Sliding hernia of the esophagus symptoms and treatment. Dietary principles of nutrition with a sliding hernia

The esophagus is a connecting tube between the pharynx and the stomach that passes through an opening in the diaphragm. Violations in gastrointestinal tract cause diseases of the esophagus. These include such gastroesophageal reflux disease as sliding axial hernia esophageal opening of the diaphragm (HH).

Feature of the pathology

During the development of the disease, the cardial section of the stomach moves to the sternum through diaphragmatic opening. There are several types of hiatal hernias:

paraesophageal (this type is characterized by the fact that the increase and growth of part of the stomach occurs on the left side of the esophagus);
axial (its main difference is the absence of a hernial sac, which allows it to penetrate into chest cavity and return freely). May be fixed or non-fixed;
combined (in this case, both types of hernia develop - axial and paraesophageal).

The difference between an axial hernia and a paraesophageal hernia is that it can move

What is a hiatal hernia (video)

Classification of HH according to the severity of the disease

Causes of axial hernia

Hernia formation can be influenced by both congenital and acquired factors.

Acquired factors of occurrence	Congenital Factors occurrence
Damage to the phrenic nerve after inflammation or injury causes the diaphragm to relax.	Congenital hernia of the esophageal opening of the diaphragm, resulting from a delayed descent of the stomach into abdominal region. This occurs during the development of the fetus in the womb.
Against the background of an ulcer, cholecystitis, there is a reflex contraction of the walls of the esophagus, which eventually leads to an increase in the circumference of the diaphragm.	The diaphragmatic muscles are not fully developed, which is why the ring of the esophageal opening in the diaphragm is expanded.
Pregnancy, constipation, heavy lifting, smoking and other reasons provoke an increase in intra-abdominal pressure and contribute to the formation of a hernia.	Untimely closure of the diaphragm, after the stomach has descended into the abdominal cavity, leads to a pre-formed hernial sac.
Age involution muscle tissue diaphragm.

Symptoms and signs

At the beginning of the development of the disease, the symptoms almost do not appear, the clinical signs are mild and the hernia does not bother. It can only be discovered by chance, for example, during medical examination ultrasound. visual inspection and palpation will not give results, since the hernia is not palpable to the touch due to its deep location inside the thoracic region. It makes it difficult to recognize an axial hernia and the fact that it has the ability to periodically go back under the diaphragm.

A longer existence of a hernia or slippage of most of the stomach into the sternum provokes the onset of symptoms, so an axial hernia is most often recognized already for more late stages development. Among the main signs that accompany the development of a hernia, the following are distinguished:

periodic nature (usually occurs after eating and in the supine position);
burning and pain behind the sternum;
exacerbation of bronchitis, tracheitis (pancreatic juice enters Airways during burping);
regurgitation (the flow of food from the stomach into the esophagus and oral cavity without vomiting);
belching;
dysphagia (a person cannot swallow as a result of cicatricial narrowing of the esophagus, which occurs due to constant inflammation of its mucosa with acid emissions).

If the disease was not detected in time, then it further development can lead to serious complications. It can be ulcers and bleeding on their background. Periodic bleeding, in turn, can lead to anemia (anemia). At the slightest hint of the development of a hernia, you should not delay the examination and subsequent treatment.

Diagnosis of a sliding hernia of the esophagus

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

Treatment

conservative

On early stages surgery is rare. Most often, the doctor prescribes medication and a diet that involves exclusion from the diet:

fatty (meat - pork, cakes, cream-based cakes with a high fat content, etc.);
spicy (spicy seasonings, onion, garlic, black and red pepper);
smoked (sausage, meat, fish, chicken products);
fried (meat, potatoes, eggs, etc.);
salty (cucumbers, tomatoes, sauerkraut And so on);
carbonated drinks (lemonade, mineral water);
coffee, strong tea.

It is necessary to eat food in small portions (no more than 200 g at one time) 5-6 times a day. The stomach needs to be given time to process food and rest, so you should not take snacks, as they provoke the production a large number gastric juice, which leads to heartburn.

You should not physically overstrain - it creates intra-abdominal pressure and provokes an increase in hernia. The number and intensity of loads should be kept to a minimum.

For occasional heartburn, it is best to sleep reclining on high pillows or raise the head of the bed if possible.

Foods to be excluded from the diet (photo gallery)

Coffee and tea
Carbonated drinks
salty foods Smoked products spicy seasonings Fatty food

Surgical intervention

When the disease is diagnosed at later stages, the hernia is removed using surgical intervention. Most frequent methods getting rid of sliding hernia are:

laparoscopy;
Tope plastic.

During a Nissen fundoplication, the gastric fundus is wrapped around the lower esophagus.

Alternative medicine

The main aggravating symptom in the course of the disease is heartburn. You can fix it with folk methods. Herbal decoctions or teas are best suited for this:

gentian tea will help not only eliminate heartburn and inflammation of the esophagus, but also improve digestion. A teaspoon of gentian is placed in one glass of water and infused over low heat for about 30 minutes. For taste, you can sprinkle with ginger and let stand for about 10 minutes. No need to stir. The remedy is taken before meals three times a day;
calendula and chamomile have anti-inflammatory effects. Tea from these herbs will relieve inflammation of the esophagus and soothe the stomach. Half a teaspoon of chamomile and calendula is placed in a glass of boiling water. It is necessary to insist at least 20 minutes. After the resulting infusion is filtered and taken in a glass 3-4 times a day. During the period of exacerbation of heartburn, you can take more often.
decoction of herbs for heartburn. A tablespoon of the collection is infused in 0.5 liters of boiling water for about 2-30 minutes. Strained infusion is taken 15-20 minutes before meals. You need to mix:
- young nettle;
- lemon balm;
- oregano;
- plantain;
- St. John's wort.
flaxseed soothes the stomach, reduces the acidity of its contents, relieves inflammation of the esophagus and heals the digestive system. A teaspoon of seeds is infused in a glass hot water(no need to cook) 30-40 minutes. You can wrap it in a towel to keep warm. The infusion is filtered and taken shortly before meals. You can also add linseed oil in food, but not more than 3 tablespoons per day.

Folk remedies for the treatment of illness (gallery)

Melissa infusion calendula tea Chamomile tea Gentian infusion Infusion of calendula

Diet after surgery

Compliance with the postoperative diet is necessary to reduce the degree of stress on the gastrointestinal tract. It will help to achieve this fractional nutrition and the exclusion from it of products that provoke gas formation, contribute to constipation, etc.

What foods should not be consumed after surgery?

From the diet should be excluded:

flour pastry (cookies, pies, cake, pancakes, pancakes, etc.);
bran bread;
fatty, smoked, salty, spicy, fried;
legumes (peas, beans, etc.);
citrus;
tomatoes, cabbage, broccoli, carrots, garlic, onions;
radish, turnip, radish;
corn, millet, barley porridge;
eggs;
dairy products with a high percentage of fat;
nuts, seeds, raisins, dried apricots, prunes;
carbonated drinks, coffee, strong tea, juices with high concentration acids.

Products prohibited for consumption after surgery (gallery)

Carbonated drinks Dried fruits Legumes
flour products Dairy products with a high percentage of fat

What foods can be consumed after surgery?

After surgery, it is best to use:

low-fat broths;
vegetable soups;
boiled lean meat or fish;
cottage cheese (low-fat);
liquid cereals;
dried White bread in a small amount;
jelly (it is advisable to prepare it not from braces containing dyes, but from fresh berries).

Use vegetable fiber allows you to restore the work of the digestive tract, but overuse vegetables can lead to stagnation of coarse fiber and the formation of feces in the intestines.

Products approved for use in the postoperative period (gallery)

Berry kissel Gruel boiled fish Low fat broth boiled meat

The best way to prevent hiatal hernia is to healthy lifestyle life. Abuse of alcohol and cigarettes, malnutrition and lack sports loads on the body entails the development of multiple diseases of the digestive system, including axial hernia. At the first signs of the disease, you need to seek medical advice and undergo full examination bodies abdominal cavity. A neglected disease leads to more serious complications, including death.

A sliding hernia of the esophageal opening of the diaphragm is characterized by the free movement of the abdominal organs into the chest and back. This phenomenon occurs due to the 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 clinic largely depends on the severity pathological process.

The main symptom of a sliding hernia is dyspepsia. The patient has frequent heartburn, belching of sour contents, 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 the pathological movement of the abdominal organs through the esophagus into the chest. This condition is not dangerous, and practically does not affect the quality of life, unless the patient adequately assesses the potential risk and takes measures to prevent complications.

General characteristics of a sliding HH

Sliding hernia of the esophagus is mostly asymptomatic, which complicates the diagnosis. 75% of patients have no symptoms and treatment because for a long time not carried out. Ignoring the problem leads to the fact that the hernia progresses, and more and more of the stomach penetrates through the diaphragm.

The main cause of the disease is muscle weakness.

But one factor alone is not enough for the appearance of the disease. The combination of the pathology of the musculoskeletal apparatus with an increase in intra-abdominal pressure since more likely lead to hiatal hernia.

Violation of the function of the slipped organ does not occur immediately. The consequences of pathology occur as the disease progresses. Uncomplicated sliding hernia of the esophagus of the first and second degree requires only diet food and taking medications. At the third stage is already being selected specific treatment. Axial hiatal hernia of the fourth degree will require surgical treatment to restore the anatomy of the abdominal organs.

Etiology of the disease

Causes of hiatal hernia:

Congenital developmental anomalies. This applies to the period of lowering the stomach into the abdominal cavity. The process may be disturbed, which will cause the appearance of congenital diaphragmatic hernia. This disease requires surgical operation as soon as possible, otherwise there is a risk of death within a few days after birth. Hiatal hernia in newborns can be removed on the first day, but the operation during pregnancy will be even more effective, then the prognosis is more favorable if only the child undergoes normal rehabilitation in a specialized center.
Underdevelopment of the muscles of the diaphragm. This phenomenon is associated with the physiological aging of the body, therefore it is almost impossible to avoid such a factor. This phenomenon can only be prevented by general prevention pathologies of the musculoskeletal system, which includes physiotherapy exercises, diet food, exclusion of bad habits.
Increased intra-abdominal pressure. This factor is associated with frequent constipation, bloating, overeating, overweight, the period of pregnancy. You can avoid this if you treat gastrointestinal pathologies in a timely manner, cope with excess weight, and use a special support belt during pregnancy.

Clinical manifestations of pathology will depend on the stage of formation of diaphragmatic hernia. At 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, the cardia of the stomach is mixed, which is located at the level of the diaphragm. In the third stage, the body of the stomach is located above the diaphragm.

On last step the formation of a hernia in the chest area is a large part of the stomach or the entire organ. In this case, it is necessary to treat the disease not only conservative methods but also by surgery.

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

How HH manifests itself

Main clinical manifestations sliding diaphragmatic hernia:

dyspepsia. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient takes horizontal position after filling the stomach. Such manifestations may occur without apparent reason, for example, at night and in the morning.
Dysphagia or difficulty swallowing. Such a phenomenon with a hernia of the esophagus will be more psychological, because while swallowing food, the patient may feel discomfort and pain associated with inflammation of the esophagus, which causes a fear of repetition. discomfort. From this, food intake begins to be accompanied by a lack of swallowing reflex. The patient switches to the use of exclusively liquid and semi-liquid food. This, in turn, leads to weight loss. In this regard, the patient is shown a therapeutic diet.
Frequent pathologies respiratory system . bronchitis, aspiration pneumonia appear as a result of particles of poorly chewed food entering the respiratory tract. It threatens purulent inflammation mild and chronic respiratory diseases that only exacerbate and so serious condition sick.
Regulation. This phenomenon is associated with the reverse reflux of the contents of the stomach into the oral cavity. Prolonged exposure to gastric acid leads to dental diseases. A patient with a hernia of the esophagus faces hypersensitivity enamel, papillitis, various stomatitis and gingivitis. Treatment local problem in the oral cavity does not lead to positive results, and until the main problem is eliminated, dental pathologies will only progress, and constant irritation of the mucous membrane may end precancerous conditions and even oncology.

Diagnosis of a hernia of the esophageal opening is carried out by endoscopic examination.

Additionally, the patient is given lab tests to detect or exclude the inflammatory process. Esophagogastroduodenoscopy is also shown, that is, a study of the state of the gastric mucosa. The introduction of the probe will not be the most pleasant procedure for the patient, but only in this way can many associated problems, with which you need to fight in parallel.

Principles of treatment

With a hernia of the esophageal opening, it will be extremely important to comply with dietary nutrition, which should become part of not only treatment in acute period but also the prevention of complications and recurrence throughout life. Additional measures there will be classes therapeutic gymnastics swimming, taking medicines.

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

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

In order to eliminate reflux without surgery, the following means are used:

Antacids. Shown to decline negative impact acidic contents on the walls of the esophagus.
Enveloping. They are used to eliminate irritation of the mucous membrane of the stomach and esophagus.
Antispasmodic drugs. Prescribed by a doctor when sliding diaphragmatic hernia accompanies peptic ulcer of the stomach and duodenum.
De-Nol. Indicated for inflammatory peptic ulcer mucous membrane of the stomach and esophagus.
Motilium. It is prescribed to improve the processes of digestion.
Inhibitors proton pump . Inhibit synthesis of hydrochloric acid, thereby reducing its irritating effect on the walls of the esophagus and stomach.

Surgical treatment of a sliding hernia of the esophageal opening of the diaphragm is prescribed by the attending physician in the case when the organs in the diaphragm area are infringed.

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

Hernias of the esophageal opening are congenital and acquired, among which sliding ones are distinguished into a separate group. With this type of hernia, the upper part of the stomach moves above the diaphragm, thus participating in the formation of a hernial sac. Sliding hernias are also classified into fixed and non-fixed. In addition, the congenital and acquired short esophagus are separated separately.

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

clinical picture.

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

Patients complain of emerging pain behind the sternum, in the epigastrium, in the hypochondrium of a burning or dull nature. Often there is irradiation of pain in the shoulder blade, left shoulder. This clinical symptoms similar to the manifestations of angina, so these patients long time may be mistakenly observed by cardiologists for angina pectoris.

When tilting the body, with a change in position to horizontal, as well as when physical activity pain intensifies. The pain is accompanied by regurgitation, belching, heartburn. Subsequently, patients develop dysphagia - difficulty swallowing. Occult bleeding is possible, manifested in the form of bloody vomiting of the color of coffee grounds or scarlet, as well as dark-colored stools. The source of bleeding are ulcers and erosion of the esophagus. In this case, the only sign indicating hidden bleeding is anemia.

Diagnostics.

X-rays are used to confirm the diagnosis endoscopic method(fibrogastroduadenoscopy). When carrying out these methods, a shortening of the esophagus, damage to the folds of the mucous membrane, the flow of the esophagus into the stomach on high level, expansion of the esophagus.

Treatment.

If sliding hernias of the esophagus are not complicated, then conservative treatment. This treatment includes proton pump inhibitors (omeprozole), antacids (almagel), prokinetics (dommperidone, ranitidine).

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

Prevention includes following a diet and taking drugs that normalize the acidity of gastric juice. The diet for diaphragmatic hernia largely has general principles.

Sliding hernia of the esophageal opening of the diaphragm is up to 90% of all. Main danger pathological condition- chronic acid reflux, leading to malignant degeneration of the esophageal mucosa. The quality of life of a patient with esophageal hernia is complicated by debilitating heartburn. radical treatment Maybe operational method. Conservative therapy signifies lifelong acceptance of heartburn remedies.

What is a "sliding hiatal hernia"

Sliding hernia of the esophageal part of the diaphragm is a weakening of the ligaments, tendons, muscles of the diaphragm and esophagus, which has chronic course and appears with age. Between the sternum and the abdominal cavity there is a separator in the form of a mobile, strong, muscular partition - the diaphragm. The opening through which the esophageal tube passes is formed by a small (4 cm in diameter) lumen between the strands of the diaphragmatic muscles. In Latin it is called hiatus oesophagus. Therefore, a sliding hernia is also referred to as a hiatal hernia.

When for some reason the esophageal opening expands, and the ligaments that support the stomach and esophagus weaken, it “falls out” into the enlarged lumen Bottom part esophagus, cardiac sphincter, part of the stomach. Thus, an axial hernia (it is also sliding) is observed if part of the gastrointestinal tract slides freely from the abdominal cavity into the chest.

The movement of the hernial protrusion can occur "back and forth" when the patient changes his position - bending, jumping. Such an esophageal non-fixed hernia esophageal opening of the diaphragm is called floating, wandering. It happens that the organs that have slipped into the chest cavity are tightly fixed in the diaphragmatic zone. It turns out a fixed hernia of the esophageal opening of the diaphragm. This rare type of hernia leads to complications in the form of strangulation and persistent symptoms of gastrointestinal upset.

If there is a pathological protrusion of the cardiac part of the stomach, then a cardiac hernia is obtained. The expulsion is facilitated by the difference in pressure within the cavities. The higher it is in the abdominal cavity, the more the stomach and esophagus protrude into the chest cavity through the enlarged esophageal opening.

Degrees of sliding hernias

According to how far the abdominal organs have advanced into the chest, there are 3 degrees of axial-hiatal hernias:

A grade 1 axial sliding hernia occurs when only the abdominal portion of the esophagus falls through the esophagus. The cardiac sphincter is located at the level of the diaphragm. The stomach with axial esophageal hernia of the 1st degree remains in its natural place. It rises and presses against the diaphragm.
Hiatal hernia of the esophagus of the 2nd degree is characterized by penetration into the chest cavity of the abdominal part of the esophagus,. The fundus of the stomach in the second stage rises to the diaphragmatic level.
Sliding HH 3 degrees differs in the position of the abdominal segment of the esophagus, cardia and most of the stomach above the membrane of the diaphragm. In especially severe cases of axial displacement, even the antrum of the stomach and loops of the small intestine “fall through”.

Sliding hernias are caused by age-related degeneration connective tissue or as a result of trauma. The size of the hernia affects the extent and severity of the symptoms.

Symptoms of a sliding hernia

The symptomatology of the manifestations of the disease depends on the anatomical parameters of the anomaly, concomitant diseases, age of the patient. HFHD of the 1st degree is almost asymptomatic, periodically manifesting itself as heartburn, belching. A deviation is detected by chance, for example, on x-ray about the heart or lungs.

Axial hernia of the esophageal opening of the diaphragm lets you know about its presence with such signs:

a third of patients develop abnormalities heart rate, soreness in the region of the heart;
pain from the epigastric region rises up the esophagus, can be given to the back between the shoulder blades. Girdle pain similar to pancreatitis is less common;
dull, moderate pain after eating, lifting weights, bending over, exercising;
due to incomplete closure of the cardia, the patient feels heartburn. aggravated by bending over, lying down, after eating and drinking heavily. Complicated by disease of the esophagus - esophagitis;
sour belching and regurgitation (regurgitation) that appear when lying down;
during sleep, the pillow gets wet due to increased salivation;
difficulty swallowing and passing food;
with a fixed hernia, circulatory disorders, stagnation of food in the stomach are possible;
frequent acid reflux, stagnation of food leads to inflammation of the gastric mucosa - gastritis;
the progression of the disease is manifested by ulcers and erosions of the stomach. If the vessels are affected, bleeding and anemia occur;
hiccups due to irritation of the diaphragm by a hernia.

When the patient likes to have a hearty supper before going to bed, the nightly eructation of fragments of food enters the nose. A person wakes up from a suffocating cough, breath holding - apnea.

Causes of sliding hernias

Axial hernia of the esophagus has a congenital or acquired etiology. Congenital factors - embryonic developmental disorders of the diaphragm. Identification of a wandering hernia of the esophagus in a newborn is an indication for urgent surgery. The condition of the baby raises serious concerns for his later life. You can consider the abnormal formation of the diaphragmatic muscle even on prenatal ultrasound.

A sliding hiatal hernia in an adult is acquired due to a number of reasons:

people over 60, especially women, experience age-related weakening of the tone of the muscle and tendon ligaments that hold the esophagus, stomach, and diaphragm. The esophageal opening of the diaphragm expands, and the organs of the gastrointestinal tract, deprived of support, rush into the cavity with relatively low pressure;
the difference in pressure in the cavities contributes to the bulging of the esophagus and stomach. Abdominal pressure rises from persistent bowel blockage stool, rotting and fermenting food with increased secretion gases;
the formation of a floating hernia of the esophagus provokes neoplasms of the esophagus, stomach and intestines, blocking the lumen of the organ. Obstruction can also occur due to low tone smooth muscle, damage to the nerve trunks responsible for the digestive tract;
diseases of the respiratory system, accompanied by a long strong cough, weaken the diaphragmatic ligaments;
sports activities related to weight lifting (weightlifting, powerlifting), training abdominal muscles as well as physically strenuous work;
excess weight creates increased intra-abdominal pressure, almost 20% of pregnant women "earn" axial hiatal hernia of varying degrees;
inflammatory chronic processes the esophagus, stomach, intestines, liver, gallbladder, pancreas are risk factors for hernia.

Adults have congenital weakness of the connective tissue due to hereditary mutation genes.

Such patients are distinguished by asthenic physique, poor adaptation to physical and mental stress, and increased nervous excitability. Rib cage funnel-shaped or keeled, the spine is deformed (scoliosis, kyphosis, lordosis). signs genetic abnormalities are clearly manifested from the age of 10 and reach their maximum development by the age of 15.

Diagnostics of the esophageal hernia

Methods for diagnosing a sliding hernia of the esophagus consist of taking an anamnesis, establishing a complete clinical picture, instrumental and hardware examination:

X-ray examination with barium sulfate is carried out in a horizontal, vertical, lateral position of the patient. Optimal diagnosis with contrast enhancement is performed in the Trendelenburg position. To do this, the patient raises the pelvis by 40 ° in relation to the head. If the stomach falls into the chest cavity, barium sulfate well defines the contours of the hernial protrusion. Such a study is contraindicated in the presence of pus, blood in the abdominal cavity, tumors of the gastrointestinal tract;
fibrogastroduodenoscopy allows you to assess the condition of the gastric mucosa, esophagus, duodenum 12. Hyperemia, edema, ulceration, erosion are revealed. The closing ability is determined;
pH-metry finds out the degree acid reflux. It is carried out in two ways. In the first method, the probe is inserted into the stomach and gradually removed. Acidity value is set different departments esophagus and stomach. The second method is daily pH-metry. Lasts from several hours to several days. A thin probe is inserted through the nose and does not interfere ordinary life person.

Distinguish sliding esophageal hernia from cardiovascular and pulmonological diseases, pancreatitis, cholecystitis, cholelithiasis.

Treatment of a sliding hernia of the esophagus

Therapeutic treatment

Non-surgical treatment consists of strict diet and lifelong medications that reduce stomach acid, improve motility, relieve spasms, and sedatives. Dietary restrictions apply to chocolate, citrus fruits, tomatoes, onions, garlic, mint. It is necessary to exclude sweet carbonated drinks, kvass, beer, champagne, strong coffee and tea. Prescribe drugs of the omeprazole group, antacids containing aluminum and magnesium, digestive enzymes.

Therapeutic conservative tactics has significant drawbacks. long-term use PPI (Omez, Losek, Pariet, Nexium) increases the risk of complications in the form of intestinal and gastric, gastropathy, malignant lesions of the digestive tract.

Surgery

cure sliding HH can only operational way. Approaches to surgical elimination of the problem are determined individually. The choice of treatment method depends on the size of the hernial sac and hernial ring, the presence of infringement, bleeding, erosion.

In the arsenal of surgeons, the classic Nissen fundoplication, modified by Toupet, and crurorrhaphy - reduction of the esophageal opening of the diaphragm to natural parameters.

Fundoplication according to Nissen

The canonical operation is performed by open access or laparoscopy, depending on the size of the hernia and the hiatus. The stomach is returned to its normal position. The fundus of the stomach is wrapped around the lower part of the esophagus for a full turn and secured with a suture. After the operation, a tight sleeve in place of the cardiac sphincter prevents the natural manifestations of the body - belching, vomiting. It prevents a person from living fully.

Operation on Tupa

The modified Tupe operation involves only 180-270° rotation of the stomach around the esophagus. The anterior right surface of the esophagus remains free. The duration of the operation is 2-3 hours, access is open or through five punctures abdominal wall. A cuff about 4 cm long is formed. The normal connection between the esophagus and stomach is restored. An anti-reflux barrier is created that prevents irritation of the esophagus by acidic gastric contents.

This is the name of the operation to suture the esophageal opening of the diaphragm. Crurorrhaphy supplements the fundoplication and prevents the development of recurrent prolapse. The Allison technique is the most popular. Access is on the left, between 7-8 ribs. The legs of the diaphragm are sutured together with 3-5 interrupted sutures. At the end of the operation, a drainage tube is installed to remove wound exudate.

Sliding hiatal hernia can be congenital or acquired with age. The main symptoms are persistent heartburn, sour belching, chest pain. Diagnosed by X-ray contrast agent. Treatment consists of taking acid neutralizers or performing an operation to restore the normal topography, physiology and anatomy of organs.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and conducts treatment. Study Group Expert inflammatory diseases. Author of more than 300 scientific papers.

Sliding hernia of the esophagus is one of the most common pathologies of the esophageal opening of the diaphragm and is characterized by certain features, unlike other hernias. In some cases, it occurs without any symptoms and is diagnosed only after the study.

Sometimes the problem may be accompanied unpleasant signs that impair the patient's quality of life and lead to grave consequences.

This article will discuss why the disease occurs and what methods are used to treat it.

What is pathology

Sliding hernia of the esophagus is a pathological condition in chronic form, in which the abdominal part of the organ (stomach and lower part of the esophagus) is displaced through the diaphragmatic opening into the sternum cavity, and are not located in the abdominal cavity.

In some cases, there is no hernial sac. The cardial part of the stomach or loops of the small intestine can also be displaced.

Reasons for the appearance

Experts say that congenital and acquired factors influence the occurrence of a hernia.

TO congenital causes development of a hernia include:

the formation of a hernial sac as a result of improper closure of the diaphragm;
slow lowering of the stomach during fetal development;
underdeveloped diaphragmatic crura.

Among the factors in the development of a hernia, experts distinguish those in which pressure in the abdominal cavity increases:

excessive body weight;
strong physical activity;
hereditary factor;
malnutrition;
stressful situations;
bad habits;
chronic constipation;
the period of bearing a child;
strong and prolonged cough.

Cholecystitis, reflux esophagitis and stomach ulcers are also common causes the occurrence of this pathological condition, since in these diseases reflex contractions of the esophagus occur.

People are at risk old age and women, especially pregnant women.

Symptoms of the disease

Most often, the pathology does not have clinical signs and is asymptomatic, therefore it is detected only with certain diagnostic methods.

It is difficult to visually determine the problem, since the protrusion is not formed under the skin, but is directed towards the chest cavity.

However, experts define the following symptoms pathology in big size hernia:

burning sensation in the pit of the stomach and behind the chest;
heartburn, manifested after eating and in a supine position;
reflux of stomach contents into the esophagus and pharynx;
belching
shortness of breath
increased salivation;
soreness in the epigastric zone;
feeling of a lump in the throat;
impaired swallowing function (so-called dysphagia).

In addition, due to belching and penetration of the contents of the stomach into the respiratory system, the patient often suffers from tracheitis and bronchitis.

In some cases, the disease is accompanied by an increase in blood pressure.

Disease classification

Sliding hernia of the esophageal opening of the diaphragm is of two types:

fixed (its location does not change when the patient's postures change);
non-fixed (the localization of the hernia changes when the position of the body changes).

Specialists define such types of hernia with a shortened esophageal opening depending on the cause of development:

acquired;
congenital.

Given the localization of the hernia, the following types are distinguished:

cardiac;

There are several degrees of hernia:

At grade 1, it penetrates into the chest cavity only lower section esophagus. Usually such a deviation is asymptomatic and is treated with medication and diet.
At 2 degrees, not only the esophagus, but also parts of the stomach are localized in the sternum. Are starting to show various signs illness.
Grade 3 is characterized by the location of the esophageal tube in the sternum and upper division stomach. The symptoms are pronounced.

The third degree of pathology requires surgical intervention.

Diagnostic methods

When the patient complains, the specialist necessarily collects an anamnesis and examines the patient.

After that, they are assigned laboratory methods diagnostics:

blood test (general);
urine test.

A hernia can be detected using fluoroscopy. A gastroscopic examination is also carried out.

In some cases, they may be assigned additional methods diagnostics and consultation of several specialists.

Treatment of pathology

Treatment of the disease should be comprehensive.

The main methods of therapy for a small hernia without complications are:

the use of medicines;
diet;
alternative therapies;
establishing a healthy lifestyle.

At large sizes hernia and the occurrence of complications against the background of pathology, surgical intervention may be required.

Medical treatment

The pathology usually responds well drug treatment.

Therapy includes the use following groups medicines:

Hydrochloric acid synthesis inhibitors. Most often use Omez or Omeprazole.
Antacids to reduce acidity. Maalox, Phosphalugel, Gastal are prescribed.
Medicines for relieving spasms and soreness: Drotaverine, Papaverine, No-shpa.

Recovery protective functions the mucous membrane of the organ, the drug De-nol is used. You can eliminate belching and heartburn with Motilium.

Only a qualified specialist should prescribe medications, their dosage and duration of use.

Folk remedies

How helper method can be used folk ways treatment.

These include internal use:

decoction of gooseberries (three times a day before meals);
potato juice;
chamomile tea;
mint decoction;
carrot juice;
infusion of flaxseeds;
decoction from the collection of mint, coltsfoot, marshmallow rhizomes with the addition of propolis;
kefir with olive oil.

More often folk remedies are used to get rid of certain symptoms: eliminate heartburn, soreness and spasms, belching.

Surgery

Indications for surgery are the following factors:

large size of the protrusion;
the presence of complications;
the occurrence of bleeding;
failure of conservative therapy.

Removal of a hernia in medicine is called a Nissen fundoplication. When it is carried out, a special cuff is installed around the organ, which will prevent the entry of gastric contents into the esophagus.

Surgery is performed laparoscopically.

Exercises

In case of illness, experts also advise performing the following exercises that help eliminate a hernia:

In the supine position, make turns left and right.
Lie on your back, bend your knees, and put your hands behind your head. Alternately touch the left elbow to the right knee and vice versa.
Lie on your back, take a deep breath and hold your breath for a few seconds. Exhale slowly slowly.
Get on your knees, put your palms on the floor. Gently lower the body down, sliding the palms along the floor.
Sit down, tilt your body forward a little. Place your palms under your ribs. Inhale as you move your fingers deeper. When exhaling, strain your palms in the other direction.
Lie on your side, raise your head, putting your hand under it. When inhaling, protrude the stomach, while exhaling, relax.

Health food

With pathology, proper nutrition is considered an obligatory component of treatment.

The following foods should be excluded from the diet:

spices and seasonings;
pickles;
marinades;
canned food;
smoked meats;
semi-finished products;
fast food;
meat and fish of fatty varieties;
fried foods.

Useful products for pathology are:

lean meat;
soups;
weak broths;
cereals from different cereals;
milk;
vegetables;
milk;
dairy products;
greenery;
fruits;
fruit drinks, compotes;
vegetable and fruit juices.

It is also important to adjust the diet. The patient is advised to eat small meals. However, the frequency of administration should be increased to six times a day. Do not eat before bed. After eating, at least two hours should pass.

Dishes should be boiled, baked in the oven or steamed. In case of impaired swallowing function, it is recommended to eat mashed food.

Complications of pathology and prognosis

If the disease progresses and is not treated, serious complications usually develop.

These severe consequences include:

esophagitis ( inflammatory process esophageal mucosa);
the formation of ulcers and erosions on the mucosa of the organ;
fibrous stenosis;
aspiration pneumonia;
oncological processes;
bleeding of the esophagus.

Because of frequent bleeding the patient is anemic.

If the treatment of pathology is timely, then the likelihood of complications is reduced several times.

Usually, with the treatment provided, the prognosis is favorable and does not affect the patient's life expectancy.

A sliding hernia is a pathology in which the stomach and lower esophagus begin to shift into the sternum. Usually, with an uncomplicated and uncomplicated form, the disease is amenable to drug treatment. However, in some cases, surgery may be used.