What is gastric hypodermic. When is it possible to treat a hernia of the esophagus without surgery and how is it carried out? Symptoms and their origins

A hiatal hernia is a protrusion into the chest cavity of the abdominal segment of the esophagus and the adjacent part of the stomach, and sometimes at the same time the intestinal loops, through the enlarged esophageal opening in the diaphragm. In the medical literature, the term "hiatal hernia" is sometimes used in relation to this pathology; in everyday life, simplified names are often used - hernia of the esophagus or diaphragmatic hernia.

The disease occurs in about 5% of the adult population and is characterized by a chronic relapsing course.

Causes and risk factors

The most common cause of hiatal hernias is congenital or acquired hiatal ligament weakness. In about half of the cases, the disease is diagnosed in patients over 50 years old due to progressive degenerative-dystrophic changes in the connective tissue. A sedentary lifestyle, exhaustion and an asthenic physique increase the likelihood of illness. The pathological development of connective tissue structures, contributing to the appearance of hernias, can be indicated by concomitant diseases: flat feet, varicose veins, hemorrhoids, Marfan syndrome, etc.

The provoking factor for the formation of a hernia of the esophageal opening is most often a significant increase in intra-abdominal pressure with prolonged tearful cough, flatulence, ascites, neoplasms and severe obesity, as well as with blunt trauma to the abdominal region, sharp bends, overwhelming physical labor and simultaneous lifting of a heavy load. In women, the disease is often diagnosed during pregnancy: according to the WHO, hiatus hernias are found in 18% of patients with repeated pregnancy.

A persistent increase in intra-abdominal pressure is also observed in some diseases of the abdominal organs, accompanied by persistent vomiting and impaired peristalsis. Inflammatory processes in the upper gastrointestinal tract, reflux esophagitis and burns of the mucous membranes lead to cicatricial deformities of the esophagus, which contribute to its longitudinal shortening and weakening of the ligamentous apparatus. For this reason, diaphragmatic hernias are often associated with chronic gastritis and gastroduodenitis, gastric ulcer and duodenal ulcer, cholecystitis, pancreatitis, etc.

The best prevention of hiatal hernias in the absence of clinical signs is the rejection of bad habits, good nutrition and regular exercise.

In rare cases, the development of a hernia of the esophagus is due to congenital malformations of the upper gastrointestinal tract. The risk group includes patients with a short esophagus and the so-called pectoral stomach (congenital shortening of the esophagus).

Forms

Hiatal hernias are divided into three groups depending on the location and anatomical features.

1. Axial (axial, sliding) - the most common type of hiatal hernias, characterized by free penetration of the abdominal segment of the esophagus, cardia and fundus of the stomach into the chest cavity with the possibility of independent return to the abdominal cavity when the position of the body changes. Taking into account the nature of the dislocation of anatomical structures, cardiac, cardiofundal, subtotal and total gastric subtypes are distinguished among axial hiatal hernias.
2. Paraesophageal - manifested by the displacement of a part of the stomach into the chest cavity with the normal location of the distal segment of the esophagus and cardia. Paraesophageal hernias are differentiated into fundic and antral hernias: in the first case, the fundus of the stomach is located above the diaphragm, in the second - the antrum.
3. Mixed hiatal hernia is a combination of the two previous types.

Congenital malformations of the gastrointestinal tract, in which there is an intrathoracic location of the stomach due to insufficient length of the esophagus, should be considered as a separate category.

A hiatal hernia occurs in about 5% of the adult population and is characterized by a chronic recurrent course.

Stages

Based on the degree of displacement of the stomach into the chest cavity, there are three stages of axial diaphragmatic hernias.

1. The abdominal segment is located above the diaphragm, the cardia is at the level of the diaphragm, the stomach is directly adjacent to the cardia.
2. The lower esophagus protrudes into the chest cavity, the stomach is located at the level of the esophageal opening.
3. Most of the subphrenic structures extend into the chest cavity.

Symptoms of a hiatal hernia

In about half of cases, a hiatus hernia is asymptomatic and is diagnosed by chance. Clinical manifestations appear as the size of the hernial sac increases and the compensatory capabilities of the sphincter mechanism at the border of the stomach and esophagus are exhausted. As a result, gastroesophageal reflux is observed - the reverse movement of the contents of the stomach and duodenum 12 along the esophagus.

With a large hiatus hernia, reflux esophagitis often develops, or gastroesophageal reflux disease - inflammation of the walls of the esophagus caused by constant irritation of the mucous membranes by an acidic environment. The main symptoms of a hiatal hernia are associated with the clinical picture of reflux esophagitis, which is characterized by:

• frequent heartburn and a feeling of bitterness in the mouth;
• hiccups and belching with a sour and bitter aftertaste;
• hoarseness and sore throat;
• thinning of tooth enamel;
• pain in the epigastrium, in the epigastric region and behind the sternum, radiating to the back and interscapular region;
• causeless vomiting without prior nausea, mainly at night;
• difficulty swallowing, which is especially pronounced when taking liquid food and in a stressful environment;

Progressive reflux esophagitis is accompanied by the development of erosive gastritis and the formation of peptic ulcers of the esophagus, causing latent bleeding in the stomach and lower esophagus, which leads to anemic syndrome. Patients complain of weakness, headaches, fatigue and low blood pressure; cyanosis of mucous membranes and nails is often noticeable.

When the hernial sac is infringed, the painful sensations increase sharply and take on a cramping character. At the same time, signs of internal bleeding appear: nausea, vomiting of blood, cyanosis, a sharp decrease in blood pressure.

Approximately one third of patients with a hiatal hernia have complaints of a cardiac profile - chest pains radiating to the scapula and shoulder, shortness of breath and cardiac arrhythmias (paroxysmal tachycardia or extrasystole). The differential sign of a diaphragmatic hernia in this case is increased pain in the supine position, after eating, sneezing, coughing, bending forward and passing intestinal gases. After a deep breath, belching, and a change in posture, the painful sensations usually subside.

Diagnostics

In the diagnosis of hiatal hernias, instrumental imaging methods play a leading role:

• esophagogastroscopy;
• intraesophageal and intragastric pH-metry;
• esophagomanometry;
• X-ray of the esophagus, stomach and chest organs.

Endoscopic examination reveals reliable signs of a hiatal hernia: expansion of the esophageal opening, displacement of the esophageal-gastric line upward and changes in the mucous membranes of the esophagus and stomach, characteristic of chronic esophagitis and gastritis. Esophagogastroscopy is often combined with a pH meter; when severe ulceration and erosion are found, the selection of a biopsy is also shown in order to exclude oncopathology and precancerous conditions.

In about half of cases, a hiatal hernia is diagnosed in patients over 50 years old due to progressive degenerative-dystrophic changes in the connective tissue.

On X-ray images, signs of axial hernias are clearly visible: high location of the esophagus, protrusion of the cardia over the diaphragm, disappearance of the subphrenic esophagus. With the introduction of a contrast agent, a suspension of suspension is observed in the area of ​​the hernia.

To assess the state of the upper and lower esophageal sphincters and esophageal motility, esophagomanometry is performed - a functional study using a water-perfusion catheter equipped with a registration sensor. Pressure indicators in the contracted state and at rest allow one to judge the strength, amplitude, speed and duration of contractions of the sphincters and smooth muscles of the esophageal walls.

Impedance measurement allows you to get an idea of ​​the acid-forming, motor-motor and evacuation functions of the stomach, based on the indicators of electrostatic resistance between the electrodes of the esophageal probe. Impedance measurement is considered the most reliable way of recognizing gastroesophageal reflux with a simultaneous assessment of its type - depending on the pH value, acidic, alkaline or slightly acidic reflux is distinguished.

In case of severe anemic syndrome, an analysis of feces for occult blood is additionally performed. To exclude cardiovascular pathology in the presence of complaints of a cardiological profile, it may be necessary to consult a cardiologist and conduct gastrocardiomonitoring - a combined daily monitoring of gastric acidity and an ECG according to Holter.

Treatment of hernia of the esophageal diaphragm

With a small hernia, medical tactics are usually limited to pharmacotherapy of gastroesophageal reflux, aimed at stopping inflammation, normalizing pH, restoring normal motility and mucous membranes of the upper gastrointestinal tract. The therapeutic regimen includes proton pump inhibitors and histamine receptor blockers; with increased acidity, antacids are prescribed - aluminum and magnesium hydroxides, magnesium carbonate and oxide.

The patient must observe a sparing daily regimen, refrain from smoking and alcohol, avoid stress and excessive physical exertion. In case of severe pain behind the sternum, it is recommended to give the head of an elevated position.

For the duration of treatment, you should adhere to diet number 1 according to Pevzner. The regimen of food intake is also important: the daily ration is divided into 5–6 servings; however, it is important that the last meal in the evening took place at least three hours before bedtime.

With the low efficiency of drug therapy, dysplasia of the mucous membranes of the esophagus and a complicated course of a hiatal hernia, surgery is the best way out. Depending on the size and location of the hernial sac, the nature of pathological changes in the esophageal wall, the presence of complications and concomitant diseases, various methods of surgical treatment of hiatal hernias are used:

• strengthening of the esophageal-phrenic ligament- suturing of the hernia orifice and hernia repair;
• fundoplication- restoration of an acute angle between the abdominal segment of the esophagus and the fundus of the stomach;
• gastropexy- fixation of the stomach in the abdominal cavity;
• resection of the esophagus- an extreme measure, which is used in case of formation of cicatricial stenosis of the esophagus.

Possible complications and consequences

Of the complications of a hiatal hernia, the greatest threat is aspiration pneumonia, which develops when large volumes of stomach contents enter the respiratory tract. Aspiration pneumonia accounts for almost a quarter of all reported cases of severe lung infection. Frequent irritation of the respiratory tract with small portions of regurgitated gastric contents leads to chronic tracheobronchitis.

Also of concern are cardiovascular complications caused by large hernia irritation of the vagus nerve. Against the background of a diaphragmatic hernia, reflex angina pectoris may develop, and with spasm of the coronary vessels, the risk of myocardial infarction increases.

Lack of treatment for hiatal hernia provokes complications and increases the degree of cancer risk.

The long-term consequences of a hiatal hernia and the progressive course of reflux esophagitis include:

• the appearance of erosions and peptide ulcers;
• esophageal and gastric bleeding;
• cicatricial stenosis of the esophagus;
• infringement of a hernia;
• perforation of the esophagus.

The long course of gastroesophageal reflux with hernia creates the prerequisites for dysplastic and metaplastic changes in the epithelial tissue of the mucous membranes of the esophagus. An example of metaplasia with a high probability of malignancy is Barrett's esophagus, which is characterized by the replacement of the normal squamous epithelium of the esophageal wall with the columnar epithelium characteristic of the intestine, as well as for the cardiac and fundic parts of the stomach. This creates the prerequisites for the development of a malignant tumor process. Metaplastic goblet cells are especially susceptible to malignancy when the length of the affected area is more than 3 cm.

Forecast

With conservative treatment, hiatal hernias are prone to recurrence, therefore, at the end of the main course of treatment, patients are subject to dispensary registration with a gastroenterologist. After surgery, the likelihood of recurrence is minimal.

Adequate selection of therapeutic regimens and regular prevention of exacerbations of reflux esophagitis can achieve long-term remission and prevent complications. With a small hernia and a good response to drug therapy, there is a chance to achieve a complete recovery. Lack of treatment, on the contrary, provokes complications and increases the degree of cancer risk.

Prophylaxis

The best prevention of hiatal hernias in the absence of clinical signs is the rejection of bad habits, good nutrition and regular exercise. The training program should include specialized exercises to strengthen the abdominal wall.

In order to prevent recurrence of hiatal hernia, it is important to timely identify and treat diseases of the digestive system, ensure the normal functioning of the gastrointestinal tract and limit the consumption of foods that irritate the mucous membranes. The ban includes spicy, fatty, fried and salty foods, rich broths, smoked meats, alcohol, tomatoes, radishes, cabbage, onions, legumes and citrus fruits, as well as coarse bread and cereals rich in fiber. Also, do not get carried away with chocolate, delicious hard and moldy cheeses, red meat and cream cakes.

The most favorable products for the restoration of the mucous membranes of the esophagus and stomach are considered to be fine-grained cereals, white rice, low-fat milk and meat, ripe sweet fruits without skin and seeds, puddings, soft-boiled eggs, steamed omelets and boiled vegetables. The health-improving effect is greatly increased if you adhere to fractional portioned meals and find time for walking after an evening meal.

Patients prone to obesity, it is desirable to bring the weight in line with the physiological norm. With a history of hernial diseases, intense power loads are contraindicated, however, exercise in exercise therapy groups has a good effect.

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The diaphragm is a large and wide muscle that separates the chest cavity from the abdominal cavity. It is, as it were, "stretched" between the sternum, ribs and lumbar vertebrae, to which it is attached. The formation of a hernia of the alimentary opening occurs due to its weakening, as a result of which parts of the organs located below penetrate into the upper (chest) cavity.

In most cases, small hiatal hernias (hiatal hernias) do not cause problems. If the hernia is large, gastric contents are thrown back into the esophagus, resulting in heartburn, belching, and dysphagia and chest pain.

Causes

A hiatal hernia (abbreviated as hiatal hernia) is diagnosed in about 5% of adults. More than half of the cases occur in old age - over 55 years old, which is due to age-related changes - in particular, the natural process of weakening of the ligamentous apparatus.

Most often, a diaphragmatic hernia develops due to the fact that the tissues, whose task is to limit the esophageal opening of the diaphragm, become much more elastic than necessary. Many do not even know that such a hernia is possible. Meanwhile, this is a rather serious problem that requires qualified medical care.

Causes of occurrence:

• Injuries to the abdomen and chest;
• Increased intra-abdominal pressure;
• Long-term coughing attacks (asthma, chronic bronchitis);
• Connective tissue diseases: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
• Asthenic physique;

Paraesophageal hernia can be congenital or acquired. Hernia of the esophageal opening of the diaphragm in children, as a rule, is associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age.

The risk group includes those who have the following diseases:

• Phlebeurysm
• Obesity.

Also, the development of a hernia of the esophageal opening of the diaphragm predisposes a violation of the motility of the digestive tract with hypermotor dyskinesia of the esophagus, accompanying duodenal ulcer and stomach ulcer, chronic gastroduodenitis, chronic pancreatitis, calculous cholecystitis.

Symptoms of a hiatal hernia

HHOD is a chronic disease affecting the digestive system, which is in 3rd place among other diseases such as duodenal ulcers and chronic cholecystitis. A hiatal hernia is a pathology in which the stomach slides up to the esophagus.

Symptoms of hiatal hernia:

1. a sign of a diaphragmatic hernia is pain syndrome, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
2. chest pain can lead the patient to a cardiologist by mistake in diagnosis;
3. pain can occur after eating or physical exertion, with intestinal and after a deep breath;
4. heartburn, burning in the throat, hiccups, bouts of nausea, retching, hoarseness;
5. cyanosis, vomiting with blood speak of a strangulated hernia;
6. in some cases, blood pressure may rise.
7. at night there are severe attacks of coughing, accompanied by suffocation, increased salivation.

The causes of pain in a hernia of the diaphragm are compression of the nerves and vessels of the stomach when its cardial part enters the chest cavity, the effect of the acidic contents of the intestine and stomach on the esophageal mucosa and stretching of its walls.

Pain sensations with a hernia of the esophagus can be differentiated based on the following symptoms:

• pain appears mainly after eating, physical activity, in a horizontal position, with increased gas production;
• they soften or disappear after a deep breath, belching, drinking water, changing posture;
• the pain increases as a result of bending forward.
• Sometimes the pain can be shingles, resembling pancreatitis.

Typical symptoms of a hernia of the esophageal diaphragm are also:

• hiccups;
• heartburn;
• pain in the tongue, burning sensation;
• the appearance of a hoarse voice.

Call an ambulance immediately if:

• you feel nauseous
• you had vomiting
• you cannot have a bowel movement or gas.

Types of HPOD

There are the following main types of hernias: sliding food hernia (axinal) and fixed (paraesophageal) hernia.

Sliding (axinal) hernia

An axial hiatal hernia is the protrusion of organs below the diaphragm through a natural opening. In the vast majority of cases (approximately 90%), diaphragm hernias are axial, or sliding.

With a sliding (axial, axial) hernia, there is a free penetration of the abdominal part of the esophagus, cardia and the fundus of the stomach through the esophageal opening of the diaphragm into the chest cavity and independent return (when changing the position of the body) back into the abdominal cavity.

Axial hiatal hernia begins to develop with reduced elasticity of the muscular connective tissues, weakening of their ligaments. Depending on the displaced area, they can be cardiac, cardiofundal, subtotal or total gastric.

For axial hernia under the esophagus, various etiologies are characteristic. The following etiological factors are distinguished:

• Impaired motility of the digestive system
• Weakness of the ligamentous apparatus and other connective tissue elements
• High abdominal pressure
• The presence of chronic pathology of the stomach, liver Diseases of the respiratory tract, accompanied by intense cough.

Among all diseases of the digestive system, this pathology is in third place, constituting a serious "competition" for such pathological conditions as gastric ulcer and.

Fixed GPOD

Fixed (paraesophageal) hiatal hernia is less common. In this case, part of the stomach is pushed out through the diaphragm and remains there. Typically, such hernias are not considered a serious condition. However, there is a risk that blood flow to the stomach could be blocked, which could cause serious injury and requires urgent medical attention.

In patients with a fixed hernia, a symptom such as belching may be noted. It appears as a result of air entering the esophagus. Sometimes it gets there with an admixture of bile or gastric juice. In this case, the belching will have a characteristic taste and smell.

Quite often, patients with paraesophageal hernia complain of intense pain in the region of the heart. This is not surprising, because the pain in the thoracic region that they feel really imitates heart pain.

Degrees of HHP

It is important to remember that early diagnosis of hiatal hernia will help to avoid complications, and the treatment of hiatal hernia will be more effective. In the early stages, you can do without surgery.

1. At the first, mildest degree, the esophagus, which is normally located in the abdominal cavity (abdominal), rises into the chest cavity. At the same time, the size of the opening does not allow the stomach to rise up, it remains in place;
2. In the second degree, the abdominal esophagus is located in the chest cavity, and part of the stomach is located directly in the esophageal opening of the diaphragm;
3. HHOD grade 3 - a significant part of the stomach, sometimes up to its pylorus, passing into the duodenum, moves into the chest cavity.

Complications

Complications that may occur with HH:

• A hiatal hernia can be complicated by the development of gastrointestinal bleeding. The cause of bleeding is peptic ulcers, erosion of the esophagus and stomach.
• Another possible but rare complication of a hiatus hernia is its entrapment and perforation of the stomach wall.
• Anemia is a common complication of hiatal hernia.
• is a natural and frequent complication of the hiatal hernia.

Other complications of hiatal hernia - retrograde prolapse of the gastric mucosa into the esophagus, intussusception of the esophagus into the hernial part are rarely observed and are diagnosed by fluoroscopy and endoscopy of the esophagus and stomach.

It is quite obvious that in the listed situations of complications of a hiatal hernia, the central goal is to treat the underlying disease.

Diagnostics

To diagnose a hiatal hernia, you need to describe in detail your complaints to the doctor, undergo a series of examinations. Since this disease is sometimes asymptomatic, it is possible to detect a hernia with random examination for other complaints.

The diagnosis of a hiatal hernia is made on the basis of specific complaints and data from instrumental research methods.

1. These include X-ray examination with contrast, endoscopic examination and manometry, which allows you to measure the pressure in different parts of the esophagus.
2. Additionally, a general blood test is prescribed to exclude a potential complication of a hernia - gastrointestinal bleeding.
3. When, in addition to a hernia of the diaphragm, the patient has gallstone disease, he needs to undergo an ultrasound examination of the abdominal cavity.
4. Since a diaphragmatic hernia is often accompanied by symptoms similar to those of heart disease, an additional electrocardiogram will have to be done.

In any case, studies are prescribed individually, taking into account the characteristics of the patient's body and the collected anamnesis.

Treatment of a hiatal hernia: drugs and surgery

Treatment of diaphragmatic hernia begins with conservative measures. Since the symptoms of gastroesophageal reflux come to the fore in the clinic for hiatal hernias, conservative treatment is aimed mainly at eliminating them.

Based on the pathogenetic mechanisms and clinical symptoms of the esophageal opening of the diaphragm, the following main tasks of its conservative treatment can be formulated:

1. reducing the aggressive properties of gastric juice and, above all, the content of r iici hydrochloric acid:
2. preventing and limiting gastroesophageal reflux;
3. local drug action on the inflamed mucous membrane of the esophagus, hernial part of the stomach,
4. reduction or elimination of esophageal and gastric:
5. prevention and limitation of trauma in the hernial orifice of the abdominal segment of the esophagus and the prolapsing part of the stomach.

Drugs for HHH

Your doctor may prescribe the following medicines for you:

• antacids to neutralize stomach acid
• blockers of H2-histamine receptors, which reduce acid production
• proton pump inhibitors (PPIs) - antisecretory drugs for the treatment of acid-dependent stomach diseases.
• Medicines - proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
• Prokinetics for improving the condition of the gastric mucosa, esophagus, optimizing their motility, getting rid of nausea, pain (motilac, motilium, metoclopramide, ganaton, itomed, trimebutin).
• Vitamins of group B in order to accelerate the regeneration of stomach tissues.

As a rule, treatment of a hernia of the diaphragm without surgery is 99% identical to the tactics for treating reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow a special diet, and adhere to all the doctor's prescriptions.

Hiatus hernia surgery

Currently, surgery is the only radical and most effective way to treat hiatal hernia. It is also indicated in the absence of a result from the drug therapy carried out.

Operation on the diaphragm for hiatal hernias is usually planned, carried out after a thorough examination and preparation. Emergency operations for complicated hernias (infringement, perforation, or bleeding from a compressed organ) are not very often performed.

Operations with hiatal hernia are carried out in different ways. The Nissen fundoplication is gaining popularity. With such an operation, a cuff is made from a part of the stomach wall, which is fixed around the opening where the diaphragm has expanded.

Doctors operate in two ways, such as:

• removal by an open, abdominal incision;
• laparoscopy with several small incisions and the use of an endoscope with a camera and optics.

Contraindications for surgery:

• Acute infectious diseases.
• Exacerbations of chronic diseases.
• Diseases of the heart in the stage of decompensation.
• Severe lung disease with respiratory failure.
• Uncompensated diabetes mellitus.
• Blood diseases with clotting disorders.
• Renal and hepatic impairment.
• Pregnancy.
• Oncological diseases.
• Recently transferred abdominal operations.

In the postoperative period, antibiotics, pain relievers are prescribed, in case of impaired motility of the gastrointestinal tract - prokinetics (cerucal, motilium). The stitches are removed on the 7th day, after which the patient is discharged from the hospital under the supervision of a gastroenterologist.

In the first months, it is necessary to significantly reduce the physical activity associated with active body movements.

The most common complications after surgery to remove a hernia of the opening of the esophagus are:

• relapse of the disease;
• slipping of the cuff;
• a feeling of discomfort in the chest area;
• pain;
• difficulty swallowing;
• inflammatory processes;
• divergence of seams.

The diet after surgery should be liquid - you will need to follow it for about 3 to 5 days. Clear liquids consist of broth, water, or juice. If after 3-5 days the liquid is well tolerated, the diet will be switched to a soft diet.

A bland diet consists of foods that are easy to chew and swallow, such as softened foods or mashed potatoes, canned or cooked soft fruits and vegetables, or tender meats, fish and poultry. If a soft diet is tolerated for three weeks, then you can switch to a regular diet.

Diet and nutrition

You need to eat in small portions. There should be 4-5 meals a day. After eating, it is undesirable to rest in the supine position. Better to sit or even walk around. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system.

The diet for hernia of the esophagus and the menu suggest an introduction to the diet:

• yesterday's wheat flour bakery products;
• slimy cereal soups;
• sour milk cuisine;
• cereals, pasta;
• meat, fish, boiled, baked, steamed;
• vegetable and animal oils.

It is forbidden to use seasonings and sugar in dishes for patients with hernia of the diaphragmatic opening, as this provokes increased acidity of gastric juice and creates risks for trauma to the esophagus.

It is necessary to adhere to a dietary diet, namely:

• eat food 5-6 times a day in small portions;
• after eating for 1 hour, do not go to bed;
• dinner should be 2-3 hours before bedtime;
• you can eat grated fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups;
• before meals, drink 1 tablespoon of sunflower or olive oil;
• it is forbidden to take fried, fatty, salty foods;
• smoking is prohibited.

How to treat a hiatal hernia with folk remedies

With diaphragmatic hernia, herbal treatment against the background of traditional therapy can improve the patient's condition as a whole and remove symptoms. The recipes described below accelerate the secretion of gastric juice, make food move faster through the esophagus, and also eliminate the causes of constipation.

A simple remedy is goat's milk, which should be drunk warm twice a day after meals. A single amount is 0.5 cups.

1. The treatment is carried out using a decoction of aspen bark - they take a large spoonful of raw materials and brew 200 ml of boiling water, insist and filter. Drink 2 large spoons up to 5 times a day before meals.
2. You can also use branches of young aspen and cherry. They need to be poured with a liter of boiling water and cooked over low heat for half an hour. Then let cool and take half a glass.
3. No less effective, according to traditional healers, is the most common mint tea. To prepare it, simply add a few dried plant leaves to boiling water, you can add sugar to taste (although it is better to abstain if possible). Drink during the day in small sips and you will soon forget that you were tormented by pain and heartburn.
4. You can mix in equal parts flax seed, aniseed fruits, marshmallow and gentian roots, fenugreek. The components are crushed, mixed, taken three times a day in a small spoonful of powder. It is permissible to mix it with honey.
5. A decoction of chamomile is a good remedy for any manifestation of a diaphragmatic hernia. It not only soothes the stomach, but also helps to improve digestion. An excellent remedy that can be safely called a panacea for all ills.
6. Calendula tea is just as effective. It can be brewed with chamomile. This tea should be drunk no more than four times a day, necessarily not earlier than an hour after a meal.

People who have this disease are advised to follow these guidelines:

1. Patients must necessarily follow a special diet that excludes foods that irritate the intestines;
2. Take food in fractional portions every few hours;
3. Avoid bending the torso forward, sudden changes in body position - this can cause pain in the sternum and heartburn;
4. Patients should not lift weights more than 5 kg
5. You can not tighten the belt tightly, wear clothes that are experiencing the stomach - this creates additional pressure in the abdominal cavity;
6. Avoid heavy physical exertion, but at the same time regularly perform physiotherapy exercises that strengthen the muscle corset and restore the tone of the diaphragm;
7. It is recommended to eat for the last time no later than 2.5-3 hours before going to bed;
8. Normalize stool - constipation and diarrhea increase intra-abdominal pressure and promote hiatal hernia.
9. Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil;

Prophylaxis

In addition to the main measures for the prevention of gastroenterological diseases (healthy lifestyle, elimination of stress, proper nutrition), it is necessary to strengthen the muscular wall of the peritoneum - to play sports, therapeutic exercises, to pump the press. Patients with a diagnosed hiatal hernia are subject to dispensary observation by a gastroenterologist.

This is all about the hiatal hernia (hiatal hernia): what kind of disease it is, what are its symptoms, treatment features. Do not be ill!

A hiatal hernia, or hiatal hernia, is a pathology that has a chronic course and is characterized by the ingress of intestinal loops, the lower esophagus and the cardiac part of the stomach into the chest cavity. The disease is quite common. Hernia of the esophagus is more common in people over 50.

Causes of hernia of the esophagus

There are many reasons for the development of the disease. The main reasons for the development of a hernia are:

• weakening of the ligaments resulting from the absence or insufficiency of physical activity;
• diseases or physiological conditions that result in increased intra-abdominal pressure - pregnancy, persistent vomiting, flatulence, severe cough;
• violation of the contractile function of the esophagus;
• congenital malformations.

The etiology of the disease may include other factors that lead to the formation of a hernia of the esophagus.

Symptoms of the disease

The symptomatology of the disease is polymorphic and includes symptoms of varying severity. Signs of a hiatal hernia often resemble those of cardiovascular disease. Basically, this is a pain syndrome, which is characterized by dull, aching pains mainly after eating, with severe flatulence, more often in a horizontal position. Sometimes the pain can be more intense and be accompanied by such cardiac symptoms as shortness of breath, irregular heartbeats.

Pain can also radiate under the scapula and other parts of the body. Often patients with hernia of the esophagus are tormented by belching associated with the throwing of the acidic contents of the stomach into the esophagus, heartburn. There may also be pain in the esophagus when swallowing, difficulty passing the food lump, the throwing of stomach contents into the airways at night, which leads to a severe cough.

Treatment of the disease

Treatment of a hiatal hernia is always complex and includes a number of measures that will allow you to cope with the disease without surgery.

Compliance with the principles of dietary nutrition. Since very often the causes of a hernia of the esophagus are diseases of the stomach and intestines, which are accompanied by belching, bloating, vomiting and constipation, the diet should be aimed at eliminating and preventing these symptoms:

• to prevent fermentation processes, a number of products should be excluded: alcoholic beverages (especially wine, beer, carbonated and sparkling drinks), fried and smoked foods, spicy dressings and seasonings, juices of sour fruits and vegetables, the use of fresh milk and dairy products is undesirable. It is also extremely undesirable to take bakery products, grapes, legumes, apples, white cabbage, onions;
• food should be small portions, that is, food should be taken in small portions several times a day, preferably up to 5-6 times a day. Dishes should not be too hot or cold. It is necessary to consume more liquid or semi-liquid food in the form of mashed potatoes, mashed soups, soufflés;
• some cooking rules must be followed: use lean meat, skinless chicken, lean fish. The cooking method should exclude frying, smoking, grilling or grilling. It is better to use steam cooking methods, boiled and stewed foods are also shown. Steamed or boiled vegetables are ideal as side dishes, except for cabbage and legumes. It is also necessary to use cereals - buckwheat, rice, millet. It is advisable to exclude the use of all types of vegetable and butter, this will help to significantly reduce the fat content of the dish;
• also after eating, you should observe the motor regimen. After eating in the first 2-3 hours, it is not recommended to perform heavy physical activity. It is also undesirable to take a horizontal position in the first hours after eating, so as not to provoke the reflux of stomach contents into the esophagus, which can cause heartburn;
• the use of remedial gymnastics, which consists of several breathing exercises. Exercise should be done daily in the morning before eating or 2-3 hours after.

Drug therapy

Treatment of a hernia of the esophagus with drugs includes the appointment of a combination of drugs that are aimed at eliminating the main symptoms and preventing their recurrence:

• drugs related to proton pump inhibitors, which reduce the production of hydrochloric acid in the stomach: Esomeprazole, Omeprazole, Pantoprazole;
• drugs with an antacid effect, which have the ability to neutralize acid in the stomach: Gaviscon, Rennie, Gastal, Almagel, Fosfalugel, Maalox;
• medicines that normalize the motility of the stomach and intestines: Cerucal, Motilium, Motilak;
• blockers of histamine receptors, which have an antiulcer effect: Cimetidine, Famotidine, Ranitidine;
• hemostatic and antianemic drugs are prescribed in case of chronic blood loss due to hernia infringement: Dicinon, Vikasol, Ferrum Lek, Sorbifer Durules, Aktiferrin;
• in cases of ingestion of duodenal gruel into the esophagus, drugs that neutralize bile are prescribed: Ursosan, Ursodez, Ursofalk.

When prescribing medicines, the doctor must take into account all the indications and contraindications, as well as the possibility of developing adverse reactions that can negatively affect the course of the disease and cause possible complications. That is why the patient should inform the doctor about the presence of concomitant diseases and drug intolerance, if any.

Treatment of hernia of the esophagus with alternative methods

In addition to traditional methods of conservative treatment, there are methods based on traditional medicine recipes. It is recommended to treat a hernia with folk remedies in combination with traditional methods. Basically, these are recipes for making infusions from medicinal herbs:

• The infusion will help relieve heartburn, bloating and constipation. Prepare a mixture of red elm bark, flaxseed, coltsfoot and marshmallow root in a ratio of 1: 1: 2: 2. Boil the collection in the amount of 60–70 g in hot boiling water (1 liter) and leave for an hour. Take 3-4 times a day as tea.
• Chamomile tea with honey is also considered effective. The tool relieves bloating, has a calming effect. Pure chamomile tea is recommended to be taken during the day, with honey at night.
• Chamomile flowers, gooseberry leaves, mint leaves, caraway seeds in a 2: 2: 1: 1 ratio, grind in a blender. Then brew two teaspoons of the mixture in 500 ml of hot water, leave for half an hour and take half a glass 3-4 times a day. This collection will relieve excruciating heartburn and flatulence.
• Celery juice will relieve the burning sensation after eating. It is recommended to drink only freshly prepared juice in an amount of no more than 30 ml per day.
• Also, with a hernia of the esophagus, aspen bark is used. A teaspoon of chopped bark is brewed in 200 ml of hot boiling water and infused for an hour. You can drink infusion with honey.
• Mix dill fruits, mint leaves, valerian root in equal proportions. A tablespoon of the mixture is brewed in a glass of boiling water and a 50 ml decoction is taken in the morning and evening. The broth relieves severe flatulence well.
• Also, crushed flax seeds have a beneficial effect on hernia of the esophagus. Grind flaxseed in a mortar, or grind in a coffee grinder, pour a tablespoon of seeds with 100 ml of hot boiling water overnight. In the morning, drink the ready-made broth on an empty stomach. The broth has an enveloping effect, which has a beneficial effect on the functioning of the stomach and intestines.

All of the above methods, including treatment with folk remedies, should be used on the recommendation of a doctor. If a hiatal hernia is diagnosed, then it is highly discouraged to treat this disease on your own. Only a specialist with the help of additional examination methods will be able to correctly diagnose and prescribe rational treatment.

The effectiveness of treatment directly depends on the correct tactics of the doctor, who will take into account all contraindications and possible complications. This will allow you to successfully cure a hernia of the esophagus without surgery. In extreme cases, when conservative treatment does not bring the desired result, the specialist will decide on a possible surgical intervention. Such situations are quite rare, mainly if all the doctor's recommendations are followed, a hiatal hernia can be treated without surgery.

Hernia of the esophageal opening of the diaphragm (HH) belongs to the category of fairly common pathologies, the risk of which increases in patients in proportion to their age.

So, in patients under the age of forty, they occur in 8% of cases, while in patients who have crossed the seventy-year line, their number increases to 70%, and women are more susceptible to them.

In almost half of the patients, this pathology is characterized by a complete asymptomatic course, and remained unrecognized. Patients can be under the supervision of a gastroenterologist for years and treat concomitant diseases (stomach ulcer, chronic gastritis, cholecystitis) with similar clinical symptoms.

The concept of pathology

In the international classification of diseases of the hiatal hernia, the code K44.9 is assigned.

The essence of this ailment lies in the fact that a number of organs of the digestive tract - the abdominal segment of the digestive tube, the cardiac part of the stomach and even part of the intestinal loops - changes its usual localization and moves through the esophageal opening of the diaphragm from the abdominal cavity to the chest cavity.

Diaphragmatic hernias are accompanied by severe chest pain, arrhythmia, dysphagia (difficulty passing food through the esophagus), heartburn, regurgitation (belching), and hiccups.

Classification

Based on the anatomical features, hernia of the esophageal opening of the diaphragm is divided into:

• Sliding.
• Paraesophageal.
• Mixed. In pathologies of this type, the manifestations of two mechanisms are combined: 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 part of the esophagus (so called small - about two centimeters long - a piece of the esophageal tube located under the diaphragm), cardia (an annular sphincter located between the stomach and the esophagus) and the fundus 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 caused by weakening of the surrounding diaphragmatic muscles.

Not being fixed, they do not appear constantly, but only under the influence of certain factors. Of prime importance are: position of the body, the degree of fullness of the stomach and intra-abdominal pressure.

The weakened muscles of the diaphragm allow the lower esophageal tube and part of the stomach to slide unhindered into the chest cavity and back. Axial hernias are the most common pathologies.

The volume and level of the elevation above the diaphragm of the displaced sections allows them to be divided into:

• Cardiac.
• Cardiofundal. Hernias of this type are characterized by free movement of the upper stomach.
• Subtotal and total gastric. With these types of hernias, either most of the stomach or its entire body is above the level of the diaphragm.

Cardial

With this type of pathology, only the cardiac sphincter, which separates the esophagus from the stomach, slips through the esophageal opening of the diaphragm.

Of the total mass of axial hernias, 95% of cases account for pathologies of the cardiac type. The remaining 5% is distributed between cardiofundal, subtotal and total gastric hernias.

Paraesophageal

Cases of paraesophageal hernia of the esophageal diaphragm are relatively rare.

Their radical difference from hernias of the sliding type is that the movement to the area of ​​the epithelial tracheoesophageal septum of the greater curvature of the stomach, its bottom, as well as part of the loops of the small or large intestine occurs when the cardiac valve is in a fixed position: it continues to remain under the diaphragm.

As a result of displacement, the above organs are restrained. 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. In the process of lifting, the greater curvature turns upward, and the lesser curvature, held by the cardiac valve, continues to maintain a 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 into the chest area, fixation of the gastroesophageal junction continues to maintain a normal subphrenic position.

In very rare cases, when there is a migration of the gastroesophageal junction into the chest cavity, they speak of the presence of a mixed hernia, often accompanied by insufficiency of the cardiac pulp (cardia).

Complications of paraesophageal hernias are very often fatal, therefore, despite the asymptomatic nature of their course, patients are advised to perform surgical treatment before complications develop. An indication for immediate surgery is a condition when up to 68% of the stomach moves to the chest area.

Fixed

A fixed hernia of the esophageal opening of the diaphragm is called a pathology in which the cardiac part of the stomach moves to the chest area and its constant (without slipping back) remains in the zone of new localization.

This explains not the transient, but the permanent nature of the clinical symptoms accompanying this pathology.

A fixed hernia is a rather rare, but much more dangerous (than an axial hernia) form of pathology, much more often leading to complications that require immediate assistance from a qualified specialist.

Infringement of a hernia usually requires surgery.

Unfixed

An unfixed hiatal hernia (also referred to as sliding or axial hernia) is a chronic disease in which the abdominal segment of the esophageal tube, lower esophageal pulp and stomach moves freely through the aforementioned opening (migration) from the abdominal cavity to the chest cavity.

Being a less complex type of disease than the above-described pathology, an unfixed hernia, nevertheless, requires an equally serious and immediate therapy.

Reasons for development

Cases of hernia of the esophageal opening of the diaphragm are detected in 6% of the adult population, and half of these cases occur in people over fifty-five years old, in whose body 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.

Weakening of the ligamentous-muscular apparatus and the formation of hiatal hernias can occur under the influence of:

1. Anatomical features of the body, formed during the period of intrauterine development of the fetus at the stage of formation of muscle structures.
2. Concomitant diseases caused by the weakness of the connective tissues. This group of ailments can include: hemorrhoids, flat feet, intestinal diverticulosis, Marfan syndrome, varicose veins. In such patients, a hiatal hernia is often accompanied by an umbilical, femoral and inguinal hernia and preperitoneal lipoma (hernia of the white line of the abdomen).
3. A sharp increase in intra-abdominal pressure due to:
   • flatulence;
   • indomitable 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;
   • trauma to the abdomen;
   • pregnancy;
   • sharp slopes;
   • heavy physical exertion;
   • simultaneous lifting of an excessively heavy object;
   • extreme obesity;
   • prolonged and very strong cough that occurs in patients suffering from any nonspecific lung disease (for example, bronchial asthma or chronic obstructive bronchitis).
4. Dyskinesia - impaired peristalsis of the esophageal tube and other organs of the gastrointestinal tract - a phenomenon accompanying chronic gastroduodenitis, gastric ulcer and duodenal ulcer, calculous cholecystitis and chronic pancreatitis.
5. Longitudinal shortening of the esophageal tube resulting from cicatricial-inflammatory processes resulting from thermal or chemical burns, reflux esophagitis, or the presence of peptic (esophageal) ulcers.
6. Pathologies resulting from intrauterine fetal malformations. These include the "pectoral" stomach and too short the esophagus.

Symptoms

In half of the patients, hernia of the esophageal diaphragm is either asymptomatic or with a minimal set of clinical manifestations. Hernial protrusions of small sizes are asymptomatic.

As a rule, they are detected quite by accident in the course of diagnostic studies undertaken for other diseases.

• With a hernia that has reached an impressive size, but accompanied by the normal operation of the obturator valves, the main clinical symptom is spasmodic pain emanating from the sternum. Arising in the stomach area, they gradually spread along the esophageal tube, in some cases radiating (spreading) between the shoulder blades or into the back.
• With the appearance of girdle pain, the HHH can disguise itself as chronic pancreatitis in the exacerbation stage.
• A hernia of the esophageal opening of the diaphragm can lead to the appearance of cardialgia - pains localized in the left side of the chest and having nothing to do with the pathologies of the heart muscle. A person who is not related to medicine may mistake them for the manifestation of angina pectoris or myocardial infarction.
• In about a third of patients suffering from HH, the main appearance of this disease is the presence of an abnormal heart rhythm resembling extrasystole or paroxysmal tachycardia. Due to the fault of this symptom, patients are often given an erroneous cardiological diagnosis. All attempts to cure a non-existent heart disease end in failure.

To avoid mistakes in diagnosing an ailment, when differentiating pain sensations, one should focus on a number of specific signs. When HHOD:

• 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 syndrome occurs when the body is tilted forward;
• relief or complete disappearance of pain occurs after a change in posture, a deep breath, a few sips of water, or the appearance of an eructation.

When a hernia is infringed, very strong cramping pains occur in the chest, 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 - lowering blood pressure.

The development of GERD - gastroesophageal reflux disease - the constant companion of the hiatal hernia provokes the emergence of a new complex of clinical symptoms. The patient has:

• Belching of bile or stomach contents.
• Regurgitation (regurgitation of food, not preceded by nausea) that occurs at night as the patient assumes a recumbent position. The occurrence of this symptom is facilitated by a belated and very hearty dinner.
• Air belching.

The most characteristic (pathognomonic) manifestation of HHH, which provides a basis for the diagnosis, is the presence of dysphagia, a pathology characterized by all kinds of disorders that occur when a food coma passes through the esophageal tube.

The appearance of dysphagia is facilitated by: the use of too hot dishes, too cold drinks, the bad habit of hastily, without chewing, swallowing food or drinking liquid, taking one big sip.

The presence of the following can be considered no less specific signs of HHP:

• severe heartburn;
• painful and persistent hiccups;
• burning and pain at the root of the tongue;
• hoarse voice.

In patients with 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 indicators of anemia, indicating a low content of hemoglobin and erythrocytes in the blood.

As a rule, anemia develops due to internal bleeding from the stomach and lower parts of the esophageal tube, arising under the influence of:

• erosive gastritis;
• peptic ulcers;
• reflux esophagitis.

The degree of the disease

The basis for identifying the degrees of hernia of the esophageal opening of the diaphragm is the data of X-ray examination, which makes it possible to judge which part of the stomach (together with the structures adjacent to it) was above the level of the diaphragm.

• The lightest is the first- 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 retains its normal physiological position.
• Second degree disease accompanied by the movement into the chest cavity not only of the abdominal segment of the esophagus, but also of the upper part of the stomach: it is localized at the level of the esophageal opening of the diaphragm.
• With a third degree ailment 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 part of the esophageal tube, the cardiac valve and the entire stomach (its body, bottom and structures of the antrum).

Diagnostics

A hiatal hernia can be detected during the execution of:

• Plain chest x-ray.
• Radiopaque diagnostic examination of the stomach and esophagus.
• Esophagoscopy - 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 hernia of the esophageal opening of the diaphragm on the roentgenogram

X-ray signs of hiatal hernia include:

• high localization of the pharyngeal sphincter;
• the location of the cardiac valve above the level of the diaphragm;
• movement of the subphrenic segment of the esophagus into the chest cavity;
• an increase in the size of the diaphragmatic opening;
• the delay of the radiopaque substance in the structures of the hernial protrusion.

Endoscopic findings generally indicate:

• movement of the esophagus and stomach from the subphrenic space;
• the presence of symptoms of esophagitis (an ailment accompanied by inflammation of the mucous membranes of the esophagus) and gastritis.

To exclude the presence of esophageal tumors, its mucous membranes are carried out, subjecting the tissue of the biopsy specimen to morphological examination. To identify hidden bleeding from the gastrointestinal tract, the patient's feces are examined for occult blood.

Esophageal manometry, a diagnostic technique that examines the contractile activity of the esophageal tube and the coordination of its motility with the work of the sphincters (pharyngeal and cardiac), is of great importance in the diagnosis of hiatal hernia. 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. In the course of these studies, designed to assess the secretory activity of the gastrointestinal tract, the acidity of gastric juice is measured in different parts of the digestive system, and the dynamics of acid-base balance under the influence of certain drugs is also studied.
• Impedance measurements - studies of the functions of the stomach and esophagus, based on measurements of the impedance (resistance) arising 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 technique for recording electric fields that occur during the work of the heart muscle) and measurements of the acidity of the digestive juice.

Endoscopic signs

Endoscopic signs of hiatal hernia indicate the presence of:

• Reduced distance from the central incisors to the cardiac sphincter.
• Incomplete closure or gaping of the cardiac pulp.
• A pathological formation (called prolapse of the gastric mucosa into the esophagus) is 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 entrance" to the stomach.
• Manifestations of gastritis and esophagitis.
• Hernial cavity.

How to treat a hernia of the esophagus?

At the first stage, methods of conservative treatment are used.

To eliminate the clinical manifestations of all concomitant diseases of the digestive system (gastritis, gastroesophageal reflux, ulcers, dyskinesia and erosions), an individual program of complex drug therapy is developed for each patient, which provides for the use of:

• Antacids(represented by Almagel, Maalox and Gastal).
• Proton pump inhibitors(esomeprazole, omeprazole, pantoprazole).
• H2 antihistamines(most often - ranitidine).
• Prokinetics that improve the condition of the mucous membranes of the esophagus (ganaton, motilium, trimebutin, motilak).
• Vitamins of group B, capable of accelerating the restoration of the structures of the stomach.

To relieve pain, patients can be prescribed non-steroidal anti-inflammatory drugs (represented by paracetamol, ibuprofen, nurofen). In some cases, taking these drugs can provoke an increase in the clinical manifestations characteristic of gastroenterological diseases.

To enhance the effectiveness of drug treatment, patients are advised to:

• adhere to a sparing diet;
• do weight normalization;
• during a night's sleep, occupy a half-sitting position (thanks to the raised head of the bed);
• avoid any kind of physical activity.

Surgery

The indication for the need for surgical intervention is the presence of:

• complete ineffectiveness of drug treatment;
• complicated forms of diaphragmatic hernias;
• precancerous (they are also called dysplastic) changes in the mucous membranes of the esophagus.

There are many options for surgical treatment of diaphragmatic hernias. For convenience, it is customary to divide them into groups, which include operations aimed at:

• For suturing the hernial opening (called hernial orifice) and strengthening the esophageal-phrenic ligament. This group of surgical interventions includes cruroraphy (surgery to suture the legs of the diaphragm) and diaphragmatic hernia repair.
• To restore an acute angle between the abdominal esophageal tube and the fundus of the stomach. Fundoplication operation 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 being thrown into the esophagus.
• To fix the stomach. During gastropexy - this is what this type of surgery is called - the stomach is sutured to the back or anterior abdominal wall.
• To remove a significant part of the esophagus (within healthy tissues) during its resection.

In modern clinics, preference is given to laparoscopic operations, which make it possible to permanently eliminate a diaphragmatic hernia through small (5-10 mm long) punctures in the skin. To prevent recurrence, the patient's abdominal wall is strengthened with a special mesh implant.

Diet after surgery

A strict postoperative diet is recommended for eight weeks.

After that, they switch to a milder diet option, which should be adhered to 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.

Date of publication of the article: 05/06/2015

Date of updating the article: 08.11.2018

Correct conservative treatment is symptomatic, carried out at home. Such therapy relieves the person of the symptoms of HH (it restores the normal passage of food and prevents the reflux of bile into the esophagus). In 90% of cases, this is enough for the patient to lead a full life. But the very first attempt to interrupt treatment will provoke a relapse of the disease. The patient must follow a diet for life, take medications, and lead a special lifestyle.

It is possible to restore elasticity to the ligaments of the alimentary opening of the diaphragm and restore its normal functioning only with the help of an operation, which is performed in 10% of cases (in the presence of complications or a severe course of the disease).

Three current conservative methods:

Medicines that reduce the production of hydrochloric acid and help normalize esophageal motility.

A diet that consists of foods that reduce gastric acid secretion and gas production. You need to eat fractionally.

Physiotherapy helps restore the elasticity of the weakened ligaments of the food opening of the diaphragm.

Folk remedies are also used to prevent heartburn, bloating and constipation. Taking broths, teas and infusions stops belching, reduces acidity and prevents the reflux of stomach contents into the esophagus. They are excellent helpers of drug therapy. Remember: home treatment can relieve unpleasant symptoms and only temporarily relieve your condition - getting rid of a hernia in this way is impossible.

Three methods of conservative treatment

1. Medicines

The first task of conservative treatment is to prevent the reflux of gastric contents into the esophagus, which causes serious damage to the mucous membrane. When performing this task, the symptoms of the disease (heartburn, belching, an unpleasant feeling of squeezing in the chest and pain after eating) are reduced. To do this, appoint:

• Antacids (Almagel, Maalox, Gastal) are drugs that bind hydrochloric acid, which is the main component of gastric juice.
• Medicines that can reduce the production of hydrochloric acid (omeprazole, esomeprazole, pantoprazole).
• Means that normalize the motility of the alimentary canal (metoclopramide, cisapride, domperidone). These drugs prevent stomach contents from returning to the esophagus.
• Blockers of histamine H2 receptors (ranitidine, famotidine, roxatidine) act on the center of secretion of hydrochloric acid and reduce its production and intake.

2. Physiotherapy exercises

Exercise therapy is necessary to strengthen the ligaments. Gymnastics is performed on an empty stomach at least half an hour before meals. The first exercises are done lying down, then they move to a sitting position.

An example of the "first lying exercise":

Starting position (IP) lying on your back, head and shoulders on a pillow. Place the middle and index fingers of both hands under the ribs, on the midline of the abdomen. Take a breath. As you exhale, press your fingers on the peritoneum as deeply as possible. Gently unbending your fingers, move the stomach to the left and down. Repeat 5-6 times.

Doing the first exercise

This exercise relieves pain and the feeling of a lump in the throat:

SP sitting on a chair. Relax as much as possible. Place the hands under the ribs so that the pads of the thumbs feel each other, and the rest of the fingers are parallel to the midline. Inhale and as you inhale, pull the skin up with your thumbs. Exhale and as you exhale, press with your thumbs as hard as you can, directing the pressure down slightly. Repeat 5-6 times.

Exercise to reduce pain and lump in the throat

An important element of therapeutic exercises is breathing exercises. It is done two hours after eating. It consists of 3 simple exercises:

3. Diet

Overeating and irregular eating are the main provocateurs of the disease. Without a diet, the treatment of a hernia of the food opening of the diaphragm is impossible, and at the very beginning of hernia formation, diet is the only method of treatment.

Three principles of the diet:

Compliance with the regime. The volume of food consumed at one time should not burden the stomach: eat 5–6 times a day, the volume of food at one time should not be more than 250 ml. The time intervals between meals should be equal. Prepare dinner only from easily digestible foods.

Decrease in acidity. Forever exclude foods that require increased production of gastric juice: all spicy foods, spices, smoked meats, sweet desserts and most confectionery. An excessive amount of gastric juice leads to its penetration back into the esophagus, which severely damages the mucous membranes and leads to the formation of ulcers and erosions.

Reduction of gas formation and prevention of constipation. The formation of gas leads to an increase in pressure on the stomach. To eliminate this moment, give up:

• cabbage,
• corn,
• legumes,
• whole milk
• yeast baked goods,
• carbonated drinks.

Treatment with folk remedies

Herbal infusions and decoctions help get rid of hernia symptoms.

Before using any recipe from the Internet or a book, be sure to consult with a gastroenterologist. Herbs that help one person can harm another.

A decoction of licorice root and orange peels helps with heartburn. Take equal parts of licorice root and dry orange peels. Pour water 2 cm above the mixture and simmer until the liquid evaporates by half. Take three tablespoons before meals.

Bloating will prevent the herbal collection of peppermint, valerian root and fennel fruit. Pour boiling water over the mixture and keep in a dark place until it cools completely. Drink in the morning and evening.

The composition of cranberries, aloe and honey will relieve belching. Pass all components through a meat grinder, fill with warm water and wait 6 hours. Peste composition gradually throughout the day.

Surgery

When conservative treatment does not give the desired result, the symptoms of hiatal hernia intensify, and against this background, a severe lesion of the esophagus occurs - gastroenterologists strongly recommend an operation.

(if the table is not fully visible, scroll to the right)

The operation - suturing the hernial opening - is carried out in three ways (the choice of method depends on the patient's condition, his age, and the size of the hernia):

open cavity method,

laparoscopic method,

by mini access.

The recovery period directly depends on the method of the operation. After abdominal surgery, the patient spends a day in the intensive care unit, then he is transferred to the ward. It is allowed to get up on the 5th day, and the stitches are removed on the 7th day. Full recovery of the body ends in 4 weeks.

After laparoscopy, the recovery time is halved. Already in the evening on the day of the operation, the patient is allowed to get up, and he is discharged 3-5 days after the operation.

It is necessary to follow a diet and follow special doctor's orders for at least 6 months. Then the person gradually moves to a normal life.

The result of the surgical treatment of HH: the cuff is formed from the stomach, prevents the reflux of the stomach contents into the esophagus

Let's summarize

Remember conservative treatment of a hernia of the alimentary opening of the diaphragm will be effective only with strict admission of all prescribed medications, lifelong adherence to the diet and daily regimen. If you are not ready to constantly limit yourself, it is worth considering an operation.

Finally, the good news: in modern pharmacology, drugs have appeared without side effects and are not addictive. This is a big step forward in the treatment of HHH, since many problems arise during therapy due to the body's habituation to certain medications, which must be looked for an alternative.

Owner and responsible for the site and content: Afinogenov Alexey.