Sliding hiatal hernia how to cure. Sliding hernia of the esophageal opening of the diaphragm: description of the disease and treatment. Indirect signs of hpod

This pathology in most cases refers to age-related diseases. A sliding hernia of the esophagus is formed when the esophagus protrudes into the sternum through the diaphragm. Over time, human muscles become less and less flexible and elastic. The same applies to the muscles of the diaphragm. The development of pathology is also facilitated by the pressure difference: in the peritoneum, the pressure is much higher than in the chest cavity. This factor is decisive in conditions such as prolonged coughing, intense physical activity.

Classification

Depending on the place of occurrence of this phenomenon, cardiac and axial hernia can be distinguished. There are several types of hernia of the esophagus:

• congenital;
• paraesophageal;
• sliding.

According to the volume of the part of the stomach that has penetrated into the cavity of the sternum, the pathology is classified into three degrees:

• first degree - the stomach is adjacent to the diaphragm, the abdominal esophagus is located in the chest cavity directly above the diaphragm, the cardia is at its level;
• the second degree - in the chest cavity there is the abdominal part of the esophagus, and in the POD area - part of the stomach;
• third degree - above the diaphragm are the body of the stomach, its bottom, as well as the abdominal part of the esophagus.

A sliding hernia of the esophagus is a fairly common pathology, however, despite this fact, it can be quite difficult to establish an accurate diagnosis: the symptoms are not always typical, and the hernia itself can not always be seen.

Causes

The gastric canal and esophagus are held within the corresponding opening of the diaphragm by means of a special ligament. It is her pathology that is the cause of such a disease as a sliding hernia of the esophagus. In the process of displacement of the upper part of the stomach, thinning and stretching of the retaining muscle ligament occurs. As a result, the opening of the esophagus increases.

A sliding hernia is characterized by the fact that, depending on how full the stomach is, and how the person is located at the moment, the hernia can either protrude or take a normal position. This does not depend on the size of the hernial formation itself.

The falling out part can be fixed in this position, this leads to an acquired shortening of the esophagus, when the fistula occupies a permanent location above the level of the diaphragm. Pinching a sliding hernia of the esophagus is impossible. But in some, especially severe cases, fibrous stenosis develops.

A hernia of the esophagus may be congenital. Thus, during the period of intrauterine development, a slowdown in the movement of the stomach into the peritoneal cavity may occur, which leads to a hernia of the esophagus in children. After the lowering of the stomach occurs with some delay, a hernial sac is formed. It is also possible underdevelopment of the muscles of the diaphragm, as a result of which the esophageal opening expands.

Acquired causes are mainly reduced to factors that increase pressure in the abdominal cavity. These are cough, physical activity, constipation, pregnancy, overweight. These factors, together with other prerequisites, allow the disease to develop. Chronic diseases, such as cholecystitis, peptic ulcer, in which contractions of the esophagus occur, can contribute to the disease.

Symptoms

As already mentioned, pronounced symptoms in this pathology may not be observed. In the event of complications and the addition of concomitant diseases, symptoms of this nature begin to appear: heartburn, belching, a burning sensation in the area behind the sternum, increased saliva, a feeling of a lump in the throat, regurgitation, pain. There may be an increase in pressure.

Depending on what position a person occupies, his sensations and symptoms may vary. But the main symptom - a burning sensation - is present in almost all patients with this disease. The pain in this pathology is specific and cannot be confused with an ulcer. It occurs after eating and depends on how much the patient consumed. If after that you take any drugs that reduce acidity, then the pain immediately disappears.

The picture of the disease is given by concomitant pathologists reflux esophagitis. This is a periodic reflux of the contents of the stomach into the cavity of the esophagus. Hydrochloric acid is found in large quantities in the contents of the stomach. Because of this, being in the esophagus, it negatively affects the walls of the esophagus, irritates the mucous membrane, eventually leading to ulcerative lesions and erosions. This is the cause of burning pain in the hypochondrium, stomach. Sometimes the pain is dull in nature, radiates to the left shoulder, which makes it possible to mistakenly diagnose angina pectoris in such a patient.

With a change in the position of the body, especially when moving to a supine position, as well as during physical exertion, the pain intensifies. There is an attack of heartburn, belching. Over time, swallowing problems may develop. In some cases, hidden bleeding appears, which is formed due to damage to the esophageal mucosa. It is manifested by anemia and bloody vomiting.

A sliding hernia of the esophagus may be accompanied by frequent bronchitis, tracheitis, or pneumonia. This is due to the inhalation of acidic gastric contents during belching.

There are two main diagnostic methods for detecting a sliding hernia of the esophagus: endoscopic and radiological. So you can identify the shortening of the esophagus, its expansion, damage to the surface of the mucosa.

Treatment

The initial non-started stages of the disease imply traditional treatment. This includes diet, medication, and exercise therapy. If such treatment does not lead to positive dynamics, or the disease is accompanied by bleeding, surgical intervention is recommended.
The method used for surgical treatment involves the formation of a special cuff around the esophagus. This prevents the contents of the stomach from entering the esophagus. The operation in our time is the least traumatic, laparoscopic. The surgical method provides a complete recovery of the patient after the operation, he quickly returns to normal life.

Diet, as the main treatment for a hernia of the esophagus, provides for small meals every three or four hours. Portions of food - up to 300 grams. Exclude any food that can irritate the gastric mucosa or increase the production of gastric juice - spicy, fried, salty, fatty, smoked and pickled foods. The diet for esophageal hernia is based on steamed dishes, cereals, vegetables, lean meats, as well as milk and fruits. In advanced cases, food should be ground, in the form of mashed potatoes. You can not take a supine position after eating, you need to wait at least half an hour.

A very important role is played by a change in lifestyle: quitting smoking, alcohol. Sufficient time must be given to rest. Physical activity should be moderate, exercises with a load on the press are prohibited. These measures can significantly improve the patient's condition, relieve painful symptoms, but it is impossible to completely get rid of the problem in this way. Eliminate a hernia of the esophagus can only be surgically.

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:

1. 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.
2. 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.
3. 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:

1. 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.
2. 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.
3. 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.
4. 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:

1. Antacids. Shown to reduce the negative impact of acidic contents on the walls of the esophagus.
2. Enveloping. They are used to eliminate irritation of the mucous membrane of the stomach and esophagus.
3. Antispasmodic drugs. They are prescribed by a doctor when a sliding diaphragmatic hernia is accompanied by a peptic ulcer of the stomach and duodenum.
4. De-Nol. It is indicated for inflammatory and ulcerative diseases of the gastric mucosa and esophageal tube.
5. Motilium. It is prescribed to improve the processes of digestion.
6. 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.

This pathology of the esophagus can be both hereditary and acquired. A sliding hernia of the esophagus is also called a sliding hiatal hernia and is quite common, women are more susceptible to this disease than men. The disease is latent, so it is difficult to detect it at the initial stage, but without treatment it can have serious consequences, for example, cause internal bleeding.

Sliding axial hernia of the esophagus is the most common type of disease, another type is a sliding cardiac hernia. It is called so because the cardia of the stomach enters the hole in the diaphragm.

Axial sliding HH: degrees of disease

A hernia is classified according to degrees and they depend on the location and size of the pathology:

1. the first degree is characterized by the location of the abdominal segment under the diaphragm, the hernia develops gradually;
2. in the second degree, the cardial section of the stomach is above the diaphragm, and the gastric mucosa enters the esophagus;
3. in the third stage of the disease, part of the stomach enters the thoracic region, the pathology is quite rare;
4. the fourth is called giant, almost the entire stomach goes into the sternum and puts pressure on other organs. This degree of hernia requires immediate hospitalization. Medical treatment will not help, surgery is necessary.

The risk group is mainly women and the elderly over 50 years of age, this is due to age-related changes in organs. The main reason for the development of pathology is a decrease in the tone of the muscles that regulate the expansion and contraction of the food section of the diaphragm. With such disorders, the esophageal opening cannot completely close, which causes the protrusion of part of the stomach and the formation of a hernia.

Causes of a sliding hernia of the esophagus

When a hernia is formed, part of the stomach is displaced into the thoracic region due to the protrusion of the lower esophagus. Pathology develops over a long period of time, but without any signs, which complicates its timely diagnosis. With early detection, the disease is easily treated, it is caused by various causes and they are divided into congenital and acquired.

Congenital:

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

Purchased:

• age-related pathology of the diaphragm;
• relaxation of the diaphragm due to injury or inflammation;
• diseases of the digestive system, leading to spasmodic contractions of the muscles of the esophagus - cholecystitis, peptic ulcer;
• diseases of the pancreas and liver;
• increased physical activity, carrying weights;
• violation in the work of the intestine;
• increased abdominal pressure due to constant overeating.

Sliding axial hernia can be triggered by pregnancy, postpartum pathologies, overweight and other diseases that cause increased pressure in the esophagus. Almost anyone can develop this disease, the only plus is that blood circulation is not disturbed and no pinching occurs.

Symptoms of a sliding hiatal hernia

Symptoms depend on the size of the hernia and are often not pronounced, but most often there are pain in the stomach, and heartburn may also appear. With an axial hernia of the esophageal opening of the diaphragm, the upper part of the stomach enters this opening, and then returns. If the protrusion is small, the symptoms may not appear; in many, the pathology is detected when undergoing an examination related to other diseases.

During an external examination of the patient, a sliding hernia of the esophageal opening of the diaphragm (HH) does not make itself felt, it is not detected. If the disease began to develop a long time ago, the esophagus constantly irritates the contents of the stomach, which is thrown into it. But still, the main signs of the disease are distinguished:

1. if a person lies down after eating, he experiences severe heartburn;
2. belching, in which food is thrown into the esophagus or oral cavity, while there is no vomiting;
3. severe pain in the stomach and burning behind the sternum, becomes more intense when leaning forward;
4. when belching, gastric juice is thrown into the respiratory tract, which causes the development of tracheitis, bronchitis and pneumonia;
5. the swallowing reflex is disturbed, the person does not feel the passage of food into the esophagus, which becomes inflamed and makes it difficult for the food coma to pass.

In some patients, a sliding hiatal hernia may increase blood pressure and increase salivation. Sometimes the symptoms are confused with a stomach ulcer, but the difference is that with a hernia, the intensity of pain depends on the amount eaten, and it disappears after taking medication to reduce acidity.

Complications of a sliding hernia of the diaphragm

If a sliding hernia is not treated, serious complications can occur:

• gastroesophageal reflux;
• cicatricial stenosis;
• perforation of the esophagus;
• ulcer;
• infringement of a hernia;
• erosion of the esophagus;
• internal bleeding.

Even after the operation, a recurrence of the disease may occur.

Diagnosis of a sliding hernia

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

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

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

Treatment of a sliding hiatal hernia

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

• fatty;
• acute;
• smoked meats;
• roast.

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

• stewed;
• steamed;
• boiled cereals from various cereals;
• vegetable dishes;
• milk soups and cereals;
• boiled meat of low-fat varieties, also applies to fish;
• non-acidic fruits must be present.

Avoid alcoholic beverages and stop smoking. Minor physical activity should be alternated with rest. Exercises that put pressure on the abdominal cavity should be avoided. The following drugs are used as drug therapy for sliding axial hernia of the esophageal opening of the diaphragm:

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

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

Prevention of sliding axial hernia

Any disease is easier to prevent than to cure. The same applies to a sliding hernia of the stomach, for its prevention it is necessary to follow some recommendations:

• engage in physical therapy;
• treat diseases of the digestive system;
• fight constipation;
• control your weight;
• adhere to the regimen and diet.

Persistent internal bleeding can cause anemia, and a sliding hernia of the stomach, left untreated, causes irreversible diaphragmatic changes and the risk of developing cancer of the stomach or esophagus.

The most common type of hernia of the diaphragm is a sliding hiatal hernia. This disease is mostly asymptomatic, which causes a lot of trouble for the patient. In addition, it can only be diagnosed under certain conditions.

The concept and types of sliding hernia

A hernia is formed in such a way that one of its walls is an organ partially covered by the abdominal cavity. We can say that this type of hernia is a defect in the septum tissue between the peritoneum and the chest. The main component of this tissue are the muscles, which eventually become less elastic and resilient. Such changes are attributed to age, so the disease is typical for the elderly.

An important prerequisite for the formation of a hernia of the esophagus can be low, compared with the abdominal cavity, pressure in the sternum. Due to this factor, with a lot of physical activity, in the case of a prolonged cough, and under other similar circumstances that increase the prenatal load, a sliding hernia (hiatal type) may occur.

In medicine, there are the following types of hernias.

Classification by field of education:

• Axial hiatal hernia, which occurs in more than 98% of cases and is divided into:
• Cardiac, making up almost 96% of all cases.
• Cardiofundal - 2.3%.
• Subtotal - the probability of its occurrence is 0.4% - 2%.
• Paraesophageal, the incidence of which is up to approximately 1.4% of all cases.
• Hernia, referred to as congenital short esophagus - 0.3%.

Classification according to the size of the stomach penetrating into the sternum:

1. Sliding hernia of the esophageal opening of the diaphragm of the 1st degree, which is characterized by the presence of a part of the esophagus above the diaphragmatic zone, the location of the cardia in the region of the diaphragmatic zone, the adherence of the stomach to the diaphragmatic organ itself.
2. HH 2 degrees - a small proportion of the esophagus, related to the peritoneum, is located in the region of the sternum, and a certain part of the stomach is located in the region of the opening.
3. Sliding hernia POD 3 degrees - the proportion of the esophagus, related to the peritoneum, as well as almost the entire stomach (sometimes even the inclusion of the antrum is possible), the cardia is located above the diaphragmatic zone.

Prerequisites for the formation of a sliding hernia

The creation of the esophageal opening occurs due to its inner right leg, which is formed from the circular muscle tissue of Gubarev. A ligament created from the diaphragm immobilizes the digestive tract and does not let the cardiac section through. Despite the fixed mechanism, this ligament is also characterized by flexibility, due to which, during vomiting, the movement of the digestive tract and esophageal motility functions in a calm mode. Also, a special membrane takes part in the static nature of the esophagus, which supports the muscle tissues that lift the esophageal organ.

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

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

1. Congenital factors:

• The slow process of lowering the stomach into the abdominal cavity in the fetus.
• Untimely accretion of the diaphragm after prolapse of the stomach. Such a pathology can be not only in the fetus, but also in an adult patient.
• Dystrophy of the muscle tissues of the legs, which led to a partial opening of the esophageal opening. The development of dystrophy is possible not only during fetal development. It can also be purchased in old age.

1. Acquired Factors:

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

Symptoms of a sliding hiatal hernia

Symptoms of a sliding hernia of the esophageal opening of the diaphragm may either be completely absent or be mild. There is a certain percentage of patients for whom such a disease turns out to be a surprise, discovered as a result of X-rays for other reasons.

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

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

• Attacks of heartburn after eating and after lying down.
• Sensation of painful burning in the epigastrium and behind the chest cavity.
• Belching and coming out of food without gagging.
• Violation of the swallowing reflex. At the very beginning, this symptom is apparent, that is, there are no problems with swallowing, since the esophagus is not yet narrowed. In the future, due to the inflammatory process, scars form in the esophagus, leading to its narrowing and creating difficulties for the passage of food.
• Frequent diseases of the respiratory organs: bronchitis, tracheitis, pneumonia. This is due to the fact that gastric juice or the acidic contents of the organ enter the respiratory system due to belching.

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

Diagnostic measures in the diagnosis

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

With the help of registration of motility by the balloon method, data are obtained on the state of the pharyngoesophageal (pharyngeal-esophageal) and gastroesophageal (lower esophageal) sphincter. This allows you to set their tone, the possibility of relaxation in the process of swallowing, the width of certain areas and compliance with their standards. In addition, such an analysis will provide data on whether the chest is healthy, as well as on the state of the esophageal individual sections: their deviation, duration and type of waves during activity, their properties.

Also, for the diagnosis of "sliding hernia of the esophageal opening of the diaphragm", they resort to gastroscopy, radiography with a study of functionality, and measurements of the daily acidity of pH in the stomach.

Treatment of the disease

In the treatment of a sliding hernia of the POD, they resort to drugs, diet, and, if necessary, surgical intervention.

Treatment with drugs is aimed at relieving symptoms in the form of heartburn, vomiting, pain. To lower the concentration of acid in the gastric juice, drugs of the antacid group are prescribed. In order to reduce the amount of hydrochloric acid produced, resort to proton pump inhibitors. To relieve symptoms such as heartburn attacks and belching, Motilium is prescribed. To relieve painful and spasmodic sensations, they resort to antispasmodic and anesthetics. When restoring the protective properties of the esophageal mucosa, De-nol is prescribed.

In case of complications in the form of bleeding and anemia, preparations containing iron are prescribed, and the question of surgical intervention is also raised.

Dietary principles of nutrition with a sliding hernia

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

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

In addition to dietary nutrition, a healthy lifestyle is the most important factor. It includes the rejection of bad habits, good rest, physical activity and physical education. Do not perform exercises that provoke an increase in pressure in the peritoneum. These may include ab exercises, curls, and twists.

Surgery

If conservative treatment and dietary nutrition was not enough, then they resort to surgical intervention. For this method of treatment of a sliding hernia of the pod, one of the following indications must be present:

• Ulcerative formations and wounds of the digestive tract, esophagitis, hemorrhages and anemia.
• The ineffectiveness of the therapeutic effect on the disease.
• The location of the GPOD in a special gate and its huge size.
• Increased risk of clamping the digestive tract due to the proximity of HH.
• Symptoms of abnormal development of tissues of the abdominal mucosa.

During the operation, the specialist will return the normal anatomical dimensions of the involved organs of the gastrointestinal tract, bring them into the desired proportions - remove the hernia, suture the hole and create a barrier for throwing substances in the stomach into the digestive tract.

To do this, resort to two types of surgical intervention:

• Open operation (fundoplication according to Nissen or plastic according to Tope).
• Laparoscopy. This method is used not only in hernia surgery, but also for other internal organs.

Sliding hernia is characterized by the absence of a hernial sac, it can be congenital or acquired, and in the early stages of formation it has a poor symptomatic picture and is diagnosed only with instrumental examination. With this pathology, a part of the stomach protrudes beyond the diaphragm, and the organ, thus, acts as a hernial sac. Allocate fixed and non-fixed hernia of the esophagus, which is differentiated from a congenital or acquired defect - a short esophagus. Traction hernias, which occur against the background of contraction of the esophagus, and pulsion hernias, which form against the background of weakness of muscle tissue, are classified separately.

At the heart of the disease, a sliding hernia of the esophageal opening of the diaphragm is the weakness of the muscular wall, which passes through itself part of the stomach outside the diaphragm. Such a deviation is typical during the period of a decrease in the protective mechanism: pregnancy, progressive obesity, when intrauterine pressure rises significantly and the organ becomes higher than the diaphragm. It is worth highlighting sliding hernias, provoked by weakness of the esophageal sphincter, as well as a disease of adjacent tissues that develops even in the prenatal period.

Etiology of a sliding hernia

Diaphragmatic hernia or hiatal protrusion differs from other forms of the disease in its localization. A wandering hernia implies the location of a part of the stomach above the diaphragm, and thus the organ independently forms a hernial sac. A fixed protrusion is characterized by a stable position of the affected organ, regardless of the position of the patient's body or jumps in intrauterine pressure. An unfixed protrusion is otherwise called a wandering hernia, since its localization can change.

The difference in pressure between the abdominal and thoracic cavities leads to the backflow of the contents of the stomach back into the esophagus, which ends with serious consequences for it: the development of erosion, ulcerative lesions of the esophagus, while the patient feels discomfort, often the disease is accompanied by severe pain. Chronic reflux leads to severe inflammation of the esophagus, it becomes irritated and bleeds, which can result in an anemic syndrome.

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

1. Weakness of the muscular wall that holds the stomach in its anatomical place.
2. Depletion of ligaments with increased stress on the body can weaken the muscle barrier.
3. The period of pregnancy, when intrauterine pressure increases, and the diaphragmatic opening increases.

With an unfixed hiatal protrusion, the stomach changes its position and returns to its place when the position of the patient's body changes, but this does not reduce the protrusion and requires adequate treatment. A hernia of the esophagus can have different sizes, with a long course of the pathological process, a large hernial protrusion is observed. The consequence of a sliding or wandering hernia is the fixation of the stomach above the diaphragm and the formation of scars along the edges of the hernial sac. Against this background, a shortening of the esophagus develops, and a fixed protrusion will be constantly outside the diaphragm.

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

Clinical manifestations of a sliding hernia

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

Complaints of patients with a sliding hernia of the diaphragmatic opening:

• soreness in the stomach area is due to the appearance of an inflammatory process and reflux;
• increased salivation, against which dental diseases may appear;
• burning sensation in the chest area;
• frequent heartburn, belching, regurgitation;
• sensation of a foreign body in the throat;
• increased blood pressure, difficulty breathing.

Clinical manifestations of hiatal lesions may differ in each patient, depending on the position of the body and associated pathologies of the digestive system. A mandatory symptom of the disease for all patients is a burning sensation behind the sternum. The nature of pain in hiatal hernia has its own pattern, a painful attack occurs after saturation and filling of the stomach, and depends on the amount of food. Increased pain and discomfort occurs with an increase in physical activity on the body, with overeating, the presence of congenital or acquired pathologies of the cardiovascular system.

Important! The pain of a hiatal hernia is easily relieved by drugs to treat high stomach acid.

Techniques for the treatment of a sliding hernia

Sliding hernia of the esophagus without complications can be treated with medications. Antacids, antispasmodics, painkillers are prescribed.

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

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

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

An obligatory stage in the treatment of a sliding hernia is the normalization of the daily regimen, the reduction of physical and emotional stress, and the exclusion of smoking. It is important to do gymnastics regularly, and for this there are special exercises shown to patients with a sliding hernia. Hiatal protrusion can be complicated and progress, therefore, in order to prevent bleeding, stenosis, scarring, the doctor may prescribe surgical treatment aimed at restoring the anatomical position of the stomach and excising the tissues affected by the ulcer.