What is a sliding hiatal hernia. Sliding hernia of the food opening of the diaphragm, hiatal. Axial hiatal hernia

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

In most cases, small hiatal hernias do not cause problems. If the hernia is large, gastric contents are thrown back into the esophagus, resulting in heartburn, belching, as well as dysphagia and chest pain.

The reasons

Hiatus hernia (HH for short) is diagnosed in about 5% of adults. More than half of the cases occur in the elderly - over 55 years old, which is due to age-related changes - in particular, the natural process of weakening the ligamentous apparatus.

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

Causes of occurrence:

• Injuries to the abdomen and chest;
• Increased intra-abdominal pressure;
• Bouts of prolonged coughing (asthma, chronic bronchitis);
• Connective tissue diseases: Marfan's syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
• Asthenic physique;

Paraesophageal hernia can be congenital or acquired. Hiatus hernia in children is usually associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age.

At risk are those who have the following diseases:

• Phlebeurysm
• Obesity.

Also, dysmotility of the digestive tract with hypermotor dyskinesia of the esophagus, concomitant peptic ulcer of the duodenum and stomach, chronic gastroduodenitis, chronic pancreatitis, calculous cholecystitis predisposes to the development of a hernia of the esophageal opening of the diaphragm.

Symptoms of hiatal hernia

HH is a chronic disease that affects the digestive system, which is in 3rd place among other diseases, such as the duodenum, chronic cholecystitis. A hiatal hernia is a condition in which the stomach slides up into the esophagus.

Symptoms of HH:

1. a sign of diaphragmatic hernia is pain, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
2. retrosternal pain can lead the patient to a cardiologist by mistake in diagnosis;
3. pain can occur after eating or physical exertion, with intestinal and after a deep breath;
4. heartburn, burning in the throat, hiccups, bouts of nausea, urge to vomit, hoarseness;
5. cyanosis, vomiting with blood speak of an incarcerated hernia;
6. in some cases, blood pressure may increase.
7. at night there are severe coughing attacks, accompanied by suffocation, increased salivation.

The causes of pain in diaphragmatic hernia are compression of the nerves and vessels of the stomach when its cardial part enters the chest cavity, the effect of the acidic contents of the intestine and stomach on the esophageal mucosa and stretching of its walls.

Pain in the hernia of the esophagus can be differentiated based on the following signs:

• pains appear mainly after eating, physical activity, in a horizontal position, with increased gas formation;
• they soften or disappear after a deep breath, belching, drinking water, changing posture;
• the pain is aggravated by bending forward.
• Sometimes the pain can be girdle in nature, resembling pancreatitis.

Typical symptoms of a hernia of the esophageal part of the diaphragm are also:

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

Call an ambulance right away if:

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

Types of HH

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

Sliding (axinal) hernia

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

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

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

For axial hernia under the esophagus is characterized by a different etiology. There are the following etiological factors:

• Dysmotility of the digestive system
• Weakness of the ligamentous apparatus and other connective tissue elements
• High pressure in the abdomen
• The presence of chronic pathology of the stomach, liver Diseases of the respiratory tract, accompanied by an intense cough.

Among all diseases of the digestive system, this pathology is in third place, making it a serious "competition" for such pathological conditions as peptic ulcer and.

Fixed HH

Fixed (paraesophageal) hernia of the esophageal opening of the diaphragm is not so common. In this case, part of the stomach is pushed through the diaphragm and remains there. As a rule, such hernias are not considered a serious disease. However, there is a risk that blood flow to the stomach may be blocked, which can cause serious injury and is a medical emergency.

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

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

Degrees of HH

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

1. In the first, mildest degree, a section of the esophagus rises into the chest cavity, which is normally located in the abdominal cavity (abdominal). The size of the hole does not allow the stomach to rise up, it remains in place;
2. In the second degree, the abdominal esophagus is located in the chest cavity, and directly in the region of the esophageal opening of the diaphragm is already part of the stomach;
3. HH 3 degrees - a significant part of the stomach, sometimes up to its pylorus, passing into the duodenum 12, moves into the chest cavity.

Complications

Complications that can occur with HH:

• A hernia of the esophageal opening of the diaphragm can be complicated by the development of gastrointestinal bleeding. The cause of bleeding are peptic ulcers, erosion of the esophagus and stomach.
• Another possible, but rare complication of a hiatal hernia is its incarceration and perforation of the stomach wall.
• Anemia is a common complication of hiatal hernia.
• is a natural and frequent complication of HH.

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

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

Diagnostics

To make a diagnosis with a hernia of the esophageal opening of the diaphragm, it is necessary to describe in detail your complaints to the doctor, to undergo a series of examinations. Since such a disease is sometimes asymptomatic, it is possible to detect a hernia during a random examination for other complaints.

The diagnosis of hernia of the esophageal opening of the diaphragm is made on the basis of specific complaints and data from instrumental research methods.

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

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

Treatment of hernia of the esophageal opening of the diaphragm: drugs and surgery

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

Based on the pathogenetic mechanisms and clinical symptoms of the esophageal opening of the diaphragm, the following main tasks of its conservative treatment can be formulated:

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

Drugs for HH

Your doctor may prescribe the following medicines for you:

• antacids to neutralize stomach acid
• H2-histamine receptor blockers, which reduce acid production
• proton pump inhibitors (PPIs) are antisecretory drugs for the treatment of acid-related diseases of the stomach.
• Medications - proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
• Prokinetics to improve the condition of the gastric mucosa, esophagus, optimize their motility, get rid of nausea, pain (motilak, motilium, metoclopramide, ganaton, itomed, trimebutine).
• B vitamins to accelerate the regeneration of stomach tissues.

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

Surgery for hiatal hernia

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

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

Operations for HH are carried out in different ways. The Nissen fundoplication is gaining popularity. With such an operation, a cuff is made from a part of the wall of the stomach, which is fixed around the hole where the diaphragm has expanded.

Doctors operate in two ways, such as:

• removal by an open abdominal incision;
• laparoscopy with several small incisions and the use of an endoscope with a camera and optics.

Contraindications for surgery:

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

In the postoperative period, antibiotics, painkillers are prescribed, in case of violation of the motility of the gastrointestinal tract - prokinetics (cerucal, motilium). The sutures are removed on the 7th day, after which the patient is discharged from the hospital under the supervision of a gastroenterologist.

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

The most common complications after surgery to remove a hernia of the esophageal opening are:

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

The diet after the operation should be liquid - you will need to follow it for about 3 to 5 days. Clear liquids consist of broth, water, or juice. If after 3-5 days the liquid is well tolerated, the diet will be switched to a soft diet.

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

Diet and Nutrition

You need to take food in small portions. There should be 4-5 meals per day. After eating, it is undesirable to rest in a prone position. It is better to sit or even walk around. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system.

Diet for hernia of the esophagus and menus suggest the introduction into the diet:

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

It is forbidden to use seasonings and sugar in dishes for patients with a hernia of the diaphragmatic opening, as this provokes an increased acidity of gastric juice and creates risks for traumatizing the esophagus.

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

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

How to treat a hiatal hernia with folk remedies

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

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

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

People who have this disease are advised to follow the following recommendations:

1. Patients must necessarily follow a special diet that excludes foods that cause intestinal irritation;
2. Take food in fractional portions every few hours;
3. Avoid tilting the body forward, sudden changes in body position - this can cause pain in the sternum and heartburn;
4. Patients should not lift weights more than 5 kg
5. You can not tighten the belt tightly, wear clothes that are going through the stomach - this creates additional pressure in the abdominal cavity;
6. Avoid heavy physical exertion, but at the same time regularly perform physical therapy exercises that strengthen the muscle corset and restore the tone of the diaphragm;
7. It is recommended to eat the last time no later than 2.5-3 hours before going to bed;
8. Normalize stool - constipation and diarrhea increase intra-abdominal pressure and contribute to the formation of a hiatal hernia.
9. Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil;

Prevention

In addition to the basic measures to prevent gastroenterological diseases (healthy lifestyle, elimination of stress, proper nutrition), it is necessary to strengthen the muscular wall of the peritoneum - go in for sports, therapeutic exercises, pump the press. Patients with a diagnosed hernia of the esophageal opening of the diaphragm are subject to dispensary observation by a gastroenterologist.

Article content:

A hiatal hernia (HH) is a protrusion of the abdominal organs through a physiological or traumatic opening into the chest. A hernia is formed under the influence of various negative factors. Its structural elements are the collar, bag and contents. The lower third of the esophagus, stomach, small or large intestine can pass through the muscle defect. All these organs are covered by the peritoneum, which forms the hernial sac. Pathology is asymptomatic for a long time, but it can cause discomfort to the patient. Timely diagnosis is the key to successful therapy.

Types and degrees of HH

1. Axial (sliding): esophageal, cardiac (hernia of the initial part of the stomach), cardio-fundic.
2. Paraesophageal: fundic, pyloric, intestinal, combined, omental.
3. Giant: subtotal, total.
4. Variant of developmental anomaly or injury: shortened esophagus I and II.

There is also a radiological classification. Separation allows you to determine the degree of protrusion (failure) of the stomach and other digestive organs into the chest cavity.

Degrees of hernia of the esophageal opening of the diaphragm:

• First - the intra-abdominal third of the esophagus is above the diaphragm.
• The second - the prolapse of the body of the stomach into the lumen of the diaphragm joins the previous changes.
• The third is the complete prolapse of the upper gastrointestinal tract into the chest.

A hernia can be fixed or non-fixed. A fixed hernia has a stable position at the gate. Unfixed - movable. The symptoms are affected by the size of the protrusion. Large hernias may cause difficulty in breathing. Sliding and paraesophageal HH, strangulated at the hilum, causes symptoms of an acute abdomen.

Where does pathology come from?

Hernia of the esophagus is divided into congenital or acquired. The congenital variant is diagnosed most often in childhood. The reason is an anomaly in the development of the digestive tract.

In addition, diaphragmatic hernia is caused by:

• traumatization (injuries, bruises, wounds, injuries);
• systemic pathologies of cartilaginous tissue (rheumatoid arthritis, ankylosing spondylitis, lupus erythematosus);
• genetic diseases (for example, Down's disease).

A hernia is formed with a combination of risk factors and pathology of the diaphragm.

Provoking factors include conditions in which intra-abdominal pressure rises:

• chronic constipation;
• fecal stones;
• profuse vomiting;
• bloating;
• ascites or peritonitis;
• weight lifting;
• hacking cough in obstructive pulmonary disease, bronchial asthma, etc.
• abdominal obesity.

During pregnancy, the growing uterus increases the pressure in the abdomen, which means that it increases the risk of a hernia of the esophagus.

The formation of a hernial sac is facilitated by a violation of peristalsis. Motility of the digestive tract decreases with:

• dyskinesia of the gallbladder by hypokinetic type;
• gastrointestinal ulcer;
• gastritis, gastroduodenitis;
• pancreatitis;
• cholecystitis;
• cancer of the head of the pancreas;
• Zollinger-Ellison syndrome.

Adhesive disease of the esophagus contributes to the formation of HH. Connective tissue cords "pull" the stomach and the lower third of the esophagus up into the chest. Adhesions are formed due to reflux esophagitis.

Clinical picture

The diagnosis of HH is made on the basis of the patient's complaints, anamnesis and data from additional clinical studies. Complaints of the patient are subjective signs of the disease, with a detailed study of which the doctor may suspect a pathology.

Subjective sensations

Signs of a hernia of the esophagus depend on the degree of pathology, on the duration of its course.

HH is manifested by the following symptoms:

• pain of varying intensity, predominantly retrosternal localization;
• feeling of a lump in the throat, dysphagia (difficulty swallowing);
• odynophagia (hernia of the esophagus hurts when swallowing);
• increased salivation;
• belching air;
• heartburn;
• bleeding.

Often an unpleasant sensation in the throat radiates to the neck and back of the head. The phenomenon is associated with the peculiarities of the innervation of this anatomical region.

Often patients complain that the pain radiates to the shoulders, shoulder blades and arms. Symptoms of esophageal hernia in adults depend on the severity of peptic esophagitis and the presence of complications. If a large hernial sac is infringed, then a clinic of an acute abdomen appears.

Indirect signs of HH

Symptoms of a hernia of the esophagus are often non-specific. Often they can be confused with other diseases of the abdominal cavity.

Extraesophageal signs:

• retrosternal pain resembling angina pectoris;
• various types of arrhythmias;
• chronic cough accompanied by shortness of breath.

A pathognomonic (specific) symptom is the association of pain with food intake, physical activity, coughing, and a change in body position.

Hoarseness, burning of the tongue, frequent hiccups are characteristic of HH. When gastric juice is inhaled, severe pneumonia develops with areas of necrosis.

What hardware and laboratory studies show

In the presence of subjective symptoms of a hernia of the esophagus, it is necessary to undergo a comprehensive examination.

The list of diagnostic measures for HH:

1. X-ray. Conduct two types of studies: with and without contrast. Barium contrast allows you to study in detail the walls of the organ, as well as the degree of hernial protrusion. The ulcer in the picture looks like a niche.
2. Esophagoscopy. During this study, erosive and ulcerative changes characteristic of peptic esophagitis are detected. If a tumor is suspected, a biopsy of the neoplasm is performed with further histological examination.
3. Feces for occult blood.
4. Esophageal manometry. The method allows to evaluate the function of sphincters and motility of the esophagus. Peristaltic antegrade movements are normal. Spasms of the esophagus are characteristic of HH.
5. Esophageal pH-metry. The acidity of the esophagus is measured.
6. Impendancemetry. Specifies the presence of reflux.

What is dangerous hernia of the esophagus

The consequences of a hernia are dangerous to health. If they are suspected, the patient is hospitalized in the surgical department for surgery. HH in women during pregnancy can threaten the health of the baby.

infringement

Infringement of a hernia is an acute pathology characterized by a strong pain syndrome. As a result of contraction of muscle structures, the organ in the hernia is infringed. Nerves and blood vessels are pinched. Due to circulatory disorders, necrosis develops.

Signs that a hernia is strangulated:

• strong pain;
• bleeding;
• vomiting with streaks of blood;
• dyspnea;
• tachycardia;
• hypotension.

If help is not provided in time, purulent peritonitis develops with perforation of the esophagus or stomach.

Ulcer

An esophageal ulcer develops against the background of peptic esophagitis. A defect is formed on the wall of the organ due to the influence of hydrochloric acid. The patient is concerned about intense retrosternal pain, aggravated by swallowing. Painkillers do not bring relief, but exacerbate inflammation. Esophagoscopy is used for diagnosis.

Perforation

Perforation is a perforation of the wall of the esophagus with the formation of a through defect. This pathology is characterized by the entry of an acidic stomach into the mediastinum. Purulent mediastinitis develops. The complication is severe and requires emergency medical care.

Bleeding

Esophageal hernia is often complicated by bleeding. With constant exposure to hydrochloric acid on the mucous membrane of the esophagus, the vessels are exposed. The walls of the arteries are damaged - profuse bleeding opens. Stopping blood from the esophageal arteries is difficult. The patient quickly falls into hemorrhagic shock. The pressure drops, the heartbeat quickens. The patient is unconscious. Urgent hospitalization in a surgical hospital is necessary.

Other complications

HH is always complicated by esophagitis. Inflammation of the esophagus occurs due to acid reflux. The caustic contents of the stomach destroy the walls of the organ. Reflux esophagitis is characterized by pain, swallowing disorders.

With severe destruction, adhesions are formed that narrow the lumen of the esophagus. These changes lead to Barrett's syndrome. When it appears, the risk of developing esophageal cancer increases by 100 times.

Against the background of impaired motor skills, chronic cholecystitis and cholecystopancreatitis develop. These diseases are caused by congestion in the venous plexuses.

Hiatus hernia in children

Infantile hernias are often the result of congenital anomalies. The intrauterine laying of the digestive tract and diaphragm is disturbed. There are 3 types of HH in pediatric practice:

• "thoracic" type of stomach;
• paraesophageal;
• sliding.

The first type of hernia is rare. Its feature is the lack of participation of the peritoneum in the formation of the hernial sac. Changes in the last two variants coincide with diseases in the adult group of patients.

An early symptom of HH in newborns is regular regurgitation and vomiting. Respiratory disorders are often associated. Children are worried about coughing and choking. Regular inhalation of the acidic contents of the stomach causes congestion in the lungs and pneumonia. With such a pathology, surgical interventions are indicated already at an early age.

How to treat a hernia of the esophagus

Treatment is carried out by a gastroenterologist or surgeon. The approach to therapy should be comprehensive. Prescribe a diet, a number of drugs.

Medications

Usually prescribe conservative therapy. Surgery is not indicated in 90% of patients. Treatment is based on taking medications.

Drugs for HH:

1. proton pump inhibitors. These include drugs with active ingredients omeprazole, pantoprazole, esomeprazole.
2. Means that affect peristalsis (Motilium, Ganaton).
3. Antacids (Gaviscon, Maalox, Almagel).
4. H2 blockers (Ranitidine, Famotidine).

Medicines have an analgesic and antiulcer effect. The duration of the course is determined by the attending physician. It is not recommended to prescribe therapy on your own.

How to cure a hernia of the esophagus with gymnastics and breathing exercises

Breathing exercises and physiotherapy exercises contribute to recovery. Deep breathing saturates cells with oxygen, stops oxidative processes.

Respiratory gymnastics is a special version of exercise therapy that helps to normalize blood circulation in the organs and restore the function of the gastrointestinal tract. Exercise reduces abdominal pressure, strengthens the muscles of the diaphragm.

Therapeutic complex of breathing exercises:

1. Lying on your side, rest your head on the arm bent at the elbow. Take a deep breath with maximum exhalation force. Repeat 10 times on each side.
2. Kneeling, bend in the spine while inhaling. Straighten your back, exhale. Repeat 5-7 times.
3. Lying on your back, make turns to the right and left. While turning, take rhythmic breaths in and out. Repeat 10 times on each side.

Maintain rhythmic breathing during exercise. Breathing exercises are carried out on the floor, as it is important to be on a flat, solid surface.

After performing breathing exercises, they switch to physiotherapy exercises. Exercises are aimed at strengthening the diaphragm and reducing intra-abdominal pressure.

Exercise therapy complex for patients with HH:

1. Sit on the floor, bend your knees, tilt your torso. On each exhalation, dip your fingers deep under the ribs. Do 5-10 repetitions.
2. Stand straight, relax your arms, straighten your back. Do tilts to the right and left, sliding your hands over your hips. Move only the upper body. Repeat 10-12 times.
3. Lie on your back, bend your knees, cross your arms behind your head. Alternately, with the right and left elbows, reach for the knee from the opposite side. Repeat 10-12 times.

After performing exercise therapy, you can repeat the breathing exercises again. With a hernia of the esophagus, it is useful to do yoga and swimming. These types of loads relax the muscles, saturate the tissues with oxygen.

Surgery

Surgical treatment is carried out with the ineffectiveness of conservative therapy. Indications for surgical intervention in HHP:

• ulcerative erosive changes;
• bleeding;
• gigantic hernia;
• Barrett's esophagus.

The Nissen operation is effective. The bottom of the stomach is wrapped around the esophagus, creating a gastric cuff. The latter prevents the retrograde movement of food. After the operation, the abdominal segment of the esophagus returns to the abdominal cavity, the normal passage of food is restored, and the emptying of the stomach is accelerated.

The duration of rehabilitation depends on the nature of the intervention. If laparoscopy was used, then rehabilitation lasts from 7 to 10 days. With laparotomy (open access), recovery takes several weeks.

Folk remedies

Is it possible to cure a hernia of the esophagus with the help of folk remedies? No, but you can alleviate the patient's condition.

Herbal medicine recipes for HH:

• 1 tsp boil cumin, fennel and peppermint in 1 liter of hot water. Let it brew for an hour. Filter with gauze, cool. Drink half a glass of decoction every 3-4 hours.
• 1 tbsp. grind flax seeds, sesame seeds and milk thistle in a coffee grinder. Take 1 tsp. powder on an empty stomach with a glass of water.
• 2 tbsp herb agrimony pour a glass of hot water. Insist 1 hour. Drink 1 glass of infusion per day.
• 1 tsp add oat fiber to a glass of kefir and drink before going to bed. The recipe eliminates constipation, beneficially influencing intestinal health.

The course of therapy is 2-3 months. The break between courses is 1-2 weeks.

Diet

Proper nutrition is the key to successful treatment of HH. The task of the diet is mechanical sparing of the esophagus. From the diet of a patient with a hernia exclude:

• muffin;
• fatty;
• acute;
• spicy;
• smoked;
• mushrooms;
• conservation;
• lemonade, cola;
• cocoa, including chocolate;
• coffee and strong tea;
• alcoholic drinks.

Remember and follow the 5 principles of therapeutic nutrition:

1. Fractionality. Reduce the volume of food to 200 ml, and increase the multiplicity to 5-6 times.
2. Correct posture. A straight back ensures the physiological position of the esophagus.
3. "Golden" half an hour. Do not lie down for 30 minutes after eating. It is at this time that the food bolus reaches the pyloric part of the stomach.
4. Sparing. Before serving, grind food in a blender. Do not eat too hot or cold food. Chew each bite thoroughly.
5. Diversity. So that the diet does not bother, the dishes should be tasty and beautiful.

It is impossible to completely get rid of a hernia with a diet. However, it is possible to stop the progression of esophagitis and speed up treatment.

Restrictions on the time of illness and rehabilitation period

HH is a chronic pathology. To avoid complications, patients need to learn how to live properly with a hernia. Recommendations for the prevention of complications of HH:

1. Ask your doctor if you can exercise.
2. Give preference to gentle physical activity. A patient with HH is recommended to do yoga, swimming and Pilates. You can not pump the abdominal press, do active aerobics.
3. Limit physical labor. It is forbidden to lift weights.
4. Do not eat while lying down.
5. During sleep, monitor the size of the patient's pillow. The angle between the head and the mattress must be at least 45°.

Complications of hiatal hernia are easier to prevent than to treat later.

What is a sliding hernia of the esophagus, and how it appears, is up-to-date information for people who are faced with such a problem. The organs of a healthy person are held in position by ligaments. In the presence of anomalies in the structure of the muscles of the diaphragm, part of the esophagus extends into the abdominal cavity, due to which a hiatal hernia is formed. If the organ does not move along its axis, the protrusion is called sliding.

In medicine, this disease is called a wandering hernia. Its identification presents some difficulties, because the esophagus during the examination can be in a physiological position, and pathological changes occur only under certain conditions. The stomach often penetrates into the hernial sac, its upper sections remain above the level of the diaphragm.

There are several types of wandering hernias. A protrusion is called fixed, in which its contents are held by adhesions. A floating hernia occurs only when a certain position is adopted.

Causes of the disease

In the presence of a small sliding hernia, the patient's health practically does not worsen. Symptoms of the disease are mild. These include frequent hiccups, belching and that appear as a result of overeating. Symptoms of the disease with proper nutrition are practically absent. A large hernial sac can be infringed, which causes severe pain in the epigastric region, nausea and vomiting, which are rarely accompanied by the release of the contents of the stomach to the outside.

Sliding hernias are also classified on the basis of which organ entered the protrusion cavity. With gastric, not only the esophagus is displaced, but also the upper sections of the stomach. With the esophagus, only the esophagus enters the hernial orifice. Cardiofundal protrusions are prolapse of the cardia and gastric fundus. There are many factors that can lead to the development of a sliding hernia:

1. Decreased muscle tone and ligaments of the diaphragm. Similar pathological changes often occur in the body of an elderly person and in persons with weak, untrained abdominal muscles.
2. Injuries of the chest and abdominal region. Various damage to the diaphragm can lead to the formation of a hiatal hernia.
3. Increased intra-abdominal pressure. It can be both sudden (high physical activity, pregnancy, difficult childbirth and trauma) and gradual (increased gas formation, overeating, constipation).
4. Congenital malformations of the structure of the digestive organs - the chest stomach.
5. Prolonged course of peptic ulcer, accompanied by scarring of tissues.

Diseases that disrupt the motility of the esophagus and stomach (pancreatitis, cholecystitis, ulcers) can also contribute to the development of a hernia. Violations in the processes of formation of connective tissues is another reason for the occurrence of protrusion.

Clinical picture of the disease

Heartburn is the main symptom of an esophageal hernia. It is aggravated by taking a lying position or eating a large amount of food. The cause of heartburn is gastroesophageal reflux - the reflux of gastric juice and semi-digested food. The feeling of a lump in the throat when eating and pain behind the sternum are no less common symptoms of a sliding hernia. Dysphagia in the presence of a large protrusion occurs even when a person consumes semi-liquid food and water. The appearance of a symptom is associated with, in which the inflammatory process occurs or adhesions form.

The appearance of problems with swallowing can also be explained by the incorrect position of the organs. Belching with air and food regurgitation are caused by the reflux of stomach contents into the esophagus, especially if a person lies down immediately after eating. Similar symptoms may be associated with a decrease in the tone of the cardia. Often the patient feels a feeling of fullness in the epigastric region, which causes him to belch on his own, after which the condition improves.

The occurrence of hiccups contributes to the defeat of the vagus nerve. Seizures are rare and can last from a few hours to a month. Hiatal hernia also has unusual symptoms that significantly complicate diagnosis. A person is unsuccessfully treated for other diseases, not realizing the displacement of the digestive organs. The hernia enlarges, causing inflammation and other complications. Content infringement is considered the most dangerous. Symptoms of a complicated hernia are manifested in the form of acute pain in the epigastric region, nausea and vomiting. Semi-digested masses often contain impurities of blood and bile.

Diagnosis and treatment of the disease

Examination of the patient begins with an examination and a survey, during which the doctor analyzes the symptoms of the disease, determines their dependence on food intake. X-ray examination allows you to assess the position of the digestive organs. It is mandatory to conduct EGD - the introduction of an optical tube into the esophagus, with which its internal surfaces are examined. Special equipment registers changes in the acidity of gastric juice.

Elimination of a sliding hernia of the esophagus can be carried out in several ways. Conservative therapy is based on the use of drugs. Wandering hernia is an indication for a special diet and exercises aimed at strengthening the muscles of the abdominal cavity. With a small hiatal hernia, treatment is carried out according to the same scheme as for gastroesophageal reflux.

The operation is prescribed in the presence of a large protrusion and creating an obstacle to the normal movement of the food bolus, frequent reflux of the contents of the stomach into the esophagus, and cardiac insufficiency. Hernias that are prone to infringement and the formation of adhesions are treated surgically. An emergency operation is performed in the presence of inflammatory changes in the esophagus.

There are several types of surgery used to repair a sliding hernia. The operation can be performed open or laparoscopically. The Allison technique is used in conjunction with other therapeutic measures, since it is not able to completely eliminate gastroesophageal reflux. During the operation, an incision is made between the 7th and 8th ribs, through which the hernial orifice is sutured.

Gastrocardiopexy involves fixing the upper stomach to the diaphragmatic ligaments through an opening in the upper abdominal line. In a Nissen fundoplication, a cuff is wrapped around the upper part of the stomach to prevent the contents from being ejected into the esophagus. After installing this device, the stomach is given the correct position, the hernial ring is sutured. The Belsi method is used when the hernia reaches a critical size, while the bottom of the stomach is sutured to the wall of the esophagus, and the cardia is fixed to the diaphragm.

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

Sometimes the problem can be accompanied by unpleasant symptoms that worsen the quality of life of the patient and lead to serious consequences.

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

What is pathology

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

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

Reasons for the appearance

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

Congenital causes of hernia development include:

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

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

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

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

The risk group includes the elderly, as well as women, in particular pregnant women.

Symptoms of the disease

Most often, the pathology has no clinical signs and is asymptomatic, therefore, it is detected only with certain diagnostic methods.

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

However, experts determine the following symptoms of pathology with a large hernia:

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

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

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

Disease classification

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

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

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

• acquired;
• congenital.

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

• cardiac;

There are several degrees of hernia:

• At grade 1, only the lower esophagus penetrates the chest cavity. Usually such a deviation is asymptomatic and is treated with medication and diet.
• At 2 degrees, not only the esophagus, but also parts of the stomach are localized in the sternum. Various signs of the disease begin to appear.
• Grade 3 is characterized by the location in the sternum of the esophageal tube and the upper part of the stomach. The symptoms are pronounced.

The third degree of pathology requires surgical intervention.

Diagnostic methods

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

After that, laboratory diagnostic methods are prescribed:

• blood test (general);
• urine test.

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

In some cases, additional diagnostic methods and consultation of several specialists may be prescribed.

Treatment of pathology

Treatment of the disease should be comprehensive.

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

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

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

Medical treatment

Usually, the pathology responds well to medical treatment.

Therapy includes the use of the following groups of drugs:

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

To restore the protective functions of the mucosa of the organ, the drug De-nol is used. You can eliminate belching and heartburn with Motilium.

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

Folk remedies

As an auxiliary method, alternative methods of treatment can be used.

These include internal use:

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

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

Surgery

Indications for surgery are the following factors:

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

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

Surgery is performed laparoscopically.

Exercises

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

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

Health food

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

The following foods should be excluded from the diet:

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

Useful products for pathology are:

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

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

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

Complications of pathology and prognosis

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

These severe consequences include:

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

Due to frequent bleeding, the patient develops anemia.

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

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

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

Diaphragm holes (a photo of the pathology is presented below in the article) and reflux esophagitis are quite dangerous diseases. Against the background of these conditions, stretching of certain sections of the gastrointestinal tract is noted. In particular, changes occur in the ligaments that support the stomach and esophagus, a photo of which is also presented in the article. As a result of stretching, displacement occurs. In particular, the upper gastric portion extends into the thoracic region. As a result, the functioning of the sphincter connecting the stomach and esophagus is disrupted (the photo illustrates this area).

Likely risk

When the angle of His changes and the activity of the esophageal (lower) sphincter is disturbed, acidic contents of the stomach or bile are thrown into the esophagus from the duodenum. The process is accompanied by the development of inflammation, restructuring of the mucosa. This greatly increases the risk of cancer. Of particular importance in the development of pathology is a sliding hernia of the esophageal opening of the diaphragm. The operation is the only available method to eliminate this violation. However, surgical intervention has its own nuances. Next, we will analyze in more detail what a hernia of the esophageal opening of the diaphragm is. Degrees, types and manifestations will also be described in the article.

General information

A hernia in the esophagus, as a rule, develops in combination with gastroesophageal disease. GREB is accompanied by a complex of cardiological, pulmonological and dyspeptic disorders. They arise mainly due to hernia and gastroesophageal reflux. In accordance with the data of the American and European Associations, in the presence of HH in a person for 5-12 years, the probability of developing cancer after five years increases by 270%, and after 12 - by 350-490% (depending on age).

The prevalence of pathology

HH, according to a number of authors, is considered the same frequently diagnosed disease as, for example, cholecystitis or esophageal ulcer. In terms of their prevalence, these pathologies occupy leading positions among diseases of the gastrointestinal tract. HH, like an esophageal ulcer, is considered a rather dangerous disease that requires timely diagnosis and careful monitoring.

Classification

There are three main categories of HHP. These include:

sliding hernia

This form of the disease differs in some features. In general, a sliding hernia is a protrusion in which one of the walls is an organ partially covered by the peritoneum. This may be, in addition to the site considered in the article, the bladder, ascending and descending intestines, and so on. At the same time, it may not be. The protrusion in this case is formed by parts of the organ that are not covered by the peritoneum.

Origin mechanism

In accordance with this feature, there are:

Inguinal sliding hernias in the large intestine, as a rule, are large protrusions with a wide gate. They are usually diagnosed in old age. Detected using x-ray methods of examination of the large intestine. Sliding hernia in the bladder is manifested by dysuric disorders. Patients have double urination. First, emptying is carried out as usual, and then, when pressing on the protrusion, another urge appears, and the patient urinates again. Diagnosis is by catheterization and cystography. During these procedures, the shape and size of the hernia, the absence or presence of stones in the bladder are revealed.

Axial hiatal hernia

This pathology is a displacement of the stomach or other abdominal organs into the chest cavity. The disease is detected in 5% of the adult population. At the same time, about half of the patients do not notice any manifestations. This course of the pathology is due to the fact that the sliding one has erased signs of a typical form, since the protrusion is located inside the body and cannot be detected during a routine examination. The disease affects women more often than men. In children, the pathology is predominantly congenital.

Forms of the disease

Sliding hernia of the esophageal opening of the diaphragm is divided into:

• Cardiofundal.
• Total stomach.
• Cardiac.
• Subtotal stomach.

Paraesophageal hernias are classified into:

• Gastrointestinal.
• Salnikova.
• Intestinal.
• Antral.
• Fundamental.

Stages of pathology

Sliding hiatal hernia can be classified according to the volume of the stomach that enters the chest cavity:

Clinical picture

The symptoms of the pathology are very similar to the manifestations of diseases of the digestive tract associated with impaired functioning. Against the background of a deterioration in the activity of the esophageal (lower) sphincter, catarrhal reflux is noted (reverse reflux of gastric contents). After a while, due to the aggressive influence of the masses, an inflammatory process develops in the lower part of the esophagus. The patient begins to complain of heartburn after eating and aggravated by physical overexertion or in a horizontal position. Often appears After eating, pain may appear. They have a different character. Soreness can spread to the shoulder blade, give to the neck, behind the sternum, to the region of the heart or lower jaw. These manifestations are similar to those of angina pectoris, with which a differential diagnosis is made. In some cases, pain appears at a certain position of the body. The patient's complaints are likely to be bloating of the upper abdomen, a feeling of the presence of a foreign body.

Effects

More severe cases are characterized by a number of complications. One of them is bleeding from the esophageal vessels. As a rule, it proceeds in a latent form and manifests itself in the form of progressive anemia. Bleeding can be chronic or acute. In some cases, even infringements of protrusions in the esophageal opening and perforation of the esophagus are detected. The most common consequence of pathology is reflux esophagitis. It can transform into a peptic ulcer in the esophagus. With prolonged therapy, this condition provokes an even more severe complication - a scar organ.

Diagnostics

Identification of pathology is carried out using several methods. Among the main ones should be mentioned: esophagogastroduodenoscopy, x-ray of the stomach and esophagus, intraesophageal PH-metry. Ultrasound, computed tomography, esophagometry are also used.

Treatment of pathology

Various measures are being taken to alleviate the manifestations that accompany a sliding hernia of the esophageal opening of the diaphragm: diet, medications. Conservative methods are aimed at eliminating the symptoms of pathology: relieving pain, heartburn, nausea. At the same time, medications are prescribed that lower the acidity of gastric juice. Such means, for example, include the drug "Kvamatel". One of the conditions for effective treatment of patients diagnosed with hiatal hernia is diet. The presence of fatty, spicy, fried foods, alcohol, chocolate, coffee, products that promote the production of gastric juice is limited in the diet. Eat small meals often. To prevent reflux, the patient is advised to sleep with the upper torso elevated and to avoid heavy lifting.

Surgical intervention: general information

It should be said that the above measures do not eliminate the reason why a sliding hiatal hernia occurs. Surgery is the only way to restore the anatomical relationship between the parts of the gastrointestinal tract. During the intervention, an antireflux mechanism is created that prevents the backflow of stomach contents. During the operation, the hernial orifice is eliminated by suturing the enlarged aperture of the diaphragm to a normal size.

Applied surgical techniques

Today, specialists use two methods of intervention:

• Open access. In this case, a Nissen fundoplication or Tope plasty can be performed. In the first case, the risk of developing many complications is high. Therefore, plastic according to Tope is preferable.
• laparoscopic access. This is the least traumatic method of intervention. After the operation in this way, the patient recovers faster and easier.

It should be said that laparoscopy for a hernia in the esophagus is often performed in conjunction with operations of other organs in the abdominal cavity. For example, cholecystomy is performed with calculous cholecystitis in the chronic stage, proximal selective vagotomy - with an ulcer in the duodenum.