The term "hernia of the esophagus" refers to a disease of a chronic nature, characterized by the displacement of some internal organs from the abdominal cavity to the thoracic cavity through the enlarged opening of the diaphragm. According to statistics, 22% of the population of the Russian Federation suffer from an ailment, while it is most often diagnosed in people with pathologies of the gastrointestinal tract. Timely seeking qualified medical help will help to avoid negative consequences and surgical intervention.
General information
The esophagus is a muscle tube hollow inside. It connects the pharynx and the stomach. Its length is 23.5-25 cm. The esophagus is necessary so that swallowed food can enter the stomach.
The muscle tube is equipped with two valves (sphincters). Thanks to their work, food moves in only one direction. Even if a person stands on his head for a long time, food will not fall back into his throat.
The esophagus passes from the chest cavity into the abdominal cavity through an opening in the diaphragm. This is a kind of septum, consisting of muscle tissue and tendons. The main task of the diaphragm is the implementation of the respiratory process. It also divides the chest and abdominal cavities. Under the influence of various adverse factors, a diaphragm malfunction occurs. In this case, the stomach moves upward, and part of the muscle tube can move in its opening along with the gastric contents. In this case, the diagnosis is “esophageal hernia”.
Causes of the disease
In most cases, pathology occurs against a background of age-related changes. Weakening of the muscles and ligaments occurs, their elasticity is lost and they begin to function worse.
In addition, the following factors can be the causes of esophageal hernia:
- genetic predisposition;
- frequent episodes of flatulence;
- the period of bearing a child;
- complicated birth;
- pathological accumulation of fluid in the abdominal cavity;
- diseases of the respiratory system, accompanied by prolonged coughing;
- high intensity of physical activity;
- vomiting
- congenital pathology of the stomach or esophagus;
- obesity;
- constipation of a chronic nature;
- constant overeating;
- pathology of the digestive system;
- scars resulting from burns (thermal or chemical);
- injuries (both open and closed);
- uncontrolled intake of certain medications;
- smoking;
- excessive use of coffee.
Classification
Depending on the development mechanism and anatomical features, a hernia of the esophagus can be:
- Sliding.
- Paraesophageal.
- Mixed.
Currently, a sliding esophageal hernia is most often diagnosed. It is characterized by penetration into the chest cavity of the cardia, a small part of the bottom of the stomach and muscle tube. When a person changes the position of the body, organs freely return to their normal position. But it also happens that they cannot cope on their own. In such situations, it is customary to talk about a fixed pathology.
Paraesophageal hernia is characterized by the fact that most of the stomach is in the chest cavity. In this case, the esophagus and lower sphincter remain motionless. Such a hernia is often pinched. This process is accompanied by the appearance of pronounced symptoms.
A disease of a mixed nature combines the signs of both sliding and paraesophageal hernias. This disease is usually classified depending on how much the internal organs have shifted from the abdominal cavity to the chest cavity.
There are 3 degrees of esophageal hernia of a mixed nature:
- I. The stomach rises slightly and is in contact with the diaphragm. The cardia remains in a normal position. The lower part of the esophagus is located in the chest cavity.
- II. The stomach and cardia are tightly attached to the diaphragm. Only the lower part of the muscle tube is still located in the chest cavity.
- III. The esophagus, cardia, and most of the stomach are significantly displaced. Often, loops of the small intestine also penetrate the chest cavity.
Based on which organs form hernias, they are divided into the following types:
- Sliding. They can be esophageal, cardiofundal or gastric.
- Perioesophageal. They are divided into fundamental and antral.
Moreover, each of them has a different severity of signs.
Symptoms
Esophageal hernia at the initial stage of development may not manifest itself in any way. As it grows, a person begins to feel the first alarming signs.
The main symptoms of esophageal hernia are the following conditions:
- Heartburn. It can be of different intensities. Most often, heartburn occurs after a meal and when the patient takes a horizontal position.
- Pain Their character can be cutting, dull, burning or stitching. Most often, pain occurs behind the sternum, less often in the epigastric region or hypochondrium. When the hernia is infringed, it is sharp.
- Dysphagia. This condition is characterized by difficulty in passing food through the muscle tube into the stomach. Patients note a discomfort associated with a jam in the esophagus.
- Burping. Its predecessor is a feeling of fullness in the upper abdomen.
- Hoarseness in voice, pain in tongue. These conditions arise due to the casting of gastric juice into the oral cavity, which causes a peptic burn.
- Hiccups. It is long lasting.
- A persistent cough.
- Bouts of suffocation.
- Heart Rate Failure.
Patients rarely display all symptoms at once. The set of signs also depends on the type of pathology.
Diagnostics
Information on what to do with a hernia of the esophagus should be provided by the doctor. When the first alarming symptoms appear, it is necessary to consult a gastroenterologist.
During the initial appointment, the doctor conducts a survey of the patient. The specialist must provide information about all the available symptoms. Based on the results of the survey, the doctor draws up a referral for examination.
It is carried out using the following instrumental diagnostic methods:
- FGDS. The essence of the method is the introduction of a flexible tube into the esophagus and stomach through the oral cavity. The duration of the procedure, as a rule, does not exceed 5 minutes.
- X-ray examination. The patient is laid on a horizontal surface, after which the doctor takes a picture. After this, a person needs to take a barium suspension. Then the specialist again takes a series of images with which you can evaluate the nature of the movement of the substance.
- Daily pH meter. An electrode is placed on the patient's skin, and a probe is inserted into the nasal passage. After that, they are connected to a block that records the acidity of the stomach and esophagus. His patient wears on a belt during the day.
Based on the diagnostic results, the doctor draws up the most effective treatment regimen for esophageal hernia. The operation is prescribed extremely rarely. As a rule, surgical intervention is indicated for the ineffectiveness of drug therapy and in advanced cases.
Drug treatment
The goal of therapy is to alleviate the severity of symptoms and prevent the development of complications.
As a rule, the doctor prescribes the following drugs:
- relieving heartburn;
- eliminating pain;
- reducing the degree of gastric secretion;
- lowering the level of acidity;
- protecting the mucous membrane.
Currently, the pharmaceutical market has many types of drugs with a similar effect. Each of them has contraindications, in connection with which only a doctor can prescribe certain drugs, taking into account the individual health characteristics of each patient.
Diet
The diet has a crucial role in the disease, since in most cases its course is accompanied by episodes of gastroesophageal reflux.
From the menu for a hernia of the esophagus, it is necessary to exclude:
- Products that increase acidity. These include: fatty, smoked, salted, fried, spicy dishes; coffee; Black tea; citrus; bakery products; confectionery.
- Products that increase gas formation: legumes, cabbage, radish, mushrooms, cereals, grapes, milk, pears.
- Any kinds of seasonings and spices.
- Carbonated drinks.
- Alcohol.
With regular diet, the patient's condition improves significantly.
Physiotherapy
Gymnastics is important in the fight against the disease. The purpose of its implementation is to get rid of unpleasant symptoms and strengthen the muscular-ligamentous apparatus.
A set of exercises:
- Lie on your side, raise your head and hold it with your hand. On a deep breath, stick out your stomach, while exhaling - relax.
- Get on your knees. While inhaling, slowly bend forward, while exhaling, you must return to its original position.
- Lie on your back. Maintaining a normal breathing rhythm, make turns with the trunk to the right and to the left.
- Take a standing position, arms extend along the body, the back should be flat. Slowly turn the body left and right, but so that the lower body remains motionless.
- Get on your knees, resting your hands on the floor. Sliding your hands on the floor, slowly fall down.
Each exercise must be performed 5 times. Contraindications to gymnastics are pronounced heartburn and pain in the sternum.
Surgical treatment
With the ineffectiveness of conservative therapy, as well as in the presence of a large hernia, surgical intervention is indicated.
Currently, it is performed using one of the following methods:
- Laparoscopy. Esophageal hernia is eliminated after lowering the upper part of the stomach back into the abdominal cavity. After that, the diaphragm opening is sutured. The operation is less traumatic. In addition, after it is held, the patient quickly returns to his usual life.
- Belsi's way. Access to the hernia is provided through an incision made to the left of the sternum. During the operation, the doctor fixes the lower part of the esophagus to the diaphragm, and the bottom of the stomach is hemmed to its front wall.
- Gastrocardiopexy. An incision is made in the middle of the abdomen just above the navel. During the operation, the upper part of the stomach and esophagus is sutured to some subphrenic structure, for example, to the preaortic fascia.
- Allison Method. Its essence consists in suturing the legs of the diaphragm. It is currently used extremely rarely.
Surgical intervention is contraindicated during pregnancy and in severe cases of other existing pathologies.
Unconventional methods
Alternative treatment of hernia of the esophagus does not exclude the need to see a doctor. With its help, it is possible to alleviate the general condition by reducing the degree of symptoms.
The most effective recipes:
- Brew chamomile tea. Drink it after each meal in small sips.
- Prepare 1 tsp. seeds of carrots and pour them 200 ml of boiling water. Cool and take the infusion in the morning after eating.
- Take 1 tbsp. l flax seeds and pour them 3 tbsp. l cold water. Let it brew for 8-10 hours. After the specified time, heat the resulting mass and eat it, chewing the seeds thoroughly.
With severe heartburn, you can add 1 tsp to a glass of water. soda and drink it. But this method should be resorted to extremely rarely. It is also contraindicated in pregnant women.
Effects
And now about what is dangerous hernia of the esophagus. In the absence of timely treatment at best, it leads to inflammation of the mucous membrane and to pinching of the muscle tube or stomach. A hernia is also accompanied by the development of reflux esophagitis, against which pathologies of a malignant nature often arise.
Recommendations to patients
A person who is diagnosed with an ailment needs to regularly follow these rules:
- Do not overeat;
- sleep on a high pillow;
- prevent constipation;
- daily find time for physiotherapy exercises;
- reduce body weight in obesity;
- follow a sparing diet.
Following these recommendations in most cases avoids surgery.
Finally
Esophageal hernia is a disease characterized by the displacement of some internal organs from the abdominal cavity to the chest cavity. Its development is accompanied by severe pain, heartburn, belching, discomfort when swallowing food. If you experience the first alarming symptoms, you must consult a gastroenterologist. The doctor will prescribe an examination and, based on its results, will draw up the most effective treatment regimen.