Hid deep. What is a sliding hiatal hernia?

A hiatal hernia occurs as a result of the displacement of a certain organ into the chest cavity through the opening of the diaphragm. More often, a similar phenomenon occurs in the stomach. As a person ages, the muscle and connective tissues of the diaphragm weaken, which leads to the expansion of the opening and the displacement of organs into the abdominal cavity.

There are also numerous provoking factors (constipation, overeating, coughing). Modern treatment methods make it possible to eliminate a hiatal hernia without surgery. It is important to go to the hospital in a timely manner and undergo examination.

Types of disease

In medicine, there are 3 main types of hiatal hernia:

There is also a mixed type of hernia. A combination of sliding and paraesophageal forms of the disease.

Depending on the degree of displacement of certain areas (volume, level), the following types of hiatal hernia are distinguished:

Esophageal hernia (treatment without surgery is carried out under the strict supervision of a gastroenterologist) requires careful medical diagnosis to determine the type of disease and select effective therapy.

Treatment of sliding hiatal hernia

Treatment of a sliding hiatal hernia involves symptomatic drug therapy and a radical solution to the problem with surgery.

Therapeutic treatment

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

Therapeutic conservative tactics have significant disadvantages. Long-term use of PPIs (Omez, Losek, Pariet, Nexium) increases the risk of complications in the form of intestinal and gastric polyps, gastropathy, and malignant lesions of the gastrointestinal tract.

Surgery

A sliding hiatal hernia can only be cured surgically. Approaches to surgical elimination of the problem are determined individually. The choice of treatment method depends on the size of the hernial sac and hernial orifice, the presence of strangulation, bleeding, and erosions.

In the arsenal of surgeons, the classic Nissen fundoplication, modified by Toupet, and crurorrhaphy - reduction of the esophageal opening of the diaphragm to natural parameters.

Nissen fundoplication

The canonical operation is performed by open access or laparoscopy, depending on the size of the hernia and the gate. The stomach is adjusted to its normal position. The fundus of the stomach is wrapped around the lower part of the esophagus a full turn and secured with a suture. After the operation, a tight sleeve at the site of the cardiac sphincter prevents natural manifestations of the body - belching, vomiting. This prevents a person from living fully.

Toupet operation

The modified Toupet operation involves turning the stomach around the esophagus only 180-270°. The anterior 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 stomach is restored. An anti-reflux barrier is created that prevents acidic gastric contents from irritating the esophagus.

Crurorrhaphy

This is the name of the operation for suturing the esophageal opening of the diaphragm. Crurorrhaphy complements fundoplication and prevents the development of recurrent prolapse. The most popular method of operation is Allison. Access is on the left, between 7-8 ribs. The legs of the diaphragm are sewn together with 3-5 interrupted sutures. At the end of the operation, a drainage tube is installed to remove wound exudate.

A sliding hiatal hernia can be congenital or acquired with age. The main symptoms are constant heartburn, sour belching, chest pain. Diagnosed by X-ray with contrast agent. Treatment consists of taking acid neutralizers or performing surgery to restore normal topography, physiology and anatomy of the organs.

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Stages and degrees

Considering the extent of the spread of pathological changes, doctors distinguish the following stages of development of a hiatal hernia:

Based on the duration of the course, temporary, transient and permanent esophageal hernia are distinguished. At each stage of the development of the disease, characteristic symptoms arise that require careful diagnosis and accurate diagnosis.

Symptoms

A small esophageal hernia occurs without clinical signs.

Its increase leads to the appearance of characteristic symptoms:

Concomitant symptoms of a hiatal hernia also include discomfort after eating, a sour taste in the mouth, and heavy breathing. In some situations, hiccups, vomiting, shortness of breath and severe nausea occur.

Seven more signs of a hiatal hernia

Heartburn

Normally, the lower esophageal sphincter tightly closes the opening between the esophagus and the stomach, preventing aggressive gastric contents from flowing back into the esophagus.

With a hiatal hernia, the locking function of the sphincter is very often disrupted, and the contents of the stomach enter the esophagus. In this case, inflammation of the walls of the esophagus and their chemical burn inevitably occur. This is manifested by heartburn, which occurs especially often in a lying position or when lying in a forward position for a long time.

Belching and bitterness in the mouth

Patients with hiatal hernia are often bothered by belching: sour, air, food. It usually appears after eating and, depending on the type of hiatal hernia, can be moderate or very pronounced.

Also, most people with a diaphragmatic hernia complain of a bitter taste in the mouth.

Sudden regurgitation

In a healthy person, regurgitation is preceded by nausea. In a patient with hiatal hernia, regurgitation occurs unexpectedly, without nausea. Most often this happens when lying down, for example at night.

Swallowing disorders

Very typical of hiatal hernias are problems swallowing food. An alarming sensation of “lump in the throat” appears. Most often it occurs after eating liquid or semi-liquid food, especially if it was cold or very hot.

Unlike esophageal cancer, which is also characterized by difficulty swallowing, with a diaphragmatic hernia such difficulties are intermittent, and difficulties with the passage of solid food rarely occur.

Anemia

Dizziness, pallor of the skin and mucous membranes, “unmotivated weakness” and darkening of the eyes can be signs of anemia.

If, when examining blood parameters, it turns out that the level of hemoglobin and/or red blood cells is reduced, it is possible that damage to the walls of the esophagus by gastric juice has led to the development of internal bleeding. In such situations, the doctor should check with the patient whether he has noticed the appearance of black, liquefied stools.

Tongue pain and hoarseness

With a hiatal hernia, hoarseness may appear due to a burn of the larynx by gastric juice.

A rare but typical symptom is pain in the tongue caused by a burn of the oral cavity by the contents of the stomach.

Cough and lung diseases

Patients with a hiatal hernia often wake up in the middle of the night coughing, which is accompanied by severe chest pain. Most often this occurs if the day before a person had a heavy dinner shortly before bed.

The cause of cough lies in the flow of gastric contents into the esophagus, and from the esophagus into the larynx, trachea and even bronchi. For the same reason, patients with hiatal hernia often develop aspiration pneumonia, bronchitis or attacks of bronchial asthma.

Reasons for appearance

A hiatal hernia (non-surgical treatment is carried out after a full medical diagnosis under the supervision of a doctor) is a consequence of high pressure in the abdominal cavity. This happens with severe bloating, constipation, vomiting, sudden bending, or due to severe obesity.

The same goes for ascites, blunt trauma to the abdomen.

Negative factors that contribute to the development of the disease also include the following reasons:

• underdeveloped diaphragm (the first symptoms in a person appear in infancy);
• penetrating injuries to the chest or stomach;
• frequent births, multiple pregnancies;
• dry cough.

Chronic diseases of the digestive system (stomach ulcer, esophagitis, pancreatitis) also increase the risk of a hiatal hernia. Pathological processes develop against the background of impaired innervation of the diaphragm. In older people (over 60 years old), changes appear due to weakened tone of the diaphragm.

Physiology of the issue

A sliding hernia is a pathology when the abdominal part of the esophagus through the enlarged opening of the diaphragm can enter both the chest and back into the abdominal cavity. Because of this, it is called a sliding hernia. In addition, one wall of the formation sac is an internal organ in the retroperitoneal space.

More often, this pathology is identified in women, and with age, the risks of such a hernia increase. It often develops without any symptoms. The patient’s complaints will directly depend on the degree of the hernia, as well as existing concomitant gastrointestinal pathologies.

There are a number of physiological openings in the diaphragm between the thoracic and abdominal zones. Vessels, nerves and the esophagus pass through here. Normally, all holes are sealed due to connective tissue. It is worth understanding that the pressure in the abdominal cavity is stronger than in the sternum, which means that under a number of provoking factors, the thin barrier can stretch, as a result of which movement from the bottom up begins. This is how a hiatus hernia is formed.

Question answer

Why do esophageal spasms occur?

Diagnostics

It is impossible to determine pathological processes on your own, since the disease is accompanied by numerous symptoms similar to other disorders of the digestive system. Diagnostics will allow you to establish an accurate diagnosis.

The following studies are used:

Esophageal hernia (treatment without surgery is carried out if the disease is detected at an early stage) in some situations is diagnosed accidentally, during an X-ray examination of the chest organs.

Additionally, daily pH measurements are also performed (acidity in the lumen of the esophagus and stomach is measured). It is important to differentiate the disease in order to select the most effective treatment and prevent serious complications.

When to see a doctor

You should visit a gastroenterologist as soon as the first symptoms of a hiatal hernia appear. Without timely assistance, the risk of an emergency condition increases. A blockage or strangulation of a hiatal hernia leads to disruption of blood flow in the stomach area.

The patient experiences severe nausea, vomiting, and the process of gas separation and emptying is disrupted. Pain in the chest area may indicate more than just a hiatal hernia. Similar symptoms are accompanied by numerous diseases (heart, peptic ulcer), which are important to identify in a timely manner.

Prevention

It is difficult to prevent the development of a hiatal hernia, but there are useful recommendations and advice from a gastroenterologist that will help reduce the risk of developing pathological changes:

1. Control your weight, get rid of extra pounds.
2. Do not lift too heavy loads yourself.
3. Engage in moderate exercise that works your abdominal muscles.
4. Do not strain during bowel movements.
5. Do not tighten the straps too tightly.

It is necessary to strengthen the abdominal muscles, treat constipation in a timely manner, eat properly and rationally, and get rid of bad habits. If a patient has been diagnosed with a disease, clinical observation is recommended.

How to treat

Hernia treatment is carried out both conservatively and surgically. It is necessary to seek advice from both a gastroenterologist and a surgeon. Therapy is often complex. Here it is worth understanding that after detecting a formation, it is necessary to begin therapy as quickly as possible in order to reduce the risk of complications. If we are talking about non-surgical treatment, then the following measures are used. Firstly, it's diet. It is recommended to eat split meals, every 3 hours, but the portions should be small - about 200-300 g. Naturally, it is necessary to exclude potentially dangerous and always classified as dangerous foods - fried, fatty, pickled, smoked and other foods. After all, they irritate the mucous membranes and further increase the production of gastric juice. The optimal solution would be to shift the diet towards the consumption of boiled and steamed dishes, fresh fruits, lean meat, etc. Depending on the severity of the situation, they may be advised to eat pureed food or dishes with a liquid consistency.

In this situation, the normalization of the regime and lifestyle is also of no small importance. Naturally, and this is not even subject to discussion, you need to give up bad habits, get proper rest and engage in physical activity in moderation. Abdominal exercises - various loads and bending - are contraindicated in this situation.

If we talk about drug therapy, antacids may be offered to reduce acidity, drugs that suppress the production of hydrochloric acid, drugs for belching and heartburn, drugs to relieve pain, drugs to restore the protective properties of the mucous membrane of the digestive system.

If there are serious complications, such as bleeding, doctors prescribe additional therapy. These may be means to restore iron balance, etc. The issue of surgical intervention may also be considered.

Therapy must be carried out in consultation with a doctor and exclusively according to his recommendations - this is the only way to guarantee a high-quality result.

Treatment methods

Esophageal hernia (treatment without surgery is carried out comprehensively) requires the help of a gastroenterologist. Properly selected therapy helps restore gastric motility, reduce the negative manifestations of a hernia and alleviate the patient’s condition. Conservative therapy involves following a strict diet, using medications, physiotherapeutic procedures and folk remedies.

Medications

Medicines are selected by a gastroenterologist after a complete medical diagnosis, taking into account the results and individual characteristics of the patient’s body.

The medicine should be taken strictly as prescribed by the doctor, since many drugs cause side effects. Self-treatment is not recommended to avoid the development of serious complications.

Traditional methods

Complex therapy for hiatal hernia involves the use of recipes from healers and healers, unless there are serious contraindications. It is recommended to discuss treatment with your doctor, since many components of traditional medicine can cause complications.

Potato, pumpkin and carrot juice, as well as orange peels, help eliminate severe heartburn. Honey and aloe can help you cope with belching. Abdominal bloating is reduced by a decoction with the addition of yarrow, fennel fruit and St. John's wort.

Other methods

It is recommended to treat a hiatal hernia using complex methods. You can get rid of disorders without surgery at an early stage if you consult a doctor in a timely manner. The gastroenterologist recommends giving up bad habits. Cigarettes relax the gasoestrophageal sphincter and surrounding muscles, which leads to organ displacement. The same goes for alcoholic drinks and coffee.

Physical work is also contraindicated for patients. You should not wear tight belts or bandages, as they increase intra-abdominal pressure. It is recommended that a person sleep with his head elevated. Proper nutrition (5-6 times a day) will reduce the unpleasant symptoms of a hiatal hernia and prevent its exacerbation.

There are foods that increase the secretion of gastric juice and increase the risk of developing the disease.

Before cooking meat, it is recommended to completely remove fat. During meals, food is consumed slowly, chewing thoroughly. Do not forget about the drinking regime; every day you need to drink 1.5-2 liters of clean still water.

The article discusses effective methods of treating hiatal hernia without surgery.

Physiotherapeutic procedures contribute to the overall recovery of the entire body. Treatment is recommended for concomitant pathologies together with a hiatal hernia.

Patients are prescribed the following procedures:

Physiotherapy improves health, eliminates inflammation and pain, and relaxes muscle tissue.

Possible complications

In the absence of timely and correct treatment, a hiatal hernia entails serious consequences:

The most serious complication of a hiatal hernia is an ulcer or scar narrowing (stricture). Long-term pathological processes provoke malignant degeneration of cells and the development of cancer. There is also a high probability of internal bleeding, which threatens a person’s life.

A hiatal hernia at an early stage of development does not require serious medical procedures. Treatment is carried out without surgery; medications and doctors’ recommendations make it easy to restore the mobility of the diaphragm. The advanced form of the disease requires complete diagnosis and therapy selected by a gastroenterologist.

Why is this hernia difficult to recognize?

It is often really very difficult to suspect a hiatal hernia.

• In half of the cases, the pathology does not manifest itself at all.
• In 35% of cases, the main complaint of patients is interruptions in the functioning of the heart and chest pain, which are often very similar to those that occur with coronary heart disease.
• The majority of patients are elderly people, who usually already have a whole “bouquet” of health problems.
• The presence of a hiatal hernia does not at all exclude the presence of cardiovascular pathology.

All this creates serious diagnostic problems. Many patients continue to undergo treatment with a cardiologist for years, all to no avail, while the actual disease continues to progress.