Hiatal hernia 2nd degree treatment. Axial hiatal hernia (sliding and fixed)

Axial hernia food opening of the diaphragm (AGD) is one of the most common pathologies gastrointestinal tract(Gastrointestinal tract).

The essence of the disease

The diaphragm is called the main respiratory muscle, which creates a barrier between the abdominal cavity and the chest. This separator muscle provides an opening for the esophagus. Normally, the esophagus should descend down through the area chest, then cross the diaphragm and come into contact with the stomach in the peritoneum. However, sometimes it happens that due to various reasons stomach and Bottom part The esophagus enters the chest through the esophageal opening in the diaphragm. A similar phenomenon is called axial hiatal hernia.

The causes of the disease can be both congenital and acquired factors:

Anatomically formed features in the womb are the insufficient development of the diaphragm and the presence of hernial pockets in it, a short esophagus or a pathology called the “thoracic” stomach.
Insufficient elasticity and strength of connective tissues due to a number of diseases: hemorrhoids, varicose veins, intestinal diverticulosis, flat feet, Marfan syndrome.
Increased intra-abdominal pressure due to the presence of the following conditions: bloating, prolonged vomiting, stool retention, abdominal dropsy, lifting heavy loads, gluttony, tumor formations or injuries in abdominal cavity, pregnancy.
Age-related changes in the body.
Reduction in the length of the esophagus due to reflux esophagitis or reflux gastritis.
Gastrointestinal dyskinesia.
Inflammation and chronic diseases of the gastrointestinal tract, duodenum, liver and pancreas.
Chronic diseases respiratory system accompanied by a constant cough.
Pregnancy and complications during childbirth.
The last stages of obesity.
Having bad habits.
Complications after operations.
Inflammation of internal organs affecting the diaphragm.

Video

Video about hernia treatment hiatus.

Symptoms

In most cases, AGPOD does not indicate its presence in any way. It is possible to detect a hernia in patients only by chance during the diagnosis of another disease.

But still, AKPOD has a number of specific signs:

Constant heartburn.
Frequent hiccups after eating.
Belching with a sour taste.
Aching, Blunt pain behind the sternum, radiating to the back and under the shoulder blades.
Violation swallowing reflex while taking liquid food.
Bitterness in the mouth.
Soreness of the root of the tongue.
Hoarse voice.

Degrees of the disease

Experts distinguish three main degrees of ACPOD, based on the size and percentage of penetration of the protrusion into the chest:

1 First degree It is considered the easiest and most treatable without surgery. This stage of the disease is characterized by movement of the abdominal portion of the esophagus to the chest area and fixation of its lower sphincter at the level with the diaphragm. In this situation, the stomach remains in the abdominal cavity, but rests tightly against the diaphragmatic opening. The first degree of ACPO may manifest itself as heartburn and pain in the area just below the middle edge of the sternum. 2 Second degree The disease is characterized by the fact that the folds of the gastric mucosa pass into the food opening of the diaphragm and its top part ends up in the chest cavity. This stage of ACPOD is manifested by constant heartburn (not associated with meals), belching, nausea, stomach pain and problems with swallowing. 3 Third degree ACPOD is considered critical and must be treated immediately. In the presence of last stage diseases in chest cavity Almost the entire stomach moves. The patient experiences constant pain in the abdomen and sternum, shortness of breath, cyanosis of the nasolabial triangle, tachycardia.

Types of hiatal hernia

Hiatal hernias are usually classified into:

Axial, they are also sliding and unfixed.
Paraesophageal or fixed.
Mixed.

In turn, axial hernias are divided into:

Cardiac.
Cardiofundal.
Subtotal and total gastric.

Sliding or unfixed hernias

The very name of this type of hiatal hernia indicates that such a protrusion can freely penetrate into the chest cavity and back into the peritoneum. The progress of the hernia depends on the position of the patient’s body, the pressure inside the abdominal cavity and the condition of the stomach (empty or full). This type of hernia is considered less dangerous than a fixed (paraesophageal) hernia, but it also needs to be treated.

Timely identified sliding hiatal hernia can often be cured by medication, without the use of surgery.

Paraesophageal or fixed hiatal hernia

This type of hernia is less common than sliding hernia, but is considered more complex disease. With a fixed hiatal hernia, first part of the stomach, and then its entire remainder penetrates into the chest cavity. The difference between this type of hernia and other types is that the protrusion occurs when the sphincter is in a fixed position under the diaphragm, and the abdominal organs cannot return back.

Paraesophageal hernia most often leads to strangulated hernia, which is considered quite dangerous condition. That is why, when a fixed type of protrusion is identified, doctors decide to operate on the patient.

Cardiac and cardiofundic ACPODS

The cardiac hernia owes its name to the cardiac valve (sphincter) separating the esophagus and stomach. With this type of hernia, only this valve extends into the chest cavity above the level of the diaphragm. This subtype of axial protrusion is considered the most common - it accounts for up to 90% of all cases.

Cardiofundal ACPOD is characterized by penetration through the alimentary opening of the diaphragm not only of the sphincter, but also of the upper part of the stomach. On this type protrusions, together with subtotal and total gastric hernias, account for the remaining 10% of all sliding hernias.

Complications

In case of absence timely treatment Hernia may occur the following consequences:

Gastroesophageal reflux.
Peptic ulcers.
Cicatricial stenosis.
Infringement of protrusion.
Esophageal rupture.
Erosion, bleeding in the esophagus.

After radical treatment complications are also possible:

Relapse.
Excessive dilatation of the esophagus.
Dilatation of the stomach.
Aspiration pneumonia.

Note!

The risks of relapse and complications after surgery to remove the hiatal hernia directly depend on the timeliness of the patient seeking help from a doctor.

Diagnostics

In most cases, hiatal hernia is diagnosed completely by accident - during an X-ray or endoscopic examination. Even a highly specialized specialist can make an approximate diagnosis based only on the patient’s own complaints. However, to confirm the disease, the doctor still needs to prescribe a number of studies:

X-ray using a contrast agent (barium) in various poses– standing, lying down, with raised hips. Such a study makes it possible to identify the hernia itself and classify it as sliding or fixed.
CT scan chest examination is an effective method for studying the effect of a hernia on the sternum organs.
Esophagogastroscopy is an endoscopic type of examination designed to examine the condition of the stomach and esophagus from the inside.
Daily and two-day RN diagnostics esophagus and stomach makes it possible to measure acidity and analyze their contents.
Stool analysis allows you to identify traces of blood in it, which indicates the presence internal bleeding.
General and biochemical analysis blood V in this case necessary for diagnosing the liver, pancreas and conditions such as anemia, any inflammatory processes in organism.
Electrocardiogram will help make sure that there is no influence on the heart from the hernia.

In addition to the above studies, the patient may be prescribed a consultation with a pulmonologist, gastroenterologist, ENT specialist, cardiologist and surgeon.

X-ray of a hiatal hernia.

Treatment

Doctors offer two methods of treating hiatal hernia – conservative and surgical treatment. The choice of method directly depends on the type of hernia, its size and the patient’s discomfort.

If the hernia is sliding, small in size and does not cause any harm to the patient, then the doctor may decide to treat it with medication. This type of therapy involves taking the following drugs:

Antacids- means that can extinguish hydrochloric acid(Maalox, Almagel).
Proton pump blockers– medications that suppress the production of gastric secretions (Omeprazole).
H2-histamine receptor blockers– drugs that can reduce the amount of gastric juice produced (Fatomotidine, Ranitidine).
Prokinetics– means that promote the normal functionality of peristalsis of the digestive organs (Domperidone).
Drugs, preventing the reflux of bile into the esophagus (Ursofalk).

Patients trying to get rid of hiatal hernia with the help of conservative method treatment is also prescribed special treatment:

Sleep with your head elevated.
The last meal is no later than a couple of hours before bedtime.
Rejection of bad habits.
Exercise therapy.
Proper nutrition.
Losing excess weight.
Refusal of bandages, belts and corsets.
Prohibition on physical activity for 2 hours after eating.
Refusal of chocolate, soda, flour, coffee, animal fats.
Prohibition on working in a bent position.

In cases where we are talking about a fixed or strangulated hernia, the ineffectiveness of drugs, the appearance of inflammation or complications, the only way The treatment for hiatal hernia is surgery.

Surgery to remove the hiatal hernia can be performed in two ways: open or laparoscopic. At open surgery the surgeon makes an incision in the peritoneum, removes the protrusion and performs gastric plastic surgery.

Laparoscopic intervention can be performed using one of the following techniques:

Nissen method- involves twisting part of the stomach around the esophagus, which provokes the creation of a kind of “plug”, which will subsequently prevent the stomach from slipping into the food opening of the diaphragm.
Belsey technique- an operation during which the esophagus is attached to the diaphragm, the fundus of the stomach is sutured, and the hernia is removed.
Gastrocardiopexy Hilley– a technique based on fixing fragments of the stomach and esophagus to the diaphragm.
Allison method– a technique accompanying the main type of operation, aimed at tightening the hernial orifice.

Video

Laparoscopic surgery to remove diaphragmatic hernia.

Questions - Answers

During an X-ray examination, an axial sliding cardiac hiatal hernia was discovered. Is it necessary to operate; the pain has become frequent; do I take omez?

You probably wanted to know whether it is possible to relieve stomach pain without surgery? Indeed, osteopathically this is possible. The fact is that a hernia forms at the place where the esophagus “passes” from the chest cavity into the abdominal cavity through the diaphragm. If the diaphragm is spasmed, it compresses or, conversely, causes tension in the esophagus. Then a hernia forms. Osteopathically, it is possible to relax the diaphragm, remove tension, and adjust its functioning so that it moves freely. Then the symptoms of the hernia are much easier or go away.

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 symptoms. 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 hiatal hernia, it is impossible to diagnose it during an external examination of the patient, because the abdominal organs, when enlarged, extend into the inner part of the 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 engages in active exercises, the body position changes, the torso bends and when brisk walking the pain intensifies. With cramps, the likelihood of reflux of stomach contents into the oral cavity through the passage of the esophagus.

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 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 antacids medicines 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 strict diet, eat small meals 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.

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Surgery

If drug therapy does not bring the expected effect, then doctors decide on the advisability of surgical intervention. the main task– restoration of 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. Put correct diagnosis will help 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 with an advanced form of the disease, patients undergo surgical intervention. Additionally, it is recommended to consult a cardiologist to exclude the development of cardiac pathology.

A hiatal hernia appears in the area of the diaphragmatic opening of the esophagus. This is the most common pathology among all diaphragmatic hernias. It is most often diagnosed in women and the risk of its occurrence increases with age. Another name for it.

What is a hiatal hernia? This is a chronic disease of a recurrent nature, in which, through an enlarged diaphragmatic opening, protrusion into the chest cavity of the lower (abdominal) portion of the esophagus, stomach, and less commonly other organs of the abdominal cavity occurs.

Classification

There are several types of hiatal hernia:

Sliding or axial hernia. With this pathology, the abdominal section of the esophagus and the cardiac part of the stomach move without problems through the diaphragmatic opening of the esophagus into the chest cavity and back. Normally, these organs should be localized in the abdominal cavity.
A paraesophageal hernia is a rare type of hiatal hernia, in which the stomach seems to turn over and its lower section, sometimes along with other organs, passes through the opening of the diaphragm, while the correct section of the stomach is in the anatomical position.
Combined hernia. With this pathology, symptoms of sliding and paraesophageal hernia are observed.

Types of hiatal hernia

Depending on the severity of the pathology, axial hernia can be grade 1 or 2.

What is a grade 1 sliding hiatal hernia? With this course of the disease, only the esophagus protrudes into the chest cavity, and the stomach is localized above its anatomical position closer to the diaphragm. If a sliding hernia of the 1st degree is found in patients of an older age group, then it is considered a borderline condition that develops as a result of age-related changes.

With the development of a grade 2 hiatal hernia, the esophagus and stomach simultaneously protrude into the chest cavity.

Causes

The reasons for the formation of a hiatal hernia are varied:

age-related changes;
malignant neoplasms;
injuries;
surgical interventions;
gastrointestinal motility disorder;
chronic diseases of the liver, pancreas and stomach;
genetic predisposition;
congenital pathologies, such as underdevelopment of the diaphragm, the appearance of hernias in the prenatal period.

Any factors that increase intra-abdominal pressure also provoke the appearance of a hernia. For example, protrusion of the esophagus is possible during physical activity or coughing.

Important! Wearing tight clothing can provoke the development of the disease.

The period of gestation and overweight body can also cause expansion of the diaphragmatic opening of the esophagus. A hernia often appears in patients suffering from flat feet and Marfan disease.

Clinical picture

The symptoms of a hiatal hernia can vary greatly depending on the extent of the disease.

At the early stage of development of the pathology, the clinical manifestations are mild and most often it is diagnosed accidentally during a medical examination or x-ray.

Depending on the type of hernia and its degree, various signs may be observed.

With a sliding hernia of the 1st degree, the following is noted:

heartburn after eating, especially if the diet is violated;
pain in the epigastrium when staying in a bent position for a long time.

One of the signs of a hiatal hernia is the appearance of pain in the epigastric region

Warning! One of the characteristic initial signs of pathology is the appearance of pain that radiates to the back. They intensify with physical activity and when taking a lying position.

When the disease progresses to stage 2, the following is observed:

constant heartburn, appearing regardless of food;
belching, nausea, dysphagia, hiccups, abdominal pain;
anemia;
burning chest pain, similar to attacks of “angina pectoris”;
painful sensations intensifies when bending over and when taking horizontal position;
development of bleeding.

Warning! A 2nd degree hernia is dangerous because if left untreated it can cause a heart attack or stroke.

With a paraesophageal hernia, signs caused by gastric prolapse are observed:

painful sensations after eating, especially if you bend your torso forward;
burning sensation in the esophagus, belching, nausea;
disorders of the heart and lungs are observed in cases of compression by formations large sizes: dyspnea, tachycardia, blue discoloration of the nasolabial triangle, especially after eating.

With the development of a combined hernia, a combination of various symptoms is observed.

Warning! A hiatal hernia of the esophagus may be accompanied by bronchoesophageal syndrome, in which respiratory disorders develop: the patient suddenly develops inflammation of the lungs, bronchi and other diseases respiratory tract. The appearance of these symptoms requires emergency hospitalization, as they indicate a severe course of the hiatal hernia.

Diagnostics

Taking a history and examining the patient helps in making a diagnosis. Suspecting the development of a hiatal hernia, the doctor gives a referral for examination. He can assign:

X-ray of the esophagus, thoracic and abdominal cavity, which is carried out in a lying position; to identify a small hernia, the study is carried out using
radiopaque agents(barium salts);
esophageal manometry, which allows assessing the functioning of the organ;
examination of the gastrointestinal tract using an esophagoscope;
tissue biopsy, which allows to exclude oncology;
laboratory tests (stool test for occult blood, general analysis blood to detect anemia);
If chest pain develops, an electrocardiogram is prescribed to rule out angina.

Therapy

The treatment regimen is selected by the doctor depending on clinical picture. If an asymptomatic course of pathology is observed, then a wait-and-see approach is indicated, that is, the patient should regularly visit the doctor at specific intervals to assess the dynamics of the disease.

If unpleasant symptoms therapy is prescribed, which can be:

conservative;
surgical

With the development of a sliding hernia of 1st and 2nd degrees, they usually resort to conservative treatment, which includes diet therapy and medication.

Products that irritate the mucous membranes of the gastrointestinal tract should be excluded from the patient’s diet, namely:

smoked meats;
pickles;
marinades;
spicy and fermented dishes.

You need to eat little and often. Dishes should be warm and crushed to a homogeneous consistency.

Medicines prescribed:

It must be remembered that self-medication with these drugs is not permissible, since each of them has its own contraindications and unwanted effects and only a doctor can choose the right medication and its dosage.

Physiotherapy exercises are also indicated for hiatal hernia.

If ineffective conservative therapy perform the operation.

With the development of paraesophageal and combined hernia, surgical treatment is prescribed more often, since with such development of pathology there is a high risk of complications. During the operation, the diaphragmatic opening is sutured and the stomach is fixed to the abdominal wall.

Consequences and prevention

Complications

Hiatal hernia can provoke pathologies such as:

gastroesophageal reflux disease;
peptic ulcer and narrowing of the esophagus;
internal bleeding;
strangulated hernia;
protrusion of the gastric mucosa into the esophagus;
violation of the integrity of the walls of the esophagus.

Patients with a hiatal hernia should be registered with a gastroenterologist. They need to undergo medical examination at least once every six months.

Hiatal hernia is a pathology that is characterized by protrusion of abdominal organs through the esophageal opening of the diaphragm. As a rule, displacement of the lower part of the esophagus, stomach, and slightly less often other organs occurs.

The pathology is accompanied by the fact that the listed organs are displaced into the chest instead of the abdomen. Another name for this disease is hiatal hernia (abbr.

What is a hiatal hernia? This is a protrusion of the abdominal organs (lower esophagus, stomach, less often other organs) through the natural opening of the diaphragm (esophageal).

That is, the organs included in the protrusion are not in the stomach, but in the chest. Another name for this pathology is hiatal hernia or, for short, hiatal hernia.

IN medical practice Axial esophageal hernia is divided into degrees according to the size of the prolapse and the symptoms of the disease.

Manifestations pathological process not every patient observes, especially initial stages progression.

Not every patient notices the changes that appear as a result of the development of an axial hernia. In the early stages there are practically no symptoms.

Due to the lack of brightness severe symptoms Treatment of hiatal hernias is almost always delayed. The development of the disease necessitates observation by a doctor and professional help.

The use of diets and pills in this case will not help the patient to recover, except perhaps to prevent complications in the form of gastroesophageal reflux disease from developing.

Diet means proper nutrition - in small portions, but often. The patient is prohibited from eating chocolate, flour, consuming animal fats, drinking coffee or soda. The patient should not take a horizontal position for at least 3 hours after eating.

To obtain the greatest benefit from non-surgical treatment, the patient must adhere to healthy image life, eliminating your bad habits. It is necessary to monitor the level of intra-abdominal pressure - it should not increase.

When the organs located below the diaphragm protrude through its natural esophageal opening, this leads to the development of a rather serious pathology of this section - an axial hernia.

This disease has long been among the ailments of the gastrointestinal tract. important place, since in the absence of timely and adequate treatment it can provoke the development of serious complications.

Axial hiatal hernia (HH) is one of the most common types of deformity localized in the digestive organs.

Among all pathologies of the gastrointestinal tract, it ranks 3rd. If it is not detected at the earliest stage of development, then therapeutic measures may not give the expected results.

A hernia is the exit of one organ from its cavity into the adjacent one through an opening without violating the integrity of the membrane. There are several types of hernias of the digestive system, but the axial one occurs in 90% of cases of disease, that is, in every twentieth.

Axial hiatal hernia

This type of hernia can be congenital or acquired. This disease is associated with pathology of the diaphragmatic opening. With age, the muscles of the diaphragm lose elasticity, so diseases associated with its work most often have an age-related nature.

Diagnosis of a hernia in athletes does not always entail leaving sports. Some types of physical activity will not only not harm the patient, but will also help improve your health. Naturally, we are not talking about professional sports.

The main cause of an axial hernia is large loads on the abdominal muscles if there is a congenital predisposition to weakness of the abdominal wall. Strength sports that require heavy lifting should be abandoned immediately.

You can go swimming and do sports exercises where the main load falls on the biceps and triceps. Not fast cycling and walking also does not cause complications of the disease. The main thing is to do everything in moderation.

Read more about the types and treatment of hiatal hernias here.

Axial hernia in newborns is extremely rare and is considered a pathology of intrauterine development of the fetus. The so-called thoracic gastric defect is characterized by a congenital form of a shortened esophagus.

In this case, the part of the stomach that is located above the diaphragm is not framed by the abdominal cavity.

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The first signs of the disease are manifested by frequent regurgitation of the baby; after six months, when complementary foods are introduced, vomiting may appear. Children with axial hernia suffer from underweight, growth retardation and malnutrition.

When diagnosing a hiatal hernia in newborns, doctors recommend surgical treatment in order to further avoid the progression of the disease and development concomitant diseases.

Proper nutrition is one of the most important factors in the treatment of hernia. Increased secretion of gastric juice and its reflux into the esophagus leads to irritation of the mucous membrane.

Therefore, it is necessary to reduce the acidity of gastric juice as much as possible, eliminating following products food: confectionery, spices, smoked meats, sweet desserts, spicy dishes and seasonings, fried.

Special exercises by establishing breathing will improve the general condition of the patient and help strengthen the muscles. Breathing exercises should be done daily, two or three hours after eating.

While on your knees, bend left and right. While bending over, inhale; in the starting position, exhale. Then repeat the same exercise while standing. Do each exercise ten times. Lie on your right side, your legs should be 15 centimeters below your head. When you inhale, stick your stomach out as much as possible, and when you exhale, relax it. With each subsequent time, the breath becomes deeper. Do gymnastics for 10 minutes four times a day. After seven days of such training, as you exhale, you need to draw in your stomach. Lie on your back and twist from side to side. In this case, breathing should be measured.

By performing such exercises, improvements are observed after three months.

The symptoms of this pathology directly depend on its type and stage. It should be noted that initially the disease occurs with mild symptoms.

This greatly complicates diagnosis, which leads to certain complications and more long-term treatment. Therefore, doctors recommend that you be very attentive to your health and, if certain signs occur, consult a specialist in a timely manner.

This will allow you to recognize the disease in the initial stages and begin effective therapy.

Sometimes the presence of the disease may be indicated by regularly occurring hiccups - this symptom is observed in approximately 3% of patients.

With significant sizes of such formations, cardiorespiratory symptoms are often observed. Caused by compression of the lungs and heart. Such signs are rapid heartbeat, cyanosis (blue discoloration of the area around the mouth), shortness of breath and some others.

This pathology refers to internal abdominal hernias, and therefore, when it appears, there are no external manifestations. The symptom complex of diaphragmatic hernia is associated primarily with disruption of the functioning of organs that change their location.

For example, normally the work of the lower esophageal sphincter is ensured by the diaphragm, providing a supporting effect on it. When the cardiac part of the esophagus is displaced upward, insufficiency of this section is observed, which is manifested by gastroesophageal reflux (stomach contents retrogradely enter the esophagus) and is accompanied by irritation of the esophageal mucosa, which is not resistant to the effects of acidic gastric juice.

IN severe cases inflammation may be accompanied by hidden bleeding, which over time may only manifest as anemia.

Main symptom diaphragmatic hernia - constant heartburn, the intensity of which increases when changing body position (lying down, while bending the body), as well as after eating and during physical activity.

The second sign of a hiatal hernia, which is observed in approximately half of patients, is chest pain. It should be differentiated from manifestations cardiovascular diseases.

In the presence of a hiatal hernia, the pain behind the sternum intensifies when bending over or during physical activity. However, when examining a patient, it is worth remembering that a hernia of the diaphragm can be combined with heart disease.

The above symptoms are often accompanied by belching of air or sour, sometimes the patient feels a lump in the throat or pain when swallowing, and there is a sudden increase in blood pressure.

With an axial hernia, characteristic symptoms are often observed.

The video shows an endoscopic analysis of a hiatal hernia. You will become familiar with the structure of this body.

There are two types of sliding hiatal hernia: non-fixed and fixed. An unfixed hernia is a less complex type of pathology, but also requires treatment.

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As for fixed, it is difficult to diagnose, because in the first stages it is almost asymptomatic. As a rule, the patient learns about the disease by chance during an X-ray or medical examination.

Axial hernia of the second degree is manifested by pain in the epigastric region, heartburn, belching, hiccups, and anemia.

In some cases, patients confuse esophageal pain with pancreatic or heart pain. The doctor’s task in this case when diagnosing is to exclude pancreatitis, heart attack, angina pectoris, so you should know the main characteristics pain symptoms in case of illness:

Moderate intensity of pain, intensifying with physical activity.
The pain syndrome appears when the patient lies down, stands for a long time, when coughing, flatulence, after eating.
The pain goes away completely after belching or vomiting.

A hiatal hernia is dangerous because respiratory tract diseases and various inflammations of the lower parts of the esophagus can develop. Prolonged hemorrhages lead to anemia, after which the patient increases the risk of developing esophageal cancer.

In most cases, after the disease develops, people experience reflux esophagitis. If, after the first signs, the disease is not treated for 7-10 years, then in patients, according to gastroenterological studies, the risk of developing esophageal cancer increases by 280%.

The pathology refers to internal hernias, so it does not manifest itself externally. Symptoms are associated with a violation of the position and functioning of internal organs. In addition, it depends on the type and degree of development of the disease.

Treatment of the disease

Symptoms of an axial hernia depend on its stage and presence accompanying pathologies. This disease is life-threatening and health-threatening, so it is important to make a timely diagnosis and begin proper treatment.

When the first signs of pathology appear, you should consult a gastroenterologist. With an axial hernia of 1st degree, no symptoms are observed.

The disease is detected during X-ray examination. In the early stages of development of the pathology, minor pain may be noted.

The intensity of pain increases with physical activity and lying down.

The stomach is one of the key organs, the health of which directly affects the comfort and full functioning of a person. The appearance of a sliding hernia can have a noticeable negative impact on this organ.

This problem cannot be ignored, so it is important to familiarize yourself with the symptoms of the pathology and treatment methods.

Paraesophageal. We are talking about displacement of only part of the stomach without the participation of other organs in the process.

sliding hernia, it is also axial. In this case, its cardiac part also moves into the chest cavity.

Mixed. We are talking about the signs of the first two types, which appear simultaneously.

Congenital. This diagnosis is made when a hernia is detected, the formation of which occurs against the background of a small esophagus located in the shape of a “thoracic ventricle”. This situation is anomalous.

1. The stomach is located under the diaphragm, the cardia is at the level with it, and the abdominal segment of the esophagus is above the level of the diaphragm.

2. A hiatal hernia of the 2nd degree is distinguished by the fact that the esophagus is compressed evenly, and the cardinal part of the stomach protrudes into the mediastinum.

3. There is a pronounced contraction of the esophagus, and the entire stomach or its component protrudes into the mediastinum.

The key symptoms can be defined as pain that appears with varying frequency and intensity. At the same time, they can be both dull and burning.

Sometimes painful sensations radiate to the heart area, as a result of which patients begin to suspect heart failure. In some cases, a hiatal hernia can cause pain in the interscapular area.

If the disease is caused by a congenital problem such as an insufficiently wide esophagus, then the symptoms may resemble those of an axial hernia. We are talking about heartburn that appears after eating, pain in the chest, worsening in a horizontal position, and pain in other parts of the body.

Difficulty in swallowing food;

Heartburn after exercise or eating;

Pain in the chest area;

Signs of a hiatal hernia may take the form of belching air or stomach contents.

These symptoms are sometimes misjudged by patients. As reviews show, people think that these are signs of other diseases and self-medicate.

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 a number of organs 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 on 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 of the 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 requiring immediate assistance qualified specialist.

A strangulated hernia usually requires surgery.

Unfixed

An unfixed hiatal hernia (also called sliding or axial) is chronic disease, in which, through the above-mentioned opening, free movement (migration) of the abdominal segment of the esophageal tube, lower esophageal sphincter and stomach occurs from the abdominal cavity to the thoracic cavity.

Being a less complex type of disease 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 significant weakening ligamentous apparatus, holding the esophageal tube in the correct 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;
- long and very severe cough occurring in patients suffering from any nonspecific lung disease (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 rate, resembling 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 should focus on a range 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 the 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.

Dysphagia is caused by: eating too hot foods, too cold drinks, bad habit hastily, without chewing, swallow food or drink liquid, 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 of clinical signs (pallor of the skin, 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 of an x-ray examination, which allows us to judge what 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.

Of great importance in the diagnosis of hiatal hernia is esophageal manometry - a diagnostic technique that studies 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 acid-base balance when exposed to certain medications.
Impedance measurements are studies 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 the 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 the clinical manifestations of all concomitant diseases of the digestive system (gastritis, gastroesophageal reflux, ulcers, dyskinesia and erosions), a individual program comprehensive drug therapy, providing for 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 the effectiveness of drug treatment, patients are recommended to:

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 is enough a large number of options for surgical treatment of 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. To this group surgical interventions include 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 abdominal wall The patient 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.