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