Let's start with the fact that not everyone is familiar with the abbreviation HHP. What is it?
Hernia of the esophageal opening of the diaphragm (still the same HH for short), or simply a hernia of the esophagus, is nothing more than a disease characterized by the displacement of an organ (located in the abdominal cavity) through the food opening in the diaphragm to the chest cavity. This organ is almost always the stomach.
Hernia of the esophagus can be congenital or acquired and has pronounced clinical manifestations. Congenital hernia is less common than acquired. HH can appear for many reasons.
In the article we will look at what is HH, symptoms, treatment and postoperative period of this disease.
General characteristics of the disease
The diaphragm (which is directly related to HH) has the shape of a domed septum, which consists of two types of tissue: muscle and connective. This septum separates the abdominal cavity from the chest. Muscle bundles in the diaphragm form a small hole through whichpasses through the esophagus. And you probably already understood why this hole is called the esophagus.
Let's get back to hiatal hernia (HH). What it is? It is formed as a result of the displacement of some organ from the abdominal cavity to the chest cavity through the same esophageal opening of the diaphragm. And this is due to his weakening.
Hiatal hernia is such a common disease that it can successfully compete with cholecystitis, pancreatitis or duodenal ulcers. However, in its seriousness, it will also compete with them.
Regarding the age of patients, we can say that most often the disease develops in people over 60 years of age. As for gender, women are more likely to suffer from this disease than men.
Classification
Hernias of the esophagus are classified according to their characteristics. There are such types:
- Non-fixed or fixed hernias (only for axial hernias and paraesophageal hernias). In particular, a paraesophageal hernia is when the part of the stomach that forms it is located right next to the esophagus, above the diaphragm. And the cardia of the stomach is concentrated under the diaphragm. Axial HH - esophageal, cardiac, subtotal or total gastric. There is also a sliding hernia, the features of which are that in this form a hernial sac is formed, lined with the peritoneum. It differs from the axial one in that the latter does not have a bag. Axial hernia can move freely with body movements.
- Paraesophageal hernia(fundal or antral).
- Congenital hernia caused by a short esophagus with an abnormal development.
- Hernias of another type (intestinal, omental, etc.).
This disease can also be classified by degree:
- Esophageal hernia of the first degree. It is characterized by the fact that the cardia of the stomach is at the level of the diaphragm, the stomach is slightly elevated and tightly adjacent to the diaphragm. The abdominal esophagus is located in the chest cavity, directly above the diaphragm.
- Esophageal hernia of the second degree. The clinical picture is as follows: the abdominal esophagus is in the chest cavity, and part of the stomach is already in the esophageal opening.
- Esophageal hernia of the third degree. The most severe degree, characterized by the presence of the esophagus, cardia, and sometimes even the body and fundus of the stomach above the diaphragm.
Causes of esophageal hernia
It was already mentioned earlier that there are a lot of reasons for hiatal hernia. However, the following factors are most often distinguished:
- Thinning of connective tissue ligaments caused by age-related changes or provoked by some other processes.
- Systematic or simultaneous chronic increase in pressure in the abdominal cavity itself. High blood pressure can be caused by chronic constipation, strenuous exercise (such as lifting heavy objects), blunt abdominal trauma, and more.
- Chronic diseases that directly affectof the digestive system and in which motility of the gallbladder, stomach or duodenum may be impaired.
- Disorders of the endocrine glands (endocrinopathy).
- Bad habits (smoking, drinking), old age of a person.
HH symptoms
Depending on the clinical manifestations of the disease, the following forms of hiatal hernia are distinguished:
- asymptomatic HH;
- HH, the course of pathology during which is caused by cardia insufficiency syndrome;
- HH, not characterized by the presence of cardia insufficiency syndrome;
- HH, which appear as a complication of other types of gastrointestinal diseases (or simply develop against their background);
- paraesophageal HH;
- congenital HH characterized by a short esophagus.
It is worth considering each type of HH (symptoms of each type) separately:
- Asymptomatic hernias. As you already understood by the name of this form of the disease, there are no signs of HH in these cases. This mainly applies to cardiac hernias or esophageal, that is, to small-sized formations. This form of hernia is discovered absolutely by accident, most often during a complete examination, and sometimes a person does not even realize that he has HH - the symptoms (we will discuss treatment below) are absent.
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hpod symptoms treatment HH with cardia insufficiency syndrome. The most common signs of HH cardiac are heartburn and pain,arising after eating, as well as with sudden changes in the position of the patient's body. It should also be noted that these symptoms most often occur at night, which can be explained by the peculiarity of increased vagal tone, as well as relaxation of the lower esophageal sphincter.
As for the intensity of heartburn, we can say that it can be both mild (in this case, it can be treated with antacids), and quite painful (so much so that it even deprives a person of working capacity). Its intensity is determined by a whole complex of various factors, and, first of all, they include acid-peptic, which is characteristic of gastric juice. It can also be affected by stretching of the esophagus and the reflux of duodenal contents (primarily bile) into it.
The most prominent symptom of a hiatal hernia is, of course, pain. It is worth noting that it directly depends on the causes of heartburn. Basically, it appears for identical reasons. The pain is localized mainly in the area behind the sternum, and intensifies when the patient assumes a prone position. In addition to this position, the pain is also caused by tilting the torso forward and backward. Its nature can be different, most often it is stabbing, cutting or burning sensations.
Regurgitation of gastric contents is also a fairly common sign of HH. What it is? This is the process of throwing the contents of the stomach into the mouth. A very unpleasant phenomenon, and at the same time, the contents of the stomach can enter the trachea or bronchi.
And again a few words about pain. Only half experience real pain.patients, and in 25% of cases it is pseudocoronary pain, which is localized in the region of the heart. You can easily get rid of it with nitroglycerin. In addition to such pain, patients may feel discomfort in the interscapular, hepatopancreatoduodenal areas, as well as in the Chauffard-Minkowski area, etc.
Also, about 70% of patients with hiatal hernia (especially if it is cardiac HH) experience belching. Most often, it occurs in the contents of the stomach, and its predecessor is an unpleasant sensation of characteristic bursting in the epigastric region, which indicates aerophagia. Brings an unpleasant bitter aftertaste. Both antispasmodics and analgesics in this case cannot remove these sensations.
Also, 40% of patients have difficulty passing food along the esophagus, even when taking liquid food. Although it is worth noting that solid food passes quite easily. In people suffering from this symptom, most often it manifests itself from very hot or vice versa, very cold food. Therefore, with a hernia, it is recommended to eat only food that has body temperature.
About 4% of HH patients suffer from hiccups due to axial hernia. Only it's not a normal hiccup. Its main distinguishing feature can be considered a significant duration (it can last weeks, or even months). It is not so easy to get rid of it, and only a qualified specialist can help in this case.
Some patients also experience glossalgia (tongue pain) and hoarseness, whichis a consequence of a peptic burn from the contents of the stomach ejected during regurgitation.
In addition to all of the above, we can add that the symptoms of a hernia directly depend on its size.
HH without a symptom of cardia insufficiency. In such cases, the symptoms of concomitant diseases are more pronounced, and not the hernia itself. Signs of this form of hernia would be pericardial, epigastric, or retrosternal pain immediately after eating or after heavy lifting
Such pains can last for several days. You can neutralize them with the help of non-narcotic analgesics (with the exception of validol, because it has no effect) or nitroglycerin. Also, pain stops when eating or drinking.
- HH, which appear as a complication or simply develop against the background of other types of gastrointestinal diseases. These diseases are most often gastric ulcer or duodenal ulcer. With this form of HH, symptoms of the main ailment appear, and not the hernia itself.
- Paraesophageal HH. This form of hernia is characterized by the absence of any symptoms and manifestations. Most often, the diagnosis of paraesophageal hernia occurs randomly, during general examinations. But when the hernia increases in size, there is esophageal compression (in other words, narrowing of the esophagus). In isolated cases, esophagospasm develops (a disease in which the peristalsis of the esophagus is disturbed).
When strangulated paraesophageal hernias cause pain in the sternum or epigastrium.
Congenital HH characterized by a short esophagus. With this form of hernia of the esophagus, there can be two variants of development. In the first of them, such a phenomenon as a “thoracic stomach” may develop, which is characterized by the following forms:
- location in the chest;
- intrathoracic localization of the stomach.
In the latter case, it is very difficult to make a diagnosis, this usually happens during surgery or even at autopsy.
Possible Complications
Hiatal hernias can cause a range of complications. The most common are:
- gastritis or an ulcer of the part of the stomach in which the hernia is located (appears in about 8% of cases);
- bleeding, anemia (occurs in 20% of cases);
- insertion of the lower part of the esophagus into the hernial sac;
- shortening of the esophagus (usually occurs only with cardioesophageal forms);
- prolapse of the gastric mucosa into the esophagus (that is, retrograde prolapse);
- incarcerated hernia (is the most difficult complication of all listed).
Diagnosis of disease
Usually, specialists perform several tests, based on the results of which it is already possible to make a diagnosis of HH. What are these tests:
- Fibrogastroscopy. With its help, you can understand the state of the esophagus and stomach. Endoscopic signs of HH are determined by the doctor himself, on the basis of which he can make a diagnosis and prescribe treatment.
- X-rayexamination, which is carried out on the basis of barium contrast. Thanks to this examination, it is possible to obtain an image of a hernial protrusion characteristic of each HH degree.
- pH-metry. This test is done to determine the level of acidity in the stomach. It is necessary in order to properly prescribe hernia treatment.
Treatment of HH in the esophagus
A hiatal hernia is usually treated with medication, but in some cases (especially with complications) surgery is required.
As far as drug treatment is concerned, it consists in reducing the acidity of the stomach (with the help of antacids), as well as reducing gastric secretion. This is the first task. Also, during treatment, it is necessary to protect the gastric mucosa, which is also provided for the use of certain drugs.
During treatment, a strict diet is prescribed, which must be strictly adhered to. Basically, this diet is almost the same as with gastritis: nothing fatty, nothing spicy, sour, s alty. Only he althy food, such as vegetables, fruits, cereals, diet soups and broths, lean meats.
So, to eliminate heartburn and to reduce the secretion of the stomach, you can take the drug "Maalox". What is very convenient, it is available not only in tablets, but also in the form of gels, dragees, suspensions. Each form of this remedy has a separate instruction for use, which can be checked at any pharmacy in your city.
You can also take things like Rennie or"Gastal". To eliminate heartburn that has already appeared, it will be enough to take one tablet, and for prevention - 4 tablets per day (an hour after eating). However, remember that these drugs only relieve the symptoms.
As for the surgical intervention, it consists in removing the hernia.
For a more accurate diagnosis and treatment, you should consult a doctor (surgeon or gastroenterologist).
Treatment with folk remedies
Treatment of HH with folk remedies will not give the desired results, since in most cases a sick person needs serious medications or even surgery.
That is, no folk remedies can remove the hernia itself. The only thing they can be used for is to relieve pain.
Some herbal teas will help reduce pain. Here are some folk remedies that will help in the fight against a hernia:
- A decoction of marshmallow roots. Pour about 20 g of crushed marshmallow root into a cup of boiling water and let it brew.
- Mix 30 drops of alcohol tincture of propolis and 50 ml of milk. Take 2 times a day.
- With flatulence, a decoction of carrot seeds helps well. Pour one gram of seeds with 2 cups of hot water and let the mixture steep for about half an hour. Drink with seeds.
Remember to consult your doctor before taking anything (especially folk remedies).
Also, with the help of folk remedies, you can get rid of heartburn, hiccups and other symptoms of HH. But remember thatthis is only a temporary result, and the cause of the disease should be treated, not the symptoms.
Hernia of the esophagus after surgery
As mentioned above, in some cases hiatal hernia requires surgery. HH-operation, reviews of which are ambiguous, can really save a person's life in especially neglected cases.
But what to do when the operation has already been done? How to follow the postoperative regimen? How long does it take to return to normal life?
HIS after surgery necessarily requires care and comprehensive therapeutic and preventive measures.
On the first day after surgery, patients need an examination by a general practitioner and an electrocardiogram. On the second day, a chest x-ray is taken. On the third - a general detailed blood test, as well as a biochemical study, according to the indications of which sonography is prescribed.
Twice a day, patients should perform simple breathing exercises and exercise therapy.
As for drug therapy, we can say the following. It consists in the introduction of saline solutions intravenously in a volume of up to 1800 ml per day. All patients take antibiotics after surgery.
Trocar wounds are treated with alcohol and bandaged every other day.
Literally a day after the operation, patients can already drink water, and starting from the second day - take liquid food. The postoperative period lasts about 3 months.
How does the HHM operation itself take place (reviews of whichdifferent, depending on the severity of the disease) we have already mentioned above. It consists in removing the hernia itself.
Conclusion
So, now you won't be afraid if you see the abbreviation GOD somewhere. You already know what it is and how it manifests.
It remains only to summarize that the disease is very serious. Self-medication, especially treatment with folk remedies, is quite dangerous and can cause serious complications.
But, alas, no one is immune from complications, since some forms of HH are asymptomatic. The only way out is to undergo a complete examination in the hospital at least once a year. So you can detect this unpleasant ailment in time.
