Sliding hiatal hernia: symptoms and treatment. Treatment of axial hernia of the esophageal opening of the diaphragm Sliding hernia of the esophageal opening of the diaphragm

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

A hernia of the esophagus most often occurs in adulthood.

Depending on the location of the defect, there are:

axial hernia;
cardiac rupture.

There are several types of pathology:

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

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

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

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

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

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

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

What is a hiatal hernia, the video will tell:

Reasons for the formation of a sliding hernia

Increased salivation is a sign of a sliding hernia.

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

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

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

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

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

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

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

What are the signs of the disease

Heartburn is a symptom of a sliding hernia.

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

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

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

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

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

How is the diagnosis carried out

To identify a sliding formation, experts use several methods:

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

Features of treatment

Maalox will help reduce the acidity of the esophagus.

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

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

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

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

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

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

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

Sliding hernias are hernias, one of the walls of which is an organ that is partially covered by the peritoneum (descending and ascending intestines, bladder, etc.).

The hernial sac may be completely absent, then the protrusion will be formed by parts of the slipped organ that are not covered by the peritoneum. With direct inguinal hernias, sliding hernias of the bladder can often be found, and with oblique ones, of the colon and caecum. 1-1.5% of all hernias in the inguinal region are sliding.

According to the mechanism of occurrence, there are:

congenital - when organs, for various reasons (this process can begin already in the embryonic period), some of their departments that are not covered by the peritoneum, can gradually descend (slide) along the loose retroperitoneal tissue to the area of \u200b\u200bthe internal gate of the hernia, exit the abdominal cavity and become an integral part of a hernia without a hernial sac;
acquired - arise due to mechanical contraction by the peritoneum of those segments of the bladder or intestine that are adjacent to it and are devoid of a serous cover.

Sliding inguinal hernias of the large intestine usually look like large protrusions in the inguinal region with a wide hernial ring, more often in older people. They are diagnosed with the help of X-ray methods of examination of the colon (irrigoscopy).

Sliding hernias of the bladder manifest themselves as dysuric disorders. There is such a symptom as urination for two times: first, the patient releases the bladder, and then, with pressure on the hernial protrusion, the urge to urinate again appears, the patient urinates again.

For diagnosis, bladder catheterization is performed and cystography is performed, which reveals the size and shape of the hernia, the presence of stones in the bladder itself.

If a sliding hernia is detected, its treatment is only surgical. The peculiarity lies in the fact that it is necessary to perform the operation extremely carefully, since without knowing its anatomical features, it is possible to open the wall of the bladder or intestine instead of the hernial sac.

Sliding hiatal hernia

Sliding hiatal hernia (hiatal hernia, sliding hiatal hernia) or esophageal hernia is the movement of the stomach or other abdominal organs through an enlarged hiatal opening in the diaphragm into the chest cavity.

The disease occurs in 5% of the total adult population, despite the fact that half of the patients do not note any clinical manifestations. This happens because with a sliding hernia of the esophageal opening of the diaphragm, the symptoms (signs) of a typical hernia are erased, since it is inside the body and cannot be seen during a normal examination of the patient. More common in women than in men; children are mostly congenital.

Sliding (axial) hernia of the esophageal opening of the diaphragm (HH), referring to one of the variants of hernia of the esophageal-gastric opening in the diaphragm, is divided into:

cardiac;
cardiofundal;
total stomach;
subtotal stomach.

Another variant of hernias is paraesophageal, classified into:

fundic;
antral;
stuffing box;
intestinal;
gastrointestinal.

There is also a classification depending on the volume of the stomach penetrating into the chest cavity:

sliding hiatal hernia of the 1st degree - above the diaphragm, in the cavity of the chest there is the abdominal esophagus, the cardia is located at the level of the diaphragm, the stomach is in an elevated position and is adjacent directly to the diaphragm;
sliding hernia of the esophageal opening of the diaphragm of the 2nd degree - the abdominal part of the esophagus is located in the chest cavity, and part of the stomach is located directly in the POD area;
sliding hernia of the esophageal opening of the diaphragm of the 3rd degree - the abdominal part of the esophagus, the bottom and body of the stomach (sometimes the antrum), the cardia are above the diaphragm.

Symptoms of a sliding hiatal hernia (stomach)

Symptoms are more similar to diseases of the digestive tract, due to a violation of its functioning. With a deterioration in the activity of the lower esophageal sphincter, gastroesophageal catarrhal reflux is observed (reflux of gastric contents into the esophagus). After a certain time, due to the impact of the aggressive contents of the stomach, inflammatory changes appear in the lower part of the esophagus.

The patient has the following complaints: heartburn after eating, aggravated by physical exertion, in a horizontal position. There are frequent complaints of a sensation of a lump in the throat.

Pain may appear immediately after eating, having a different character, extending beyond the sternum, into the neck, shoulder blade, lower jaw, into the region of the heart. Such pains resemble angina pectoris, with which a differential diagnosis is made. Sometimes pain with sliding HH occurs only in a certain position of the body. The patient may complain of bloating in the upper part, sensation of a foreign body.

In more severe cases, as a complication, there is bleeding from the vessels of the esophagus, which, most often, is hidden and manifests itself only as progressive anemia. Bleeding is acute and chronic, there are even infringements of a hernia in the esophageal opening of the diaphragm and perforation of the esophagus.

Reflux esophagitis is the most common sequela of a herniated esophagus, which can progress to a peptic ulcer of the esophagus.

With a long course, this condition leads to a more severe complication - cicatricial stenosis (narrowing) of the esophagus.

For diagnosis, esophagogastroduodenoscopy, X-ray examination of the stomach and esophagus, ultrasound, intraesophageal PH-metry, esophagometry, and computed tomography are used.

Treatment of a sliding hiatal hernia (stomach)

With a sliding hernia of the stomach, conservative treatment is first recommended, it is aimed more at alleviating the symptoms of reflux esophagitis: heartburn, nausea, pain. Drugs that reduce the acidity (PH) of gastric juice (such as Kvamatel from Gedeon Richter) are used.

The patient must follow a diet with a restriction of spicy, fatty, fried foods, chocolate, coffee, alcohol, all products that contribute to the production of gastric juice. Eat often, in small portions. To avoid reflux, it is recommended to sleep with an elevated upper torso and avoid heavy lifting.

But, unfortunately, conservative therapy of a sliding hernia of the esophageal opening of the diaphragm, the treatment (h) of which was carried out with medications, diet, does not eliminate the cause of the disease (the hernia itself) and brings only a temporary effect. Therefore, a planned operation is recommended.

For surgical treatment of HH, the criteria are:

the presence of complications such as bleeding, anemia, ulcers and erosion of the esophagus, esophagitis;
inefficiency of conservative methods of treatment;
the large size of the sliding hernia of the stomach and its fixation in the hernial orifice;
paraesophageal (paraesophageal) sliding hernia, due to the high risk of strangulation;
signs of dysplasia of the esophageal mucosa, which acquires signs of the structure of the mucous membrane of the small intestine.

The essence of the operation is to restore the correct anatomical relationship between the stomach and esophagus: elimination of the hernia, elimination of the hernial orifice by suturing the esophageal opening of the diaphragm to normal size and creating an antireflux mechanism that prevents gastric contents from being thrown into the esophagus.

Today, there are two types of techniques used for surgical treatment:

open access - Nissen fundoplication (complications of which may be early dysphagia, small ventricular syndrome, cascade stomach) or, more preferable, Tope plasty (with fewer complications);
laparoscopic access - allows you to perform the operation in the least traumatic way (with incisions of 1-2 mm by 5-10 mm), contributes to a faster recovery of the patient after the operation.

Laparoscopic surgery for hiatal hernia is often combined with surgery for other pathologies of the abdominal organs: in chronic calculous cholecystitis, cholecystectomy is performed, and in duodenal ulcer, selective proximal vagotomy.

Video: Operation EsophyX - hiatal hernia

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

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

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

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

Types of hiatal hernia

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

axial, or sliding;
cardiac.

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

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

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

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

Causes of a sliding hiatal hernia

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

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

Typical symptoms and treatments for a sliding hiatal hernia

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

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

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

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

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:

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.
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.
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:

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.

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.

Crushing food. Eating should occur every 3-4 hours, the amount of food should be small, a maximum of 300 g at a time.
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.
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.
In the case of a narrowed esophagus, all food must be ground to a semi-liquid state.
Eating should occur no later than an hour before going to bed.
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.

Hernia of the esophagus can be both acquired and hereditary. The most common is a sliding hernia (or axial), and if not treated in time, it can provoke internal bleeding. What is a sliding hernia of the esophageal opening of the diaphragm - read in our article.

A sliding hernia of the esophagus is a protrusion of the lower part of the esophagus, in which part of the stomach is displaced into the chest cavity. The disease develops for a long time, at first without symptoms. A sliding hernia of the esophagus lends itself well to non-surgical treatment, if it is noticed in time.

According to statistics, up to 5% of adults suffer from a sliding hernia of the esophagus, and women suffer from it more. Usually, more than one cause leads to the disease. Of the congenital factors, there are:

insufficient development of the muscles of the diaphragmatic legs and an enlarged esophageal opening;
untimely closure of the diaphragm;
in the embryonic period, insufficiently rapid lowering of the stomach.

Among the acquired factors are:

age-related changes in the diaphragm;
inflammation or injury of the nerve of the diaphragm, and its relaxation;
ulcer, cholecystitis and subsequent strong contractions of the esophagus;
increased abdominal pressure.

Also, an axial hernia of the esophagus can be caused by pregnancy, the consequences of childbirth, obesity, various stomach diseases that increase pressure in the organ. Due to many reasons, no one can be insured against this type of hernia. Axial hernia, fortunately, is not infringed and there is no circulatory disturbance.

Symptoms

Typical symptoms of the disease are pain in the stomach and heartburn. With this hernia, the upper part of the stomach is displaced into the chest cavity through the enlarged opening of the diaphragm, and then returns to its normal position. But often the symptoms are mild, especially if the hernial protrusion is small. In many patients, a hernia is discovered by chance, after undergoing an X-ray.

An external examination also does not give results - with an axial type of hernia, the abdominal organs are displaced into the internal cavity and there are no external symptoms. But with a prolonged course of the disease, the contents of the stomach are thrown into the esophagus, irritating its mucous membrane.

Main symptoms:

Lying down after eating - severe heartburn.
Belching, movement of food into the esophagus and even into the oral cavity in the absence of vomiting.
Burning pain behind the sternum and in the epigastric region, the symptoms are especially pronounced when bending over.
Frequent tracheitis, bronchitis (sometimes pneumonia), due to the penetration of the acidic contents of the stomach into the respiratory tract, with belching.
Swallowing disorder, initially reflex (no feeling of swallowing while eating liquid food). Then the mucous membrane of the esophagus becomes inflamed, narrows and the food bolus passes with difficulty.

Occasionally, patients can observe increased salivation and high blood pressure. The pains of a sliding hernia and an ulcer are different. In this case, the pain depends on the amount of food taken, and it can be eliminated by drugs that reduce acidity.

Video “Hiatal hernia”

Diagnostics

Sliding ulcer is diagnosed mainly by X-ray examination. Ultrasound and FGDS do not allow to notice it. Sometimes changes can be seen on an MRI. In order to accurately diagnose and begin treatment, in addition to x-rays, the following examination methods can be used:

probing of the esophagus, gastroscopy;
esophageal pH-metry;
endoscopy (better done in combination with radiography);
study of the work of the esophageal-gastric junction.

Treatment Methods

Once diagnosed, treatment should begin immediately to reduce the risk of complications and the likelihood of future surgery.

Doctors treat a hernia without complications in conservative ways. Surgical treatment is indicated in the late stages of axial hernia and bleeding.

Conservative treatment includes three activities:

Diet.

The diet must be constantly monitored. Patients are prescribed frequent meals with small portions of 250 g. Fatty, spicy, smoked, fried foods should be excluded (as well as everything that stimulates the production of gastric juice and irritation of the mucosa). The basis of nutrition: stewed, steamed, boiled dishes from cereals, vegetables, milk, dietary meat, fruits. With symptoms of dysphagia, food should be semi-liquid or frayed, and you should not eat before bedtime. It is forbidden to rest lying down after a meal.

Normalization of the rhythm of life.

To effectively cure a hernia, the patient must give up alcohol and smoking. Physical activity should not be too much. Requires both night rest and daytime rest. All exercises that increase pressure in the abdominal cavity are contraindicated.

Medicines.

When the disease is used drugs:

reducing acidity (gastal, maalox);
eliminating heartburn and belching (motilium);
suppressing the secretion of hydrochloric acid (omez);
relieving pain and spasms (no-shpa and painkillers).

If surgical treatment is necessary, it is usually carried out according to the Nissen method. A special cuff is made around the esophagus, which eliminates the reflux of gastric contents into the esophagus. The operation is performed laparoscopically. Less common surgical treatments are fundoplication and Tope plasty.

Video “Sliding hernia of the esophagus”

What is an axial hernia of the esophagus, how to treat it and how to diagnose it - you will learn from the video below.