Axial hernia hiatus diaphragm is the most common type of deformation. Among all the diseases digestive system it ranks third. Treatment of such pathology is very problematic if it is not detected at an early stage of formation.
Most often, axial hiatal hernia affects the female population, as well as elderly people - over 50 years old. Hiatal protrusion is a partial protrusion of the esophagus into the chest. This also leads to displacement of other adjacent internal organs located in the peritoneum.
Esophageal hernia can be either acquired or congenital. This defect has two types: axial (sliding) and paraesophageal (fixed).
The disease is characterized by the protrusion of organs through an enlarged hole in the diaphragm.
Pathology can develop for many reasons. So sometimes a problematic pregnancy, difficult birth child can lead to the onset of deformation processes and weakening of the transverse abdominal muscles.
An axial hiatal hernia begins to develop with reduced elasticity of muscle connective tissues and weakening of their ligaments. This type of muscle must regulate diaphragmatic expansion and contraction. If they begin to function poorly, then all the prerequisites appear for the upper part of the digestive organ to protrude through the hole in the diaphragm. Disturbed regulation does not allow the esophageal opening to close completely, which is where health problems begin.
A sliding hernia can form with prolonged reflux gastritis, which shortens the length of the esophagus. This is caused by an active inflammatory process, as well as the appearance of scars on its walls. Can cause a number of serious complications.
Deformation and displacement of internal organs into the abdominal cavity can occur due to chronic diseases of the glands. Frequent illnesses, affecting the liver or pancreas have a negative impact on human health and can also affect the formation of a hernia.
The next common cause of signs of an axial hernia is frequent spasmodic syndrome of the esophagus, inflammation of its mucous membrane and epithelium. This is also associated with impaired motility of the gastrointestinal tract.
The increased load has a direct impact on the abdominal muscles and their work. Weakening and loss of elasticity of ligaments can be caused by high physical activity and heavy lifting. Pressure inside abdominal cavity rises at excessive consumption food, as well as during the occurrence of some symptoms of stomach disease - flatulence, constipation, increased gas exchange in the body.
The formation of a sliding hernia also often occurs when overweight patient, severe injuries to the diaphragm or abdominal muscles. A large mass leads to constant tension in muscle tissue and ligaments, preventing them from contracting normally and being in good shape. And strong targeted physical damage can disrupt the integrity of their structure.
The causes of deformation of the muscle tissue of the diaphragm may be associated with diseases of the human respiratory system. If the patient constantly experiences severe uncontrollable cough, this will lead to increased loads on longitudinal muscles belly. Frequent and regular tension, without the ability to relax them, will affect the functioning of the esophagus. Then the hole will not close completely or will undergo spasms.
also in Lately doctors say that some bad habits of the patient can lead to the formation of a sliding hernia.
These causes of pathology belong to the category of acquired ones, which can be controlled if you monitor your health. But a congenital form of axial hiatal hernia also occurs. It can have an initial stage in a child from the first years of his life. This is explained by the characteristics of his body, the mother’s difficult pregnancy, or hereditary predisposition. The last reason is observed quite rarely. It does not appear immediately, but only after the influence of basic facts that can develop a pathological condition.
Symptoms
With an axial hernia, characteristic symptoms are often observed.
First of all, heartburn may appear. It usually occurs after eating. When food enters the stomach, the gastroesophageal reflex can cause the contents to reach the esophagus. Most often it bothers the patient when he is in horizontal position.
In addition to burning and heartburn, frequent hiccups are observed. Irritation of the hernial sac of the phrenic nerves leads to convulsive contraction of the entire diaphragm. Hiccups can be prolonged and may also be accompanied by a wheezing sound that is produced by spasm of the glottis.
The pathology is characterized by pain in the intestines and a burning sensation in the chest. This is caused by the displacement of the hernia through the opening of the esophagus into the diaphragm. The feeling of pain becomes stronger when the patient's body position changes, bends or strains on the muscles.
Belching and gagging often occurs. The patient's intragastric pressure increases, and air comes out with force. The level of acidity in the body increases, which leads to sour belching. At the same time there is chronic cough, signs of bronchitis, shortness of breath. The reason for this is that food gets into the Airways.
When a hernia occurs, swallowing function is impaired (dysphagia). It is difficult for any food or liquid to enter the stomach. Local bleeding may also occur if the surface of the mucous membrane is damaged.
Doctors can often detect an axial hernia at an active stage of development when diagnosing other diseases in a patient. During this period of time, the patient may not experience symptoms of diaphragm muscle deformation at all. Fixed this pathology randomly.
This pathological condition can cause many complications. These include: acid reflux, cicatricial stenosis, bleeding from the esophagus and ulcer.
Video “What is a hiatal hernia”
Treatment options
Treatment of axial hernia consists of a conservative approach (the use of medications, diet, nutrition) and a surgical approach (surgery).
Before prescribing a method of treating pathology, it is necessary to diagnose the patient. Treatment methods depend on the completeness of the information collected about the patient’s condition.
IN medical practice it was decided to divide the process of development of a sliding hiatal hernia into several degrees. Determining the degree of pathology depends on the location and stage of progression of the hernia.
The first degree is an axial esophageal hernia. At this stage, the abdominal segment is under the diaphragm. The cardia at this time is located at the same level, and the stomach is located under them. Axial deformity develops simultaneously with the patient's hiatal protrusion.
The second degree is cardiac. IN in this case the cardia is already located above the diaphragmatic membrane. At this time, the gastric mucosa is partially in the esophagus.
The third degree is cardiofundic. Part of the stomach flows into the sternum. Similar cases are not recorded often.
The fourth degree is gigantic. The stomach is almost completely pressed into the chest, pressing on adjacent internal organs. Hospitalization and urgent surgical intervention. In such a situation, medication treatment will not help significantly.
For axial hernia, therapeutic treatment is indicated.
Drugs are prescribed that normalize the acid-base balance in the stomach. These include antisecretory and antacid medications.
It is necessary to take medications to regulate the motility of all digestive organs - prokinetics.
Medicines that reduce the stomach's production of hydrochloric acid. These include special proton pump inhibitors, H2 blockers histamine receptors. They also treat some complications of a sliding hernia - ulcers, erosion of a hollow organ and intestines.
Surgical intervention is necessary in case of complications of the pathology. If systematic bleeding occurs in the esophagus or gastroesophageal reflux, then the patient needs surgery. Also treatment in a similar way necessary when a hernia is pinched, several internal organs enter the chest cavity, which begin to compress the heart.
Prevention
Among preventive measures There are very effective methods for preventing and treating axial hernia.
Leading a healthy lifestyle is very simple but effective. If the human body does not experience excessive stress and gives up most bad habits, then the likelihood of acquiring such a pathology will significantly decrease.
You need to eat constantly healthy food and follow a diet.
You should exercise and maintain correct posture.
Among diseases of the digestive system, not the least axial hiatal hernia, which According to medical observations, it occurs in 5% of the adult population, has severe symptoms and requires immediate medical attention. In the gastroenterological practice of doctors, such a disease can often be found under the term “axial vital hernia”, “HH” or the simplified name “esophageal hernia”. The disease has a chronic relapsing course, characterized by protrusion of the lower esophagus and displacement of part of the stomach into the chest cavity. What is a hiatal hernia, what are its causes, symptoms, how dangerous is the disease and what treatment methods does modern gastroenterology offer?
Description of the disease
An axial hiatal hernia occurs when the muscles of the diaphragm around the hiatus hiatus weaken. This pathological condition leads to the fact that part of the stomach, after eating or exercising, enters the chest cavity, but after a while returns to its previous state. At the initial stages of the development of the disease, the clinic may be absent or manifest minor signs, but as it progresses, the symptoms become pronounced and require immediate medical intervention.
As practice shows, hernia most often occurs in women, less often in men. It can be congenital or acquired.
Based on morphological characteristics, esophageal hernia is divided into several stages and classifications, each of which has its own characteristics. In practice, the most common type is a sliding (axial) hernia, which is diagnosed in 90% of patients. It received its name, a sliding axial hernia, because it is able to slip into the upper stomach and lower alimentary sphincter, penetrate the sternum and return freely.
Causes
There are several causes and predisposing factors that can trigger the development of a hiatal hernia, but in 50% of cases the disease is not an independent disease, but manifests itself against a background of progressive dystrophic changes esophagus and connective tissue. The trigger mechanism for the development of the disease can be following reasons and factors:
- Sedentary lifestyle.
- Asthenic physique of a person.
- Flat feet.
- Scoliosis.
- Haemorrhoids.
- Increased intra-abdominal pressure.
- Hurting cough.
- Obesity.
- Hard physical labor.
- Pregnancy period.
- Reflux esophagitis.
In addition to the above reasons, gastritis, stomach ulcers, cholecystitis, pancreatitis and other diseases can provoke the development of a hernia. Regardless of the etiology of the disease, treatment should be started as quickly as possible, this will help reduce the risk of complications and surgery.
Classifications and stages of development
Axial hiatal hernia is divided into three main types:
- Sliding (not fixed)– able to move from the lower part of the esophagus to the upper and sternum;
- Paraesophageal (fixed)– only the cardiac part of the organ moves into the chest cavity, which does not descend back. This type of disease is much less common, but fixed hernias are more dangerous and often require immediate surgical intervention.
- Combined– accompanied by two signs of the first two options.
Depending on the spread of the hernia into the chest I distinguish three stages:
First degree– the abdominal section of the esophagus is located above the diaphragm, the stomach is raised and pressed tightly against it. At grade 1, clinical signs are invisible, and minor disturbances in the gastrointestinal tract often go unnoticed.
Second– the esophagus is present in the sternum, the stomach is located at the level of the diaphragmatic septum. When diagnosing stage 2 of the disease, the symptoms are severe and require medical intervention.
Third stage– there is part of the esophagus above the diaphragm. This is the most severe degree of the disease, requiring surgery.
It is known that the first degree of the disease is often accompanied by other concomitant diseases of the gastrointestinal tract, so at this stage it is difficult to recognize a hernia. Most often, the underlying disease is treated.
Clinical signs
In almost 30% of cases, an axial hernia does not cause any symptoms, but only until it reaches more serious stages of development. Often the symptoms can resemble other diseases, which makes diagnosis very difficult. Clinical manifestations intensify as the hernial sac enlarges.
The main symptom of the disease is pain in the chest, back, and abdomen. Intensity pain syndrome quite different, from weak and aching pain, to the point of acute and unbearable. The pain often worsens after eating, physical activity, coughing, turning or bending the body.
In addition to pain, there are other symptoms, including:
- Unpleasant belching.
- Nausea, vomiting.
- Difficulty swallowing food and liquids.
- Severe heartburn.
- Hoarseness of voice.
- Sore throat.
- Discomfort in the epigastrium.
- Dyspeptic disorders.
- Increased fatigue.
- Frequent headaches.
- Low blood pressure.
When the hernial sacs are strangulated, the symptoms become more pronounced, the patient’s condition worsens sharply, and the risk of internal bleeding. Such symptoms require immediate hospitalization of the patient in a hospital where he will receive proper medical care.
Possible complications
Absence timely treatment can lead to unpleasant and sometimes irreversible processes. Among the complications, the most common are:
- aspiration pneumonia;
- chronic tracheobronchitis;
- strangulated hernia;
- reflex angina;
- the risk of myocardial infarction increases;
- stomach bleeding;
- perforation of the esophagus;
With a long-term disease, the risk of developing malignant tumors increases. Given the complexity of the disease and its possible consequences, the only way to prevent complications is considered timely diagnosis and proper therapy.
Diagnostics
If an axial hiatal hernia is suspected, the doctor prescribes a number of laboratory and instrumental research methods, including:
- X-ray examination.
- Computed tomography of the chest organs.
- Laboratory analysis of urine and blood.
- Endoscopic examination (esophagogastroscopy).
- Esophagomanometry.
The results of the examinations will allow the doctor to obtain a complete picture of the disease, assess the patient’s condition, the stage of the disease, and diagnose correct diagnosis, appoint necessary treatment. In addition, the patient will be prescribed a consultation with other specialists, in particular a pulmonologist, cardiologist, and otolaryngologist.
Treatment methods
Treatment of an axial hernia can be carried out conservatively or promptly. The doctor determines the treatment tactics based on the diagnostic results, general condition sick. Conservative therapy consists of receiving several groups medicines symptomatic action, also compliance strict diet.
Drug treatment will not eliminate the problem, but will only stop it. severe symptoms diseases. Your doctor may prescribe the following medications:
- Enzymes – Mezim, Pancreatin, Creon.
- Antacids - Rennie, Phosphalugel, Maalox.
- Drugs that normalize peristalsis - Domperidone.
- Proton pump inhibitors - Omeprazole, Rabeprazole.
If necessary, the doctor can prescribe other medications, the dose of which, as well as the duration of administration, is determined individually for each patient.
When the disease is advanced or conservative treatment does not bring the desired results, the doctor will prescribe a planned or unscheduled operation. Surgical treatment will help restore the natural anatomical structure and location of organs, reduce the risk of relapse, and improve the patient’s quality of life.
The choice of surgery directly depends on the capabilities of the clinic and the degree of the axial hernia.
It is considered important in treatment therapeutic nutrition which must be followed at any stage of treatment. The patient is prescribed fractional meals, up to 6 times a day. Portions should be small, food only at medium temperature. Fried, spicy, fatty and smoked foods, as well as alcohol, coffee, and strong tea should be excluded from the diet. Sample menu for the patient will be prepared by the attending physician or nutritionist.
Prevention
To reduce the risk of developing a hiatal hernia, prevention should be carried out far before the first manifestations of the disease. It includes compliance following rules and recommendations:
- rejection of bad habits;
- rational and balanced nutrition;
- healthy lifestyle;
- moderate physical activity;
- body weight control;
- timely and correct treatment of all concomitant diseases.
By following basic rules, you can not only reduce the risk of developing a hernia, but also other diseases of the gastrointestinal tract. In any case, self-medication should be excluded. The sooner a person applies for medical care, the greater the chance of a successful forecast.
Axial hiatal hernia is a condition when the cardiac part of the ventricle is located above the esophageal opening of the diaphragm, as a result of which the relationship between the esophagus and the stomach changes, which leads to drastic violation its closing function. This is the most common type of hernia. IN clinical practice You can find another definition of the disease - hiatal hernia (hereinafter referred to as hiatal hernia).
Sliding hiatal hernias got their name due to the fact that the posterior wall of the upper part of the cardiac part of the stomach, which is not covered by the peritoneum, participates in the formation of the hernial sac.
Initially, the disease is asymptomatic and does not bother the patient at all. After some time, a person may notice symptoms similar to diseases of the gastrointestinal tract and heart. If not treated promptly, symptoms can be so severe that they limit normal life activities.
When there is a suspicion of hiatal hernia, it is necessary to contact a surgeon; it is this doctor who deals with the treatment of this pathology. The choice of treatment method for hiatal hernia and subsequently developed reflux esophagitis is determined by the size of the hernia, the severity of the clinical picture and the degree of damage to the mucous membrane of the esophagus. Therefore, it is important to consult a specialist as early as possible and detect the disease at an early stage of development. In this case, simple drug therapy and a special diet may be sufficient.
In medicine, there are three types of hernia:
1. Sliding (A). This type pathology provides for the normal position of the stomach and esophagus. But they can easily move into the esophageal opening. Sliding hernias can be fixed or non-fixed. In the latter case, they are adjusted independently when the patient is in an upright position. Large hernias (cardiofundal and giant), as a rule, are fixed due to the suction effect of the chest cavity and the formation of adhesions in the hernial sac. The scientific name is axial hernia.
2. Paraesophageal (B). It is characterized by the fact that the cardia does not change its position, and the fundus and greater curvature of the stomach emerge through the enlarged opening. With paraesophageal hernias, the cardia remains fixed under the diaphragm, and one or another abdominal organ is displaced into the mediastinum near the esophagus, which is why the hernia has this name. Thus, it seems as if the stomach has turned over.
3. Combined (C). Consists of all the signs of the two types of hernia described above.
Consequently, three degrees of hiatal hernia are determined – I, II and III.
Reference! The grade of the hernia is based on the level of the protrusion into the chest, as well as the size of the mass.
1st degree– in the chest cavity (above the diaphragm) there is the abdominal section of the esophagus, and the cardia is at the level of the diaphragm, the stomach is elevated and directly adjacent to the diaphragm.
II degree– the abdominal section of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of the esophageal opening of the diaphragm.
III degree- above the diaphragm are the abdominal part of the esophagus, cardia and part of the stomach (fundus and body, and in severe cases and antrum).
The main causes of pathology
Root Causes pathological changes are congenital and acquired. However, all types of hiatal hernia occur under the influence of similar factors.
| Congenital | Purchased |
|---|---|
| During the formation of the chest, the diaphragm was underdeveloped | Injuries and injuries to the chest |
| Hernia pockets formed during embryo development | Insufficient functional load on the diaphragm in people who are predominantly sedentary life |
| Elderly age. As a consequence of age-related changes |
|
| Repeated longitudinal spastic shortening of the esophagus due to esophageal dyskinesia, and also reflex and symptomatic esophagospasm |
|
| Atrophy of the left lobe of the liver, used disappearance of adipose tissue under the diaphragm, which contributes to disruption of the relationships between organs in the area of the esophageal opening of the diaphragm and the formation of its hernia |
|
| Constitutional weakness connective tissue, which is confirmed by their frequent combination with hernias other localizations, flat feet, varicose veins of the subcutaneous and hemorrhoidal veins |
|
| The difference in pressure between the chest and abdominal cavity. The following causes an increase in intra-abdominal pressure: current conditions: obesity, cough, overeating, constipation, flatulence, as- cyt, large intra-abdominal tumors, pregnancy, heavy lifting |
Attention! Sometimes a patient can combine two factors at the same time - acquired and congenital. For example, a heavy smoker suffers from a cough and the abdominal organs protrude through the esophageal opening.
Symptoms of the disease
The initial stages of the disease do not bother the patient in any way and occur in a latent form. As a result, diagnosis becomes difficult, which leads to untimely treatment and possible complications.
However, if you are wary of any discomfort, you can diagnose pathological changes in a timely manner.
Most frequent symptoms axial hernia.
| Symptom | Main features |
|---|---|
| Pain | Burning on the level xiphoid process and the lower third of the sternum, worsening after eating and in a horizontal position, accompanied by sharing with other typical signs of gastroesophageal reflux. In some patients, the pain simulates angina pectoris. |
| Heartburn | Usually appears after eating or when a change in body position contributes to the occurrence of reflux. May occur at night. |
| Belching air | Happens or air or acidic contents. Often brings relief by reducing a feeling of fullness in the epigastric region, but in some patients after this appear burning pain behind the sternum. In most cases it occurs immediately after eating or after 20-30 minutes. |
| Regurgitation | Reflux of sour or bitter liquid occurs suddenly when the patient is in a horizontal position or when the body is tilted and is not accompanied by nausea. |
| Dysphagia | Patients localize the sensation of food retention at the level of the xiphoid sprout. Appears periodically, often intensifies with excitement and hasty eating. |
Nausea, vomiting, shortness of breath, hiccups, burning sensationlanguages are relatively rare symptoms axial hernia.
How is diagnosis done?
When a patient notices clearly manifesting symptoms, this may be evidence of complications:
- There is slight bleeding resulting from damage to the esophagus or part of the stomach.
- Severe pain or shock occurs when the part of the stomach that is located just above the diaphragm is pinched.
In order to prevent gastric perforation, immediate surgical intervention is necessary. An esophagoscope is used to diagnose pathological changes. The specialist begins an examination of the esophagus as a whole and its individual muscles.
To exclude the possibility of developing cancer, the patient undergoes a biopsy, that is, a small amount of tissue is taken for examination cellular level. If the hernia is large, it can be easily detected using x-rays. To diagnose hernial protrusion, barium X-ray examination is used. Thanks to laboratory tests the presence of internal bleeding (if organs are damaged), gastro-food reflux, the presence of blood in the stool, and insufficient amount of iron in the body are established.
Features of treatment
Axial hiatal hernia can be treated with special medications and following a certain diet.
Two types of pathology treatment
| View | Description |
|---|---|
| Drug therapy | Appointment required medicines, which correct the motor process of the stomach and normalizes secretory activity. In general, inhibitors, antacids, and prokinetics are used for such therapy. Drug treatment is used only in the early stages without complications. Thanks to medications, it increases vitality the patient feels relieved. If treatment is applied in a timely manner, the likelihood of complications is significantly reduced |
| Surgical treatment | This method is used extremely rarely, only when drug therapy is ineffective or complications arise. |
Well therapeutic therapy for hiatal hernia includes:
- Medicines to strengthen the lower esophageal sphincter.
- Doctor's recommendations for eliminating discomfort in the abdomen and chest during a certain position.
- Avoiding activities and physical activity that lead to high pressure in the abdominal cavity.
- Rejection of bad habits. In particular, from smoking, as a result of which a large amount of stomach acid is produced under the influence of nicotine.
- Taking antiemetic drugs to eliminate symptoms.
- If there is a cough, then remedies against it.
- The use of drugs that help soften the stool.
- If there are problems with overweight, then you immediately need to lose unnecessary pounds.
Axial hernia, regardless of the degree and severity, is mainly eliminated by conservative treatment methods.
| Treatment with diet | Drug treatment |
|---|---|
| The patient must switch to fractional meals. That is, food intake should occur in small portions, but much more often. In this case, all food should be crushed to a mushy state and consumed only warm. Some foods will need to be excluded from your usual diet, as they can be irritating to the mucous membranes. digestive tract. These include all pickles and marinades, spicy food, smoked meats | The use of antacids is indicated, which suppress the activity gastric juice(Phosphalugel). Take enveloping drugs (Vicalin). For elimination painful sensations You can use painkillers (Novocaine). Use of antispasmodics (No-spa) |
Attention! If the axial hernia of the second degree does not respond conservative treatment and no positive dynamics are observed, the patient requires surgical treatment.
If we talk about paraesophageal and combined types of hernia, treatment with surgery is prescribed much more often. This is explained by the fact that the risk of complications such as bleeding and organ strangulation is very high. As a result, the digestive opening is partially sutured, which prevents the digestive organs from slipping, and the body and fundus of the stomach are fixed.
How does traditional medicine help?
It is extremely difficult to cure pathological changes using non-traditional treatment methods. On the contrary, using folk recipes You can quickly and effectively eliminate unpleasant symptoms.
Recipe No. 1. To eliminate common symptoms
For cooking remedy You will need gooseberry and mint leaves, cumin, dry chamomile. So, all the ingredients are placed in a blender and crushed. Then pour boiling water and infuse for ten minutes. Accept herbal decoction necessary throughout the day in small quantities. The duration of treatment is determined by the disappearance of uncomfortable symptoms.
Recipe No. 2. Anti-burning
With hiatal hernia, the patient may experience a frequent burning sensation; to eliminate it, you can use chamomile tea. It is recommended to take every time after meals to relieve the condition.
Possible complications
To the extent that long time Axial hiatal hernia can develop asymptomatically, which increases the likelihood of untimely diagnosis and treatment, resulting in complications:
- Bleeding may begin in the esophagus.
- The hernia is strangulated.
- Arises common occurrence perforation of the esophagus.
- A peptic ulcer of the esophagus develops.
- Cicatricial narrowing of the esophagus occurs.
But complications are possible even after surgical intervention during the rehabilitation period:
- Abnormal dilatation of the esophagus may occur.
- Recurrences of axial hernia occur.
- The stomach area becomes pathologically enlarged.
Carefully! If an axial hiatal hernia is present, a lung problem in the form of aspiration pneumonia may occur. To eliminate this consequence requires the use of antibiotics, which are introduced into the body without affecting the digestive tract. It is very important to diagnose the complication in time and begin immediate treatment.
Video - Hiatal hernia
When diagnosing an axial hiatal hernia, the patient is advised to make changes to familiar image life.
- First of all, physical activity is reduced to a minimum.
- The food goes on a special diet.
- Regulate sleep and observe rest times.
- If the disease causes discomfort during sleep, it is recommended to sleep with a high or raised headboard.
- Lose extra pounds.
- After eating food, try not to lie down or bend over.
- Avoid fatty foods.
- The last meal should be at least two hours before bedtime.
- Avoid sweets, white bread and legumes.
- Avoid drinking coffee and alcoholic beverages.
- Review your wardrobe and stop wearing tight clothes.
To prevent pathological changes, it is necessary to strengthen the abdominal muscles, prevent frequent constipation, avoid heavy physical activity, attend exercise therapy classes.
Diagnostic methods and treatment methods are selected exclusively by the attending physician. Otherwise, the patient may experience complications that will worsen the health condition. Therefore, self-diagnosis and self-medication are excluded.
Hiatal hernia (HH) belongs to the category of fairly common pathologies, the risk of which increases in patients in proportion to their age.
Thus, in patients under forty years of age, they occur in 8% of cases, while in patients who have crossed the seventy-year mark, their number increases to 70%, and women are more susceptible to them.
In almost half of the patients, this pathology is completely asymptomatic and remains unrecognized. Patients can be under the supervision of a gastroenterologist for years and treated for concomitant diseases (stomach ulcer, chronic gastritis, cholecystitis) with similar clinical symptoms.
The concept of pathology
IN international classification hiatal hernia diseases are assigned code K44.9.
The essence of this disease is that whole line organs of the digestive tract - the abdominal section of the digestive tube, the cardiac part of the stomach and even part of the intestinal loops - changes its usual location and moves from the abdominal cavity to the thoracic cavity through the esophageal opening of the diaphragm.
Diaphragmatic hernia is accompanied by severe chest pain, arrhythmia, dysphagia (difficulty in passing food through the esophagus), heartburn, regurgitation (belching) and hiccups.
Classification
Based anatomical features, hiatal hernias are divided into:
- Sliding.
- Paraesophageal.
- Mixed. Pathologies of this type combine the manifestations of two mechanisms: paraesophageal and axial.
sliding
A sliding hernia (also called axial or axial) of the esophageal opening of the diaphragm is characterized by free movement of the abdominal portion of the esophagus (the so-called small - about two centimeters long - piece of the esophageal tube located under the diaphragm), cardia (ring-shaped sphincter located between the stomach and esophagus) and the bottom of the stomach into the chest cavity and the equally free independent return of the listed organs to the abdominal cavity.
The reason for such movements may be a normal change in body position.
Axial
Axial hiatal hernias are formed as a result of weakening of the surrounding diaphragmatic muscles.
Not being fixed, they do not appear constantly, but only under the influence of certain factors. Of primary importance are body position, degree of stomach fullness and intra-abdominal pressure.
Weakened diaphragm muscles allow the lower part of the esophageal tube and part of the stomach to slide freely both into the chest cavity and in the opposite direction. Axial hernias are the most common pathologies.
The volume and level of elevation above the diaphragm of the displaced areas allows us to divide them into:
- Cardiac.
- Cardiofundal. Hernias of this type are characterized by free movement upper section stomach.
- Subtotal and total gastric. With these types of hernias, above the level of the diaphragm there is either most of stomach, or its entire body.
Cardiac
With this type of pathology, only the cardiac sphincter, separating the esophagus from the stomach, slips through the esophageal opening of the diaphragm.
Of the entire mass of axial hernias, 95% of cases are due to pathologies of the cardiac type. The remaining 5% is distributed between cardiofundal, subtotal and total gastric hernias.
Paraesophageal
Cases of paraesophageal hiatal hernia are relatively rare.
Their radical difference from sliding type hernias is that the movement of the greater curvature of the stomach, its fundus, as well as part of the loops of the small or large intestine into the area of the epithelial tracheoesophageal septum occurs with a fixed position of the cardiac valve: it continues to remain under the diaphragm.
As a result of displacement, the above organs are infringed. This often results in serious mechanical complications.
As a result of the migration of the peritoneal sac surrounding the stomach into the chest, there is a gradual movement into it first of the fundus of the stomach, and then of its greater curvature. During the ascent, the greater curvature turns upward, and small curvature, held by the cardiac valve, continues to maintain its lower position.
Over time, the entire stomach (along with the tissues of the parietal pleura) can move into the chest cavity. Despite the movement of the stomach and a number of abdominal organs to the chest area, fixation of the gastroesophageal junction continues to maintain its normal subphrenic position.
In very rare cases, when migration of the gastroesophageal junction into the chest cavity is observed, they speak of the presence of a mixed hernia, often accompanied by insufficiency of the cardiac sphincter (cardia).
Complications of paraesophageal hernias very often end in fatal Therefore, despite their asymptomatic course, patients are recommended to undergo surgical treatment before complications develop. An indication for immediate surgery is a condition when up to 68% of the stomach moves into the chest area.
Fixed
A fixed hiatal hernia is a pathology in which the cardiac part of the stomach moves to the chest area and constantly (without sliding back) remains in the area of the new localization.
This explains not the transient, but the permanent nature clinical symptoms accompanying this pathology.
A fixed hernia is a fairly rare, but much more dangerous (than axial hernia) form of pathology, much more often leading to complications that require immediate assistance from a qualified specialist.
A strangulated hernia usually requires surgery.
Unfixed
An unfixed hiatal hernia (also called sliding or axial) is a chronic disease in which free movement (migration) of the abdominal segment of the esophageal tube, lower esophageal sphincter and stomach from the abdominal cavity to the chest occurs through the above-mentioned opening.
Being less complex look diseases than the pathology described above, an unfixed hernia, however, requires equally serious and immediate treatment.
Reasons for development
Cases of hiatal hernia are detected in 6% of the adult population, and half of these cases occur in people over fifty-five years of age, in whose bodies age-related changes (atrophy, dystrophic processes and loss of elasticity) have led to a significant weakening of the ligamentous apparatus that holds the esophageal tube in the correct position. position
Weakening of the ligamentous-muscular apparatus and the formation of hiatal hernias can occur under the influence of:
- Anatomical features of the body formed during the period of intrauterine development of the fetus at the stage of formation of muscle structures.
- Concomitant diseases caused by weakness of connective tissues. This group of ailments may include: hemorrhoids, flat feet, intestinal diverticulosis, Marfan syndrome, varicose veins veins In such patients, a hiatal hernia is often accompanied by umbilical, femoral and inguinal hernia and preperitoneal lipoma (hernia of the white line of the abdomen).
- A sharp increase in intra-abdominal pressure due to:
- flatulence;
- uncontrollable vomiting;
- abdominal dropsy – a condition accompanied by the accumulation of fluid in the abdominal cavity;
- constipation (chronic constipation);
- large tumors localized in the abdominal cavity;
- abdominal injuries;
- pregnancy;
- sharp bends;
- heavy physical activity;
- lifting an excessively heavy object at once;
- extreme obesity;
- prolonged and very severe cough that occurs in patients suffering from any nonspecific disease lungs (for example, bronchial asthma or chronic obstructive bronchitis).
- Dyskinesia - impaired peristalsis of the esophageal tube and other organs of the gastrointestinal tract - a phenomenon accompanying chronic gastroduodenitis, peptic ulcer stomach and duodenum, calculous cholecystitis and chronic pancreatitis.
- Longitudinal shortening of the esophageal tube, resulting from scar-inflammatory processes resulting from thermal or chemical burns, reflux esophagitis or the presence of a peptic (esophageal) ulcer.
- Pathologies resulting from malformations of intrauterine development of the fetus. These include a “chest” stomach and a too short esophagus.
Symptoms
In half of patients, hiatal hernia is either asymptomatic or with minimum set clinical manifestations. Hernial protrusions of small sizes are asymptomatic.
As a rule, they are detected completely accidentally during diagnostic tests undertaken for other diseases.
- For a hernia that has reached an impressive size, but is accompanied by normal operation obturator valves, the main clinical symptom is spasmodic pain emanating from the sternum. Occurring in the stomach area, they gradually spread along the esophageal tube, in some cases radiating (spreading) between the shoulder blades or into the back.
- When girdle pain appears, the hiatal hernia can masquerade as chronic pancreatitis in the acute stage.
- A hiatal hernia can lead to cardialgia - pain localized in the left side of the chest and having nothing to do with pathologies of the heart muscle. A person not related to medicine may mistake them for a manifestation of angina pectoris or myocardial infarction.
- In approximately a third of patients suffering from hiatal hernia, the main manifestation of this disease is the presence of an abnormal heart rhythm, reminiscent of extrasystole or paroxysmal tachycardia. Due to this symptom, patients are often given an erroneous cardiac diagnosis. All attempts to cure non-existent heart disease end in failure.
To avoid errors in diagnosing the disease, when differentiating pain you should focus on a number of specific signs. For hiatal hernia:
- the appearance of pain is observed immediately after eating, serious physical exertion, taking a horizontal position and in the presence of flatulence;
- a sharp increase in pain occurs when the body is tilted forward;
- Alleviation or complete disappearance of pain occurs after a change in posture, a deep breath, a few sips of water, or the appearance of a belch.
When a hernia is strangulated, very strong cramping pain occurs behind the sternum, radiating to the area of the shoulder blades and accompanied by the appearance of:
- nausea;
- shortness of breath;
- vomiting blood;
- tachycardia – a condition characterized by an increase in heart rate;
- cyanosis of mucous membranes and skin(cyanosis);
- hypotension – low blood pressure.
The development of GERD - gastroesophageal reflux disease - an invariable companion of a hiatal hernia provokes the emergence of a new complex clinical symptoms. The patient appears:
- Belching of bile or stomach contents.
- Regurgitation (regurgitation of food not preceded by nausea) occurring at night because the patient is taking supine position. A late and very heavy dinner contributes to the occurrence of this symptom.
- Air burp.
The most characteristic (pathognomonic) manifestation of hiatal hernia, which gives rise to a diagnosis, is the presence of dysphagia - a pathology characterized by all sorts of disorders that occur during the passage of a food coma through the esophageal tube.
The appearance of dysphagia is promoted by: eating too hot foods, too cold drinks, the bad habit of hastily, without chewing, swallowing food or drinking liquids, taking one large sip.
No less specific signs of hiatal hernia can be considered the presence of:
- severe heartburn;
- painful and persistent hiccups;
- burning and pain at the root of the tongue;
- hoarse voice.
In patients suffering from a hiatal hernia, as a rule, there is an anemic syndrome characterized by a combination clinical signs(skin pallor, increased fatigue, tachycardia, weakness, dizziness) and laboratory parameters anemia indicating reduced content hemoglobin and red blood cells in the blood.
As a rule, anemia develops due to internal bleeding from the stomach and lower parts of the esophageal tube, which occurs under the influence of:
- erosive gastritis;
- peptic ulcers;
- reflux esophagitis.
Degrees of the disease
The basis for distinguishing the degrees of hiatal hernia is the data x-ray examination, allowing us to judge which part of the stomach (together with the adjacent structures) is above the level of the diaphragm.
- The easiest one is the first one– the degree of pathology is characterized by the transition into the chest cavity of only the abdominal part of the esophageal tube. The dimensions of the esophageal opening of the diaphragm are such that the stomach is not able to pass through it, therefore at this stage of the pathology the main digestive organ maintains its normal physiological position.
- Second degree disease is accompanied by movement into the chest cavity of not only the abdominal segment of the esophagus, but also the upper part of the stomach: it is localized at the level of the esophageal opening of the diaphragm.
- For third degree illness there is a migration into the chest cavity of all organs that were previously located in the abdominal cavity - under the diaphragm. The group of these organs consists of the abdominal section of the esophageal tube, the cardiac valve and the entire stomach (its body, fundus and antral structures).
Diagnostics
A hiatal hernia can be detected by:
- Plain radiography of the chest organs.
- X-ray contrast diagnostic study stomach and esophagus.
- Esophagoscopy is an endoscopic examination of the esophageal tube, carried out using an optical apparatus - an esophagoscope.
- Esophagogastroscopy is a diagnostic technique that allows you to assess the condition of the mucous membranes of the stomach and esophagus. All manipulations are performed using a flexible optical tube - a fibroesophagogastroscope.
Photo of a hiatal hernia on an x-ray
TO X-ray signs The hiatal hernia includes:
- high localization of the pharyngeal sphincter;
- location of the cardiac valve above the level of the diaphragm;
- movement of the subphrenic segment of the esophagus into the chest cavity;
- increasing the size of the diaphragmatic opening;
- retention of radiopaque substance in the structures of the hernial protrusion.
The results of endoscopic studies usually indicate:
- movement of the esophagus and stomach from the subphrenic space;
- the presence of symptoms of esophagitis (a disease accompanied by inflammation of the mucous membranes of the esophagus) and gastritis.
To exclude the presence of esophageal tumors, it is carried out on the mucous membranes, subjecting the tissue of the taken biopsy to morphological examination. To identify hidden bleeding from the gastrointestinal tract, the patient's stool is examined for hidden blood.
Esophageal manometry is of great importance in the diagnosis of hiatal hernia - diagnostic technique, studying the contractile activity of the esophageal tube and the coordination of its motility with the work of the sphincters (pharyngeal and cardiac). When assessing the motor functions of the esophagus, the amplitude, duration and nature (it can be peristaltic or spastic) of its contractions are taken into account.
The results of esophageal manometry allow us to draw conclusions about how successful conservative treatment is.
To obtain data on the nature of the environment in the gastrointestinal tract, diagnostic techniques are used:
- Intraesophageal and intragastric pH-metry. During these studies, designed to evaluate the secretory activity of the gastrointestinal tract, the acidity of gastric juice is measured in different areas digestive system, and also study the dynamics of the acid-base balance under the influence of certain medications.
- Impedancemetry is a study of the functions of the stomach and esophagus, based on measurements of the impedance (resistance) that occurs between the electrodes of a special probe inserted into the upper parts of the gastrointestinal tract through oral cavity.
- Gastrocardiomonitoring is a combined electrophysiological study that combines electrocardiography (a method for recording electric fields arising during the work of the heart muscle) and measurements of the acidity of digestive juice.
Endoscopic signs
Endoscopic signs of hiatal hernia indicate the presence of:
- Reduced distance from central incisors to the cardiac sphincter.
- Incomplete closure or gaping of the cardiac sphincter.
- Pathological formation (called prolapse of the gastric mucosa into the esophagus) - a fold formed by the mucous membranes of the stomach and displaced towards the esophageal tube.
- Gastroesophageal reflux of stomach contents.
- Hiatal narrowing of the esophagus, called the “second opening” to the stomach.
- Manifestations of gastritis and esophagitis.
- Hernial cavity.
How to treat a hiatal hernia?
At the first stage, conservative treatment methods are used.
To eliminate clinical manifestations all concomitant diseases of the digestive system (gastritis, gastroesophageal reflux, ulcers, dyskinesia and erosions), for each patient a individual program complex drug therapy, involving the use of:
- Antacids(represented by almagel, maalox and hastal).
- Proton pump inhibitors(esomeprazole, omeprazole, pantoprazole).
- H2-antihistamines(most often ranitidine).
- Prokinetics, improving the condition of the mucous membranes of the esophagus (ganatone, motilium, trimebutine, motilak).
- B vitamins, capable of accelerating the restoration of gastric structures.
To relieve pain, patients can be prescribed non-steroidal anti-inflammatory drugs (represented by paracetamol, ibuprofen, nurofen). In some cases, taking these medications can provoke an increase in clinical manifestations characteristic of gastroenterological diseases.
To enhance efficiency drug treatment patients are recommended:
- adhere to a gentle diet;
- start normalizing your weight;
- during night sleep, take a semi-sitting position (thanks to the raised head of the bed);
- avoid any physical activity.
Surgery
Indications for the need for surgical intervention are the presence of:
- complete failure of drug treatment;
- complicated forms of diaphragmatic hernia;
- precancerous (also called dysplastic) changes in the mucous membranes of the esophagus.
There are quite a large number of options surgical treatment diaphragmatic hernias. For convenience, they are usually divided into groups, which include operations aimed at:
- For suturing the hernial opening (called the hernial orifice) and strengthening the esophageal-diaphragmatic ligament. This group of surgical interventions includes crurorrhaphy (suturing the legs of the diaphragm) and repair of diaphragmatic hernia.
- For restoration acute angle between the abdominal part of the esophageal tube and the fundus of the stomach. Fundoplication surgery solves such problems. During its execution, the fundus of the stomach is wrapped around the esophageal tube. The result is a cuff that prevents stomach contents from refluxing into the esophagus.
- To fix the stomach. During gastropexy - this is the name of this type of surgery - the stomach is sutured to the posterior or anterior abdominal wall.
- To remove a significant part of the esophagus (within healthy tissue) during its resection.
In modern clinics, preference is given to laparoscopic operations, which make it possible to permanently eliminate diaphragmatic hernia through small (5-10 mm long) punctures in the skin. To prevent relapses, the patient's abdominal wall is strengthened using a special mesh implant.
Diet after surgery
A strict postoperative diet is recommended for eight weeks.
After this, they move on to a softer diet, which should be followed for six months. Further, the need to follow a diet and take medications, as a rule, disappears. However, the question of the possibility of returning to the previous way of eating can only be decided by the attending physician.
What is an axial hiatal hernia? It is characterized by the movement of the stomach into the chest cavity. This disease is diagnosed in older patients, and most often it occurs without obvious clinical signs.
IN in good condition The abdominal organs (stomach and spleen) are located in the abdominal cavity. If new growths appear on them, they protrude under the skin. If there is an axial hernia of the esophagus, it is impossible to diagnose it during an external examination of the patient, because the abdominal organs, when enlarged, come out into the inner part chest.
Pain may occur when changing body position. Advanced forms of axial hiatal hernia are characterized by the opening of internal bleeding from the vessels of the esophagus. Patients experience signs of anemia and anemia.
There are several reasons that lead to the development of this pathology:
Classification
Axial hiatal hernia, what it is, the doctor will help you figure it out, is divided into several types:
Clinical manifestations
For such a series of diseases as axial cardiac hiatal hernia, fixed axial hiatal hernia, axial hiatal hernia, different clinical manifestations are characteristic. If you notice the first symptoms, you should immediately seek help from a doctor.
Self-medication and purchasing medications without a prescription is strictly prohibited, because there is high risk serious complications.
Heartburn
Patients experience a burning sensation in the stomach and larynx. This symptom needs to be addressed Special attention. As gastroesophageal reflux progresses, discomfort appears after eating food because it moves from the stomach back into the esophagus and irritates the mucous membrane. The tone of the esophageal sphincter becomes weak and does not perform its functions. Heartburn in patients most often occurs in a horizontal position at night.
Hiccups and intestinal discomfort
Hiccups refer to spontaneous spasms of the diaphragm. When a hernia increases in size, it irritates the diaphragmatic nerve fibers. Hiccups appear after eating and last for several minutes. Pressing and sharp pain in the intestines, as well as the chest, manifests itself in morning time after sleep, when the hernia descends to the diaphragmatic opening.
When a person practices active exercises, the position of the body changes, the torso bends and when walking quickly the pain intensifies. With spasms, the likelihood of reflux of stomach contents into the oral cavity through the esophagus increases.
Belching
If oxygen enters the stomach when chewing food, patients experience belching. In the absence of pathological disorders in the body, healthy person the air gradually and slowly escapes through the mouth. Axial hernia provokes high pressure inside the stomach. That is why the air quickly and with some effort comes back out.
When a patient has an increased level of acidity in the stomach, a sour taste appears in the mouth. During sleep, patients with axial hernia often belch with food. There is a high probability of pieces of food getting into the respiratory tract, so a person experiences a characteristic suffocating cough, shortness of breath, and pneumonia.
Dysphagia
Difficulties in swallowing are observed in patients who do not chew food well, drink very hot tea, or quickly eat ice cream. A person feels sharp pain and discomfort, so you should not ignore this symptom.
If complications develop, a person will not be able to swallow dry and solid foods, therefore, food is taken in liquid or pureed form.
This disease can cause hemorrhage in internal organs. Patients' general health sharply deteriorates, weakness and malaise occur.
Diagnosis of the disease
Axial hiatal hernia can be diagnosed using the following methods:
- X-ray. It is carried out in a vertical position. When diagnosing a defect such as axial hiatal hernia of the 1st degree, the patient lies on his back. Injected into the blood contrast agent to differentiate between axial and paraesophageal hernia.
- CT scan chest. The doctor examines the internal organs and their contents layer by layer.
- Endoscopic examination– checking the condition of the mucous membranes of the esophagus and stomach.
- Esophagomanometry. In laboratory conditions, internal pressure and contractility in the esophagus are measured.
Treatment with medications
Treatment of axial hiatal hernia begins with conservative methods. On initial stage this pathology has similar symptoms to gastroesophageal reflux. It is strictly forbidden to buy medicines without a doctor’s prescription or on the recommendation of friends.
Patients are prescribed complex therapy:
- taking antacid medications containing magnesium and aluminum hydroxide;
- H2 blockers production of histamine receptors (ranitidine);
- Omeprazole, Esomeprazole, Pantoprazole.
During treatment with medications, it is important for patients to normalize their own weight, adhere to a strict diet, eat small portions 4-5 times a day . It is forbidden to sleep after eating. In bed, you need to raise the head of the bed and not engage in physical activity.
Useful video
How axial hiatal hernia of the 2nd degree, axial fixed hiatal hernia, axial hiatal hernia of the 1st degree are treated worries many. Let's figure it out.
Surgery
If drug therapy does not bring the expected effect, then doctors decide on the advisability of surgical intervention. The main task is to restore the natural anatomical features of the gastrointestinal tract.
Surgery is indicated in the following situations:
During surgery, a specialist removes the hernia and restores the areflux mechanism (to prevent the re-reflux of food from the stomach into the esophagus). The operation is indicated for patients who have serious complications, the hernia regularly increases, and the mucous membrane of the esophagus is deformed. After receiving the diagnostic results, patients are prescribed one of the following surgical operations:
If acute cramps in the abdomen or chest appear during sleep, you should consult a physician. It will help to make a correct diagnosis electrocardiography And esophagoduodenoscopy. Some patients have an x-ray of the esophagus, but a radiopaque contrast agent is injected into the blood before the procedure.
Upon confirmation of diagnosis further treatment is a gastroenterologist. If there is a high risk of complications and neglected form patients undergo surgical intervention. Additionally, it is recommended to consult a cardiologist to exclude the development of cardiac pathology.