Gpod erosive gastritis. Laparoscopic method according to Nissen

The diaphragm is large and vastus muscle, separating the chest cavity from the abdominal cavity. It is, as it were, “stretched” between the sternum, ribs and lumbar vertebrae, to which it is attached. The formation of a hiatal hernia occurs due to its weakening, as a result of which parts of the lower organs penetrate into the upper (thoracic) cavity.

In most cases, small hernias hiatus diaphragms do not cause problems. If the hernia is large, stomach contents back up into the esophagus, causing heartburn, belching, dysphagia and chest pain.

Causes

A hiatal hernia (abbreviated as hiatal hernia) is diagnosed in approximately 5% of adults. More than half of the cases occur in elderly age– over 55 years of age, which is due to age-related changes – in particular, the natural process of weakening ligamentous apparatus.

Most often, a diaphragmatic hernia develops due to the fact that the tissues whose task is to limit the esophageal opening of the diaphragm become much more elastic than necessary. Many people don’t even know that such a hernia is possible. Meanwhile, this is a fairly serious problem that requires qualified medical care.

Causes:

Abdominal and chest injuries;
Promotion intra-abdominal pressure;
Seizures prolonged cough(asthma, chronic bronchitis);
Diseases connective tissue: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
Asthenic physique;

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 already at an early age.

Those at risk include those who have the following diseases:

Phlebeurysm
Obesity.

Impaired motility also predisposes to the development of a hiatal hernia. digestive tract with hypermotor dyskinesias of the esophagus accompanying peptic ulcer disease duodenum and stomach, chronic gastroduodenitis, chronic pancreatitis, calculous cholecystitis.

Symptoms of a hiatal hernia

The hiatus is chronic illness, affecting the digestive system, which is in 3rd place among other diseases, such as the duodenum and chronic cholecystitis. A hiatal hernia is a condition in which the stomach slides upward toward the esophagus.

Symptoms of hiatal hernia:

sign diaphragmatic hernia serves as a pain syndrome, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
chest pain can lead the patient to a cardiologist by mistake in diagnosis;
pain may occur after eating or physical stress, with intestinal and after a deep breath;
heartburn, burning in the throat, hiccups, attacks of nausea, vomiting, hoarseness;
cyanosis, vomiting with blood indicate strangulated hernia;
in some cases, blood pressure may increase.
are celebrated at night severe attacks cough accompanied by suffocation, increased salivation.

The causes of pain with a hernia of the diaphragm are compression of the nerves and vessels of the stomach when its cardiac part enters the chest cavity, the effect of the acidic contents of the intestines and stomach on the esophageal mucosa and stretching of its walls.

Pain from a hiatal hernia can be differentiated based on the following symptoms:

pain appears mainly after eating, physical activity, horizontal position, with increased gas formation;
they soften or disappear after a deep breath, belching, drinking water, changing posture;
the pain intensifies as a result of bending forward.
Sometimes the pain can be tingling in nature, resembling pancreatitis.

Typical symptoms of a hiatal hernia also include:

hiccups;
heartburn;
pain in the tongue, burning sensation;
the appearance of hoarseness.

you feel nauseous
you were vomiting
you cannot have a bowel movement or pass gas.

Types of hiatal hernia

There are the following main types of hernias: sliding food hernia (axinal) and fixed (paraesophageal) hernia.

Sliding (axial) hernia

An axial hiatal hernia is a protrusion of organs located below the diaphragm through a natural opening. In the vast majority of cases (approximately 90%) hiatal hernias are axial, or sliding.

With a sliding (axial, axial) hernia, there is free penetration of the abdominal part of the esophagus, cardia and fundus of the stomach through the esophageal opening of the diaphragm into the chest cavity and independent return (when changing body position) back into the abdominal cavity.

An axial hiatal hernia begins to develop with reduced elasticity of muscle connective tissues and weakening of their ligaments. Depending on the area being displaced, they can be cardiac, cardiofundal, subtotal or total gastric.

For axial hernia under the esophagus there are different etiologies. The following etiological factors are distinguished:

Dysfunction of the digestive system
Weakness of the ligaments and other connective tissue elements
High blood pressure abdominal cavity
Availability chronic pathology stomach, liver Diseases of the respiratory tract, accompanied by intense cough.

Among all diseases of the digestive system this pathology is in third place, representing serious “competition” to such pathological conditions as gastric ulcer and.

Fixed hiatal hernia

Fixed (paraesophageal) hiatal hernia is not that common. In this case, part of the stomach is pushed out through the diaphragm and remains there. As a rule, such hernias are not considered a serious disease. However, there is a risk that blood flow to the stomach may be blocked, which could lead to serious damage and needs urgent medical attention.

Patients with a fixed hernia may experience a symptom such as belching. It appears as a result of air entering the esophagus. Sometimes it gets there mixed with bile or gastric juice. In this case, the belching will have a characteristic taste and smell.

Quite often, patients with paraesophageal hernia complain of intense pain in the heart area. This is not surprising, because that pain in thoracic region the pain they feel actually mimics the heart.

Degrees of hiatal hernia

It is important to remember that early diagnosis of the disease will help to avoid complications, and treatment will be more effective. In the first stages, you can do without surgery.

At the first, most mild degree, a section of the esophagus rises into the chest cavity, which is normally located in the abdominal cavity (abdominal). The size of the hole does not allow the stomach to rise up, it remains in place;
In the second degree, the abdominal part of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of the esophageal opening of the diaphragm;
Stage 3 hiatal hernia - a significant part of the stomach, sometimes up to its pylorus, which passes into the duodenum, moves into the chest cavity.

Complications

Complications that may occur with hiatal hernia:

A hiatal hernia may be complicated by the development of gastrointestinal bleeding. The causes of bleeding are peptic ulcers, erosions of the esophagus and stomach.
Another possibility, but rare complication hiatal hernia is its strangulation and perforation of the stomach wall.
Anemia is a common complication of hiatal hernia.
is a natural and frequent complication of hiatal hernia.

Other complications of a hiatal hernia—retrograde prolapse of the gastric mucosa into the esophagus, intussusception of the esophagus into the hernial part—are rare and are diagnosed by fluoroscopy and endoscopy of the esophagus and stomach.

It is quite obvious that in the listed situations of complications of hiatal hernia, the central goal is to treat the underlying disease.

Diagnostics

To make a diagnosis of a hiatal hernia, you need to describe your complaints to the doctor in detail and undergo a series of examinations. Since this disease is sometimes asymptomatic, a hernia can be detected during a random examination for other complaints.

The diagnosis of hiatal hernia is made on the basis of specific complaints and data instrumental methods research.

These include X-ray examination with contrast, endoscopic examination and manometry, which allows you to measure pressure in different parts of the esophagus.
Additionally prescribed general analysis blood to exclude potential complication hernia - gastrointestinal bleeding.
When, in addition to a diaphragmatic hernia, the patient has cholelithiasis, he needs to undergo ultrasound examination abdominal cavity.
Since a diaphragmatic hernia is often accompanied by symptoms similar to those of heart disease, an additional electrocardiogram will have to be done.

In any case, studies are prescribed individually, taking into account the characteristics of the patient’s body and the collected medical history.

Treatment of hiatal hernia: drugs and surgery

Treatment of diaphragmatic hernia begins with conservative measures. Since in the clinic of hiatal hernia the symptoms of gastroesophageal reflux come to the fore, conservative treatment is aimed mainly at eliminating them.

Based pathogenetic mechanisms And clinical symptoms esophageal opening of the diaphragm, we can formulate the following main tasks of its conservative treatment:

reduction of the aggressive properties of gastric juice and, above all, the content of hydrochloric acid:
prevention and limitation of gastroesophageal reflux;
local medicinal effect on the inflamed mucous membrane of the esophagus, hernial part of the stomach,
reduction or elimination of esophageal and gastric:
prevention and limitation of trauma in the hernial orifice of the abdominal segment of the esophagus and the prolapsing part of the stomach.

Drugs for hiatal hernia

Your doctor may prescribe the following medications for you:

antacids to neutralize stomach acid
H2 blockers histamine receptors which reduce acid production
inhibitors proton pump(PPI) - antisecretory medications for the treatment of acid-dependent stomach diseases.
Medicines – proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
Prokinetics to improve the condition of the mucous membrane of the stomach and esophagus, optimize their motility, relieve nausea, pain (Motilak, Motilium, metoclopramide, Ganaton, itomed, trimebutine).
B vitamins to accelerate the regeneration of stomach tissue.

As a rule, the treatment of diaphragmatic hernia is 99% identical to the treatment tactics for reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow special diet, and adhere to all doctor's instructions.

Surgery for hiatal hernia

Currently, surgery is the only radical and most effective way to treat hiatal hernia. It is also indicated in the absence of results from drug therapy.

Diaphragm surgery for hiatal hernias is usually planned and performed after careful examination and preparation. Not performed very often emergency operations for complicated hernias (strangulation, perforation or bleeding from a compressed organ).

Operations for hiatal hernia are carried out in different ways. Nissen fundoplication is gaining popularity. During this operation, a cuff is made from part of the stomach wall, which is fixed around the hole where the diaphragm expanded.

Doctors operate in two ways, such as:

removal open, cavity incision belly;
laparoscopy with several small incisions and the use of an endoscope with a camera and optics.

Contraindications for surgery:

Acute infectious diseases.
Exacerbations of chronic diseases.
Heart diseases in the stage of decompensation.
Severe lung diseases with respiratory failure.
Uncompensated diabetes mellitus.
Blood diseases with clotting disorders.
Kidney and liver failure.
Pregnancy.
Oncological diseases.
Recent abdominal surgery.

In the postoperative period, antibiotics and painkillers are prescribed if motor skills are impaired. gastrointestinal tract– prokinetics (cerucal, motilium). The sutures are removed on the 7th day, after which the patient is discharged from the hospital under the supervision of a gastroenterologist.

In the first months, it is necessary to significantly reduce physical activity associated with active body movements.

The most common complications after surgery to remove a hiatal hernia are:

relapse of the disease;
cuff slippage;
feeling of discomfort in the chest area;
pain;
difficulty swallowing;
inflammatory processes;
divergence of seams.

The diet after surgery should be liquid and will need to be followed for approximately 3 to 5 days. Clear liquids consist of broth, water or juice. If after 3-5 days the liquid is well tolerated, the diet will switch to a soft diet.

A soft diet consists of foods that are easy to chew and swallow such as foods softened by cooking or pureing, canned or cooked soft fruits and vegetables, or tender meats, fish and poultry. If the soft diet is tolerated for three weeks, then you can switch to a regular diet.

Diet and nutrition

You need to eat food in small portions. There should be 4-5 meals a day. After eating, it is not advisable to rest in a lying position. It's better to sit or even walk. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system.

The diet for hiatal hernia and the menu suggest the introduction of:

yesterday's bakery products made from wheat flour;
slimy cereal soups;
sour-milk cuisine;
porridge, pasta;
meat, fish, boiled, baked, steamed;
oils of vegetable and animal origin.

It is prohibited to use seasonings and sugar in dishes for people with hernia. diaphragmatic hole, since it provokes increased acidity gastric juice and creates risks for injury to the esophagus.

It is necessary to adhere to a dietary diet, namely:

eat food 5-6 times a day in small portions;
after eating, do not lie down on the bed for 1 hour;
dinner should be 2-3 hours before bedtime;
You can eat grated fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups;
before meals, drink 1 tablespoon of sunflower or olive oil;
It is forbidden to eat fried, fatty, salty foods;
Smoking is prohibited.

How to treat a hiatal hernia with folk remedies

For diaphragmatic hernia, herbal treatment against the background of traditional therapy can improve the patient’s condition as a whole and eliminate symptoms. The recipes described below accelerate the secretion of gastric juice, make food move faster through the esophagus, and also eliminate the causes of constipation.

A simple remedy - goat milk, which should be drunk warm twice a day after meals. A single quantity is 0.5 cups.

Treatment is carried out using a decoction of aspen bark - take a large spoon of the raw material and brew 200 ml of boiling water, infuse and filter. Drink 2 large spoons up to 5 times a day before meals.
You can also use branches of young aspen and cherry. They need to be poured with a liter of boiling water and simmered over low heat for half an hour. Then let it cool and take half a glass.
No less effective, according to traditional healers, is also the most common Mint tea. To prepare it, simply add a few dried leaves of the plant to boiling water; you can add sugar to taste (although it is better to abstain if possible). Drink in small sips throughout the day and soon you will forget that you were tormented by pain and heartburn.
You can mix flax seed, anise fruit, marshmallow and gentian roots, and fenugreek in equal parts. The components are crushed, mixed, and a small spoon of powder is taken three times a day. It can be mixed with honey.
Chamomile decoction - good remedy for any manifestations of diaphragmatic hernia. It not only soothes the stomach, but also helps improve digestion. An excellent remedy that can safely be called a panacea for all ills.
Calendula tea is also effective. It can be brewed with chamomile. This tea should be drunk no more than four times a day, always no earlier than an hour after meals.

People with this disease are advised to follow the following recommendations:

Patients must follow a special diet that excludes foods that cause intestinal irritation;
Take food in fractional portions every few hours;
Avoid bending the body forward, sudden changes in body position - this can cause pain in the sternum and heartburn;
Patients should not lift weights exceeding 5 kg
You should not tighten your belt too tightly or wear clothes that are tight to your stomach - this creates additional pressure in the abdominal cavity;
Avoid strenuous physical activity, but still exercise regularly physical therapy, strengthening the muscle corset and restoring the tone of the diaphragm;
It is recommended to eat your last meal no later than 2.5-3 hours before going to bed;
Normalize stool - constipation and diarrhea increase intra-abdominal pressure and contribute to the formation of a hiatal hernia.
Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil;

Prevention

In addition to the basic measures to prevent gastroenterological diseases ( healthy image life, avoidance of stress, proper nutrition) it is necessary to strengthen the muscular wall of the peritoneum - play sports, therapeutic exercises, pump up the abs. Patients with a diagnosed hiatal hernia should be dispensary observation from a gastroenterologist.

When the organs located below the diaphragm protrude through its natural esophageal opening, this leads to the development of a rather serious pathology of this section - an axial hernia. This disease has long occupied a very important place among the ailments of the gastrointestinal tract, since in the absence of timely and adequate treatment it can provoke the development serious complications. Axial hiatal hernia (HH) is one of the most common types of deformity localized in the digestive organs. Among all pathologies of the gastrointestinal tract, it ranks 3rd. If you don't find it on your own early stage developments then carried out therapeutic measures may not give the expected results.

Main types and stages of pathology

Such hernias are called hiatal hernias and are a pathological protrusion of the peritoneal organs through a natural opening located in it. This is mainly the stomach and lower part of the esophagus. During human development of this disease Instead of the abdominal cavity, they end up in the sternum. The disease can be either congenital or acquired, and morphological characteristics hiatal hernias are divided into 2 types:

Sliding (axial, also called axial). The most common type of pathology. According to statistics, it is diagnosed in 90% of cases. An axial hiatal hernia gets its name because it causes the upper stomach and lower alimentary sphincter (LES) to freely slip into the chest cavity and return. This type of digestive disease is divided into several varieties - total gastric, esophageal, subtotal and cardiac hernia. Most often, this pathological movement occurs when a sick person changes body position.
Paraesophageal (fixed) hernia is much less common than sliding one. It represents a movement into the chest cavity of the cardiac part of the main digestive organ, which does not descend back, but remains there forever. That is why this variety pathology has unchanged symptoms. A fixed type paraesophageal hernia is more dangerous than a sliding one and more often causes the development large quantity serious complications that require immediate treatment.

Also, this disease is usually divided according to the degrees of development. A hernia of the first stage is characterized by the fact that the abdominal part of the esophagus is located directly above the diaphragm, and the stomach is slightly elevated and pressed tightly against it. In degree II, part of the main digestive organ has already been moved to the POD, and III, the heaviest, is characterized by the presence above the diaphragm of not only the cardia of the stomach, but often its body, or bottom.

Reasons for the development of the disease

Towards education hernial opening in the diaphragm can result in both congenital and acquired prerequisites. Among the first, experts highlight the underdevelopment of the diaphragmatic muscle and those formed during intrauterine development hernial pockets. Acquired reasons include the influence age-related changes, serious injuries to the sternum, constantly increased intra-abdominal pressure and the occurrence of an inflammatory process near the diaphragm.

There are also factors that increase the risk of developing pathology. Among them are the following circumstances that provoke a one-time sharp or constant increase in intra-abdominal pressure:

last degree of obesity;
blunt abdominal trauma;
lifting excessive weights;
hard physical work;
ascites;
prolonged uncontrollable vomiting;
constant constipation.

A professional heavyweight athlete can also get a hernia, especially if he does not follow safety rules when lifting weights. Also of no small importance in the development of this disease is the hypermotor dyskinesia of the esophagus that accompanies chronic gastroduodenitis or pancreatitis, calculous cholecystitis and gastric or duodenal ulcers, namely the disruption of its motor function.

Contributes to a person developing an axial hernia of the esophagus and its longitudinal shortening, which occurs due to the appearance of scar-inflammatory deformation, the occurrence of which is provoked by thermal or chemical burn, esophageal peptic ulcer and reflux esophagitis.

Signs of the disease

In almost half of the cases, the disease is completely asymptomatic or has such minor manifestations that people with developing disease they do not pay attention and the pathology continues to progress, carrying the threat of complications. Such hernias of the PAD are diagnosed completely by accident, when an X-ray is performed for a completely different reason.

But still, patients of the gastroenterology department who are at risk for developing this disease digestive organs, you should know its main possible symptoms. First of all, it includes pain, localized in the epigastric region and having a pressing and dull nature. It can radiate along the esophagus to the area between the shoulder blades.

Most often, exacerbation of pain occurs in a lying position, with excessive physical activity or severe cough and after a heavy meal. Also characteristic symptoms pathologies can be:

Hiccups that occur because the hernial sac begins to irritate the phrenic nerve.
Heartburn and belching. They are the most common negative manifestations of this disease and are provoked by the entry of acidic stomach contents into the esophagus due to gastroesophageal reflux.
Burning pain behind the sternum and squeezing in the intestines. Their appearance most often occurs in the morning and is associated with the movement of the hernial sac through the hole in the diaphragm.
Dysphagia (impaired swallowing process). Patients with a history of this disease find it most difficult to swallow, no matter how strange it may be, liquid food. This symptom can occur when eating very hot or cold foods, or eating food too quickly.

Very often the negative symptoms of this pathology are similar to the main symptoms cardiac diseases, and this can complicate diagnosis, and may cause treatment to be prescribed incorrectly and not give the expected effect.

Diagnosis and basic therapeutic measures

Hernial sacs of the esophagus are most often discovered during an endoscopic examination or radiography of the abdominal or chest organs. The main signs indicating the presence of the disease during such a study are considered:

increased location of the esophageal sphincter;
the absence of a subdiaphragmatic section in this digestive organ;
cardia, located directly above the diaphragm;
expanded diameter of the esophageal opening;
delay in a hernia injected directly for barium suspension contrast.

When performing endoscopy, the development of this disease is indicated by signs of diseases such as ulcers, erosion, gastritis or esophagitis, as well as the presence of the esophageal-gastric line above the diaphragm. In order to exclude the presence malignant neoplasms in patients with suspected hiatal hernia mandatory a biopsy is performed. To detect internal bleeding from the gastrointestinal tract, feces for occult blood.

After all these diagnostic measures and confirmation of the diagnosis, the specialist selects a treatment protocol for the disease that is appropriate for each specific patient and begins to treat the axial hernia.

Treatment of the disease

Treatment of pathological protrusion of the diaphragm is carried out in two ways - surgical and conservative. The second, non-surgical method, is indicated in cases where the hernia is small in size and occurs without obvious symptoms. An integral part of such therapy is the correction of lifestyle and diet, as well as the appointment of medication, the same as for gastroesophageal reflux. Reviews from patients who have undergone this treatment are only positive. Almost all of them achieved full recovery or transition of the pathology into a state of long-term remission.

But unfortunately, conservative therapy is not suitable for everyone. In this case, surgical intervention is prescribed. Indications for it are severe esophagitis that is not amenable to drug treatment, insufficiency of the lower diaphragmatic sphincter, significant. This operation serves the following purposes:

creation of an anti-reflux mechanism that prevents the reflux of acidic gastric enzyme into the esophagus;
restoration of the anatomical structures of damaged digestive organs, as well as the natural relationship between the stomach and esophagus.

There are several operations to get rid of this pathology, and each has its own advantages and disadvantages. Access to a protruding hernial sac can be performed laparoscopically or openly.

After surgery, the patient must be prescribed a course of medications, including histamine receptor blockers, proton pump inhibitors, antacids and prokinetics.

A complete revision of the lifestyle and habits of the sick person is also necessary:

physical activity, if any, should be reduced;
a fixing bandage is worn for long-term wear;
a diet is prescribed to spare the digestive organs and also reduce weight.

Also, after surgery, patients should completely avoid situations that contribute to increased intra-abdominal pressure and completely stop smoking. Among the possible complications of the pathology that develop when the recommendations of the attending physician are ignored and the therapeutic course is violated, the occurrence of such pathologies as massive ulcers, peptic ulcers, cicatricial stenosis and reflux esophagitis is noted.

Choice therapeutic tactics in this disease is the prerogative of a specialist. In order to cope with negative symptoms and stop the development of a hernia without surgery, the patient must strictly follow all the recommendations of the attending physician. After the therapeutic course, visits to a gastroenterologist for routine examinations will be necessary for a certain period of time. They are held every six months.

A hiatal hernia (HH) develops due to the displacement of organs that are normally located under the diaphragm into the chest cavity. The upper part of the stomach, the abdominal part of the esophagus, and intestinal loops can change their location.

The figure schematically shows a hiatal hernia

This disease is quite often diagnosed by gastroenterologists, and the older the person, the more likely he is to develop a hiatal hernia. Thus, among patients with this disease, about 10% are under 40 years of age and approximately 70% of those who have crossed the 70-year mark. This pathology of the diaphragm is more common among the female population, and the patient may not even realize that she has a hiatal hernia.

You can learn more about the causes and treatment of such hernias from the video:

Why does a diaphragmatic hiatal hernia occur?

Like many pathologies, a person can have a diaphragmatic hernia from birth, or it can appear in adulthood.

The development of the disease during intrauterine development is associated with an embryonic defect, which consists of a decrease in the length of the esophagus. This pathology of the digestive tract requires surgical treatment in the first years of a child’s life.

The causes of acquired diaphragmatic hernia of the esophagus are associated with weakness of the diaphragm ligaments in the area of the esophageal opening. As a person ages, the connective tissue in many organs and systems undergoes degeneration, atrophy and loss of elasticity. A weakened system of diaphragmatic ligaments forms the so-called hernial orifice, through which the abdominal organs protrude into the chest.

But not only age contributes to development pathological changes in the diaphragm. Some other types of hernias (umbilical, femoral, inguinal, etc.) lead to connective tissue weakness.

The reasons for which systematically or suddenly increases intra-abdominal pressure increase the risk of disease. These include:

frequent vomiting;
excessive gas formation in the intestines;
regular constipation;
excessive physical stress;
lifting and moving heavy objects;
the last stage of obesity.

In addition, a strong and prolonged cough provoked by asthma can increase intra-abdominal pressure, obstructive bronchitis and some other respiratory diseases. According to official statistics, a hiatal hernia develops in approximately 20% of women who carry a child repeatedly.

Impaired motility of the digestive tract can also be considered as a cause of diaphragmatic hernia. It can be caused by:

esophageal dyskinesia, which often occurs against the background of gastric and duodenal ulcers;
relapses of gastroduodenitis;
chronic inflammation of the pancreas;
calculous cholecystitis.

People with longitudinal shortening of the esophagus, which could be caused by scar-inflammatory deformation caused by a thermal or chemical burn, can know first-hand what a hiatal hernia is.

Types of hiatal hernia

Depending on the anatomical features, in medicine there are 3 types pathological condition food diaphragmatic opening:

fixed (paraesophageal) hernia;
unfixed (sliding, axial) hernia;
mixed type of protrusion.

A fixed hiatal hernia differs from a sliding one in that in it the distal part of the esophagus and cardia are located under the diaphragm, while the upper part of the stomach is displaced into the chest cavity and is in close proximity to the thoracic segment of the esophagus.

Axial hiatal hernia is characterized by the fact that the abdominal part of the esophageal tube and the upper segment of the stomach freely penetrate from the abdominal into the chest cavity, but also independently return to their normal position. This type of pathological protrusion occurs in the practice of gastroenterologists more often than other types. In turn, sliding hernia includes cardiofundal, subtotal, total gastric and cardiac hiatal hernia.

The mixed type of hiatal hernia combines both axial and paraesophageal types of pathology. TO separate form diseases include an anomaly of intrauterine development - a short esophagus, in which the stomach has an “intrathoracic” position.

There is also a classification of this disease according to the degree of displacement of the stomach into the chest cavity. It includes 3 degrees of pathology:

In the first degree, the abdominal section of the esophageal tube is located above the diaphragm. The stomach is adjacent to it.
The second degree is characterized by a transition to the abdominal region of the esophagus and displacement of the stomach directly to the esophageal opening.
If the disease has reached the third stage, then the above anatomical structures, normally located under the diaphragm, enter the chest cavity.

In the photo, a couple is walking in the park

What symptoms are characterized by hiatal hernia?

Symptoms of a hiatal hernia are often mild or absent altogether, and therefore a person may not even be aware of the development of a problem in his internal organs.

First of all, hiatal hernia symptoms manifest themselves in the occurrence of pain, which are localized in the lower part of the sternum, along the esophagus tube, and extend to the area between the shoulder blades on the back. In some cases, the pain seems to surround the torso at the level of the diaphragm, reminiscent of manifestations of pancreatitis.

Often, a patient with pathologies in the diaphragm area may experience pain similar to that during angina or myocarditis. Approximately a third of people with hiatal hernia suffer from impaired heart rate– a condition close to extrasystole or tachycardia develops. Therefore, in this case it plays important role differential diagnosis of hiatal hernia in order to correctly determine the nature of the patient’s pathology.

It is natural that the displacement of the organs of the gastrointestinal tract (GIT) from the abdominal to the chest cavity negatively affects the act of digestion itself. There are a number of clinical manifestations that indicate this. These include belching with a hint of bile or stomach contents, a bitter taste in the mouth, and belching with air. A very common manifestation of the disease is sudden regurgitation of recently eaten food, without prior nausea. Last symptom occurs, as a rule, when a person is in a lying position.

A characteristic sign for protrusion of the diaphragmatic esophageal opening is the difficult passage of food from the oral cavity through the esophagus into the stomach. This often concerns liquid dishes, too cold or hot drinks.

An indirect sign of the disease may be attacks of heartburn, hiccups, a burning sensation in the tongue, and a change in voice. If the contents of the stomach enter the respiratory tract, the patient may develop asthma, aspiration pneumonia, or tracheobronchitis. If there is occult blood loss from the lower esophageal tube, the patient will develop signs of anemia.

In the photo, a doctor performs an endoscopy of the stomach

How to diagnose displacement of internal organs

As mentioned above, a hiatal hernia can develop without any obvious manifestations, and therefore many patients learn about the problem directly during a gastroenterological examination. This may be an x-ray of the chest cavity, esophagus, stomach, or an endoscopy procedure.

During an X-ray examination, a hernia in the diaphragm area can be identified by the following signs:

the esophageal sphincter is located unnaturally high;
the subphrenic part of the esophageal tube is not detected;
the food opening in the diaphragm is increased in size.

Endoscopic signs may be as follows:

the esophagogastric line has moved to the area above the diaphragm;
symptoms similar to those of gastritis, erosion and peptic ulcer.

If a hiatal hernia is suspected, the diagnosis should be differential so as not to confuse the pathology with another disease. Thus, with the help of endoscopic biopsy it is possible to exclude oncological process in the tissues of the esophagus. To determine whether the patient has hidden internal bleeding, his stool is taken to test for the presence of red blood cells.

One of the most effective methods Diagnosis of a hiatal hernia is esophageal manometry. This study evaluates the two functionality of the sphincters - cardiac and pharyngoesophageal, which can characterize the movement of food along the esophageal tube. Additionally, environmental analysis of the gastrointestinal tract is carried out, namely samples of the contents of the esophagus and stomach.

How to treat hiatal hernia

After the patient has been diagnosed, the attending physician prescribes conservative therapy. First of all, this is a reception medications, among which antacids and histamine receptor blockers.

For hiatal hernia, treatment should include normalizing the patient's weight if he or she has signs of obesity. Physical activity must be completely avoided so as not to aggravate the pathological process.

This video clearly shows how Nissen fundoplication occurs:

Has a special place proper diet with hiatal hernia. So, meals should be fractional (you need to eat at least 6 times a day in small portions), and the last meal should be no later than 3 hours before bedtime. Food should not be washed down, just as it is unacceptable to overeat. Otherwise, the patient may begin to vomit without prior nausea.

To effectively treat a hiatal hernia, daily menu The patient should avoid smoked foods, too fatty and spicy foods, and alcoholic drinks. Nutrition for a hiatal hernia should help normalize intra-abdominal pressure and enter the body required quantity nutritional components, prevent the development of flatulence, prevent constipation.

Surgical treatment of hiatal hernia is indicated for complications of hernia disease, as well as for unsuccessful use conservative methods therapy. Today, there are several methods that can be used to remove a hiatal hernia:

reduction of the hernial protrusion gate with strengthening of the ligamentous apparatus of the diaphragm;
fixation of the gastric pouch;
surgical restoration of the acute angle between the esophagus and the gastric wall;
resection of the esophagus.

But hiatal hernia surgery is a radical method of therapy, which doctors turn to as a last resort.

For this disease, treatment at home should be limited to proper nutrition. Any attempts at self-medication can aggravate the problem and cause allergic reaction and only cause more harm to the patient. Therefore the treatment folk remedies for this disease, if it can be used, it is only after consultation with the attending physician.

Hiatal hernia is a common and quite dangerous disease. Between the thoracic and abdominal cavities of a person is located respiratory muscle– diaphragm. It has the shape of a dome with several openings, through one of which the esophagus passes.

Due to the influence of various external and internal factors on the body, a displacement of structures located in upper section abdominal cavity. The result of such changes may be the entry into the chest area of parts of internal organs that are normally located under the diaphragm.

Types of hiatal hernia

A diaphragmatic hernia is a serious pathology that causes many symptoms in humans. IN medical practice The disease is usually divided into several types. Each of them has its own anatomical features and flow patterns. Hiatal hernia is classified according to several criteria.

Sliding

Sliding or, as they are also called, wandering hernias are distinguished by the absence of a hernial sac. The disease is acquired or congenital. This type of pathology has mild symptoms early stages development, most often the disease is diagnosed accidentally during examination of other internal organs.

Sliding hernias are characterized by protrusion of part of the stomach into the sternum area. A characteristic sign of pathology is that with certain postures of the patient, organs that have moved beyond the diaphragm fall into place.

Fixed

Fixed (axial) hernias are similar to the previous type, but here parts of the organs do not correct themselves. That is why this type of pathology is called fixed. Often, axial hernias are a complication of vagal hernias.

Axial type food hernia is large. Pathology provokes symptoms that significantly reduce the patient’s quality of life.

Mixed

Symptoms of hiatal hernia mixed type It is customary to call simultaneously manifestations of fixed and sliding types of the disease.

There is a congenital type of pathology and an acquired form. Congenital hernia occurs against the background of a short esophagus with an atypical intrathoracic location of the stomach.

Causes of pathology

A hiatal hernia (HH) can occur under the influence of various provoking factors. The causes of esophageal hernia include:

Increased abdominal pressure.
Digestive motility disorders.
Ligament weakening and loss muscle tone diaphragm.

Most often, the reasons described above are a consequence of anatomical aging of the body, when irreversible changes begin to occur in the tissues of the diaphragm and stomach. degenerative changes.

Factors that increase the risk of developing pathology include:

Slouching can cause hiatal hernias

the patient is overweight;
scoliosis, stoop and other diseases leading to poor posture;
diseases that cause coughing, as well as frequent attacks vomiting;
genetic predisposition;
congenital pathologies esophagus and stomach;
poor nutrition, especially for diseases of the digestive system;
smoking, drinking alcoholic beverages;
violation contractility stomach (dyskenisia) due to infectious diseases organs of the gastrointestinal tract.

Often, a hiatal hernia is diagnosed after receiving abdominal injuries, with intense physical activity on the abdominal area. The disease often occurs in pregnant women.

Main signs of the disease

Symptoms of a hiatal hernia in many cases are mild or absent altogether. This is explained by the small size of the protrusion.

Most often, the manifestation of pathology is observed in patients with large hernias. Signs of the disease include:

heartburn (occurs after eating);
pain in the sternum;
belching, feeling of fullness in the stomach;
prolonged hiccups;
difficulty passing food through the esophagus.

Symptoms of a hiatal hernia such as burning of the tongue (glossalgia), sour taste in the mouth, pain when bending or turning the body are often observed. Many patients complain of a feeling of a lump in the throat, increased salivation, and sudden coughing attacks, especially at night.

The appearance of hernias can provoke pain in the heart area. Such signs make it difficult to diagnose the disease, as patients mistake the pathology for cardiac disorders.

One of the symptoms of a hiatal hernia is heartburn.

Against the background of the formation of the disease, patients are diagnosed with anemia. The disease is a consequence of hidden internal bleeding in the esophagus and upper stomach.

Diagnosis of a hiatal hernia, as well as treatment of the pathology, must be timely, since the disease can provoke many Negative consequences for human health.

Diagnostics

To provide necessary treatment hiatal hernia must be performed correct diagnosis diseases. To do this, the patient is prescribed a series of procedures to determine the size of the protrusion and associated disorders in the body.

The first stage of diagnosis is collecting anamnesis. Based on the patient’s complaints, the specialist prescribes the necessary laboratory tests and procedures. These include:

Radiography.
Esophagoscopy (examination of the esophagus using a bronchoesophagoscope).
Biopsy of samples of mucous tissue of the esophagus.
Examination of stool for the presence hidden blood.
Gastrocardiomonitoring (performed to assess the environment of the gastrointestinal tract).
Laboratory examination of urine and blood.

After taking the necessary measures, the patient is diagnosed, which allows treatment of esophageal hernias in accordance with the type of disease and the characteristics of the course of the disease.

Possible complications of the disease

A hiatal hernia often causes serious consequences for human health and life. One of the most common complications is considered to be strangulation of internal organs within the hernial sac. Incarceration causes severe pain, increased body temperature, gagging (vomiting is impossible), as well as the risk of developing tissue necrosis of the injured organ.

As a result of numerous studies, it became known that such a disease can not only carry the risk of strangulation of internal organs, but also cause functional disorders related to the functioning of the digestive organs, respiratory system, work of the heart muscle.

Complications of the disease include:

Failure of heart rhythm with hiatal hernia

development of anemia;
internal bleeding;
shortening of the esophagus;
heart rhythm disturbances;
bronchial spasms;
acute course diseases;
hemoptysis;
the phrenic nerve is affected.

Esophageal hernia requires competent and timely therapy. Necessary measures treatment of pathology will help to avoid complications of the disease and concomitant diseases.

Therapy methods

Symptoms and treatment of hiatal hernias are pressing issues in modern medical practice. The disease is quite common and requires immediate treatment. Used to get rid of illness A complex approach, which includes drug treatment, dieting, use special gymnastics, as well as such a radical type of therapy as surgical removal of the hernia.

Each treatment method is selected by a specialist based on medical history, as well as data from the methods used to diagnose the disease. Self-medication is strictly prohibited, as it can cause serious consequences for human health.

Use of medications

Treatment of a hiatal hernia with synthetic drugs is carried out to eliminate the main symptoms of the pathology.

Therapy includes the following groups of drugs:

Medicines that reduce acidity (Rennie, Gaviscon, Almagel).
Agents that help neutralize excess hydrochloric acid (Omeprazole, Pantoprazole).
Prokinetics that help normalize gastrointestinal motility (Cisapride, Domperidone).
H2 histamine receptor blockers - help reduce the secretion of hydrochloric acid (Famotidine, Ranitidine).
To relieve pain, antispasmodics (Spazmalgon, No-Shpa) are prescribed.

At severe forms illness, can be prescribed additional medications. Anemia due to internal bleeding requires the use of hemostatic agents. These include Vikasol, Dicynon.

The development of the disease with manifestations of the gag reflex and frequent release of intestinal contents requires the use of drugs that break down bile, as well as agents that reduce irritation of the mucous membrane of the digestive organs.

Diet for hiatal hernia

When answering the question of how to treat a hiatal hernia without surgery, due attention should be paid to compliance proper nutrition with the development of pathology. In addition to introducing recommended foods into your diet, as well as excluding prohibited foods, you should adhere to preventive measures aimed at eliminating complications and alleviating the patient’s condition. These include:

Meals should be small, and you should never overeat.
It is forbidden to eat before bedtime. The last meal should be 2-3 hours before going to bed; foods should be low-calorie and easily digestible.
It is forbidden to lie down for several hours after eating. The horizontal position increases pressure on the diaphragm.
It is not recommended to perform physical activity (squatting, running, bending) after eating.

If the patient has overweight doctors recommend getting rid of the body excess weight. Normalization of body weight can be achieved through diet and certain physical exercises.

Alcoholic drinks are strictly contraindicated in case of illness. Alcohol consumption can aggravate the course of the pathology and provoke complications of the disease.

For normal functioning entire digestive system, to avoid exacerbation of hiatal hernia, the patient’s diet should include foods with low content fat, carbohydrates. You should avoid sour, spicy, salty foods.

Food is best prepared by boiling, stewing or baking. Permitted products include:

bananas, apples;
boiled carrots;
green pea;
low-fat varieties fish and meat;
porridge;
vegetarian soups;
steamed casseroles and omelettes;
bread products made from dark flour.

The principle of nutrition during illness is to eat light foods and avoid overeating.

Esophageal hernia provokes a violation normal processes digestion. To eliminate unnecessary stress on the digestive system, as well as to avoid complications of pathology, the following should be excluded from the diet:

drinks containing caffeine;
ice cream;
too much hot tea;
pickles;
garlic and leeks;
carbonated drinks;
fatty types meat and fish;
sweet pastries, baked goods;
dairy products with a high percentage of fat;
hot sauces, ketchups, seasonings.

The diet for esophageal hernia does not have a strict framework. The patient's diet can be varied and rich in various dishes. By adhering to simple recommendations, it is possible to eliminate many of the negative consequences of the disease.

Physiotherapy

One of the methods of treating the disease is the use special exercises aimed at strengthening the muscles of the diaphragm. Physical education includes breathing exercises, and physical exercise. It is recommended to perform physical exercise on an empty stomach, 2 hours after eating.

A set of breathing exercises

To strengthen muscles and reduce the manifestations of pathology, you can perform the following complex:

Lying on your right side, take a slow deep breath, while protruding your stomach, and then gradually exhale, relaxing your abdominal muscles. Perform 2-5 approaches on the right and left sides.
In a standing position, with your feet shoulder-width apart, tilt your body to the left, while taking a deep breath, then return to the starting position, exhaling slowly. Repeat the exercise on the other side.
Lying on your back, perform body crunches. When turning to one side, inhale, when returning to the starting position, exhale.

All movements should be performed slowly, avoiding sudden movements. During gymnastics, you should carefully monitor your condition. If pain, dizziness or other alarming symptoms occur, exercise should be stopped immediately.

Surgical treatment of hernia

A small esophageal hernia does not require surgical intervention; treatment of an uncomplicated type of pathology is carried out mainly by medication, as well as through diet and necessary preventive measures. During development severe complications, therapy is carried out through surgery.

By using various techniques organs extending beyond the diaphragm are reset to their natural place. Indications for surgical intervention there may be a protrusion that provokes tachycardia and difficulty breathing, the risk of strangulation of internal organs, the ineffectiveness of conservative treatment, the presence of erosions and bleeding.

The postoperative period requires careful monitoring of the patient's condition by medical personnel. Complications include recurrence of the hernia, discrepancy surgical sutures, bleeding, change in voice timbre, discomfort in the sternum.

At timely treatment disease, taking measures aimed at preventing relapse, the prognosis for recovery is quite favorable. In most cases, it is possible to get rid of the pathology without consequences for health.

A hiatal hernia is a chronic disease in which the abdominal esophagus, cardia of the stomach, and sometimes even the loops are displaced small intestine, into the chest cavity through the esophageal opening in the diaphragm. This disease is quite common; according to statistics, it affects 5% of the adult population. The disease is most often detected in people over 60 years of age; in women this type of hernia is registered more often than in men.

Predisposing factors in the development of the disease are:

weakness of the ligamentous apparatus that strengthens the esophagus in the diaphragmatic opening;
increased intra-abdominal pressure;
impaired motility of the gastrointestinal tract, resulting in upward displacement of the esophagus.

There are several types of hiatal hernias:

An axial (sliding) hernia is characterized by the fact that part of the esophagus, cardia and fundus of the stomach can freely penetrate into the chest cavity and return through the enlarged esophageal opening in the diaphragm. This most often occurs during sleep or with a strong cough.
A paraesophageal hernia is characterized by the fact that through the esophageal opening in the diaphragm, part of the fundus of the stomach penetrates into the chest cavity and is located next to the esophagus, and its abdominal part and cardia do not emerge from under the diaphragm.
In the mixed version, a combination of sliding and paraesophageal hernias is observed.

Symptoms

In some cases, hiatal hernias are asymptomatic and are discovered by chance during an X-ray examination of the esophagus or stomach for another reason.

In 50% of cases, the disease is asymptomatic, or its manifestations are so insignificant that patients do not pay any attention to them. Hiatal hernias in such situations are diagnosed by chance during an X-ray examination of the esophagus or stomach for another reason.

The main symptom of the disease is dull pressing pain, localized in most cases in the epigastric region, spreading along the esophagus and into the interscapular region. Pain syndrome most often occurs after a heavy meal, during physical activity, coughing, bloating, or while lying down. After taking a deep breath, belching, or going into vertical position the pain may disappear or decrease.

Quite often, the symptoms of a hiatal hernia are very similar to the signs of cardiac diseases, which complicates diagnosis and can lead to the prescription of incorrect and ineffective treatment.

In a third of patients, the main clinical manifestation of the disease is pain in the heart. When a hernia is strangulated, intense constant pain appears behind the sternum, radiating to the interscapular area. Similar symptoms characteristic of myocardial infarction.

Patients suffering from this disease almost always develop, which is also accompanied by certain symptoms:

belching of acidic stomach contents, bile or air;
regurgitation of gastric contents, especially in a horizontal position of the body;
difficulty passing food through the esophagus, accompanied by unpleasant sensations;
pain behind the sternum when swallowing;
bitter taste in the mouth;
hiccups;
bouts of persistent coughing at night, caused by stomach contents entering the respiratory tract.

Diagnosis and treatment

The disease is diagnosed based on characteristic complaints the patient and the results of an X-ray examination of the esophagus and stomach with a contrast agent.

The treatment tactics chosen by the doctor depend on the type of hernia.

Paraesophageal hernias require surgical treatment due to the presence high risk occurrence of infringement. If this complication does develop, emergency surgery is required.

Sliding hernias, in which the patient does not have any symptoms of the disease, do not require drug treatment. However, patients are advised to follow the instructions developed for patients with diseases of the stomach and esophagus. In addition, patients need to monitor their body weight and avoid obesity, as this contributes to an increase in intra-abdominal pressure. To prevent the reflux of stomach contents into the respiratory tract, it is recommended to sleep with the head of the bed raised.

If symptoms of the disease occur, patients are prescribed medication. To normalize gastrointestinal motility, it is recommended to take prokinetics (Trimedat). Antacid medications (Almagel, Phosphalugel, Gaviscon, Maalox) will help get rid of heartburn.

At large sizes axial hernia, the occurrence of ulcers of the esophagus, dysplasia of its mucous membrane and ineffectiveness conservative therapy Surgical treatment is recommended for patients.

Which doctor should I contact?

Paraesophageal hernias require surgical treatment.

If you experience pain in the abdomen or chest, especially worse at night and when lying down, you should consult a physician. The doctor will prescribe at least two studies: electrocardiography (ECG) and esophagoduodenoscopy (EFGDS), as well as an x-ray of the esophagus with X-ray contrast agent. If a hiatal hernia is confirmed, you need to be treated by a gastroenterologist. In severe cases, surgery is required. It is advisable to consult a cardiologist to exclude cardiac pathology.