Hiatal hernia is a pathology that is associated with weakening of the ligamentous apparatus of the diaphragm. As a result of such changes, the esophageal opening in the diaphragm expands, which leads to a displacement of the stomach (its upper part goes into the chest cavity) and the esophagus.
This problem is considered very common, so many people are looking for more information. Why does hiatal hernia develop? Symptoms, treatment, possible complications, patient prognosis are all important data.
General information about the disease
Hiatal hernia is a pathology that is accompanied by expansion of the diaphragm opening and stretching of the ligamentous apparatus, as a result of which the abdominal segment of the esophagus, the cardia of the stomach, and sometimes part of the loops of the small intestine penetrate into the chest cavity.
Against the background of such a process, the angle between the organschanges, and the work of the lower esophageal sphincter is disturbed, as a result of which the acidic contents of the stomach and bile from the intestines are thrown into the esophagus, damaging its mucous membranes.
In modern gastroenterological practice, such a pathology occurs quite often. According to statistics, the risk of developing such a disease increases with age - older people are much more likely to suffer from the disease.
The main causes of the development of the disease
To date, the mechanisms of formation of such a pathology are not fully understood. Nevertheless, there is still information about some causes of a hernia.
- Sometimes there are some birth defects, in particular shortening of the esophagus. As a rule, such pathologies are diagnosed almost immediately after birth and are often eliminated surgically.
- Risk factors include age. As the body ages, the connective tissue structures that hold the organs in their natural position weaken and stretch, lose their elasticity, and sometimes even atrophy.
- Hernia is often diagnosed in patients with diseases that are accompanied by weakness of the connective tissue. The group of potentially dangerous diseases include intestinal diverticulosis, varicose veins, Marfan's syndrome, hemorrhoids. Often, the expansion of the esophageal opening is associated with umbilical, inguinal and femoral hernia.
- Dangerous is a systematic or sharp, critical increase in intra-abdominal pressure. That is why risk factors include indomitable vomiting, blunt abdominal trauma,chronic constipation, ascites, severe obesity, heavy lifting, heavy physical labor.
- If we talk about diaphragmatic hernia in women, it often develops during pregnancy, as the growth of the fetus and the accumulation of amniotic fluid creates pressure in the abdominal cavity.
- Risk factors include some lung diseases, in particular obstructive bronchitis and bronchial asthma. A strong prolonged cough also affects the condition of the ligaments and tissues of the diaphragm.
- Dangerous is also a violation of the motility of the wall of the digestive tube, which is observed against the background of chronic pancreatitis, gastritis and gastroduodenitis, esophageal dyskinesia, peptic ulcer of the stomach and intestines.
- Thermal or chemical burns, esophageal peptic ulcer, reflux esophagitis can also lead to hernia, as against the background of such diseases, the tissues of the esophagus are amenable to cicatricial-inflammatory deformities, as a result of which the esophageal tube is gradually shortened.
Of course, during the diagnosis it is important to determine what exactly led to the formation of a hernia. First of all, it is necessary to eliminate the cause of the expansion of the diaphragm, since otherwise the likelihood of a relapse is high.
Forms of the disease and their features
Hiatal hernia can occur in different ways. Gastroenterologists distinguish three forms of this disease.
- Sliding hiatal hernia is considered the most common. According toAccording to statistics, 90% of patients are diagnosed with this particular form of the disease. In this case, the organs are displaced so that the cardial part of the stomach lies above the diaphragmatic opening. In this case, total, subtotal, cardiofundal and cardiac hiatal hernias are isolated.
- The paraesophageal form is relatively rare - about 5% of cases. With this form of the disease, the cardia does not change its position and remains under the diaphragm. At the same time, other parts of the stomach, in particular the greater curvature and fundus, move into the chest cavity. There may also be bowel movement. There are several subtypes, in particular fundal, antral, gastrointestinal, intestinal, omental hernia.
- In some patients, a mixed form occurs, which combines the features of paraesophageal and sliding hiatal hernia.
Sometimes, a pathology such as a short esophagus, which is a congenital anatomical anomaly, is also isolated in a separate form. Such a pathology is extremely rarely diagnosed as an independent disease - in most cases it is combined with axial hiatal hernia. Treatment in this case is carried out surgically.
Degrees of hernia
There are three degrees of hiatal hernia, each of which is accompanied by characteristic signs.
- First degree - the cardia is located at the level of the diaphragm, and the esophagus is slightly higher.
- Second degree - the abdominal esophagus moves into the chest cavity, stomachlocated in the region of the esophageal opening.
- Third degree - almost all structures that are normally located under the diaphragm are displaced into the chest cavity, including the esophagus, fundus and body of the stomach, sometimes part of the intestine.
Signs of hiatal hernia
Of course, many people are interested in information about the features of the clinical picture. Symptoms of a hernia of the esophageal opening of the diaphragm depend on the form and degree of development of the pathology. In some patients, the disease is completely asymptomatic. But in most cases, violations are still present.
- Perhaps the typical and very first sign is pain in the epigastric region. Unpleasant sensations spread along the esophagus, often radiating to the back and the area between the shoulder blades. Pain intensifies during physical exertion, as well as when coughing, after eating, when the body is tilted forward. Discomfort is relieved by taking a deep breath, vomiting, drinking, burping.
- Sometimes there is shortness of breath and retrosternal pain - the symptoms resemble the clinical picture of myocardial infarction and angina pectoris. Sometimes there is an increase in heart rate, increased heartbeat. According to statistics, in about a third of cases there is a diagnostic error - the patient is being treated for cardiovascular diseases.
- If there is an incarcerated hernia, then patients suffer from acute pain in the abdomen.
- Digestive disorders also appear. In particular, the symptoms of diaphragmatic hernia include belching withbile or gastric contents, the appearance of bitterness in the mouth, nausea, heartburn, hiccups. Often in the morning, the patient has a hoarse voice, which is associated with the reflux of the contents of the stomach into the esophagus, irritation and swelling of the mucous membranes.
- A characteristic symptom is dysphagia - a violation of the passage of food through the esophagus. Attacks of dysphagia are often observed when eating too hot or cold, liquid food, as well as against the background of a stressful situation.
- Sometimes stomach contents enter the respiratory tract, which leads to the development of asthma, tracheobronchitis, aspiration pneumonia.
Possible complications of the disease
Many people are faced with such a problem as hiatal hernia. Reviews of experts, as well as statistics, indicate that the disease responds well to treatment. Nevertheless, there is always a risk of developing dangerous complications.
- According to recent studies, failure to treat hiatal hernia significantly increases the chance of developing esophageal cancer.
- The disease is often accompanied by inflammation of the mucous membrane of the esophagus, which is associated with the reverse reflux of gastric juice into the esophagus (hydrochloric acid irritates the mucous membranes, causing inflammation, and in some cases the formation of erosions and ulcers).
- High chance of developing peptic esophageal stricture.
- In some patients, a hernia causes bleeding from the esophagus (this can beacute and chronic).
- The strangulation of a hernia is also dangerous, as it is accompanied by a violation of blood flow, damage to nerve fibers, and serious changes in tissue trophism. This complication requires emergency surgery.
- Sometimes there is a prolapse of the mucous membranes of the stomach into the esophageal tube.
- In severe cases, perforation of the esophagus occurs.
Diagnostic measures
In this case, the correct diagnosis is extremely important. After collecting information and compiling an anamnesis, the doctor sends the patient for additional studies.
- First of all, fibrogastroscopy is performed. With the help of special equipment, the doctor examines the mucous membranes of the esophagus and stomach, assesses their condition, examines for erosions, ulcers and other injuries.
- Informative is the X-ray of the chest and stomach. Thus, a specialist can obtain information about the location of the esophagus in the stomach, the presence of organ displacement.
- Daily pH-metry of the esophagus and stomach is also carried out, which makes it possible to check the acidity of gastric juice and the degree of its back reflux within 24 hours.
Conservative treatment
To begin with, conservative treatment of hiatal hernia is performed. Since this pathology is accompanied by reflux, it is first necessary to removeprecisely his symptoms.
Patients are first prescribed antacids, in particular drugs that contain magnesium oxide, magnesium and aluminum hydroxide, magnesium carbonate. Proton pump inhibitors are also used, such as Pantoprazole and Omeprazole. H2-blockers of histamine receptors are considered effective.
Immediately it should be said that the treatment of hiatal hernia (without surgery) helps to relieve digestive disorders and improve the patient's condition. However, an existing extension cannot be removed in this way.
Proper nutrition in the presence of a hernia
Diet for hiatal hernia is extremely important. As already mentioned, obesity is a risk factor, so if the patient is overweight, it is advisable to reduce the daily calorie intake. In addition, a properly selected diet will help get rid of constipation, stimulate peristalsis, and saturate the body with much-needed nutrients and vitamins. For reflux esophagitis, the following foods are especially helpful.
- Grapes are rightfully considered one of the most alkaline foods, therefore they neutralize the effects of stomach acid well. Of course, it is better to opt for a home-made product that does not contain pesticides.
- Pineapple contains proteolytic enzymes and therefore aids in digestion.
- Cabbage is also useful. It's believed thatthis product speeds up the healing process of ulcers. If a person does not digest fresh cabbage, it can be consumed stewed or boiled.
- It is worth including potatoes in the diet, as this product also neutralizes high acidity well.
- Crops such as wheat, millet and rice will be beneficial.
- As an antacid, you can use special clay, which is sold in a pharmacy (for example, Smecta will help to cope with high acidity).
Recommended fractional nutrition - so the load on the esophagus will be less, and the walls of the stomach will not stretch too much. Experts recommend eating 5-8 times a day, but in small portions. This, by the way, contributes to the rapid digestion of food.
By the way, there are foods that need to be discarded. Their list is as follows:
- fatty meats;
- sausages;
- fried foods;
- sugar;
- milk and dairy products;
- alcohol;
- coffee and cocoa;
- refined foods;
- baking;
- some spices, in particular pepper, cinnamon, ginger, cloves.
Meals are best steamed or baked in the oven.
Surgical treatment of hiatal hernia: operation and features of its implementation
Conservative therapy does not always give the desired result. What should a patient with hiatal hernia do in this case? The operation is performed in the presence of the following indications:
- no effect fromdrug therapy and diet;
- the presence of complications, in particular bleeding, anemia, ulcers and erosions of the esophagus;
- large hernia;
- esophageal mucosal dysplasia;
- strangulated hernia or risk of its development.
Today, there are many procedures to normalize the patient's condition. But all of them are aimed at suturing the esophageal opening in the diaphragm and creating an antireflux mechanism that will prevent the contents of the stomach from refluxing into the esophagus.
In most cases, the fundus of the stomach is rotated around the esophagus by 270 or 360 degrees. Thus, the doctor creates a kind of cuff that prevents the gastric juice from refluxing into the esophageal tube. At one time, a similar procedure was carried out through direct access. But today, more and more often, the operation is performed laparoscopically - this helps to reduce the risk of infections and other complications, since the instruments are inserted inside through small punctures in the skin.
Recipes of traditional medicine
Home remedies certainly won't fix a herniated diaphragm. Nevertheless, traditional medicine relieves the patient's condition, copes well with high acidity, accelerates the healing process of erosions and ulcers.
- Regular baking soda helps to neutralize the acid. A teaspoon of the powder should be dissolved in a glass of warm water and drunk. It is immediately worth noting that such a remedy can only be used occasionally - the constant use of soda can only aggravate the condition.
- Decoction is considered usefulchamomile. You can buy ready-made chamomile tea in the store or prepare a decoction yourself from dried flowers. Healers recommend drinking this tea immediately after the appearance of discomfort in the stomach. Chamomile has pronounced anti-inflammatory properties, helps to relieve irritation of the mucous membrane of the digestive tract.
- Mint tea will also help to cope with pain and discomfort in the epigastric region.
- Flax seeds are also useful - they are recommended to be eaten daily for breakfast. In the evening, a tablespoon of seeds should be poured with three tablespoons of water and left overnight. In the morning, the mixture should be heated, not boiling. The resulting slurry must be eaten, chewing the grains thoroughly. This tool helps to neutralize the acid. Moreover, flaxseed decoction has enveloping properties - they protect the mucous membranes of the esophagus and stomach from the irritating effects of gastric juice.
- Experts recommend including natural yogurt and kefir in the diet - they will also protect the walls of the digestive tract and help prevent heartburn.
- Ginger root tea is also considered he althy.
- Almonds also help protect the lining of the digestive tract from acid attack. All you have to do is eat a few nuts every day.
- Some folk healers recommend taking apple cider vinegar. A teaspoon of vinegar should be poured into 100 ml of boiled warm water and the solution sweetened with linden honey. This remedy is good for heartburn.
- A special herbal collection is also considered effective. Forits preparation, you need to mix 50 g of red elm bark and flax seeds, as well as 100 g of marshmallow root and coltsfoot leaves. Three tablespoons of medicine are poured with a liter of boiling water, covered with a lid and infused for an hour. Throughout the day, the strained solution should be drunk instead of tea.
Of course, it is impossible to self-medicate with such a disease. Be sure to tell your doctor about using any home remedy.
Forecasts and prevention
Prognosis for patients directly depends on the form of the disease, the stage of its development, the general condition of the patient, as well as the chosen method of treatment. The operation of a hernia of the esophageal opening of the diaphragm minimizes the likelihood of recurrence. Patients who have undergone drug therapy should be registered with a gastroenterologist and undergo regular examinations.
There are no specific means of prevention. Doctors, however, recommend proper nutrition to prevent constipation, which puts extra pressure on the abdominal organs. Regular therapeutic exercises, special exercises aimed at strengthening the muscles of the press will be useful. But excessive physical exertion and heavy lifting should be avoided. If you notice any violations in yourself, you need to urgently consult a doctor - the sooner the disease is diagnosed, the higher the chances of a quick recovery.
