Axial hernia of the esophagus (sliding and fixed). Moving hiatal hernia: how to recognize and treat the disease in time? Sliding hernia how to deal with it

Date of: 19.10.2019

Among the diagnosed hernia of the esophagus in adults, a sliding hernia of the esophageal opening of the diaphragm is more often found, which has its own characteristics of the clinical course.

A sliding or axial HH appears as a result of the lower part of the esophagus entering the chest and the cardia of the stomach through a weakened diaphragm wall. Normally, these organs are located in the abdominal cavity, and are held by the muscular ligament.

The disease itself does not pose a threat to human health, unless it is complicated. A difference in such a violation as an unfixed cardiac hernia of the esophageal opening of the diaphragm is the free movement of the cardia of the stomach and part of the esophagus from the abdominal cavity to the chest and vice versa. In connection with this feature, the risk of complications is reduced, but timely diagnosis is complicated.

With a disease, a sliding hernia of the esophagus, symptoms and treatment are two of the most important points, but it is worthwhile to understand the reasons. At risk of developing a disease such as axial sliding hernia of the esophageal aperture of the diaphragm, the treatment of which should be timely, include obese people, women during the gestation period and patients with diseases of the gastrointestinal tract. Causal factors can be divided into acquired and congenital.

Congenital Causes the appearance of such a violation as a floating hernia of the esophagus:

violation of the process of lowering the stomach;
the appearance of a hernia bag in the womb due to insufficient fusion of the diaphragm;
underdevelopment of the muscles of the diaphragm around the natural opening of the esophagus.

Acquired Factorsat which the moving HHP develops:

The mechanism of the appearance of such a pathology as a sliding cardial hernia of the esophageal opening of the diaphragm consists in weakening the natural opening of the diaphragm, through which the lower part of the esophagus and the cardia of the stomach freely penetrate. The disease is very slow, SGPOD of the 1st degree that this is better explained by the doctor, and can not be determined without instrumental diagnosis.

Clinical symptoms

A feature of this form of pathology will be a long latent course. The patient may not have any signs with a small defect. Quite often, the detection of pathology occurs by chance when examining the body for other diseases. But some people still have a whole range of symptoms.

For pathology, a sliding axial hernia of the esophageal opening of the diaphragm (SGPOD) is characterized by such signs:

burning behind the sternum after eating and in a horizontal position;
regurgitation and frequent belching without concomitant vomiting spasms;
violation of swallowing, dysphagia due to narrowing of the esophagus or against a background of inflammation;
reflux esophagitis with the addition of inflammation of the bronchi or even lungs.

The gradual progression of pathology leads to complications. Develops first reflux esophagitis, which gives symptoms of pain and constant heartburn.

Without appropriate treatment, an axial or sliding hernia of the esophageal opening of the diaphragm may result in the formation of erosion or ulcers, as well as internal bleeding and anemic syndrome.

The severity of the clinic will depend on the stage:

Associated Violations

Symptoms are supplemented against the background of concomitant diseases:

inflammation of the stomach and ulcer;
internal bleeding;
bronchitis and tracheitis;
reflux esophagitis.

Signs of dental diseases may be added due to ingestion of acidic stomach contents. The patient feels a burning sensation of the tongue, there is an unpleasant smell and sour taste in the mouth. The voice changes, hoarseness and cough appear in the case of a combination of a hernia with pathologies of the respiratory organs, including bronchial asthma or tracheobronchitis.

Esophageal sliding hernia: treatment and its principles

When an uncomplicated sliding hernia of the esophageal opening of the diaphragm is diagnosed, treatment is carried out depending on the symptoms. The defect itself cannot be removed with medications or non-medication techniques. A doctor prescribes drugs only to eliminate symptoms and improve the quality of life.

Mandatory components of maintenance treatment:

dieting;
the exception of heavy physical exertion;
treatment of concomitant diseases;
taking medications to normalize the acidity of gastric juice;
giving up bad habits, eliminating stress factors.

Surgery for this disease is extremely rare when a complication develops and there is a danger to the health and life of the patient.

Indications for surgical treatment:

severe anemic syndrome;
chronic bleeding;
large hernia, more than 10 cm in diameter;
multiple erosions or ulcers;
esophageal dysplasia;
infringement of the hernial sac.

Drug therapy

The main goal of drug treatment with a diagnosis of an unfixed hernia of the esophageal opening of the diaphragm will be the elimination of unpleasant symptoms in the form of heartburn, sensation of a foreign body, heaviness after eating and soreness. Drug therapy for SGPOD:

The drug treatment regimen for a sliding hernia is determined individually by the attending physician after a comprehensive examination of the organs of the chest and gastrointestinal tract. Often, medications are prescribed only during the period of severe symptoms.

Additionally, such funds are prescribed:

to eliminate spasm and pain - No-spa, Drotaverine;
to eliminate heartburn with belching - Motilium;
to protect the mucosa and restore it - De nol.

Treatment regimens for concomitant esophagitis:

long-term use of proton pump inhibitors (PPIs) in large dosage;
taking PPI for 5 days during the period of severe symptoms;
taking PPIs only when symptoms appear.

With a mild course of pathology, they are prescribed prokinetics and antacids. For moderate severity, diet and histamine H2 blockers are indicated. In severe clinical manifestations, prokinetics, histamine H2 blockers and PPIs are prescribed. In the case of a complicated process with life-threatening manifestations, only surgical treatment is indicated.

Physiotherapy

In addition, physiotherapeutic procedures are prescribed:

therapeutic baths;
mud applications;
drug electrophoresis;
inductothermy;
magnetotherapy.

Physiotherapy is indicated to further maintain the condition of the digestive tract with esophagitis or hyperacid gastritis.

Useful video

When a hernia of the esophagus is diagnosed as sliding, you should know what measures to take. Important recommendations are presented in this video.

Non-drug methods

For therapeutic effects directly on the affected area, it is effective to supplement therapy with physiotherapy exercises. This is important in order to strengthen the ligaments, which in the future will help prevent infringement of the hernial sac. Experts also recommend doing breathing exercises, giving it a few minutes 3 hours after eating.

A prerequisite for treatment will be diet.

The principles of nutrition at SGPOD:

Folk remedies

Means of traditional medicine at SGPOD:

infusion of orange peel and licorice root to eliminate heartburn;
a decoction of valerian root with fennel fruits with bloating;
a mixture of cranberries, honey and aloe to get rid of burping.

The use of traditional medicine is an addition to the main treatment regimen prescribed by a doctor. Medicines prepared at home can not affect the disease in any way, eliminating the hernia. They are acceptable for use in order to relieve symptoms only after examination by a doctor and diagnosis.

Comprehensive treatment of a sliding hernia of the esophagus is effective only in the case of lifelong adherence to the diet and taking all medications prescribed by the doctor. When indications for surgical treatment cannot be avoided, since the need for this already indicates a life-threatening condition.

A sliding hernia of the esophageal opening of the diaphragm (axial) is a protrusion of the esophagus, in which part of the stomach moves into the cavity of the sternum. This periodically causes discomfort, belching and regurgitation (the reverse movement of food from the stomach to the esophagus, not accompanied by cramping). Discomfort in the stomach appears more often after a heavy meal.

A sliding hernia of the esophagus is formed under the influence of congenital and acquired factors. The first include an abnormally shortened esophagus, when a certain part of the stomach is located in the sternum.

Acquired causes of sliding hernia are:

atrophy of the liver;
multiple pregnancy;
weakening of the food sphincter (age-related);
chronic constipation;
overweight;
excessive lifting;
esophageal dysfunction;
pathology of the gallbladder;
burn of the esophagus mucosa with chemicals or hot food;

Symptoms and diagnosis of pathology

The disease can be completely hidden. Indirect symptoms include:

pain in the sternum;
asthma attacks;
lingering cough;
prolonged heartburn.

The presence of problems with a sliding axial hernia is signaled by an unpleasant exhaled odor, frequent exacerbation of tracheitis, when pancreatic juice enters the airways with burping.

A sliding hernia of the esophageal opening of the diaphragm (HAP) is diagnosed by laboratory and instrumental methods:

analysis of feces for occult blood;
radiography of the esophagus, stomach, and chest organs;
endoscopic biopsy;
gastrocardiomonitoring;
biopsy test.

Disease Therapy Methods

Treatment for moving HPAP is usually conservative. At the initial stage, surgery is rarely used. The disease is classified in 3 degrees. At the first - a diet is prescribed, excluding:

fatty (pork, cakes);
smoked (fish, sausage);
fried (potatoes, meat);
hot (seasoning, onion and garlic);
salted (cabbage, cucumbers).

Treatment involves eating food in small portions up to 6 times a day. For 1 reception, more than 200 grams can not be consumed. The stomach that has processed the food needs rest, so snacks should be excluded. They contribute to the production of excess gastric juice, this provokes heartburn.

Physical stress is also dangerous, intra-abdominal pressure increases, leading to an increase in hernia. With heartburn, it is recommended to sleep by lifting the headboard.

The risk factors include:

weakness of the ligaments that strengthen the esophagus;
jumps in abdominal pressure;
displacement of the esophagus with impaired motility of the digestive system.

Drug treatment eliminates the main symptoms, but requires an integrated approach to prevent complications. Usually, experts prescribe:

Almagel, Rennie, Maalox - antacids that have a binding effect on hydrochloric acid, which is in the gastric juice and prevents irritation of the esophagus.
Inhibitors Omeprazole, Esomeprazole, Pantoprazole reduce the amount of acid production.
Prokinetics. Cisapride, metoclopramide, domperidone prevent the penetration of the contents of the stomach into the esophagus.
Histamine receptor blockers. Ranitidine, Famotidine, Roxatidine reduce the secretion of hydrochloric acid and its entry into the stomach.

Surgical treatment is carried out in the following cases:

with ineffective conservative therapy;
with an enlarged hernia;
with dysplasia of the mucous membrane of the esophagus;
in the presence of complications of HPOD;
with a high risk of infringement of the esophageal hernia.

Axial hernia of the esophageal opening of the diaphragm with the help of surgical intervention is treated with the following methods:

laparoscopy;
nissen fundoplication;
tope plastic.

Laparoscopy is the most popular surgery. Punctures are made in the area of \u200b\u200bhernia development. The surgeon monitors the progress of the procedure through a video monitor. The recovery period after the intervention is short and painless due to the absence of large incisions.

Nissen fundoplication is performed openly or using laparoscopic equipment. The goal is to stop the development of reflux (abnormal movement of the contents of hollow organs). The growth of the hernia also ends.

Tope plastic surgery is an open type of surgical intervention. The esophagus is cut longitudinally and a part of the diaphragm is inserted. Splicing occurs quickly because the tissues of these organs are identical.

For the 1st degree of the disease, penetration into the sternum of only the lower part of the esophagus is characteristic, therefore, surgical treatment is not indicated.

After the operation is completed, a diet is required to reduce the level of stress on the digestive tract. The patient should abandon the use of products that provoke constipation and gas formation. Excluded from the diet:

fried, smoked, greasy;
legumes;
citrus;
nuts, eggs, prunes.

Treatment of a sliding hernia with recipes of traditional healers is not capable of giving the desired result. In many cases, medication or surgery is required. Decoctions and herbal infusions of hernia cannot be removed, but pain can be relieved.

HAPD affects up to 6% of the adult population. If the disease is started, then this will lead to the development of dangerous complications (ulcers, bleeding). Periodic hemorrhages can provoke the appearance of anemia (anemia). Only a specialist should treat the ailment.

Sliding hernia of the esophageal opening of the diaphragm is up to 90% of all. The main danger of the pathological condition is chronic acid reflux, leading to malignant degeneration of the esophagus mucosa. The quality of life of a patient with esophageal hernia is complicated by debilitating heartburn. Radical treatment is possible by the operational method. Conservative therapy means taking life-long remedies for heartburn.

What is a “sliding hiatal hernia”

A sliding hernia of the esophageal diaphragm is a weakening of the ligaments, tendons, muscles of the diaphragm and esophagus, which has a chronic course and manifests itself with age. Between the sternum and the abdominal cavity there is a separator in the form of a movable, strong, muscular septum - the diaphragm. The hole through which the esophageal tube passes is formed by a small (4 cm in diameter) clearance between the cords of the diaphragmatic muscles. In Latin it is called hiatus oesophagus. Therefore, a sliding hernia is also referred to as a hiatal hernia.

When for some reason the esophagus opens up and the ligaments supporting the stomach and esophagus weaken, the lower part of the esophagus, cardiac sphincter, part of the stomach “falls out” into the enlarged lumen. Thus, an axial hernia (it is also sliding) is observed if part of the digestive tract freely slides from the abdominal cavity into the chest.

Movement of hernial protrusion can occur "back and forth" when patients change their position - inclines, jumps. Such an esophageal unfixed hernia of the esophageal opening of the diaphragm is called floating, wandering. It happens that the organs that slip into the chest cavity are tightly fixed in the diaphragmatic zone. It turns out a fixed hernia of the esophageal opening of the diaphragm. This rare type of hernia leads to complications in the form of pinching and persistent symptoms of gastrointestinal upset.

If pathological protrusion of the cardial part of the stomach occurs, then a cardial hernia is obtained. The ejection is facilitated by the pressure difference inside the cavities. The higher it is in the abdominal cavity, the more the stomach and esophagus protrude into the chest cavity through the enlarged esophagus.

Degrees of sliding hernia

According to how much the abdominal organs have advanced into the chest, 3 degrees of axiol-hiatal hernias are distinguished:

A sliding axial hernia of the 1st degree occurs when only an abdominal fragment of the esophagus falls through the esophagus. The cardiac sphincter is at the diaphragm level. The stomach with axial esophageal hernia of the 1st degree remains in its natural place. He rises and presses against the diaphragm.
A hiatal hernia of the esophagus of the 2nd degree is characterized by penetration of the abdominal part of the esophagus into the chest cavity. The fundus of the stomach in the second stage rises to the diaphragmatic level.
Grade 3 sliding glaucoma is distinguished by the position of the abdominal segment of the esophagus, cardia, and most of the stomach above the diaphragm membrane. In especially severe cases of axial displacement, even the antrum of the stomach and the loop of the small intestine “fail”.

Sliding hernias occur due to age-related degeneration of connective tissue or as a result of traumatic exposure. The size of the hernia affects the degree and severity of the symptoms.

Symptoms of a sliding hernia

Symptoms of the manifestations of the disease depend on the anatomical parameters of the anomaly, concomitant diseases, and the patient's age. SGPOD 1 degree is almost asymptomatic, periodically manifesting itself as heartburn, belching. A deviation is detected by chance, for example, in an X-ray about a heart or lungs.

An axial hernia of the esophageal opening of the diaphragm makes you aware of your presence with the following symptoms:

in a third of patients there are deviations of the heart rhythm, pain in the heart;
pain from the epigastric region rises up the esophagus, may be given to the back between the shoulder blades. Shingles similar to pancreatitis are less commonly observed;
dull, moderate pain after eating, weight lifting, bending, physical activity;
due to incomplete closure of the cardia, the patient feels heartburn. aggravated by bending, lying down, after plentiful food and drink. Complicated by a disease of the esophagus - esophagitis;
belching with sour and regurgitation (regurgitation), which appear in a lying position;
during sleep, the pillow gets wet due to increased salivation;
difficulty swallowing and passing food;
with a fixed hernia, circulatory disturbances, stagnation of food in the stomach are possible;
frequent acid reflux, stagnation of food leads to inflammation of the gastric mucosa - gastritis;
disease progression is manifested by ulcers and erosion of the stomach. If vessels are affected, bleeding and anemia occur;
hiccups due to irritation of the diaphragm of hernia.

When a patient likes to have a tight dinner before bedtime, night burping with food fragments gets into his nose. A person wakes up from a choking cough, holding his breath - apnea.

Causes of sliding hernia

Axial hernia of the esophagus has a congenital or acquired etiology. Congenital factors - embryonic violation of the development of the diaphragm. Identification of a vaginal hernia of the esophagus in a newborn is an indication for urgent surgery. The condition of the baby causes serious concern for his future life. It is possible to consider the abnormal formation of the diaphragmatic muscle during an antenatal ultrasound examination.

A sliding hiatal hernia in an adult is acquired due to a number of reasons:

people over 60 years old, especially women, experience an age-related weakening of the tone of the muscle and tendon ligaments that hold the esophagus, stomach, and diaphragm. The esophageal opening of the diaphragm expands, and the gastrointestinal tract, devoid of support, rush into the cavity with a relatively low pressure;
the difference in pressure in the cavities contributes to bulging of the esophagus and stomach. The pressure in the abdominal cavity rises from constant obstruction of the intestine with feces, rotting and fermentation of food with increased gas emission;
the formation of a floating hernia of the esophagus provokes neoplasms of the esophagus, stomach and intestines, overlapping the lumen of the organ. Obstruction can also occur due to a decreased tonus of smooth muscles, damage to the nerve trunks responsible for the digestive tract;
diseases of the respiratory system, accompanied by prolonged severe cough, weaken the diaphragmatic ligaments;
sports activities related to weight lifting (weightlifting, powerlifting), training of the abdominal muscles, as well as physically intense work;
overweight creates increased intra-abdominal pressure, almost 20% of pregnant women “earn” axial hiatal hernia of varying degrees;
chronic inflammatory processes of the esophagus, stomach, intestines, liver, gall bladder, pancreas are risk factors for the appearance of a hernia.

Adults have congenital connective tissue weakness due to hereditary gene mutations.

Such patients are distinguished by asthenic physique, poor adaptation to physical and mental stress, and increased nervous excitability. The chest is funnel-shaped or keeled, the spine is deformed (scoliosis, kyphosis, lordosis). Signs of genetic abnormalities are clearly manifested from 10 years and reach their maximum development by 15 years.

Diagnosis of esophageal hernia

Diagnostic methods for a sliding hiatal hernia consist of a history taking, establishing a complete clinical picture, instrumental and hardware examination:

x-ray examination with barium sulfate is carried out in a horizontal, vertical, lateral position of the patient. Optimal diagnosis with contrast enhancement is performed in the Trendelenburg position. For this, the patient raises the pelvis by 40 ° in relation to the head. If the stomach falls into the chest cavity, barium sulfate well defines the contours of hernial protrusion. A similar study is contraindicated in the presence of pus, blood in the abdominal cavity, gastrointestinal tumors;
fibrogastroduodenoscopy allows you to assess the condition of the mucous membrane of the stomach, esophagus, 12 duodenal ulcer. Hyperemia, edema, ulceration, erosion are detected. The closing ability is determined;
pH meter determines the degree of acid reflux. It is carried out in two ways. In the first method, the probe is inserted into the stomach and is gradually removed. The acidity value of different sections of the esophagus and stomach is established. The second method is a daily pH meter. It lasts from several hours to several days. A thin probe is inserted through the nose and does not interfere with the normal life of a person.

Distinguish a sliding esophageal hernia from cardiovascular and pulmonological diseases, pancreatitis, cholecystitis, cholelithiasis.

Esophageal sliding hernia treatment

Therapeutic treatment

Treatment without surgery consists in following a strict diet and taking lifelong medications that reduce stomach acidity, improve motility, relieve cramps, and sedatives. Dietary restrictions relate to chocolate, citrus fruits, tomatoes, onions, garlic, peppermint. It is necessary to exclude sweet carbonated drinks, kvass, beer, champagne, strong coffee and tea. Prescribe drugs of the omeprazole group, antacids containing aluminum and magnesium, digestive enzymes.

Medical conservative tactics have significant drawbacks. Long-term use of PPI (Omez, Losek, Pariet, Nexium) increases the risk of complications in the form of intestinal and gastric, gastropathy, and malignant lesions of the digestive tract.

Surgery

It is only possible to cure a moving HHP in an operational way. Approaches to surgical removal of the problem are determined individually. The choice of treatment technique depends on the size of the hernial sac and hernial portal, the presence of pinching, bleeding, and erosion.

In the arsenal of surgeons, classic Nissen fundoplication, modified according to Tupa, and crurography - reducing the esophageal opening of the diaphragm to natural parameters.

Nissen fundoplication

Canonical surgery is performed by open access or laparoscopy, depending on the size of the hernia and the gates. The stomach is set in a normal position. The fundus of the stomach is wrapped around the bottom of the esophagus for a full turn and secured with a suture. After the operation, a tight coupling in place of the cardiac sphincter prevents the body's natural manifestations - belching, vomiting. This prevents a person from living fully.

Stupid operation

The modified Toupe operation provides for a revolution of the stomach around the esophagus only 180-270 °. The front right surface of the esophagus remains free. The duration of the operation is 2-3 hours, access is open or through five punctures of the abdominal wall. A cuff about 4 cm long is formed. The normal connection between the esophagus and the stomach is restored. An anti-reflux barrier is created that interferes with irritation of the esophagus with acidic gastric contents.

This is the operation for suturing the esophageal opening of the diaphragm. Krurorafiya complements fundoplication and prevents the development of repeated loss. The most popular Allison surgery technique. Access is on the left, between 7-8 ribs. The legs of the diaphragm are stitched together with 3-5 interrupted sutures. At the end of the operation, a drainage tube is installed to withdraw the wound exudate.

A sliding hiatal hernia is congenital or acquired with age. The main symptoms are persistent heartburn, sour belching, pain behind the sternum. Diagnosed with radiography with a contrast agent. Treatment consists of taking acid neutralizers or performing surgery to restore normal topography, physiology and anatomy of organs.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, Professor, Doctor of Medical Sciences. Prescribes diagnostics and conducts treatment. Expert of the group for the study of inflammatory diseases. The author of more than 300 scientific papers.

Esophageal hernia is both acquired and hereditary. Most often, a sliding hernia (or axial) is found, and with untimely treatment, it can provoke internal bleeding. What is a sliding hernia of the esophageal opening of the diaphragm - read in our article.

A sliding hernia of the esophagus is a protrusion of the lower part of the esophagus, in which part of the stomach moves into the chest cavity. The disease develops for a long time, initially without symptoms. A sliding hernia of the esophagus lends itself well to non-surgical treatment, if you notice it in time.

According to statistics, up to 5% of adults suffer from a sliding hernia of the esophagus, and women suffer from it more. Usually more than one reason leads to the disease. Of congenital factors, there are:

insufficient development of the muscles of the diaphragmatic legs and an enlarged esophagus;
untimely fusion of the diaphragm;
in the embryonic period, the lowering of the stomach is not fast enough.

Of the acquired factors, there are:

age-related changes in the diaphragm;
inflammation or trauma of the nerve of the diaphragm, and its relaxation;
ulcer, cholecystitis and subsequent severe contractions of the esophagus;
increased abdominal pressure.

Also, an axial hernia of the esophagus can cause pregnancy, the consequences of childbirth, obesity, various stomach diseases that increase pressure in the organ. Due to many reasons, no one can be insured against this type of hernia. Axial hernia, fortunately, is not impaired and there is no violation of blood circulation.

Symptomatology

The characteristic symptoms of the disease are pain in the stomach and heartburn. With this hernia, the upper part of the stomach moves into the chest cavity through the enlarged opening of the diaphragm, and then returns to its normal position. But often the symptoms are mild, especially if the hernial protrusion is small. In many patients, a hernia is detected by chance after passing an x-ray.

External examination also does not give results - with the axial type of hernia, the organs of the abdominal cavity are displaced into the internal cavity and there are no external symptoms. But with a prolonged course of the disease, the contents of the stomach are thrown into the esophagus, irritating its mucous membrane.

The main symptoms are:

In supine position after eating - severe heartburn.
Belching, movement of food into the esophagus and even into the oral cavity in the absence of vomiting.
Burning pain behind the sternum and in the epigastric region, the symptoms are especially pronounced when bending.
Frequent tracheitis, bronchitis (sometimes pneumonia), due to the penetration of the acidic contents of the stomach into the respiratory tract, with belching.
Violation of swallowing, first reflex (not feeling swallowing while taking liquid food). Then the mucous membrane of the esophagus becomes inflamed, narrows and the food lump is already difficult to pass.

Occasionally, increased salivation and high blood pressure can be observed in patients. Pain with a sliding hernia and ulcer are different. In this case, the pain depends on the amount of food taken, and it can be eliminated with drugs that lower acidity.

Video “Esophageal hernia of the diaphragm”

Diagnostics

A sliding ulcer is diagnosed mainly with the help of an X-ray examination. Ultrasound and FGDS do not allow to notice it. Sometimes changes can be seen on an MRI. In order to accurately diagnose and begin treatment, in addition to x-rays, the following examination methods can be used:

sounding of the esophagus, gastroscopy;
esophageal pH meter;
endoscopy (best done in combination with radiography);
study of the esophageal-gastric transition.

Treatment methods

After a diagnosis is established, treatment should be started immediately to reduce the risk of complications and the likelihood of surgery in the future.

Doctors treat a hernia without complications in conservative ways. Surgical treatment is indicated in the late stages of axial hernia and bleeding.

Conservative treatment includes three measures:

Diet.

The diet must be monitored constantly. Patients are prescribed frequent meals with small portions of 250 g. Fatty, spicy, smoked, fried foods should be excluded (like anything that stimulates the production of gastric juice and irritation of the mucous membrane). The basis of nutrition: stewed, steamed, boiled dishes from cereals, vegetables, milk, dietary meat, fruits. With symptoms of dysphagia, the food should be semi-liquid or grated, and you can’t eat before bedtime. It is forbidden to rest lying down after a meal.

Normalization of the rhythm of life.

To effectively cure a hernia, the patient must give up alcohol and smoking. Physical activity should not be too large. Both night and daytime rest is required. All exercises that increase pressure in the abdominal cavity are contraindicated.

Medicines

With the disease, drugs are used:

reducing acidity (gastal, maalox);
eliminating heartburn and belching (motilium);
suppressing the secretion of hydrochloric acid (omez);
relieving pain and cramping (no-spa and painkillers).

If surgical treatment is necessary, it is usually carried out according to the Nissen method. A special cuff is made around the esophagus, which eliminates the reflux of gastric contents into the esophagus. An operation is performed laparoscopically. Less common methods of surgical treatment are fundoplication and Tope plastic surgery.

Video “Sliding hernia of the esophagus”

What is an axial-type esophageal hernia, how to treat it and how to diagnose it, you will learn from the video below.

This deviation is caused by the penetration of parts of the stomach into the sternum due to the enlarged opening of the esophagus of the diaphragm. The norm is when the ligamentous system of the diaphragm opening is dense and prevents the movement of the lower organs.

The causes of this pathology

The factors causing this ailment are diverse. In the vast majority of cases, a hiatal hernia occurs in people who have crossed the fifty-year threshold. This is due to a weakening of the ligamentous system of the esophagus opening. Especially susceptible to this disease are people with an asthenic structure.

Other causes of this disease may include the following factors:

increased intrauterine pressure due to pregnancy, various tumors, excessively frequent attacks of nausea or persistent coughing;
various inflammatory diseases that have a chronic form and entail violations of peristalsis: gastric ulcers, pancreatitis and other diseases;
congenital abnormalities leading to a shortened esophagus or improper position of the digestive organs.

For the most part, the first signs of the disease with a small hernia are asymptomatic. The danger of this pathology is the penetration of gastric secretion into the esophagus, causing inflammation of the mucous membranes. The most serious consequence of a hernia is a pinched esophagus, in which acute paroxysmal pains appear and swallowing function is impaired.

The most dangerous manifestation for life is the constant ingestion of gastric fluid into the esophagus, which subsequently corrodes its walls and can cause malignant tumors.

In order not to bring to such consequences, it is necessary to be examined by a doctor on time at the first symptoms or a genetic predisposition to the disease. A timely diagnosis will help to cure the disease more easily without causing serious harm to the body.

Symptoms of a diaphragmatic hernia

Diaphragm hernia has its own characteristic symptoms:

heartburn after eating, at night, with the body leaning forward;
sharp pains that appear behind the sternum, sometimes in the area under the ribs;
sometimes there are pains in the heart region resembling symptoms of ischemic disease, however, they quickly disappear after taking nitroglycerin;
aching pains over the xiphoid process of the sternum;
frequent burping, accompanied by acidic contents of the stomach;
difficult passage of food through the esophagus, constant hiccups.

Disease classification

Esophageal hernia is divided into two types:

Sliding hernia. This type of disease is characterized by free penetration of the stomach through the opening of the diaphragm into the chest cavity and returning to the place. A similar phenomenon is pronounced when changing the position of the body. However, there is a fixed hernia, unable to "return" to the place. Such a phenomenon may be caused by its too large size. This type of disease, which proceeds without complications, may not cause any symptoms.
Axial hernia. In this case, the esophagus remains in place, but through the large opening of the diaphragm the bottom of the stomach or its large parts comes out. This position of the organ can take place near the thoracic esophagus. This arrangement leads to a displacement of the stomach into the sternum, which later became known as the “chest stomach”, and the esophagus becomes short. This pathology is considered quite rare. In most cases, the esophagus is shortened due to changes in scar tissue.

It is divided into three degrees of severity, which are determined by the size and volume of the education itself:

Only a small part of the esophagus enters the thoracic region, and the stomach itself rises a little and fits snugly against the diaphragm.
Parts of the organ enter the diaphragmatic opening.
The stomach floor or body is in the chest cavity.

Diagnostic Methods

Due to the fact that a hernia can occur in conjunction with many other diseases, the diagnosis of this disease can be complicated due to the similarity of symptoms.

To diagnose a hernia, doctors use the following methods to detect it:

x-ray apparatus is designed to study the internal cavity of the body. Since the body has different, in density, parts - they manifest themselves differently in the x-ray. The denser parts are the bones, which are clearly visible in the picture. To identify organ pathologies, it is necessary to introduce a special contrasting substance. "Highlighted" internal organs allow you to determine the presence of pathologies;
in order to determine the quality of motility of the esophagus, esophageal manometry is used inside. Food entering the esophagus must be delivered to the digestive system through muscle contractions. This procedure helps to determine the dysfunction of the muscle apparatus, determine the quality of pressure during contractions and observe the amplitude of movements. To do this, a probe with pressure-sensing sensors is inserted through the nasopharynx.

Treatment

Treatment of esophageal hernia in the early stages occurs with conservative methods. The goal of treatment is mainly to prevent GER (gastroesophageal reflux) and relieve symptoms. Drugs that help correct the motility of the esophagus, restoring gastric function, are used for preventive purposes.

In order to prevent the development of the disease in people predisposed to it, the following recommendations exist:

exclude foods containing animal fats, fiber, sodas, bright spices, etc .;
eat at short intervals, in small portions;
finish eating 2-3 hours before going to bed;
it is necessary to get rid of addictions: smoking, alcohol;
try to avoid increasing pressure inside the abdominal cavity.

If the disease is severe in nature and manifestations, and treatment with drugs does not help, then surgical intervention is required. Similar operations and the course of treatment in the future, require mandatory registration with a gastroenterologist.

Proper nutrition for esophageal hernia

If this disease is detected, it is necessary to start preventive and therapeutic procedures. One of the effective methods of treatment is special nutrition. With diaphragmatic hernia, a diet is prescribed that helps to restore the normal functioning of the esophagus.

To choose the right products, you need to find out which of them can cause bloating and increased gas formation. It will be necessary to exclude these products from the diet. The purpose of this nutrition is to restore the normal functioning of the digestive tract. In order to choose the right diet, you need to consult your doctor.

In case of a hernia, the nutrition should meet the following requirements:

fractional nutrition;
eat in small portions;
products must be well processed;
food should be soft and light;
exclude from the diet foods that cause high acidity and require high costs during digestion.
avoid overeating;
the inclusion in everyday life of special gymnastics and physical exercises.

In order to reduce the acidity of the esophagus, it is recommended to drink alkaline water, in particular before bedtime. During sleep, it is best to lie on the right side, which reduces the penetration of acid into the esophagus. Raising the head of the bed is also recommended. To do this, you can use additional pillows or put solid objects under the bed legs.