🔓 🧝🏾 💼 Esophageal hernia: signs, symptoms, treatment, diet 🍛 🏬 ⬅️

A hiatal hernia is a pathology that is associated with a weakening of the ligamentous apparatus of the diaphragm. As a result of such changes, the esophageal opening in the diaphragm expands, which leads to a displacement of the stomach (its upper part extends into the chest cavity) and the esophagus.

This problem is considered very common, so many people are looking for additional information. Why does a hiatal hernia develop? Symptoms, treatment, possible complications, prognoses for patients are all important data.

General information about the disease

Hernia of the esophageal opening of the diaphragm is a pathology that is accompanied by the expansion of the opening of the diaphragm and stretching of the ligamentous apparatus, as a result of which the abdominal segment of the esophagus, the cardiac section of the stomach, and sometimes part of the loops of the small intestine penetrate the chest cavity.

Against the background of a similar process, the angle between the organs changes, and the work of the lower esophagus sphincter is disrupted, as a result of which the acidic contents of the stomach and bile from the intestines are thrown into the esophagus, damaging its mucous membranes.

In modern gastroenterological practice, such a pathology is quite common. According to statistics, the risk of developing such an ailment increases with age - older people suffer from the disease more often.

The main causes of the development of the disease

To date, the mechanisms of formation of such a pathology are not fully understood. Nevertheless, information is still available on some of the causes of hernia.

Sometimes there are some congenital malformations, in particular, shortening of the esophagus. As a rule, such pathologies are diagnosed almost immediately after birth and are often eliminated by surgery.
Risk factors include age. As the body ages, connective tissue structures that hold organs in their natural position, weaken and stretch, lose elasticity, and sometimes atrophy.
Hernia is often diagnosed in patients with diseases that are accompanied by connective tissue weakness. Potentially dangerous diseases include diverticulosis of the intestine, varicose veins, Marfan syndrome, hemorrhoids. Often, the expansion of the esophageal opening is associated with an umbilical, inguinal and femoral hernia.
Dangerous is a systematic or a sharp, critical increase in intra-abdominal pressure. That is why risk factors include indomitable vomiting, blunt abdominal injuries, chronic constipation, ascites, severe obesity, lifting too heavy a load, hard physical labor.
If we talk about diaphragmatic hernia in women, then it often develops against the background of pregnancy, since the growth of the fetus and the accumulation of amniotic fluid creates pressure in the abdominal cavity.
Risk factors include some lung diseases, in particular obstructive bronchitis and bronchial asthma. A strong lingering cough also affects the condition of the ligaments and tissues of the diaphragm.
A violation of the motility of the wall of the digestive tube is also dangerous, which is observed against the background of chronic pancreatitis, gastritis and gastroduodenitis, dyskinesia of the esophagus, peptic ulcer of the stomach and intestines.
Thermal or chemical burns, an esophageal peptic ulcer, and reflux esophagitis can also lead to a hernia, since, against the background of such diseases, the esophagus tissue is susceptible to scar-inflammatory deformities, as a result of which the esophageal tube is gradually shortened.

Of course, during the diagnosis it is important to determine what exactly led to the formation of a hernia. First of all, it is necessary to eliminate the cause of the expansion of the diaphragm, since otherwise the likelihood of relapse is high.

Forms of the disease and their features

Esophageal hernia may occur in different ways. Gastroenterologists distinguish three forms of such an ailment.

A sliding hiatal hernia is considered the most common. According to statistics, in 90% of patients diagnosed with this particular form of the disease. In this case, the organs are displaced so that the cardial part of the stomach lies above the diaphragmatic opening. In this case, total, subtotal, cardiofundal and cardial hernia of the esophageal opening of the diaphragm is isolated.
Paraesophageal form is relatively rare - in about 5% of cases. With this form of ailment, the cardia does not change its position and remains under the diaphragm. At the same time, other parts of the stomach move to the chest cavity, in particular the greater curvature and the bottom. Perhaps intestinal displacement. Several subtypes are distinguished, in particular the fundus, antrum, gastrointestinal, intestinal, omental hernias.
In some patients, a mixed form occurs, which combines the features of a paraesophageal and sliding hernia of the esophageal opening of the diaphragm.

Sometimes a pathology such as a short esophagus, which is a congenital anatomical abnormality, is isolated into a separate form. Such a pathology is rarely diagnosed as an independent disease - in most cases, it is combined with an axial hernia of the esophageal opening of the diaphragm. Treatment in this case is carried out surgically.

Hernia degree

Three degrees of a hernia of the esophageal opening of the diaphragm are distinguished, each of which is accompanied by characteristic signs.

The first degree - the cardia is located at the level of the diaphragm, and the esophagus is slightly higher.
The second degree - the abdominal esophagus moves to the chest cavity, the stomach is located in the area of the esophagus.
The third degree - almost all structures that normally are located under the diaphragm, including the esophagus, the bottom and the body of the stomach, sometimes part of the intestine, are displaced into the chest cavity.

Signs of hiatal hernia

Of course, many people are interested in information about the features of the clinical picture. Symptoms of a hiatal hernia depend on the shape and degree of development of the pathology. In some patients, the disease is completely asymptomatic. But in most cases, violations are still present.

Perhaps a typical and very first sign is pain in the epigastric region. Unpleasant sensations spread along the esophagus, often radiating to the back and the area between the shoulder blades. The pain intensifies during physical exertion, as well as coughing, after eating, with the body leaning forward. Unpleasant sensations decrease after a deep breath, vomiting, drinking, burping.
Sometimes shortness of breath and chest pain appear - the symptoms resemble the clinical picture with myocardial infarction and angina pectoris. Sometimes there is an increase in heart rate, increased heart rate. According to statistics, in about a third of cases there is a diagnostic error - the patient is treated for cardiovascular disease.
If there is a strangulation of the hernia, then patients suffer from acute abdominal pain.
Digestive upsets also appear. In particular, the symptoms of diaphragmatic hernia include belching with bile or stomach contents, the appearance of bitterness in the mouth, nausea, heartburn, hiccups. Often in the morning the patient has hoarseness, which is associated with the throwing of the contents of the stomach into the esophagus, irritation and swelling of the mucous membranes.
A characteristic symptom is dysphagia - a violation of the passage of food through the esophagus. Attacks of dysphagia are often observed when eating too hot or cold, liquid foods, as well as against the background of a stressful situation.
Sometimes the gastric contents enter the respiratory tract, which leads to the development of asthma, tracheobronchitis, and aspiration pneumonia.

Possible complications due to the disease

Many people experience problems such as hiatal hernia. Reviews of specialists, as well as statistical data, indicate that the disease is well treatable. Nevertheless, there is always a risk of developing dangerous complications.

According to recent studies, failure to treat a hiatal hernia significantly increases the likelihood of developing cancer of the esophagus.
The disease is often accompanied by inflammation of the mucous membrane of the esophagus, which is associated with the reflux of gastric juice into the esophagus (hydrochloric acid irritates the mucous membranes, causing inflammation, and in some cases the formation of erosion and ulcers).
The likelihood of developing peptic stricture of the esophagus is high.
In some patients, a hernia causes bleeding from the esophagus (it can be either acute or chronic).
Injury of the hernia is also dangerous, since this is accompanied by a violation of blood flow, damage to nerve fibers, and serious changes in trophic tissue. This complication requires emergency surgical intervention.
Sometimes there is a prolapse of the mucous membranes of the stomach into the esophagus tube.
In severe cases, perforation of the esophagus occurs.

Diagnostic measures

In this case, the correct diagnosis is extremely important. After collecting information and making an anamnesis, the doctor sends the patient for additional studies.

First of all, fibrogastroscopy is performed. Using special equipment, the doctor examines the mucous membranes of the esophagus and stomach, evaluates their condition, and examines for erosion, ulcers and other injuries.
Informative is the chest x-ray and stomach. Thus, a specialist can obtain information about the location of the esophagus in the stomach, the presence of displacement of organs.
A daily pH measurement of the esophagus and stomach is also carried out, which makes it possible to check the acidity of the gastric juice and the degree of its reverse casting within 24 hours.

Conservative treatment

For starters, conservative treatment of a hiatal hernia is performed. Since this pathology is accompanied by reflux, it is first of all necessary to remove its symptoms.

To begin with, patients are prescribed antacids, in particular drugs, which contain magnesium oxide, magnesium and aluminum hydroxide, and magnesium carbonate. Proton pump inhibitors, such as Pantoprazole and Omeprazole, are also used. H2 blockers of histamine receptors are considered effective.

Immediately it is worth saying that treatment of a hiatal hernia (without surgery) helps to relieve digestive disorders and improve the patient's condition. However, an existing extension cannot be removed in this way.

Proper nutrition with hernia

The diet for a hiatal hernia is extremely important. As already mentioned, obesity is considered a risk factor, therefore, if the patient is overweight, it is advisable to reduce the daily calorie intake. In addition, a properly selected diet will help get rid of constipation, will stimulate peristalsis, saturate the body with much-needed nutrients and vitamins. With reflux esophagitis, the products described below are especially useful.

Grapes are considered to be one of the most alkaline products, therefore it well neutralizes the effects of stomach acid. Of course, it is better to give preference to a home-made product that does not contain pesticides.
Pineapple contains proteolytic enzymes, and therefore contributes to digestion.
Cabbage is also useful. It is believed that this product speeds up the healing process of ulcers. If a person is poorly digesting fresh cabbage, it can be consumed stewed or boiled.
Potato should be included in the diet, as this product also neutralizes high acidity well.
Cereals, in particular wheat, millet and rice, will be useful.
As an antacid, you can use special clay, which is sold in a pharmacy (for example, Smecta will help to cope with high acidity).

Partial nutrition is recommended - so the load on the esophagus will be less, and the walls of the stomach will not stretch too much. Experts recommend eating 5-8 times a day, but in small portions. This, incidentally, contributes to the rapid digestion of food.

By the way, there are products that need to be discarded. Their list is as follows:

fatty meats;
sausages;
fried foods;
sugar;
milk and dairy products;
alcohol;
coffee and cocoa;
refined products;
bakery products;
some spices, in particular peppers, cinnamon, ginger, cloves.

Dishes are best steamed or baked in the oven.

Surgical treatment of hiatal hernia: surgery and its features

Not always conservative therapy gives the desired result. What to do in this case to the patient with a hiatal hernia? The operation is performed if the following indications are available:

there is no effect of drug therapy and diet;
the presence of complications, in particular bleeding, anemia, ulcers and erosion of the esophagus;
large hernia;
dysplasia of the mucous membrane of the esophagus;
infringement of a hernia or risk of its development.

Today, there are many procedures to normalize the patient's condition. But they are all aimed at suturing the esophageal opening in the diaphragm and creating an antireflux mechanism that will prevent the stomach contents from being thrown into the esophagus.

In most cases, the bottom of the stomach is rotated around the esophagus by 270 or 360 degrees. Thus, the doctor creates a kind of cuff that prevents the reflux of gastric juice into the esophagus tube. At one time, a similar procedure was carried out through direct access. But today, more and more often, surgery is performed laparoscopically - this helps to reduce the risk of infections and other complications, as the instruments are inserted through small punctures on the skin.

Traditional medicine recipes

Home remedies certainly will not help eliminate a diaphragm hernia. Nevertheless, traditional medicine relieves the patient’s condition, copes well with high acidity, accelerates the healing of erosion and ulcers.

Normal baking soda helps neutralize acid. A teaspoon of the powder should be dissolved in a glass of warm water and drunk. It is immediately worth noting that such a tool can only be used occasionally - the constant use of soda can only aggravate the condition.
Useful is considered a decoction of chamomile. You can buy ready-made chamomile tea in the store or prepare a decoction yourself from dried flowers. Healers recommend drinking such tea immediately after the appearance of discomfort in the stomach. Chamomile has pronounced anti-inflammatory properties, helps relieve irritation of the mucous membrane of the digestive tract.
Mint tea will also help cope with pain and discomfort in the epigastric region.
Flax seeds are also useful - they are recommended to eat daily for breakfast. In the evening, a tablespoon of seeds should be poured with three tablespoons of water and left overnight. In the morning, the mixture must be heated, not bringing to a boil. The resulting slurry should be eaten, chewing the grains carefully. Such a tool helps to neutralize acid. Moreover, flax decoction has enveloping properties - they protect the mucous membranes of the esophagus and stomach from the irritating effects of gastric juice.
Experts recommend including natural yogurt and kefir in the diet - they will also protect the walls of the digestive tract and help prevent the occurrence of heartburn.
Tea from ginger root is also considered useful.
Almonds also help protect the digestive tract from acid exposure. You only need to eat a few nuts every day.
For some people, folk medicine men recommend apple cider vinegar. A teaspoon of vinegar should be filled with 100 ml of boiled warm water and sweetened with a solution of linden honey. This remedy helps with heartburn.
Special grass collection is also considered effective. To prepare it, you need to mix 50 g of the bark of red elm and flax seeds, as well as 100 g of the root of the medicinal marshmallow and leaves of coltsfoot. Three tablespoons of the medicine is poured with a liter of boiling water, covered with a lid and insisted for an hour. Throughout the day, the filtered solution should be drunk instead of tea.

Of course, you can not self-medicate with such a disease. The use of any home remedy must be reported to the doctor.

Forecasts and Prevention

Predictions for patients directly depend on the form of the disease, stage of its development, general condition of the patient, as well as the chosen method of treatment. . , , .

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Esophageal hernia: signs, symptoms, treatment, diet