To begin with, not everyone knows the abbreviation GPOD. What it is?
Hernia of the esophageal opening of the diaphragm (all the same HHP abbreviated), or simply a hernia of the esophagus, is nothing more than a disease characterized by the displacement of an organ (located in the abdominal cavity) through the food hole in the diaphragm to the chest cavity. This organ is almost always the stomach.
Esophageal hernia can be congenital or acquired in nature and has pronounced clinical manifestations. Congenital hernia is less common than acquired. GPOD may appear for many reasons.
In the article, we will examine what exactly is HHP, symptoms, treatment, and the postoperative period of this ailment.
General characteristics of the disease
The diaphragm (to which GPOD is directly related) has the shape of a domed septum, which consists of two types of tissue: muscle and connective tissue. This septum separates the abdominal cavity from the chest cavity. The muscle bundles in the diaphragm form a small hole through which the esophagus passes. And you probably already understood why this hole is called the esophagus.
Let us return to the hiatal hernia. What it is? It is formed as a result of the displacement of some organ from the abdominal cavity into the chest cavity through the very esophageal opening of the diaphragm. And this is due to its weakening.
A hiatal hernia is such a common disease that it can successfully compete with cholecystitis, pancreatitis, or duodenal ulcers. However, in its seriousness, it will also compete with them.
Regarding the age of patients, we can say that most often the disease develops in people over 60 years old. As for gender - women are more likely to suffer from this disease than men.
Classification
Esophageal hernia is classified according to their characteristics. These types are distinguished:
- Unfixed or fixed hernias (axial and paraesophageal hernias only). In particular, a paraesophageal hernia is when the part of the stomach that forms it is located directly near the esophagus, above the diaphragm. And the cardia of the stomach is concentrated under the diaphragm. Axial HHP - esophageal, cardiac, subtotal or total gastric. There is also a sliding hernia, the features of which are that with this form, a hernial sac lined with a peritoneum is formed. It differs from the axial one in that the last bag does not. Axial hernia can move freely with body movements.
- Paraesophageal hernia (fundal or antral).
- Congenital hernia, the cause of which is a short esophagus with an abnormality in development.
- Hernias of another type (enteric, omental, etc.).
This disease can also be classified by degree:
- Esophageal hernia of the first degree. It is characterized by the fact that the cardia of the stomach is at the level of the diaphragm, the stomach is slightly elevated and is closely adjacent to the diaphragm. The abdominal esophagus is located in the chest cavity, directly above the diaphragm.
- Esophageal hernia of the second degree. The clinical picture is as follows: the abdominal esophagus in the chest cavity, and a part of the stomach is already in the esophagus.
- Esophageal hernia of the third degree. The most severe degree is characterized by the presence of the esophagus, cardia, and sometimes even the body and the bottom of the stomach above the diaphragm.
Causes of esophageal hernia
Earlier it was mentioned that there are a lot of reasons for a hiatal hernia. However, the following factors are most often distinguished:
- Thinning of connective tissue ligaments caused by age-related changes or provoked by any other processes.
- A systematic or simultaneous chronic increase in pressure in the abdominal cavity itself. The causes of increased pressure can be chronic constipation, severe physical exertion (for example, lifting heavy objects), blunt abdominal injuries and much more.
- Chronic diseases that directly affect the digestive system and in which the motility of the gallbladder, stomach or duodenum may be impaired.
- Disorders of the endocrine glands (endocrinopathy).
- Bad habits (smoking, drinking), the elderly person.
HPOD: symptoms
Depending on the clinical manifestations of the disease, the following forms of hiatal hernia are distinguished:
- asymptomatic HPOD;
- HH, the course of the pathology during which is caused by cardia insufficiency syndrome;
- GHAP, not characterized by the presence of cardia insufficiency syndrome;
- HHAP, which appear as a complication of other types of gastrointestinal diseases (or simply develop against their background);
- paraesophageal HPOD;
- congenital HPOD, characterized by a short esophagus.
It is worth considering each type of HPOD (symptoms of each type) separately:
- Asymptomatic hernia. As you already understood by the name of this form of the disease, there are no signs of HPA in these cases. This mainly applies to cardiac hernias or esophageal, that is, to small formations. This form of hernia is detected absolutely by accident, most often during a full examination, and sometimes a person does not even realize that he has a HHP - the symptoms (we will discuss the treatment below) are not present.
- HPOD with cardia failure syndrome. The most common signs of cardiac HPOD are heartburn and pain that occur after eating, as well as during sudden changes in the patient’s body position. It should also be noted that these symptoms most often occur at night, which can be explained by the peculiarity of increasing the tone of the vagus nerve, as well as the relaxation of the lower esophageal sphincter.
Regarding the intensity of heartburn, we can say that it can be mild (in this case, it can be treated with antacids), and quite painful (so much that it even deprives a person of working capacity). Its intensity is determined by a whole complex of various factors, and, first of all, it includes acid-peptic, which is characteristic of gastric juice. Also, stretching of the esophagus and the casting of duodenal contents into it (primarily bile) can affect this.
The most prominent sign of a hiatal hernia is, of course, pain. It is worth noting that it directly depends on the causes of heartburn. It mainly appears for identical reasons. The pain is localized mainly in the area behind the sternum, and intensifies when the patient assumes a supine position. In addition to this position, pain is also caused by torso back and forth. Its nature may be different, most often it is stitching, cutting or burning sensations.
Regurgitation of gastric contents is also a fairly common sign of HPOD. What it is? This is the process of casting the contents of the stomach into the oral cavity. A very unpleasant phenomenon, and the contents of the stomach can get into the trachea or bronchi.
And again a few words about the pain. Only half of the patients experience real pain, and in 25% of cases it is pseudo-coronary pain, which is localized in the region of the heart. You can easily get rid of it with nitroglycerin. In addition to such pain, patients can feel discomfort in the interscapular, hepatopancreatoduodenal areas, as well as in the Shoffar-Minkowski region, etc.
Also, about 70% of patients with hiatal hernia (especially if it is a cardiac HPOD) experience a symptom such as burping. Most often, it occurs by the contents of the stomach, and its predecessor is an unpleasant sensation of characteristic bursting in the epigastric region, which indicates aerophagy. Brings an unpleasant bitter aftertaste. Both antispasmodics and analgesics in this case cannot remove these sensations.
Also, 40% of patients have difficulty passing food along the esophagus, even when taking liquid food. Although it is worth noting that solid food is quite easy. In people suffering from this symptom, most often it manifests itself from very hot or, conversely, very cold food. Therefore, with a hernia, it is recommended to use only food that has a body temperature.
About 4% of patients with HPOD suffer from hiccups against the background of the axial form of a hernia. Only this is not an ordinary hiccup. Its main distinguishing feature can be considered a significant duration (it can last weeks, or even months). It is not so easy to get rid of it, and only a qualified specialist can help in that case.
Some patients also experience glossalgia (pain in the tongue) and hoarseness, which is a consequence of peptic burns from the contents of the stomach ejected during regurgitation.
In addition to all of the above, it can be added that the symptoms of a hernia directly depend on its size.
- HPOD without a symptom of cardia failure. In such cases, the symptoms of concomitant diseases are more manifested, rather than the hernia itself. Signs of this form of hernia will be pericardial, epigastric or retrosternal pain that appears immediately after eating or after lifting weights.
Such pains can last for several days. They can be neutralized using non-narcotic analgesics (with the exception of validol, because it has no effect) or nitroglycerin. Also, pain stops when eating food or liquid.
- HHs, which appear as a complication or simply develop against the background of other types of gastrointestinal diseases. Such diseases are most often a stomach ulcer or duodenal ulcer. With this form of HPOD, symptoms of the main ailment appear, and not the hernia itself.
- Paraesophageal HPOD. This form of hernia is characterized by the absence of any symptoms and manifestations. Most often, the diagnosis of paraesophageal hernia occurs randomly during general examinations. But when the hernia increases in size, esophageal compression appears (in other words, narrowing of the esophagus). In isolated cases, esophagospasm develops (a disease in which the motility of the esophagus is impaired).
With infringement of paraesaphageal hernias, pain appears in the sternum or in the epigastrium.
- Congenital HPPs characterized by a short esophagus. With this form of esophageal hernia, there may be two developmental options. In the first of them, a phenomenon such as a “chest stomach” can develop, which is characterized by the following forms:
- location in the chest;
- intrathoracic localization of the stomach.
In the latter case, it is very difficult to make a diagnosis; this usually happens with surgery or even with an autopsy.
Possible complications
Hernias of the diaphragm can provoke a number of complications. Most often, the following are manifested:
- gastritis or ulcer of that part of the stomach in which the hernia is located (appears in about 8% of cases);
- bleeding, anemia (occur in 20% of cases);
- the introduction of the lower part of the esophagus into the hernial sac;
- shortening of the esophagus (usually found only with cardiac esophageal forms);
- prolapse of the gastric mucosa into the esophagus (i.e. retrograde prolapse);
- infringement of a hernia (is the most difficult complication of all those listed).
Diagnosis of the disease
Typically, experts conduct several tests, based on the results of which it is already possible to diagnose "GPOD". What are these tests:
- Fibrogastroscopy. With its help, you can understand the state of the esophagus and stomach. The endoscopic signs of HPOD are determined by the doctor himself, on the basis of which he can make a diagnosis and prescribe treatment.
- X-ray examination, which is based on barium contrast. Thanks to this examination, it is possible to obtain an image of hernial protrusion characteristic of each HPOD degree.
- pH meter This test is done to determine the level of acidity in the stomach. It is necessary in order to properly prescribe a hernia treatment.
Esophageal Treatment
Usually, the treatment of a hernia of the esophageal opening of the diaphragm is carried out with the help of drugs, but in some cases (especially with complications) surgery is required.
As for the treatment with medicines, it consists in reducing the acidity of the stomach (with the help of antacids), as well as reducing gastric secretion. This is the first task. Also, during treatment, it is necessary to protect the gastric mucosa, which is also provided for with the use of certain drugs.
During treatment, a strict diet is prescribed, which must be adhered to unquestioningly. Basically, this diet is almost the same as with gastritis: nothing fatty, nothing sharp, sour, salty. Only healthy foods, such as vegetables, fruits, cereals, diet soups and broths, lean meats.
So, to eliminate heartburn and to reduce the secretion of the stomach, you can take the drug "Maalox". Which is very convenient, it is available not only in tablets, but also in the form of gels, dragees, suspensions. Each form of this tool has a separate instruction for use, which can be clarified at any pharmacy in your city.
You can also take funds such as Rennie or Gastal. To eliminate the already appeared heartburn, it will be enough to take one tablet, and for prevention - 4 tablets per day (one hour after eating). However, remember that these drugs only eliminate the symptoms.
As for surgical intervention, it consists in the removal of a hernial mass.
For a more accurate diagnosis and treatment, you must consult a doctor (surgeon or gastroenterologist).
Treatment with folk remedies
Treatment of HPAI with folk remedies will not give the desired results, since in most cases a sick person needs serious medications or even surgical intervention.
That is, no folk remedies are able to remove the hernia itself. The only thing they can be used for is to relieve pain.
Some decoctions of herbs will help reduce pain. Here are a few folk remedies that will help in the fight against hernia:
- Broth from the roots of the marshmallow. Pour about 20 g of crushed marshmallow root with a mug of boiling water and let it brew.
- Mix 30 drops of propolis alcohol tincture and 50 ml of milk . Take 2 times a day.
- With flatulence, a decoction of carrot seeds helps well. Pour one gram of seeds with 2 cups of hot water and let the mixture brew for about half an hour. You need to drink with the seeds.
Remember that before taking anything (especially folk remedies), you must always consult a doctor.
Also, with the help of folk remedies, you can get rid of heartburn, hiccups and other symptoms of HPOD. But remember that this is only a temporary result, and you need to treat the cause of the disease, not the symptoms.
Esophageal hernia after surgery
As mentioned above, in some cases, a hiatal hernia requires surgical intervention. HHAP-operation, reviews of which are ambiguous, can actually save a person’s life in especially neglected cases.
But what to do when the operation has already been done? How to follow the postoperative regimen? After how long can I return to my normal lifestyle?
HAPP after surgery necessarily requires care and comprehensive medical and preventive measures.
On the first day after surgery, patients need a GP examination and electrocardiography. On the second day, a chest x-ray is taken. On the third - a general detailed blood test, as well as a biochemical study, according to the indications of which a sonography is prescribed.
Twice a day, patients must perform simple breathing exercises and physiotherapy exercises.
As regards drug therapy, the following can be said. It consists in the introduction of saline solutions intravenously in a volume of up to 1800 ml per day. All patients take antibiotics after surgery.
Trocar wounds are treated with alcohol and bandaged every other day.
Literally a day after the operation, patients can already drink water, and starting from the second day - take liquid food. The postoperative period lasts about 3 months.
How does the HPAP operation itself (reviews about which are different, depending on the severity of the disease) we have already mentioned above. It consists in removing the hernia itself.
Conclusion
So, now you will not be scared if you see the abbreviation GPOD somewhere. What it is and how it manifests, you already know.
It remains only to conclude that the disease is very serious. Self-medication, especially treatment with folk remedies, is quite dangerous and can cause serious complications.
But, alas, no one is safe from complications, as some forms of HPA are asymptomatic.The only way out is to undergo a full examination at the hospital at least once a year. So you can find this unpleasant ailment in time.