Sliding hernia what. What is a sliding hiatal hernia. Hiatus hernia in children

Sliding hernias are pathologies in which one wall of the hernial sac is an internal organ located retroperitoneally and partially covered by the peritoneum. For surgeons, these hernias present difficulties. They do not occur as often as usual, but for their successful treatment, the doctor must perfectly know and represent the anatomical features of sliding hernias. Without knowledge of the features, it is possible, through negligence, to open the bladder or intestinal wall instead of the hernial sac.

Predisposing factors

Chronic constipation.
Age changes.
Bad habits.
Inactive way of life.
genetic predisposition.
Overweight.
Unbearable physical labor.
Diseases of the spine.

There are many reasons for the formation of a sliding hernia. They may be related to the anatomical structure of the human body. Gender, age and physique also have a direct impact on the appearance of a hernia. Genetic predisposition manifests itself in 25% of cases. Most often, sliding hernias are diagnosed in children under one year old. But their maximum frequency occurs in people over 30 years old.

Increased intra-abdominal pressure can also cause the development of a hernia. Provoking factors include indigestion, coughing, problematic urination, hysterical screaming, wearing a tight bandage, childbirth, and hard work.

Reasons for weakening of the abdominal wall:

pregnancy;
elderly age;
hypodynamia;
injury to the abdominal wall;
diseases that reduce muscle tone.

Sliding hernia classification

The contents of sliding hernias can be:

bladder;
kidneys;
ureter;
departments of the large intestine;
small intestine;
mother, etc.

According to the type of occurrence, they are found congenital and acquired. At first, protrusions of organs not covered by the peritoneum can only be called a hernia conditionally. But as they develop, they become overgrown with a hernial sac. According to the anatomical structure, they are divided into:

ingraparietal- the intestine is fused by the mesentery with the hernial sac, against which the attached mesentery slips;
paraperitoneal- the intestine is partially located behind the peritoneum, being the wall of the hernial sac;
intraparaperitoneal- a sliding hernia is connected by a mesentery with a hernial sac;
extraperitoneal- the intestine is located behind the peritoneum, while the absence of a hernial sac is noted.

Symptoms

Heartburn.
Burning pain in the hypochondrium or behind the sternum.
Belching.
Dysphagia, which is a swallowing disorder.
Chronic bronchitis and tracheitis.

The clinical picture of this disease is due to the development of reflux esophagitis, which is the return of gastric contents into the esophagus. A high level of hydrochloric acid in the gastric contents leads to irritation of the esophageal mucosa, causing damage to its walls. This often causes ulcerative formations and erosions.

Sliding hernia causes pain behind the sternum, in the hypochondrium and epigastrium. In some cases, the pain extends to the area of the scapula and left shoulder. Such symptoms are very similar to the signs of angina pectoris, so patients may mistakenly be registered with a cardiologist for a long period of time.

Increased pain can occur with a change in body position or during physical exertion. In this case, regurgitation, heartburn or belching may occur. The progression of the disease leads to the development of dysphagia.

With a sliding hernia, occult bleeding may occur. This can be determined by bloody vomiting or stools with blood clots.

As a rule, ulcers or erosions in the esophagus act as sources of bleeding. Another important sign that indicates hidden bleeding is anemia.

It is often difficult to make a diagnosis of a sliding hernia. Outwardly and in general manifestations, they almost do not differ from ordinary ones. But with a detailed history taking, the doctor may suspect or assume the absence of the peritoneum under the skin covering the prolapsed organs and prescribe an additional X-ray examination.

Diagnosis of the disease

To confirm or refute the diagnosis, the patient will have to undergo an x-ray examination and fibrogastroduadenoscopy. Such diagnostic methods make it possible to identify the expansion or shortening of the esophagus, its descent into the stomach.

Examination of the patient.
Detailed x-ray examination of the esophagus and gastrointestinal tract.
Passage of esophagometry.
Ultrasound procedure.
CT scan.

Among these diagnostic methods, the most accurate is considered to be radiological. With the help of ultrasound, it is also possible to determine the location of the sliding hernia and the affected area, then it is difficult to guarantee accuracy in this case. True, computed tomography can give a good result. If it is possible to undergo such an examination, then the accuracy of diagnosis will be ensured.

Treatment

Treatment is performed surgically. The operation is difficult due to anatomical features, especially if the hernia is very large and cannot be reduced. Often during surgery, they perform:

reduction of prolapsed organs;
closure of the defect in the peritoneum;
fixation of slipped organs;
plastic surgery of the mesentery of the intestine.

To prevent the dangerous consequences of a sliding hernia, when diagnosing a disease, the doctor should always remember the possibility of developing a hernia without a hernial sac. In this regard, it is necessary to carefully study the patient's history and symptoms, not to neglect additional methods of examination. During the operation, tissue dissection must be carried out carefully, layer by layer.

If the organ wall is damaged, it is important to react quickly and decide on further actions: resection or herniolaparotomy of the damaged organ. The success of the operation largely depends on the experience and skill of the surgeon.

Conservative treatment

If the disease is at the development stage, then conservative therapy can bring good results, but only if the doctor's recommendations are followed. The principle of treatment is to eliminate heartburn (Motilium), pain (No-shpa) and other unpleasant symptoms.
To reduce acidity in the stomach, Kvamatel is sometimes prescribed. To protect the mucous membrane of the digestive tract, you can resort to the help of the drug De-nol. For treatment, you can use other medications:

prokineniki (Domperidone);
inhibitors (Omeprazole, Omez);
antacids (Almagel, Maalox, Gastal).

If anemia is noted against the background of bleeding, the patient is recommended to take iron supplements. The patient should avoid serious physical exertion. During sleep, it is recommended to slightly raise the upper body. In addition to these rules, you will need to follow others:

exclude spicy and smoked dishes from the diet;
minimize the consumption of fatty foods;
remove from the diet foods that provoke the production of gastric juice;
give up smoking and alcohol.

It is also necessary to try not to overeat and adhere to proper nutrition according to the regimen. This will help prevent constipation and flatulence. But the main measure in the prevention of a sliding hernia is to strengthen the abdominal muscles.

hernia surgery

Nissen method.

Cuffs are formed around the esophagus to prevent the contents of the stomach from being ejected directly into the esophagus. In this case, the upper part of the main digestive organ is located in the abdominal region, and the ends of the diaphragm are sutured. The result is a decrease in the diameter of the esophageal opening. Among the advantages of such an operation is a slight injury to the patient, a reduction in the period of stay in the hospital and a decrease in the risks of the consequences associated with the operation.

Allison Method.

The main essence of the operation is the reduction of the hernial orifice by suturing them.

Belsey method.

In this case, the lower part of the esophagus is fixed along with the sphincter directly to the diaphragm, and the fundus of the stomach is fixed on the wall of the esophagus. The Belsi operation differs from the first method of treatment in the presence of pain.

Gastrocardiopexy.

As a rule, patients are operated on under local anesthesia. The choice of anesthesia method depends on the operation itself. The age and condition of the patient is also taken into account. In complicated hernias, the operation is performed under spinal anesthesia or under local anesthesia with multicomponent anesthesia intravenously. But the best option is endotracheal anesthesia and adequate ventilation.

During the operation, an incision is made above the navel in the middle of the abdomen. Next, the upper part of the stomach is sutured along with the esophagus. This method of operation avoids possible complications.

The choice of the appropriate method of operation to remove a sliding hernia depends on its type and condition of the contents. With the wrong technique of surgical intervention, a violation of the integrity of the lumen of the organ, which acts as the wall of the hernial sac, can occur.

The opening of the bag should take place on the side opposite the slipped organ, and on its thinnest section. An important process during surgical treatment is the identification of particles of the spermatic cord. Next, the displaced intestine is carefully isolated, trying to avoid damage to the integrity of the walls and blood vessels that feed it or nearby organs. After that, the intestine is reduced into the peritoneal cavity.

If the presence of a large sliding hernia is noted, then the treatment of the hernial sac cannot occur in the usual way, since there is a high probability of deformation of the hollow organ.

Sewing and bandaging of the hernial sac is carried out near the intestine, more often from the inside, using a purse-string suture. The detected lesions on the intestine are sutured. Similar actions should be carried out in relation to the bladder.

If necrosis of the intestinal loop is detected, the specialist is obliged to resort to a median laparotomy, followed by resection of a segment of the strangulated intestine. When necrosis is observed on any wall of the bladder, it means that resection is carried out with the imposition of an epicystostomy. A Folley catheter may also be used to provide permanent catheterization of the bladder. But this method is acceptable only for women.

A sliding hernia of the esophageal opening of the diaphragm is characterized by the free movement of the abdominal organs into the chest and back. This phenomenon occurs due to the weakness of the diaphragmatic ligament, which is aggravated by the presence of an inflammatory process of the esophagus or its congenital anomalies.

In another way, pathology is defined as a hiatal hernia, cardiac or axial, and its clinic largely depends on the severity of the pathological process.

The main symptom of a sliding hernia is dyspepsia. The patient has frequent heartburn, belching of sour contents, hiccups. These conditions indicate damage to the mucous membrane of the esophageal tube due to the reflux of acidic contents from the stomach.

So what is a sliding hernia? This is the pathological movement of the abdominal organs through the esophagus into the chest. This condition is not dangerous, and practically does not affect the quality of life, unless the patient adequately assesses the potential risk and takes measures to prevent complications.

General characteristics of a sliding HH

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

The main cause of the disease is muscle weakness.

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

Violation of the function of the slipped organ does not occur immediately. The consequences of pathology occur as the disease progresses. Uncomplicated sliding hernia of the esophagus of the first and second degree requires only dietary nutrition and medication. At the third stage, a specific treatment is already selected. An axial hiatal hernia of the fourth degree will require surgical treatment to restore the anatomy of the abdominal organs.

Etiology of the disease

Causes of hiatal hernia:

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

Clinical manifestations of pathology will depend on the stage of formation of diaphragmatic hernia. At grade 1, there is a slight displacement of the abdominal part of the esophagus through the enlarged opening of the diaphragm, while the stomach remains in its place. At stage 2 of the pathological process, the cardia of the stomach is mixed, which is located at the level of the diaphragm. In the third stage, the body of the stomach is located above the diaphragm.

At the last stage of the formation of a hernia in the chest area, there is a large part of the stomach or the entire organ. In this case, it is necessary to treat the disease not only with conservative methods, but also with surgical intervention.

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

How HH manifests itself

The main clinical manifestations of a sliding hernia of the diaphragm:

dyspepsia. This is heartburn, hiccups, belching. Symptoms increase especially after eating, and when the patient assumes a horizontal position after filling the stomach. Such manifestations can also occur for no apparent reason, for example, at night and in the morning.
Dysphagia or difficulty swallowing. Such a phenomenon with a hernia of the esophagus will be more psychological, because while swallowing food, the patient may feel discomfort and pain associated with inflammation of the esophagus, which causes a fear of a repetition of unpleasant sensations. From this, eating begins to be accompanied by a lack of a swallowing reflex. The patient switches to the use of exclusively liquid and semi-liquid food. This, in turn, leads to weight loss. In this regard, the patient is shown a therapeutic diet.
Frequent pathologies of the respiratory system. Bronchitis, aspiration pneumonia appear as a result of particles of poorly chewed food entering the respiratory tract. This threatens with purulent pneumonia and chronic respiratory diseases, which only aggravate the already serious condition of the patient.
Regulation. This phenomenon is associated with the reverse reflux of the contents of the stomach into the oral cavity. Prolonged exposure to gastric acid leads to dental diseases. A patient with a hernia of the esophagus is faced with increased sensitivity of the enamel, papillitis, various stomatitis and gingivitis. Treatment of a local problem in the oral cavity does not lead to positive results, and until the main problem is eliminated, dental pathologies will only progress, and constant irritation of the mucous membrane can result in precancerous conditions and even oncology.

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

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

Principles of treatment

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

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

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

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

Antacids. Shown to reduce the negative impact of acidic contents on the walls of the esophagus.
Enveloping. They are used to eliminate irritation of the mucous membrane of the stomach and esophagus.
Antispasmodic drugs. They are prescribed by a doctor when a sliding diaphragmatic hernia is accompanied by a peptic ulcer of the stomach and duodenum.
De-Nol. It is indicated for inflammatory and ulcerative diseases of the gastric mucosa and esophageal tube.
Motilium. It is prescribed to improve the processes of digestion.
proton pump inhibitors. They inhibit the synthesis of hydrochloric acid, thereby reducing its irritating effect on the walls of the esophagus and stomach.

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

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

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

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

Features of the formation of pathology

One of the most common diseases is a hernia of the POD (esophageal opening of the diaphragm). The older a person gets, the higher the likelihood of its occurrence.

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

A POD hernia is formed as a result of the fact that the following move into the chest cavity:

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

Distinguish protrusion:

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

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

Any form is provoked by various factors:

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

Stages and characteristics

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

Usually, with a pathological formation at the initial stage, the patient almost does not feel discomfort. This explains why complications arise, for the elimination of which it is necessary to resort to surgical intervention.

Sliding hernia happens:

esophageal (1 degree);
cardiac (grade 2);
cardiofundal (grade 3);
giant (4 degree).

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

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

Feeling worse when the diet is disturbed.

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

Because of a sliding cardiac hernia, a person feels heartburn regardless of whether he has been eating or not. Also the state is supplemented:

severe painful discomfort in the abdomen;
constant belching;
nausea;
pain in the chest, which are similar to manifestations of angina pectoris;
problematic swallowing;
increased pain in the supine position or when bending over.

If the stomach partially bulges into the chest cavity, a cardiofundal hernia is diagnosed. Pathology is quite rare and is accompanied by:

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

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

Possible Complications

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

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

After the operation, complications are also not excluded in the form of:

pathological expansion of the esophagus;
re-education of the protrusion;
enlargement of a certain gastric area.

Treatment Methods

In the absence of these complications, non-fixed cardiac hernia is eliminated with the help of:

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

For the treatment to be effective, you will need:

Follow a diet.
Review your daily routine.
Reduce the number of loads.
Give up smoking.
Set aside time for gymnastic exercises.

It is important to always remember that successful recovery depends on early diagnosis. Do not choose drugs on your own. Any drugs should be taken only for medical purposes.

Denial of responsibility

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

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With age, the septum of muscles loses its elasticity and flexibility. The esophagus protrudes into the sternum through a hole in the diaphragm. alimentary esophageal opening of the diaphragm most often occurs in adulthood.

A hernia of the esophagus most often occurs in adulthood.

Depending on the location of the defect, there are:

axial hernia;
cardiac rupture.

There are several types of pathology:

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

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

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

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

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

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

The patient begins anemia associated with iron deficiency due to tissue manifestation.

What is a hiatal hernia, the video will tell:

Reasons for the formation of a sliding hernia

Increased salivation is a sign of a sliding hernia.

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

The upper part of the stomach with this disease is shifted upward. This leads to the fact that the muscle ligament becomes much thinner.

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

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

However, the possibility of slippage of the cuff cannot be ruled out. This increases the risk of complications after surgery. Surgical intervention in most cases helps to achieve positive results. Success largely depends on the passage of physiotherapy procedures during rehabilitation.

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

In severe cases, a person may develop fibrous stenosis. A complication of a sliding hernia is also reflux esophagitis. The sliding fallout cannot be impaired. If there is a narrowing of the hole, then the cardia is compressed, which enters the sternum. This condition does not lead to circulatory disorders.

What are the signs of the disease

Heartburn is a symptom of a sliding hernia.

Sliding hernia of the esophagus does not have clear manifestations. Symptoms in a patient appear only when various complications of the disease occur.

There are several characteristic signs of a sliding hernia of the esophagus:

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

Symptoms of the disease depend on the position of the patient's body. Burning occurs in almost every person with this pathology. Severe pain is experienced by a person with a stomach ulcer. A large amount of food can provoke the appearance in the esophagus.

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

How is the diagnosis carried out

To identify a sliding formation, experts use several methods:

in the process of gastroscopy, doctors use endoscopic equipment to determine inflamed areas, the presence of ulcers and erosions;
fluoroscopy of the stomach is designed to assess the state of hernial formations;
a study of changes in daily pH in the esophagus is designed to determine which leads to the appearance of pain.

Features of treatment

Maalox will help reduce the acidity of the esophagus.

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

To reduce acidity, doctors prescribe antacids to patients (Phosphalugel,). To help patients suffering from attacks of belching, you can use Motilium. The dosage is indicated by the doctor, taking into account the patient's condition.

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

Sometimes patients experience slippage of the cuff, and the disease occurs again. Reoperation can help such patients.

Patients must adhere to At the time of illness, you will have to abandon the use of fatty and spicy foods. Eliminate smoked meats and marinades from the diet. Eat small meals to speed up the digestion process.

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

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Classification, treatment and symptoms of hernia of the esophagus. Details about…

With age, the internal organs not only lose the ability to fully perform the functions assigned to them, but in some cases shift in different directions. In this case, quite often there is a hiatal hernia, or a hernia of the esophageal opening of the diaphragm.

This pathological condition is characterized by the fact that the esophageal opening in the body of an adult expands significantly, and through it those internal organs penetrate into the chest cavity, which, in the absence of violations, are located in the peritoneum.

The occurrence of this disease is always associated with pathological changes in the diaphragm. This organ takes part in respiration and blood circulation and, in fact, is the organ that delimits the abdominal and thoracic cavities.

It is in the diaphragm that the necessary physiological openings are located through which the nerve fibers, blood vessels and esophagus pass. Since the pressure in the chest cavity is normally much lower than in the abdominal cavity, with a pathological expansion of the esophageal opening of the diaphragm, some organs or their parts are displaced into the mediastinum. Despite the fact that in most cases this disease manifests itself due to age-related changes, in some situations it is also diagnosed in newborns.

Types of hiatal hernia

By and large, any hiatal hernia can be classified into one of two types:

axial, or sliding;
cardiac.

In 9 out of 10 patients, a sliding axial hernia of the esophageal opening of the diaphragm develops, when the lower esophageal sphincter, the abdominal part of the esophagus, and in some cases even the upper part of the stomach rises into the mediastinum. At the same time, all organs, which by their nature are located in the abdominal cavity, freely move into the chest and return back.

Only 10% of patients have a pathological condition in which one or more organs are displaced into the chest region and will no longer change their position on their own. As a rule, in such a situation, the patient is immediately placed in a hospital of a medical institution to decide on the need for an urgent surgical operation.

In turn, a sliding hernia of the esophagus differs in the degree of penetration of organs into the mediastinum, namely:

in the first degree of the disease, the stomach itself, or even a small part of it, is not located in the chest cavity. Usually this internal organ is raised and is close to the diaphragm;
in the second degree, the upper part of the stomach periodically shifts to the chest area;
finally, with the third degree of a sliding hernia, the body and fundus of the stomach penetrate into the sternum, and in some rather rare cases, even its antrum.

Causes of a sliding hiatal hernia

As noted earlier, a sliding hernia can be either congenital or acquired.

In most cases, a combination of several causes leads to the onset and development of this disease at once, including:

a violation of intrauterine development of the fetus, in which the stomach does not descend quickly enough into the abdominal cavity;
untimely overgrowth of the diaphragmatic opening after lowering the stomach into the peritoneum;
age-related changes in the diaphragm, in particular, its thinning;
regular exposure to external factors leading to a gradual increase in pressure in the peritoneum, namely: chronic cough, frequent heavy lifting, excessive body weight or obesity, a new pregnancy that occurred a short period of time after the previous one, chronic constipation associated with various diseases and work disorders gastrointestinal tract;
stomach ulcer, chronic cholecystitis and other ailments that cause strong reflex contractions of the esophagus;
post-traumatic or inflammatory lesion of the phrenic nerve, leading to excessive relaxation of the diaphragm.

Typical symptoms and treatments for a sliding hiatal hernia

An axial hernia may not show up in any way for a long period of time. As a rule, the characteristic symptoms of this disease appear in the patient only when complications begin or other concomitant ailments join the displacement of the internal organs.

It is also almost impossible to notice a sliding hernia of the esophageal opening on a medical examination. Since the stomach and other internal organs do not go under the skin with this pathology, they cannot be distinguished with the naked eye. In most cases, patients learn about their diagnosis only when they go to medical institutions for an X-ray or ultrasound examination during a medical examination or for a completely different reason.

However, in some cases, with a severe development of the disease, the patient may notice the following symptoms of the disease:

heartburn and a burning sensation in the stomach;
frequent vomiting. This is especially true for infants with congenital pathology;
severe discomfort and burning in the sternum;
unpleasant belching;
increased salivation;
feeling of "lump" in the throat, dry mouth;
increased blood pressure and headaches;
pain in the upper and middle part of the abdomen. Pain sensations are noted especially acutely with a sharp change in body position, for example, tilt;
feeling of difficulty in swallowing food;
frequent colds, pneumonia, bronchitis, tracheitis and so on. This is due to the regular ingestion of excessively acidic stomach contents into the respiratory tract.

In most cases, the treatment of this disease does not require surgical intervention. However, in order to get rid of the problem and significantly alleviate your condition, you must strictly follow all the recommendations of the attending physician.

As a rule, the fight against the disease and its characteristic symptoms comes down to the following:

constant adherence to a therapeutic diet. With this diagnosis, patients are advised to eat small meals every 3-4 hours. From the diet it is necessary to exclude fatty, fried, spicy and overly salty dishes, smoked meats, pickles and marinades, as well as any other foods that activate the production of gastric juice and can irritate the mucous membranes. The basis of the patient's daily menu should be dishes from boiled or steamed vegetables, cereals with milk, low-fat meats and fish, as well as fresh fruits, with the exception of citrus and other exotic species. Any food at the same time should have a semi-liquid consistency or be served in the form of mashed potatoes. Dinner should be carried out no later than one hour before bedtime. In addition, every time after eating it is recommended to relax a little, sitting in a comfortable chair for 15-30 minutes. It is impossible to take a supine position immediately after eating !;
To effectively get rid of pathology, you should completely reconsider your lifestyle. It is necessary to finally give up smoking and alcohol, not bring yourself to excessive overwork and sleep at least 7-8 hours a day. In addition, it is recommended to perform feasible physical exercises, however, those gymnastic elements that can increase pressure in the peritoneum, such as swinging the press, should be avoided;
finally, in almost all cases, medication is prescribed, including:
antacids - "Gastal", "Maalox" to reduce acidity;
inhibitors - "Omez" to suppress the production of hydrochloric acid;
antispasmodics - "No-Shpa" to eliminate pain symptoms;
gastroprotectors - "De-Nol" to restore the gastrointestinal mucosa.

When the first symptoms of the disease are detected, in no case do not delay treatment, since in the future this will most likely lead to the need for emergency surgery. Monitor your health and report any changes to your doctor immediately.