative and erosive changes.

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

Acquired	Congenital
Damage to the nerve trunk of the cervical plexus or inflammation relaxes the muscles of the diaphragm.	The disease can form during the prenatal period, when the digestive organ slowly descends towards 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.

This is a hollow muscular tube that connects the pharynx to the stomach. On average, its length ranges from 23.5 cm (in women) to 25 cm (in men).

Promotion of a swallowed bolus of food from the pharynx to the stomach.

Anatomical structure

The esophagus has two sphincters:

the upper one is located on the border of the pharynx and esophagus
lower (cardia) is located at the junction of the esophagus and stomach

They act as valves, thanks to which food moves in only one direction - from the mouth to the stomach. They also prevent stomach contents from flowing back into the esophagus, pharynx and oral cavity.

Anatomical position of the esophagus

provided by several structures:

The diaphragmatic-esophageal ligament (Morozov-Savvin ligament), which secures the lower part of the esophagus and prevents the upper part of the stomach from exiting into the chest cavity during swallowing, vomiting and coughing.
The Bertelli-Laimer muscle-tendon membrane, as well as the Yavar and Rouget muscles, which fixes the lower part of the esophagus, pulling it slightly upward.
The fatty tissue that is located under the diaphragm.
Normal anatomical position of the abdominal organs.

The esophagus enters the abdominal cavity through an opening in the diaphragm and then enters the stomach.

Diaphragm This is a partition of tendons and muscles that separates the abdominal and thoracic cavities. Conventionally, its border is located at the level of the lower ribs. The main function of the diaphragm is breathing. It works like a piston:

when inhaling, it draws air into the lungs (in this case, intraperitoneal pressure increases and intrathoracic pressure decreases)
when exhaling, it pushes out air (intrathoracic pressure increases, and intraperitoneal pressure decreases)

In the diaphragm there are

three parts

: lumbar, costal and sternal.

The muscles that form them originate circumferentially from the inner surface of the lower ribs, the lower third of the sternum, and the lumbar vertebrae. Then they go to the center and upward, forming two bulges that are directed upward due to the fact that the pressure in the abdominal cavity is slightly higher.

In the center, the muscle fibers pass into tendon bundles - the tendon center.

The muscles and tendons of the diaphragm form several openings through which the inferior vena cava, aorta, esophagus and nerves pass from the chest cavity to the abdominal cavity.

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A sliding hiatal hernia is a protrusion of the lower part of the esophagus, in which part of the stomach is displaced into the chest cavity. The disease develops over a long period of time, initially without symptoms. A sliding hiatal hernia can be treated well without surgery if it is noticed in time.

According to statistics, up to 5% of adults suffer from a sliding hiatal hernia, with women suffering from it more. Usually there is more than one cause for a disease. Congenital factors include:

insufficient development of the muscles of the diaphragmatic legs and an enlarged esophageal opening;
untimely fusion of the diaphragm;
during the embryonic period, the stomach does not descend quickly enough.

The acquired factors include:

age-related changes in the diaphragm;
inflammation or injury to the nerve of the diaphragm, and its relaxation;
ulcer, cholecystitis and subsequent strong contractions of the esophagus;
increased abdominal pressure.

What is an axial hiatal hernia, how to treat it and how to diagnose it - you will learn from the video below.

A hiatal hernia is essentially a defect in the septum between the abdominal cavity and the sternum. This septum consists of muscles that tend to lose their elasticity and flexibility with age.

Therefore, the prolapse of the esophagus into the sternum through the openings of the diaphragm is often attributed to age-related diseases. It is older people who are most vulnerable to such illnesses.

As the upper part of the stomach moves upward during a sliding hernia, this muscle ligament becomes exhausted and stretched. The esophageal opening becomes larger in diameter.

Therefore, depending on the amount of contents in the stomach and the position of the person’s body, the hernial phenomenon (including part of the gastroesophageal canal) may first move into the sternum from the abdominal cavity and then return back.

In this case, a hernial formation of the esophagus can be both large in size and small in size. As a rule, a large hernial prolapse is observed in patients who have been suffering from a similar illness for a long time.

Strangulation of a sliding hernia

As already stated, the sliding fallout cannot be pinched. Even if the hole narrows and the cardia that has entered the sternum is compressed, this does not threaten circulatory problems.

Because the contents are emptied through the esophagus, and the outflow of blood occurs through the veins of the esophagus.

As a rule, a sliding formation occurs without pronounced symptoms. Serious symptoms appear when concomitant diseases are added to the sliding prolapse or complications begin.

Then, the patient may complain of:

heartburn;
regurgitation;
burping;
pain;
burning effect behind the sternum;
lump in throat;
increased salivation;
sometimes increased blood pressure.

Symptoms may vary depending on the position of the patient’s body. A burning sensation occurs in almost every patient with a sliding hiatal hernia.

Diagnostics

You can diagnose a sliding formation in the following ways:

gastroscopy;
X-ray of the stomach, including functionality analysis;
changes in daily pH in the esophagus.

Surgery is also indicated for bleeding.

In modern surgery, a sliding hernia is removed using a method called Nissen fundoplication. During this manipulation, a special cuff is created around the esophagus. It allows you to eliminate the disease and prevent the contents of the stomach from entering the esophageal mucosa.

This operation is performed laparoscopically, which reduces trauma to a minimum. There is a possibility of the cuff slipping, which increases the risk of relapse of the disease, but in general, surgical intervention has a positive prognosis and with proper treatment in the postoperative period, the patient quickly returns to normal activities.

Among all diaphragmatic hernias in adults, the most common is a sliding esophageal hernia, which is classified as a hiatal hernia (HH).

A sliding hiatal hernia (also called axial hiatal hernia) is formed when the stomach and lower esophagus are displaced into the chest cavity (and normally they are located in the abdominal cavity).

The disease does not have any critical impact on the patient’s quality of life. It lasts a long time, gradually progressing, often completely asymptomatic.

The disease responds very well to conservative therapy (without surgery). The main thing is to recognize the signs of a hernia in time and begin treatment.

The causes of the formation of a sliding hiatal hernia can be divided into congenital and acquired. Most often, a combination of several causes leads to the disease.

(if the table is not completely visible, scroll to the right)

Slowing down of the descent of the stomach into the abdominal cavity during fetal development (congenital hiatal hernia in children).

Numerous reasons associated with increased pressure inside the abdominal cavity (heavy lifting, coughing attacks, chronic constipation, obesity, pregnancy, etc.) increase the risk of organs exiting through the esophageal opening of the diaphragm, especially in the presence of congenital prerequisites.

Formation of a “pre-prepared” hernial sac due to untimely fusion of the diaphragm after descent of the stomach.

Age-related changes in the diaphragm.

Underdevelopment of the muscles of the diaphragmatic legs covering the esophageal opening, which is why it appears dilated.

(In the last two cases, the hiatal hernia can form at any age with additional external provoking influences.)

After confirmation of the diagnosis, treatment should begin immediately: the sooner it is prescribed and performed, the lower the risk of complications and the lower the risk of surgical intervention.

The mandatory and main method of treating a sliding hiatal hernia is constant adherence to a diet.

Patients are recommended to eat split meals (frequently, every 3–4 hours, in small portions of 200–300 g) with the exception of fried, fatty, spicy, salty foods, pickled, smoked and other foods that irritate the mucous membranes and stimulate the secretion of gastric juice.

The basis of the diet consists of boiled, stewed and steamed dishes from vegetables, cereals, milk, lean meat, and fresh fruits.

With true dysphagia, food should have a ground, semi-liquid consistency. You should eat no later than 1 hour before bedtime, and after eating it is advisable to rest for 15–30 minutes in a sitting or reclining position (but not lying down!).

2. Normalization of lifestyle

A complete cessation of smoking, alcohol, sufficient rest, and dosed physical activity are required. Physical exercises that can increase pressure in the abdominal cavity (with stress on the abs, flexion) are prohibited.

3. Medicines

Restoring the protection of the mucous membrane of the digestive tract

If bleeding and anemia develop as complications, patients are given iron supplements and the need for surgery is decided. Surgical treatment of sliding hernias is performed relatively rarely, and is used only when conservative treatment methods are ineffective.

The choice of treatment method, combination of drugs, their dosage and course of administration should be made only by a surgeon.

Medicines can be used intermittently, but therapy without medications (diet and lifestyle adjustments) depends only on the patient and must be carried out constantly, otherwise a positive result cannot be achieved.

Treatment of a hiatal hernia begins with the elimination of irritating factors - rough food, overeating, high stress on the body.

Diet is the main treatment for hiatal hernia, necessary to restore the esophageal mucosa and reduce the load on the stomach to reduce pressure.

Patients with an axial hernia are advised to completely give up alcohol and smoking, count on physical activity and normalize their daily routine. Any movements and exercises that can increase pressure inside the abdominal cavity are excluded.

A person should avoid bending the body, which increases discomfort and heartburn.

Drug treatment includes the following drugs:

antispasmodics and analgesics for symptomatic treatment;
antacids to normalize acidity and eliminate heartburn;
proton pump inhibitors to suppress hydrochloric acid.

These are products such as De-nol, Maalox, No-shpa, Omez, Motilium, Gestal and others.

Additionally, a person can do breathing exercises and yoga (only some poses). Conservative treatment relieves symptoms and makes the hernia safe, but does not eliminate it.

The operation can be performed at the request of the patient or in case of complications. Laparoscopy and open access are used - Nissen fundoplication.

Diaphragmatic hernia or hiatal protrusion differs from other forms of the disease in its localization. A wandering hernia involves the location of part of the stomach above the diaphragm, and thereby the organ independently forms a hernial sac.

Fixed protrusion is characterized by a stable position of the affected organ, regardless of the position of the patient’s body or surges in intrauterine pressure.

An unfixed protrusion is also called a wandering hernia, since its location can change.

The difference in pressure in the abdominal and thoracic cavities leads to the reflux of stomach contents back into the esophagus, which ends in serious consequences for it: the development of erosions, ulcerative lesions of the esophagus, the patient feels discomfort, and the disease is often accompanied by severe pain.

Chronic reflux leads to severe inflammation of the esophagus, it becomes irritated and bleeds, which can result in anemic syndrome.

The following negative factors can trigger the formation of hiatal pathology:

Weakness of the muscular wall that holds the stomach in its anatomical place.
The muscle barrier can be weakened by exhaustion of ligaments due to increased stress on the body.
The period of pregnancy, when intrauterine pressure increases and the diaphragmatic opening increases.

With an unfixed hiatal protrusion, the stomach changes its position and returns to its place when the patient’s body position changes, but this does not reduce the protrusion and requires adequate treatment.

An esophageal hernia can have different sizes; with a long course of the pathological process, a large hernial protrusion is observed. The consequence of a sliding or wandering hernia is the fixation of the stomach above the diaphragm and the formation of scars along the edges of the hernial sac.

Against this background, shortening of the esophagus develops, and a fixed protrusion will constantly be outside the diaphragm.

Important! With a wandering hernia, pinching is impossible, because blood circulation is maintained and the hernial lesion does not appear for a long time, but instead stenosis or reflux esophagitis can develop.

The appearance of the first specific symptoms is observed when concomitant deviations of the esophagus and stomach appear, as well as in case of complications.

Complaints from patients with sliding diaphragmatic hernia:

pain in the stomach area is caused by the appearance of an inflammatory process and reflux;
salivation increases, which can lead to dental diseases;
burning sensation in the chest area;
frequent heartburn, belching, regurgitation;
sensation of a foreign body in the throat;
increased blood pressure, difficulty breathing.

Clinical manifestations of hiatal lesions may differ in each patient, depending on the position of the body and concomitant pathologies of the digestive system.

A mandatory sign of the disease for all patients is a burning sensation in the chest. The nature of pain with a hiatal hernia has its own pattern; a painful attack occurs after the stomach is full and full, and depends on the amount of food.

Increased pain and discomfort occurs with increased physical stress on the body, overeating, and the presence of congenital or acquired pathologies of the cardiovascular system.

Important! Pain from a hiatal hernia can be easily relieved with medications to treat high stomach acidity.

A sliding hiatal hernia can be treated with medications without complications. Antacids, antispasmodics, and painkillers are prescribed.

Antacids (Gastal, Phosphalugel) are prescribed for increased stomach acidity to normalize the pH and relieve the painful syndrome.
The drug De-nol is indicated to enhance the protective function of the mucous membrane of the digestive organs.
Antispasmodics are aimed at treating spasms and pain relief.
The drug Motilium is prescribed for the symptomatic treatment of belching, regurgitation, and heartburn.

Complex treatment of a hiatal defect requires changes in nutrition, the patient is prescribed a special diet.

Eating crushed foods in small portions, but often.
Heavy fatty, fried, pickled foods are excluded.
The diet consists of steamed dishes: vegetables, cereals, white meat.
The last meal occurs an hour before bedtime.

An obligatory stage in the treatment of a sliding hernia is the normalization of the daily routine, reduction of physical and emotional stress, and elimination of smoking. It is important to exercise regularly, and for this there are special exercises indicated for patients with a sliding hernia.

Hiatal protrusion can become complicated and progress, therefore, in order to prevent bleeding, stenosis, scarring, the doctor may prescribe surgical treatment aimed at restoring the anatomical position of the stomach and excision of tissue affected by the ulcer.

A sliding hiatal hernia (hiatal hernia) or hiatal hernia is the movement of the stomach or other abdominal organs through the dilated esophageal opening in the diaphragm into the chest cavity.

The disease occurs in 5% of the entire adult population, despite the fact that half of the patients do not note any clinical manifestations. This happens because with a sliding hiatal hernia, the symptoms (signs) of a typical hernia are erased, since it is located inside the body and cannot be seen during a routine examination of the patient.

More often observed in women than in men; in children they are mainly congenital.

Sliding (axial) hiatal hernia (HHH), which refers to one of the variants of hernia of the esophagogastric opening in the diaphragm, is divided into:

cardiac;
cardiofundic;
total gastric;
subtotal gastric.

Recognition of sliding hernias presents significant difficulties. At first glance, the clinical picture differs little in its course and symptoms from ordinary inguinal hernias.

You should pay attention to the age of the patient, the duration of the disease, the large size and peculiar consistency of the hernial protrusion, rumbling when trying to reduce it, wide hernial orifices, as well as dyspeptic syndrome.

When the intestine slips, dysuric phenomena may indicate the possibility of direct contact with the sliding organs of the bladder. Sliding hernias are usually strangulated more often; the clinical course of their injuries is much more severe.

With irreducible sliding hernias, which are more common, recognition is difficult.

It is important to pay attention to unusual symptoms and the main thing to remember is the possibility of a sliding hernia.

Operations for sliding hernias of the colon. Due to the unique nature of surgical anatomy, these operations can present significant difficulties, especially with large, poorly reducible hernias.

Reduction of hernial contents en masse (reposition).
Peritonization of slipped sections of the colon with subsequent reduction of them into the abdominal cavity.
Fixing the slipped section of intestine to the abdominal wall in front of it.
Mesenteric plastic surgery and fixation of the slipped area to the anterior surface of the posterior abdominal wall. The diagram according to M.I. Pototsky (Fig. 66) clearly shows the main methods of surgical treatment of the most common sliding hernias of the colon.

Savario's method: open the inguinal canal, release the hernial protrusion from adhesions to the transverse fascia, open the hernial sac and, after freeing the sliding intestine and suturing the opened sac, the latter, together with the intestine, is inserted into the abdominal cavity
Method B and vein (Beven): after reduction of the hernial contents and resection of the hernial sac, a purse-string suture is applied to the remains of the hernial sac and the intestinal wall
Method of Barker, Hartmann and Erkes: after resection of the hernial sac, the stump of the latter is sutured, and the long ends of the threads are passed behind the Pupart ligament, possibly higher, through the anterior abdominal wall (back to front)

Hernias are classified by degree and depend on the location and size of the pathology:

the first degree is characterized by the location of the abdominal segment under the diaphragm, the hernia develops gradually;
in the second degree, the cardiac part of the stomach is located above the diaphragm, and the gastric mucosa enters the esophagus;
in the third stage of the disease, part of the stomach enters the thoracic region, the pathology is quite rare;
the fourth is called giant; almost the entire stomach enters the sternum and puts pressure on other organs. This degree of hernia requires immediate hospitalization. Drug treatment will not help; surgical intervention is necessary.

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The risk group is mainly women and older people over 50 years old, this is due to age-related changes in organs. The main reason for the development of pathology is a decrease in the tone of the muscles that regulate the expansion and contraction of the alimentary section of the diaphragm.

With such disorders, the esophageal opening cannot completely close, which causes protrusion of part of the stomach and the formation of a hernia.

When a hernia forms, part of the stomach is displaced into the thoracic region due to protrusion of the lower esophagus. The pathology develops over a long period of time, but without any signs, which complicates its timely diagnosis.

If detected early, the disease can be easily treated; it is caused by various causes and they are divided into congenital and acquired.

Congenital:

underdevelopment of the diaphragm muscles and too large opening of the esophagus;
delayed diaphragmatic fusion;
delayed prolapse of the embryo's stomach.

Diagnosis of a sliding hiatal hernia is carried out not only on the basis of symptoms, and treatment is prescribed by the attending physician after a complete examination. For this, a number of diagnostic measures are prescribed:

X-ray examination;
FGDS;
sometimes an MRI is prescribed;
gastroscopy;
acidity measurement;
endoscopy.

After a complete diagnosis has been made, the doctor prescribes treatment. It must be started immediately to avoid surgery. If the hernia is discovered late and internal bleeding begins, treatment is carried out only surgically.

In addition to drug therapy, treatment should include a mandatory diet. A patient with hiatal hernia needs to eat in small portions, portions should be no more than 250 g per meal. It is necessary to exclude:

fat;
spicy;
smoked meats;
roast.

All these products increase the production of hydrochloric acid and provoke irritation of the gastric mucosa. The diet should consist of dishes:

stewed;
steamed;
boiled porridges from various cereals;
vegetable dishes;
milk soups and cereals;
boiled lean meat, also applies to fish;
Non-acidic fruits must be present.

Alcoholic drinks should be avoided and smoking should be stopped. Light physical activity should be alternated with rest.

Exercises that put pressure on the abdominal cavity should be discontinued. The following drugs are used as drug therapy for sliding axial hiatal hernia:

to reduce the acidity of gastric juice - Maalox, Gastal;
for heartburn – Motilium, Rennie;
suppressing the production of hydrochloric acid - Omez;
antispasmodics – No-shpa;
painkillers.

Treatment of a sliding esophageal hernia has a positive prognosis if the diagnosis is made on time and the disease is not advanced.

Axial hernia can be diagnosed using radiography, esophageal manometry, fibroesophagogastroduodenoscopy, gastroscopy, esophagoscopy.

The condition of the ligaments affects the formation of the esophageal opening of the diaphragm.

With this disease, the upper part of the stomach moves upward. This causes the muscle ligament to become much thinner.

There are several methods for removing hernias. Through fundoplication, the surgeon creates a special cuff around the esophagus.

It prevents stomach contents from refluxing into the esophagus. During the operation, the laparoscopic method is used.

With its help, doctors manage to reduce trauma to a minimum. This shortens the patient's recovery time.

Sometimes the hernial prolapse is fixed in one position. This occurs due to the narrowing of the scars in the hernial sac. In this case, the patient is diagnosed with acquired shortening of the esophagus. The esophagogastric canal is located above the diaphragm.

In severe cases, a person may experience fibrous stenosis. A complication of a sliding hernia is also reflux esophagitis.

The sliding dump cannot be pinched. If the opening narrows, the cardia is compressed and enters the sternum.

This condition does not lead to circulatory problems.

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

About half of cases of hiatal hernia are asymptomatic or accompanied by mild clinical manifestations.

A typical sign of a diaphragmatic hernia is pain, which is usually localized in the epigastrium, spreads along the esophagus, or radiates to the interscapular region and back. Sometimes the pain can be tingling in nature, resembling pancreatitis.

Substernal pain (non-coronary cardialgia) is often observed, which can be mistaken for angina pectoris or myocardial infarction. In a third of patients with hiatal hernia, the leading symptom is a heart rhythm disturbance such as extrasystole or paroxysmal tachycardia.

Often these manifestations lead to diagnostic errors and long-term unsuccessful treatment by a cardiologist.

Typically, hiatal hernias are first detected during chest x-rays, x-rays of the esophagus and stomach, or during an endoscopic examination (esophagoscopy, gastroscopy).

To exclude tumors of the esophagus, an endoscopic biopsy of the mucous membrane and a morphological examination of the biopsy specimen are performed. In order to recognize latent bleeding from the gastrointestinal tract, feces are examined for occult blood.

To study the gastrointestinal tract environment, intraesophageal and intragastric pH-metry, gastrocardiomonitoring, and impedance measurements are performed.

With prolonged course of esophagitis, the likelihood of developing esophageal cancer increases.

After surgery, recurrence of hiatal hernia is rare.

Prevention of the formation of a hiatal hernia, first of all, consists of strengthening the abdominal muscles, exercising, treating constipation, and avoiding heavy physical activity. Patients with a diagnosed diaphragmatic hernia are subject to clinical observation by a gastroenterologist.

There are three main types of hiatal hernia.

Sliding (axial) hernia. Occurs in almost 90% of patients. In this case, the cardia lies above the esophageal opening of the diaphragm, and therefore the relationship between the esophagus and the stomach changes, and the closure function of the cardia is sharply disrupted.
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.
Short esophagus. As an independent disease, it is rare and represents a developmental anomaly. Usually occurs in combination with a sliding hernia and is a consequence of spasm, inflammatory changes and scar processes in the wall of the esophagus.

Diagnosis is based on the clinical picture described above and instrumental examination methods. Instrumental examination methods used to diagnose hiatal hernia and endothelial hernia include:

fibrogastroscopy - during which the condition of the mucous membrane of the esophagus, stomach and duodenum is assessed, and prolapse of the gastric mucosa into the esophagus is detected,
X-ray examination of the esophagus and stomach, during which the hiatal hernia itself is revealed, its size, fixation, and the motility of the esophagus and stomach and the presence of reflux of barium suspension into the esophagus are assessed,
and the third study, which helps the surgeon in determining the indications for surgery and choosing the method of surgical correction, is daily pH-metry of the esophagus and stomach, during which the level of gastric secretion and the presence of pathological refluxes from the stomach into the esophagus are determined. The most important criterion for the presence and severity of reflux esophagitis is the total time at which the pH is less than 4 units. Increased number of refluxes lasting more than 5 minutes. and an increase in the duration of the most prolonged reflux indicates a decrease in esophageal clearance and suggests the presence of hypomotor dyskinesia of the esophagus.

If there is no effect from drug therapy for hiatal hernia, surgical treatment is indicated, the essence of which is to restore normal anatomical relationships in the area of the esophagus and stomach.

Forms of the disease

When treating a sliding hernia, they resort to medications, diet, and, if necessary, surgery.

Treatment with medications is aimed at relieving symptoms such as heartburn, vomiting, and pain. To reduce the concentration of acid in gastric juice, medications from the antacid group are prescribed.

In order to reduce the amount of hydrochloric acid produced, proton pump inhibitors are used. To relieve symptoms such as heartburn attacks and belching, Motilium is prescribed.

To relieve painful and spasmodic sensations, they resort to antispasmodics and anesthetics. When the protective properties of the esophageal mucosa are restored, the drug De-nol is prescribed.

If complications develop in the form of bleeding and anemia, drugs containing iron are prescribed, and the question of surgical intervention is also raised.

Factors that lead to the development of diaphragmatic hernias can be divided into predisposing and producing.

Predisposing factors include: congenital or acquired weakness of connective tissue, traumatic damage to the diaphragm, degenerative changes in the musculo-ligamentous apparatus, etc.

Producing (implementing) factors are all conditions associated with increased intra-abdominal pressure: heavy physical labor, heavy lifting, pregnancy, constipation, large meals and regular overeating.

The main complaint is pain. Protrusion of discs (protrusion) with their further prolapse into the lumen of the spinal canal (herniated disc) most often lead to compression of the nerve roots, causing pain along the compressed nerve.

Therefore, pain can “radiate” to the leg, arm, back of the head, neck, intercostal spaces (depending on the nerve being compressed) with a weakening of muscle strength, as well as muscle pain in the areas of their innervation and impaired sensitivity.

Most often, the sciatic nerves suffer from compression due to their anatomical location.

The diagnosis of the disease is made in the presence of the symptoms described above. Such patients need to consult a neurologist.

Depending on location:

external hernia of the stomach - the organ enters from the abdominal cavity into the chest through weak areas of the muscle wall;
internal - the stomach enters the chest from the abdominal cavity through an opening in the diaphragm.

Sliding hernias can be fixed or non-fixed, and depending on the displaced area they are divided into cardiac, cardiofundal, subtotal and total gastric. Paraesophageal hernias, in turn, are classified into antral and fundal.

Often the reason to consult a doctor is symptoms similar to diseases of the gastrointestinal tract, since when a hernia persists for a long time, the contents of the stomach partially enter the esophagus, which destroys its walls.

Symptom 1 – heartburn

This ailment is observed in almost 100% of patients; it occurs precisely due to the entry of aggressive stomach contents into the esophagus. It manifests itself after eating, during physical activity and at night when a person is in a lying position.

The difference can also be observed in the intensity of the manifestation; for some, heartburn does not cause problems, being only an unpleasant feature, while for others it causes intense pain that can interfere with their usual way of life.

Often patients do not pay due attention to this symptom, blaming it on junk food, but if it is observed constantly, you need to consult a specialist to identify the cause.

Symptom 2 – pain

When you go to the doctor with an ailment, he will need to conduct diagnostics to make a diagnosis. A sliding hernia can be detected using an x-ray or endoscopy.

After the doctor has made a diagnosis, he analyzes the extent of the problem. If a medical solution cannot help, an operation to remove the hernia (Nissen fundoplication) is prescribed; otherwise, medications are prescribed to eliminate symptoms and bring stomach acidity back to normal.

To remove the hernia itself, certain recommendations are prescribed, by following which exactly, the patient can quickly get rid of the problem.

A sliding hernia requires adherence to a certain diet. Among its basic rules are the following:

Since ailments occur due to the destruction of the walls of the esophagus by acidic foods, it is necessary to exclude all foods that cause intense production of gastric juice. These include fried, spicy, sweet dishes, etc. Priority should include boiled or steamed food with minimal addition of salt, for example, vegetables, lean meat, cereals.
You should eat several times a day (3-4) in small portions at regular intervals. The last meal should be at least 2 hours before bedtime. You should avoid coffee; you can replace it with herbal tea or decoction.
At least until the sliding hernia completely disappears, you need to give up bad habits - smoking and alcohol. They have a detrimental effect on the functioning of the gastrointestinal tract.

At the very beginning, you need to understand the concepts that will be used in the article. First of all, you need to understand what a gastric hernia is. So, in short, this is a prolapse of the stomach into the chest cavity. In this case, doctors distinguish two types of hernia:

Internal (the abdominal cavity enters the chest through the diaphragm). This disease is also called hiatal hernia.
External (organ exit abdominal cavity, which occurs through weak points in the abdominal wall).

Currently, according to many authors, hiatal hernia is considered one of the most common diseases of the gastrointestinal tract and, in terms of its frequency, among other gastroenterological pathologies, it occupies 2–3 place, competing with such common diseases as peptic ulcer and cholecystitis.

Causes

This pathology is typical for older people. Almost 70% of older people are at risk.

Statistics! A gastric hernia in children cannot be ruled out. Medical data confirms about 9% of cases of pathology development in a child.

The causes of a sliding hiatal hernia are conventionally divided into congenital and acquired. Very often they act together, that is, the preconditions already existing in the body are aggravated by external factors.

Having studied these reasons, it becomes clear that the disease can suddenly overtake anyone. Acquired causes are present to one degree or another in the lives of many people (especially excess weight), but we may not know about congenital ones.

The formation of a hernia can be influenced by both congenital and acquired factors.

Establishing a diagnosis

Most specialists insist on examining the motor ability of the esophagus. Esophagomanometry most directly allows us to establish this diagnosis, as well as the degree of development of the disease.

By recording motility using the balloon method, data is obtained on the state of the pharyngoesophageal (pharyngeal-esophageal) and gastroesophageal (lower esophageal) sphincter.

This allows you to establish their tone, the possibility of relaxation during the swallowing process, the width of certain areas and compliance with their standards. In addition, such an analysis will provide data on whether the chest is healthy, as well as on the condition of individual esophageal areas: their deviation, duration and type of waves during activity, their properties.

Also, to make a diagnosis of “sliding hiatal hernia,” they resort to gastroscopy, radiography with a study of functionality, and measurements of daily pH acidity in the stomach.

The disease is diagnosed after gastroscopy and radiography of the stomach, esophagus and chest. To determine the extent of the tumor and the presence of complications, the patient is referred to:

Determination of atmospheric pressure PH.
Examination of stool for occult blood.
Biopsy of the walls of the examined organs.

All studies are performed after preparation, which the doctor will tell you about.

Diagnostics

1. To diagnose a gastric hernia, first of all, an objective examination is carried out and the patient is asked about his complaints. An anamnesis is being collected.