What causes hiatal hernia (HH). Hiatal hernia (Hiatal hernia, Diaphragmatic hernia, Paraesophageal hernia)

Normally, organs located under the diaphragm in the abdominal cavity cannot enter the thoracic region. This is prevented by anatomical features. Ligamentous structures formed by fibers connective tissue, strengthen the esophageal diaphragmatic opening. It is also supported by adipose tissue, which is located directly under the diaphragmatic septum. The movement of part of the stomach, esophagus and even intestinal loops into the chest cavity is called hiatal hernia. Diagnosis is particularly difficult of this disease, since its symptoms are very similar to those of cholecystitis, gastritis and stomach ulcers. The patient can treat these diseases for a long time without knowing what he has hiatal hernia.

There are several options for this type of hernia:

Axial– characterized by the prolapse of part of the esophagus, stomach and cardia into the chest cavity, which can return through the stretched esophageal gap in the diaphragm. As a rule, this condition occurs during intense coughing or during sleep.
Paraesophageal– it is characterized by penetration of the stomach through an opening in the esophagus directly into the thoracic region. The hernia is located near the esophagus, but the cardia and abdominal part remain under the diaphragm.
Mixed– in such a situation there is a combination of the two hernias listed above.

Reasons

The described disease can be congenital, develop in children as a result of embryonic pathology - a shortened esophageal tube, or acquired. The causes of hernia development are related to dystrophic changes in the structure of connective tissue, loss of elasticity and atrophy. Therefore, a hiatal hernia is often accompanied by other hernial protrusions: umbilical , inguinal And hernia of the white line of the abdomen .

Frequent or sudden changes in intra-abdominal pressure can contribute to the formation and development of a hernia. Due to stress, injuries, obesity, ascites, constipation, flatulence, prolonged cough at bronchial asthma or bronchitis, the abdominal organs put pressure on all the walls surrounding it and find weak point, come out.

Often the cause of the development of this type of hernia is the accompanying gastric ulcer, chronic cholecystitis, pancreatitis, gastroduodenitis.

Due to previous reflux esophagitis, peptic ulcer or burn, both chemical and thermal, the esophagus becomes shorter.

Due to various processes leading to weakening of the diaphragm, the esophageal opening in this septum widens significantly. It becomes a hernial orifice, through which the cardial (upper) part of the stomach and the abdominal (located in the abdominal) part of the esophagus rise into the chest.

Hiatal hernia, symptoms

The disease can be asymptomatic and not manifest itself in any way. Sometimes clinical manifestations are present, but very mild. This depends on the degree of development of the hernia and the individual characteristics of the patient. Typical symptoms are:

pain in the epigastric region, which can spread to the back and surround, as with pancreatitis;
chest pain can lead the patient to a cardiologist by mistake in diagnosis;
pain may occur after eating or physical stress, with intestinal flatulence and after a deep breath;
heartburn, burning in the throat, hiccups, attacks of nausea, vomiting, hoarseness;
Cyanosis and vomiting blood indicate a strangulated hernia.

When diagnosing a hiatal hernia, the symptoms can be deceiving. Therefore, to clarify, an X-ray examination of the organs of the digestive system and chest, and duodenal fibrogastroscopy are performed.

In half of the cases the disease is asymptomatic. Sometimes the symptoms are so minor that the person is not even aware of the development. serious problems with health. Therefore, a doctor’s diagnosis often simply shocks a patient who came for a diagnosis of a completely different disease.

The main symptom indicating the development of a hernia is a dull pain, which is concentrated mainly in the epigastric region. It can also spread to the esophagus and interscapular area. Often pain syndrome makes itself felt after overeating, when lifting weights, coughing and bloating. The pain may temporarily disappear when you take a deep breath or burp. Changing body position sometimes also helps reduce pain.

In most cases, the symptoms associated with a hiatal hernia are very similar to those of heart disease. For this reason, difficulties arise in making an accurate diagnosis. After all, if you suspect a problem of a cardiac nature, treatment may not produce results due to an erroneous definition of the disease.

The vast majority of patients suffer from heart pain and disorders heart rate. Pain in the sternum may appear due to a strangulated hernia in the diaphragm.

In this case, the pain often radiates to the area between the shoulder blades. Similar symptoms accompany angina attacks, as well as myocardial infarction.

Common symptoms of a hernia are heartburn and regurgitation. Sometimes prolonged stay of gastric juice in the esophagus leads to the appearance of ulcers and bleeding. This, in turn, causes anemia, which is caused by a decrease in the level of red blood cells in the blood.

At night, increased salivation may be disturbing, which provokes coughing and attacks of suffocation. The next morning your voice may become hoarse.

Diagnostics

The initial stage of diagnosing the disease is an objective medical examination, during which the patient’s medical history and complaints are collected.

Next, the patient in mandatory must undergo an x-ray examination. For better information, a troscope is used, and the patient is transferred to a supine position. Fluoroscopy using techniques that increase intra-abdominal pressure is indicated for minor diaphragmatic hernias.

If necessary, biomaterial is taken for further morphological examination. This is done to determine the nature of concomitant diseases of the esophagus.

Thanks to this study, it is possible to recognize an inflammatory process or tumor disease.

In some cases, esophagomanometry is required, which can be used to:

determine the length of the esophagus;
check the condition of the cardiac sphincter;
study the peristaltic activity of the esophagus;
evaluate the pharyngoesophageal sphincter;
identify hiatal hernias.

But when diagnosing paraesophageal hernias, this method is not informative enough. In this case, pH monitoring is usually carried out to determine the frequency and characteristics of the reflux of stomach contents into the esophagus. If the patient has a peptic ulcer digestive tract, a fractional analysis of gastric functions is performed.

When, in addition to a diaphragmatic hernia, a patient has cholelithiasis, he needs to undergo an ultrasound examination of the abdominal cavity. Since a diaphragmatic hernia is often accompanied by symptoms similar to those of heart disease, an additional electrocardiogram will have to be done. In any case, studies are prescribed individually, taking into account the characteristics of the patient’s body and the collected medical history.

Hiatal hernia, treatment

Conservative therapy is symptomatic. It is necessary to eliminate signs of gastroesophageal reflux. For this use:

antacids: almagel, maalox, etc.;
antisecretory drugs - proton pump blockers: dexlansoprazole, omeprazole, etc.;
histamine receptor inhibitors: ranitidine.

It is very important to avoid stress and follow a gentle diet. Meals should be small, and the last meal should take place several hours before bedtime.

As a rule, the treatment of diaphragmatic hernia is 99% identical to the treatment tactics for reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow special diet, and adhere to all doctor's instructions. During this treatment, the patient's condition is relatively satisfactory. But as soon as the course of therapy ends, all the symptoms return again. In such a situation, the patient begins to think about deciding on surgical intervention.

Experts note that patients with unfixed hernias of small size are subject to conservative treatment, but on the condition that they are ready to take the prescribed medications for the rest of their lives.

Complex forms of hernia are treated surgically.

Breathing exercises

Execute breathing exercises no earlier than 3 hours after eating. The following exercises are considered effective:

The patient turns on his right side and positions his legs so that they are slightly lower than his head. Then you need to inhale and loosen your stomach as much as possible so that it protrudes, followed by exhalation without retracting your stomach. The next repetition of the exercise helps to deepen your breathing. You need to do it every day for 10 minutes, four times a day. After 7 days, the exercise can be complicated - as you exhale, you need to draw in your stomach.
Having dropped to your knees, you should carefully bend first to one side and then to the other. When bending over, inhale, and when returning to the starting position, exhale. This exercise is then performed while standing.
The patient lies on his back and alternately turns in different sides trying to control your breathing. Regular performance of these exercises allows the patient's condition to improve after about 3 months.

The benefits of physical therapy

If we talk about non-surgical treatment of a hiatal hernia, then performing therapeutic exercises is a mandatory measure. Do it on an empty stomach, about half an hour before meals. The exercises are carried out first in a lying position, and then in a sitting position.

The patient should lie on his back so that upper part the body ended up on the pillow. The middle finger, together with the index finger, should be placed under the ribs on the center line of the abdomen. First, the skin shifts to the right side and upward. When exhaling, the fingers smoothly plunge into the peritoneal cavity as deep as possible. Using the extensor actions of the fingers, they try to move the stomach to the left side and down, and this should be done exclusively when the diaphragm is lowered, that is, when exhaling. The exercise is carried out 5-6 times. If during gymnastics you feel a pulling sensation in your throat and the pain has decreased, then you are doing everything correctly.
It is necessary to take a sitting position with a slight deflection of the spine in the thoracic region. The exercise is carried out in a relaxed state. You need to place your fingers under the ribs, while thumbs should rest against one another through the skin. The remaining fingers are concentrated opposite the midline of the abdomen. When inhaling the skin, which is under control thumbs, try to move it upward towards the head, and when exhaling, it is necessary to apply pressure to the back and legs for 5-8 seconds. Repeat the exercise 3-6 times.

Maintain body weight within normal limits.
Follow your diet and ensure that the intervals between each meal are at least 3 hours.
Relax with your head elevated, on right side or half-sitting.
Give up bad habits (alcohol, smoking).
Avoid excessive physical activity, especially those accompanied by bending the body forward.
Wear comfortable clothes, avoid wearing corsets, bandages and tight belts that squeeze the stomach.
Drink still mineral water (for example, Borjomi) half a glass an hour before meals.
Prevent constipation by improving bowel function.

Possible complications

If the development of a hiatal hernia is not prevented in time, then it may soon appear serious consequences such an irresponsible attitude towards your health. Indeed, in some cases the disease develops into cancer. If it exists for more than 5 years without proper treatment, then there is a risk of malignant tumor. This is facilitated by metaplasia of the epithelium of the diaphragm, which develops under the influence of gastric juice. Stomach cancer can also appear against the background of an esophageal hernia. Similar consequences are entailed by the systematic use of drugs that help reduce the acidity of gastric juice (Ranitidine, Omez), which results in problems with intestinal motility. The contents with bile enter the stomach from the small intestine, which gives impetus to the development of metaplasia of the gastric epithelium.

Hiatal hernia, diet

You need to eat food in small portions. There should be 4-5 meals a day. After eating, it is not advisable to rest in a lying position. It's better to sit or even walk. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system. It is important not to overeat and not eat foods that increase gas formation: cabbage, legumes, grapes, pears, black bread.

Your doctor may recommend following a strict esophageal diet. Diet No. 1 is suitable. All food should be taken in a semi-mashed state. You can eat: soft-boiled eggs; pureed porridges and vegetable soups; butter; fermented milk products (sour cream, cottage cheese); fruit jelly and compotes; baked apples; boiled ground meat; fish.

Nothing spicy, hot or sour is allowed. Carbonated drinks, alcohol, and fruit juices are prohibited. For people with overweight body needs nutritional adjustments and very strict adherence a diet developed individually for each patient.

Surgical treatment of hernia

If drug treatment and therapeutic exercises do not produce the expected results, then the diaphragm hernia is removed surgically. Surgical treatment allows you to restore the anatomical location of organs in the area of the esophagus and abdominal cavity.

Indications for surgery:

failure of drug treatment;
dysplasia of the esophageal mucosa;
presence of complications;
paraesophageal sliding hernia;
impressive size of the hernia;
fixation of the hernia in the hernial opening.

Nowadays there are different types surgical treatment diaphragm hernia. All of them are based on the creation of an areflux mechanism, which will prevent gastric contents from returning to the esophagus.

Many specialists perform the operation using the Nissen method. Its essence is as follows: the fundus of the stomach is surgically wrapped 350 degrees around the esophagus. This allows the formation of a cuff that prevents the return of stomach contents into the esophagus through the diaphragm, which prevents the development of esophagitis.

Nissen surgery can be performed either open or laparoscopically. However, it is worth mentioning some disadvantages. First, traditional fundoplasty can lead to a deterioration in the patient’s condition if the patient’s hiatal hernia exists sufficiently for a long time.

The main problem is a significant shortening of the esophagus due to a constant inflammatory process. Ultimately, it is completely located in the chest. In this case, instead of creating a cuff on the esophagus, its formation occurs on the stomach itself. This situation entails the appearance of a valve in the cardia area, which results in the loss of the ability to use the protective function of the stomach in the form of regurgitation. This means that when drinking carbonated drinks, gases will not be able to leave the stomach through the cardia and, accordingly, will contribute to its bloating. Pain and discomfort in the stomach can also occur when overeating.

The second disadvantage is that traditional fundoplasty is performed without fixing the formed cuff. And this is a direct path to relapse, since over time there is a risk of the cuff slipping. The disease can return even 1 year after the operation.

Laparoscopic hernia treatment

The use of laparoscopy allows you to clearly see the problem and control all actions on the monitor. An enlarged image provides excellent visualization of the disease picture. With the help of laparoscopy, you can see the finest formations, ranging from vagus nerve, and ending with the gastric vessels.

During the operation, the apex of the stomach and esophagus are removed from the adhesions, and then lowered into the peritoneum to required level. After this, crurography is performed, which is the normalization of the size of the diaphragm opening. This is followed by fundoplication - the formation of a cuff from the lining of the stomach, which will subsequently prevent the reflux of stomach contents into the esophagus.

Advantages of this technique:

careful operation;
creation of a functional valve between the esophagus and stomach;
recovery anatomical structure apex of the abdominal cavity.

A combination of esophageal hernia, cholelithiasis and duodenal ulcer is often found. Such a condition also requires surgical treatment and the laparoscopic method is ideal option. The surgeon is thus able to simultaneously perform operations on different abdominal organs. The duration of the surgical process is usually 40-60 minutes.

After an operation using a laparoscope, the patient is left with incision marks on the abdomen, the length of which can reach 10 mm. At the same time, after the operation, the ability to move independently remains. On the first day the patient is allowed to get up, walk and drink, and the next day he can already eat warm liquid food. He can leave the hospital for 1-5 days, which depends mainly on the severity of the disease. The patient can return to his usual routine of life after 3 weeks. You will need to follow a strict diet for 1.5-2 months.

Laparoscopic surgery allows for quick adjustments existing problem and return the patient to his usual course of life.

Traditional medicine

To maintain your health and prevent the occurrence of unpleasant symptoms If you have a hernia, you should take advantage of the healing power of herbs. With their help you can reduce bloating, get rid of constipation and cope with heartburn.

Combine 30 drops of propolis tincture and 50 ml of milk. The drug is taken twice a day half an hour before meals.
The following remedy will help cope with bloating. To do this, take 1 tbsp. l. herbal mixture consisting of peppermint and fennel fruits. You will also need to add caraway and anise seeds. All components are poured with boiling water (300 ml) and placed on the stove for 15 minutes. Take the product after it has been infused for 1 hour. It is filtered before use. Take half a glass half an hour before meals three times a day.

Hernia food opening diaphragm or hiatal hernia is a displacement of part of the stomach or other abdominal organ into the mediastinum when the esophageal opening of the diaphragm is a hernial orifice. It is a consequence of a decrease in the elasticity of the diaphragm and the esophageal-phrenic ligament, with a parallel increase in the natural opening of the diaphragm, as well as some other gastroenterological diseases. For a long time, the hernia may manifest itself as only minor discomfort, which should not be ignored, since it is at the early stage of development of the hernia that conservative treatment may be sufficient. Without treatment, the symptoms of the disease become so severe that surgery becomes inevitable.

With a hiatal hernia, pathological movement of the abdominal organs occurs through the natural opening in the diaphragm into the chest. Pathology can involve organs in whole or in parts, while maintaining mobility or losing it completely. How smaller area penetration into a cavity that is unnatural for specific organs, the more favorable the prognosis, but then the symptoms are less pronounced.

For some time the disease does not have specific symptoms, and as the disease progresses, patients begin to notice:

burning pain at the level of the xiphoid process and the lower third of the sternum, intensifying after eating and in a horizontal position;
belching, which, like pain, appears after eating or when a change in body position contributes to the occurrence of reflux;
belching of air, regurgitation;
Rarely, nausea, vomiting, shortness of breath, hiccups, burning of the tongue may occur;
dysphagia (difficulty in swallowing food).

A critical condition is considered to be the herniation of the vessels that supply the organs or the organs themselves. The strangulation can be gradual as the hernia increases - in this case, the vessels are pinched, and disruption of blood flow leads to extensive tissue necrosis. In the event of a sudden provoked injury - from laughter, overeating, heavy exertion - the patient experiences severe pain, the pulse quickens, and the blood pressure, sweating increases, which is already an indication for emergency hospitalization and surgery.

Etiology of development of hiatal hernia

Reasons

In the vast majority of cases, hiatal hernia occurs among the adult population and is a consequence of wear and tear of the body, loss of elasticity of the ligaments, impairment acid-base balance and a combination of acquired parallel ailments. Among the predisposing reasons are:

the presence of untreated gastroenterological reflux disease (GERD);
increased abdominal pressure that occurs during pregnancy, frequent constipation and other disorders of intestinal motility;
the presence of neoplasms in the digestive tract;
weakening ligamentous apparatus, supporting the esophagus and stomach;
constitutional weakness of connective tissue, which is confirmed by their frequent combination with hernias of other localizations, flat feet, varicose veins of the saphenous and hemorrhoidal veins;
esophageal dyskinesia, as well as reflex and symptomatic esophagospasm. (Reflex
esophagospasm is a common disease that occurs against the background of various lesions of the esophagus, gall bladder, stomach, duodenum, cervical and thoracic spine);
being at risk if you have varicose veins, hemorrhoids, overweight, common problems with digestion;
intrauterine pathology of the diaphragm;
acquired abnormality of the length of the esophagus (short esophagus I, II degrees).

A short esophagus is a congenital or acquired pathology of the size and tortuosity of the esophagus, in which a part of the stomach is located supradiaphragmatically.

Of course, some mechanical injuries can also lead to penetration of part of the abdominal organs either through the enlarged opening of the diaphragm or through formed mechanical damage additional holes. In this case, only surgical intervention is recognized as therapy.

Types of hiatal hernia

The most common are two types of hiatal hernia, and a combination of these types is possible.

Sliding (axial) hernia– this is a condition when the cardia is located above the esophageal opening of the diaphragm, as a result of which the relationship between the esophagus and the stomach changes, which leads to a sharp disruption of its closing function.
Paraesophageal- characterized by the fact that the cardia does not change its position, and the fundus and greater curvature of the stomach emerge through the enlarged opening

Axial hernia is considered the most common of all hiatal hernias.

Paraesophageal hernia can be antral, fundic, intestinal and omental, where the first 2 varieties are considered the most common.

Comparative characteristics of the most common hiatus hernias:

Axial (sliding). Labile penetration of the entire abdominal organ or part of it into the food opening of the diaphragm. There are: esophageal (displacement of the abdominal part of the esophagus), cardiac (displacement of the esophagus, cardia of the stomach), cardio-fundal (displacement of the esophagus, cardia and fundus of the stomach). An axial hernia is considered a false hernia because there is no hernial sac.
Paraesophageal is a fixed displacement of the entire stomach or part of it through the food opening of the diaphragm next to the esophagus. There are: antral (displacement of the final part of the stomach) and fundal (displacement of the fundus of the stomach). It is considered a true hernia (a hernial sac is present) with a risk of strangulation.

With a long-term course of the pathology without treatment, the hernia can be differentiated as total or subtotal giant, which is no longer subject to conservative treatment.

Diagnostics

If a hernia is suspected, the gastroenterologist is recommended to ask the patient to bend forward as part of a non-instrumental examination - if there is a hiatal hernia, a sharp burning pain in the retrosternal space with belching, gastroesophageal reflux or heartburn. And to further clarify the diagnosis and differentiate it from a disease with similar symptoms (myocardial infarction, pancreatitis, intestinal obstruction) instrumental diagnostic methods are recommended, such as:

X-ray of the chest organs;
fluoroscopy of the stomach;
X-ray of the abdominal cavity;
fibrogastroduodenoscopy (FGDS).

FGDS allows you to most accurately determine the location of the hernia and the degree of expansion of the food opening, as well as assess the condition of the esophageal mucosa. When using fluoroscopy, the supradiaphragmatic ampulla of the esophagus is well differentiated from the hiatal hernia, which in turn requires only observational tactics.

A hiatal hernia on fluoroscopy appears as an oval or round body with unclear visualization of the lower border, asymmetrically located in relation to the esophagus.

If a hiatal hernia has been confirmed by fluoroscopy or EGD, stool sampling for occult blood may be indicated if internal bleeding is suspected. A biochemical blood test with a long course of the disease often has deviations, while the parameters clinical analysis may remain within normal limits.

To determine treatment tactics, a biopsy of the esophageal mucosa and pH measurements may be indicated.

Conservative treatment

If the hernia is not total or subtotal in nature, and the patient’s condition is not assessed as severe, the main recommendation for the treatment of hiatal hernia will be the use of all conservative methods, since surgical intervention is usually used only in extreme cases due to high risk relapses.

At the same time, you should be aware that the conservative technique in 90% of cases does not eliminate the hernia itself, but only helps to normalize the patient’s life and reduce the risk of complications.

Lifestyle correction

Treatment of hiatal hernia is carried out on an outpatient basis under regular medical supervision. After an accurate diagnosis, the doctor prescribes diet and drug treatment, and also gives a number of instructions, neglect of which can worsen the situation and nullify all the benefits of taking medications and correcting nutrition:

A patient with hiatal hernia is prohibited from performing heavy physical activity, lifting weights, or straining the abdominal area. Some types of physical therapy, stretching exercises, and body relaxation are welcome.
The use of tight clothing, belts, tights with a rigid waist frame is also prohibited. If the patient, after removing things, notices marks on the abdomen from squeezing the skin, such clothes cannot be worn with hiatal hernia, as they provoke an increase in abdominal pressure.
IN acute period When gastroesophageal reflux and belching manifest, it is recommended to sleep in a semi-sitting position.

Video - Hiatal Hernia

Nutrition

An important aspect is the correction of the usual lifestyle, since the development of a hiatal hernia is most often due to poor nutrition. It is necessary to ensure a complete diet while maintaining acidity control, that is, exclude hot, spicy, fatty foods that contribute to gas formation and constipation.

Meals should be frequent, fractional, without excess. After eating, you should not take a horizontal position. It is necessary to realize the importance of diet, and not rely only on medications, since after the inevitable withdrawal of medications, in the absence of proper attention to food, a deterioration in well-being will be observed.

Medication assistance

Treatment advanced disease only with the help of nutritional correction can drag on for too long, so the body needs medicinal support.

Group of drugs	Antispasmodics and painkillers	Anti-inflammatory drugs	Antacids	Histamine blockers	Prokinetics
Indication	Pain relief	Associated inflammatory processes (with esophagitis)	Binding of already produced hydrochloric acid	Reduced production of hydrochloric acid	Gastrointestinal stimulation
Titles	No-shpa (drotaverine), novocaine	Antibiotics, NSAIDs	Almagel, Phosphalugel, Reni, Gastal, Maalox	Omeprazole, Omez, Ranitidine, Gastrozole, Pantoprazole, Roxatidine, Famotidine	Motilium, Motilak, Ganaton, Trimebutin

It is possible to take astringents, antimicrobials, sedatives and antihistamines using the vitamin supplement cyanocobalamin, thiamine, folic acid and pyridoxine. In a hospital setting, physiotherapeutic procedures can be used for up to 10 sessions per course.

It is prohibited to stop taking medications without permission, since even at the very beginning of their use there is a significant improvement in well-being, but it is extremely untimely to talk about a cure at this stage.

Traditional methods of treatment

Draw from traditional medicine methods of treating a hernia are worth only as additional method improvement of well-being, if the doctor who determined the tactics of treatment with diet and medication approves the auxiliary intervention.

A good addition to your diet would be to use mild, anti-inflammatory chamomile or lightly brewed green tea. When choosing infusions and herbs, you should look for an option that will reduce stomach acidity, heartburn and abdominal discomfort. Often recommended ginger and lemon teas for hernia and other gastroenterological diseases are contraindicated.

If the conservative method of treating a hernia has not brought success, then surgical intervention is indicated. Since it is associated with certain risks and frequent relapses without eliminating the actual cause of the hernia, they try to resort to it as a last resort. Therefore, the eternal recommendation for the treatment of gastroenterological diseases, especially any type of hiatus hernia, is to take care of your body. Uniform physical activity, weight and nutrition control, avoidance chronic diseases and their timely elimination will keep the organs healthy and the ligaments strong, and then the risk of hernia formation will be reduced to zero.

A hiatal hernia is a pathology that manifests itself as a result of an abnormal displacement of internal organs that are physiologically located under the diaphragm (intestinal loops, cardia of the stomach, abdominal segment of the esophagus and other elements). This disease occurs quite often in medicine. The risk of progression of this pathology increases significantly with the patient's age. But it is worth noting that at this time medical statistics are such that hernia of this type is more often diagnosed in middle-aged women.

In more than half of the cases, a hiatal hernia does not manifest itself in any way, and in some cases remains completely unidentified. The statistics are that accurate diagnosis“hiatal hernia” is diagnosed only by a third of patients from total number sick. The pathology is usually diagnosed accidentally, during annual examinations. preventive examinations or during treatment in a hospital, but for a completely different reason.

Quite often it happens that patients with such an illness are treated for completely different diseases. For example, from or. This is due to the fact that all these diseases have very similar symptoms. In fact, if you conduct a full diagnosis and prescribe the correct treatment, you can completely get rid of the pathology. Treatment is mainly carried out with several simple operations and medications.

Etiology

The appearance of a hiatal hernia can be associated with either a genetic predisposition or be acquired. Often in children, such a hernia occurs due to a common congenital anomaly - shortening of the esophagus. In this case, there is only one treatment - immediate surgery.

Acquired causes include weakness of the opening of the diaphragm in the esophagus. With age, this lumen becomes less elastic or even atrophies. People with, or are much more susceptible to the progression of this pathology.

It is possible that this pathology will progress simultaneously with other similar lesions. Most often, the pathological process is accompanied by or. Factors that may increase the risk of acquiring a hernia:

, especially chronic;
persistent vomiting or passing gas;
advanced stages;
difficult working conditions;
various abdominal injuries;
pregnancy;
chronic form or.

These factors contribute to the weakening of the walls of the diaphragm, which, in turn, leads to the collapse of parts of the esophagus and stomach into the chest cavity.

Varieties

Depending on the anatomical structure and cause of formation, there are the following types hernias:

sliding;
peri-esophageal (permanent);
a type of hernia that combines the two previous types.

A sliding hiatal hernia occurs quite often against the background of all types of hiatal hernia. It also has other names - axial, vagus and axial. With this type bottom part The esophagus and abdominal cavity freely penetrate the chest cavity and return to their anatomical position without problems. This happens when a person changes body position (usually from sitting to standing). But not all hernias can be repaired on their own. Often, due to its large size and high degree of suction in the chest cavity, the hernia remains there because it cannot go back.

A fixed (permanent) hernia is characterized by the fact that the lower part of the esophagus and stomach fall out of the opening of the diaphragm. Such a hernia is accompanied by nausea, which occurs due to disruption of the passage of food.

At mixed type manifestations of the two above types are combined.

Depending on the extent of displacement of organs into the chest cavity, there are three degrees of hiatal hernia:

the first - when only the lower part of the esophagus penetrates, and the stomach remains in place, but presses on the diaphragm;
the second - when the lower part of the esophagus appears in the chest cavity, and the stomach rises and becomes on the same level with the diaphragm;
the third - penetrates into the chest cavity not only part of the esophagus, but also the bottom of the stomach. Less commonly, loops of the small intestine.

Hernias are divided depending on the organs that form the sac. The sliding is divided into:

esophageal;
cardiofundic;
gastric

Fixed only happens:

fundic (only the bottom of the stomach);
antral. When it enters the chest cavity end part organ.

Symptoms

More than half of hiatal hernia cases occur without symptoms. It is worth noting that the severity of symptoms directly depends on the size of the hernia. Therefore, the larger it is, the stronger the following symptoms will make themselves felt:

heartburn varying degrees intensity;
pain in the stomach, which can spread to the back;
heart pain that spreads down the left side of the body;
difficulty passing food through the esophagus;
belching and hiccups;
hoarseness of voice.

Complications

A hiatal hernia does not always lead to complications. They are strictly individual in nature, depending on what diseases a person has suffered in his life, and on the general level of immunity.

Possible complications may be:

heart problems, up to;
stomach ulcer;
constant burping or regurgitation;
aspiration pneumonia.

Diagnostics

It is very difficult to carry out diagnostics without tests or devices, because the symptoms are very diverse and are similar to some diseases of the digestive system and gastrointestinal tract.

The main methods for diagnosing a hiatal hernia are x-rays of the esophagus with contrast and measuring acidity in the gastrointestinal tract. You may additionally need to undergo a procedure such as endoscopy.

Treatment

First of all, treatment of such a hernia is aimed at eliminating symptoms with medications, which can only be prescribed by a doctor. Self-medication is not acceptable. In addition to medications, the treatment plan includes:

a diet that the patient must strictly adhere to. It consists of eliminating fried and salty foods from the diet. The last meal should be taken three hours before bedtime;
reduction in quantity physical activity on the body during treatment.

In cases where drug treatment does not have an effect or the hernia condition is very advanced, more measures should be taken. serious methods treatment. In this case, doctors resort to surgical intervention. To solve the problem of esophageal hernia in medicine, there are several types of surgical interventions performed. Possible options for surgical treatment of hernia:

surgical intervention, the essence of which is to sew together the opening through which organs enter the chest cavity, as well as to strengthen the walls of the esophagus;
gastropexy. The stomach is surgically fixed in a certain position;
surgery that will restore correct ratio the fundus of the stomach with the esophagus;
in some cases, resection surgery on the esophagus may be necessary.

Once fully recovered, patients who have suffered a hiatal hernia must register with a gastroenterologist.

Prevention

The main preventive remedy for hiatal hernia is a proper diet. But you should also follow these recommendations:

eating in small portions, but with greater frequency throughout the day;
exclusion from the diet of foods that cause heartburn attacks;
completely stop drinking alcohol and smoking;
prevent weight gain;
during sleep, the head should be fifteen centimeters higher than the level of the legs.

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A hiatal hernia, which is also commonly defined as a hiatal hernia (or HH), is a disease with a characteristic displacement of an organ located in the abdominal cavity to the chest cavity through the esophageal opening located in the diaphragm. An esophageal hernia, the symptoms of which have pronounced clinical manifestations, is also associated with the specifics of its own formation, which determines its congenital or acquired nature; a hernia can appear as a result of a number of reasons.

A hiatal hernia is a protrusion into the chest cavity of the abdominal segment of the esophagus and the adjacent part of the stomach, and sometimes also intestinal loops, through the enlarged esophageal opening in the diaphragm. In the medical literature, the term “hiatal hernia” is sometimes used in relation to this pathology; in everyday life, simplified names are more often used - esophageal hernia or diaphragmatic hernia.

The disease occurs in approximately 5% of the adult population and is characterized by a chronic relapsing course.

Causes and risk factors

The most common cause of hiatal hernia is congenital or acquired weakness of the hiatal ligaments. In approximately half of the cases, the disease is diagnosed in patients over 50 years of age due to progressive degenerative changes in the connective tissue. A sedentary lifestyle, exhaustion and asthenic physique increase the likelihood of the disease. The pathological development of connective tissue structures, which contributes to the appearance of hernias, may be indicated by concomitant diseases: flat feet, varicose veins, hemorrhoids, Marfan syndrome, etc.

The provoking factor for the formation of a hiatal hernia is most often a significant increase in intra-abdominal pressure with prolonged hysterical cough, flatulence, ascites, neoplasms and severe obesity, as well as with blunt trauma abdominal area, sharp bends, backbreaking physical labor and immediate lifting of a heavy load. In women, the disease is often diagnosed during pregnancy: according to WHO, hiatal hernias are found in 18% of patients with repeat pregnancies.

A persistent increase in intra-abdominal pressure is also observed in certain diseases of the abdominal organs, accompanied by persistent vomiting and impaired peristalsis. Inflammatory processes in the upper gastrointestinal tract, reflux esophagitis and burns of the mucous membranes lead to cicatricial deformities of the esophagus, which contribute to its longitudinal shortening and weakening of the ligamentous apparatus. For this reason, diaphragmatic hernias are often accompanied by chronic gastritis and gastroduodenitis, gastric and duodenal ulcers, cholecystitis, pancreatitis, etc.

The best prevention of hiatal hernias in the absence of clinical signs– giving up bad habits, rational nutrition and regular physical exercise.

IN in rare cases the development of a hiatal hernia is caused by congenital developmental anomalies upper sections Gastrointestinal tract. Patients with a short esophagus and the so-called thoracic stomach(congenital shortening of the esophagus).

Forms

Depending on the location and anatomical features Hiatal hernias are divided into three groups.

Axial (axial, sliding) is the most common type of hiatal hernia, characterized by free penetration of the abdominal segment of the esophagus, cardia and fundus of the stomach into the chest cavity with the possibility of independent return to the abdominal cavity when the body position changes. Taking into account the nature of the dislocation anatomical structures, among axial hiatal hernias, cardiac, cardiofundal, subtotal and total gastric subtypes are distinguished.
Paraesophageal - manifested by displacement of part of the stomach into the chest cavity with the normal location of the distal segment of the esophagus and cardia. Paraesophageal hernias are differentiated into fundal and antral: in the first case, the fundus of the stomach is located above the diaphragm, in the second - the antrum.
Mixed hiatal hernias are a combination of the two previous types.

Congenital malformations of the gastrointestinal tract, in which there is an intrathoracic location of the stomach due to insufficient length of the esophagus, should be considered as a separate category.

Hiatal hernia occurs in approximately 5% of the adult population and is characterized by a chronic, recurrent course.

Stages

Based on the degree of displacement of the stomach into the chest cavity, three stages of axial diaphragmatic hernia are distinguished.

The abdominal segment is located above the diaphragm, the cardia is at the level of the diaphragm, the stomach is directly adjacent to the cardia.
The lower part of the esophagus protrudes into the chest cavity, the stomach is located at the level of the esophageal opening.
Most of the subphrenic structures extend into the chest cavity.

Symptoms of a hiatal hernia

In approximately half of cases, hiatal hernia is asymptomatic and is diagnosed by chance. Clinical manifestations appear as the size of the hernial sac increases and the compensatory capabilities of the sphincter mechanism at the border of the stomach and esophagus are exhausted. As a result, gastroesophageal reflux is observed - the reverse movement of the contents of the stomach and duodenum along the esophagus.

With a large hiatal hernia, reflux esophagitis often develops, or gastroesophageal reflux disease - inflammation of the walls of the esophagus caused by constant irritation of the mucous membranes acidic environment. The main symptoms of a hiatal hernia are associated with the clinical picture of reflux esophagitis, which is characterized by:

frequent heartburn and a feeling of bitterness in the mouth;
hiccups and belching with a sour and bitter taste;
hoarseness and sore throat;
thinning of tooth enamel;
pain in the epigastrium, in the epigastric region and behind the sternum, radiating to the back and interscapular region;
causeless vomiting without previous nausea, mainly at night;
difficulty swallowing, especially pronounced when taking liquid food and in stressful situations;

Progressive reflux esophagitis is accompanied by the development of erosive gastritis and the formation of peptic ulcers of the esophagus, causing hidden bleeding in the stomach and lower sections esophagus, which lead to anemic syndrome. Patients complain of weakness, headaches, fatigue and low blood pressure; Blueness of the mucous membranes and nails is often noticeable.

In case of strangulation of the hernial sac painful sensations sharply intensify and take on a cramp-like character. At the same time, signs of internal bleeding appear: nausea, vomiting with blood, cyanosis, a sharp decrease in blood pressure.

Approximately a third of patients with hiatal hernia have complaints cardiological profile– retrosternal pain radiating to the shoulder blade and shoulder, shortness of breath and heart rhythm disturbances (paroxysmal tachycardia or extrasystole). Differential feature Diaphragmatic hernia in this case is caused by increased pain in a lying position, after eating, when sneezing, coughing, bending forward and passing intestinal gases. After a deep breath, burping and changing posture, the painful sensations usually subside.

Diagnostics

When diagnosing hiatal hernias, instrumental visualization methods play a leading role:

esophagogastroscopy;
intraesophageal and intragastric pH-metry;
esophagomanometry;
X-ray of the esophagus, stomach and chest organs.

Endoscopic examination reveals reliable signs hiatal hernia: expansion of the esophageal opening, upward displacement of the esophagogastric line and changes in the mucous membranes of the esophagus and stomach, characteristic of chronic esophagitis and gastritis. Esophagogastroscopy is often combined with pH measurement; if severe ulcerations and erosions are detected, selection of a biopsy specimen is also indicated in order to exclude oncopathology and precancerous conditions.

In approximately half of the cases, hiatal hernia is diagnosed in patients over 50 years of age due to progressive degenerative changes in the connective tissue.

On x-rays, signs of axial hernias are clearly visible: high location of the esophagus, protrusion of the cardia above the diaphragm, disappearance of the subphrenic part of the esophagus. When inserted contrast agent There is a retention of suspension in the hernia area.

To assess the condition of the upper and lower esophageal sphincters and esophageal motility, esophagomanometry is performed - a functional study using a water-perfusion catheter equipped with a registration sensor. Pressure indicators in the contracted state and at rest make it possible to judge the strength, amplitude, speed and duration of contractions of the sphincters and smooth muscles of the esophageal walls.

Impedansometry allows you to get an idea of the acid-forming, motor-motor and evacuation functions of the stomach, based on the indicators of electrostatic resistance between the electrodes of the esophageal probe. Impedance testing is considered the most in a reliable way recognition of gastroesophageal reflux with simultaneous assessment of its type - depending on the pH value, acidic, alkaline or weakly acidic reflux is distinguished.

In case of severe anemic syndrome, a stool test for occult blood is additionally performed. To exclude cardiovascular pathology if you have cardiological complaints, you may need to consult a cardiologist and perform gastrocardiomonitoring - combined daily monitoring of stomach acidity and Holter ECG.

Treatment of hiatal hernia

For a small hernia medical tactics, as a rule, is limited to pharmacotherapy of gastroesophageal reflux, aimed at relieving inflammation, normalizing pH, restoring normal motility and mucous membranes of the upper gastrointestinal tract. Inhibitors are included in the therapeutic regimen proton pumps and blockers histamine receptors, at increased acidity Antacids are prescribed - aluminum and magnesium hydroxides, magnesium carbonate and magnesium oxide.

The patient must maintain a gentle daily routine, refrain from smoking and alcohol, and avoid stress and excessive physical activity. At severe pain behind the sternum, it is recommended to give the head of the bed an elevated position.

During treatment, you should adhere to diet No. 1 according to Pevzner. Eating regimen is also important: daily ration divided into 5–6 servings; it is important that the last evening meal takes place at least three hours before going to bed.

With low effectiveness of drug therapy, dysplasia of the mucous membranes of the esophagus and complicated course of hiatal hernia, surgery is the best solution. Depending on the size and location of the hernial sac, the nature of pathological changes in the wall of the esophagus, the presence of complications and concomitant diseases apply various techniques surgical treatment of hiatal hernias:

strengthening the esophageal-diaphragmatic ligament– suturing of the hernia orifice and hernia repair;
fundoplication– restoration of the acute angle between the abdominal segment of the esophagus and the fundus of the stomach;
gastropexy– fixation of the stomach in the abdominal cavity;
esophagectomy– an extreme measure that is resorted to in the event of the formation of cicatricial stenosis of the esophagus.

Possible complications and consequences

Of the complications of a hiatal hernia, the greatest threat is aspiration pneumonia, which develops when large volumes of stomach contents enter the respiratory tract. Per share aspiration pneumonia accounting for almost a quarter of all reported cases of severe lung infection. Frequent irritation of the respiratory tract with small portions of regurgitated gastric contents leads to chronic tracheobronchitis.

Also of concern are cardiovascular complications caused by irritation of the vagus nerve by a large hernia. Against the background of a diaphragmatic hernia, reflex angina may develop, and with spasm of the coronary vessels, the risk of myocardial infarction increases.

Lack of treatment for a hiatal hernia provokes complications and increases the degree of cancer risk.

The long-term consequences of a hiatal hernia and the progressive course of reflux esophagitis include:

the appearance of erosions and peptide ulcers;
esophageal and gastric bleeding;
cicatricial stenosis of the esophagus;
strangulated hernia;
perforation of the esophagus.

The long course of gastroesophageal reflux during a hernia creates the preconditions for dysplastic and metaplastic changes in the epithelial tissue of the mucous membranes of the esophagus. An example of metaplasia with a high probability of malignancy is Barrett's esophagus, which is characterized by the replacement of normal squamous epithelium of the esophageal wall with columnar epithelium characteristic of the intestine, as well as the cardial and fundic parts of the stomach. This creates the preconditions for the development of a malignant tumor process. Metaplastic goblet cells are especially susceptible to malignancy when the length of the affected area is more than 3 cm.

Forecast

With conservative treatment, hiatal hernias are prone to recurrence, therefore, at the end of the main course of treatment, patients are subject to follow-up with a gastroenterologist. After surgical intervention the likelihood of relapse is minimal.

Adequate selection of therapeutic regimens and regular prevention of exacerbations of reflux esophagitis make it possible to achieve long-term remission and prevent complications. If the hernia size is small and there is a good response to drug therapy there is a chance to achieve full recovery. Lack of treatment, on the contrary, provokes complications and increases the degree of cancer risk.

Prevention

The best prevention of hiatal hernias in the absence of clinical signs is giving up bad habits, a balanced diet and regular exercise. The training program must include specialized exercises to strengthen the abdominal wall.

In order to prevent recurrence of hiatal hernia, it is important to promptly identify and treat diseases of the digestive system, ensure normal functioning Gastrointestinal tract and limit consumption of foods that irritate mucous membranes. The ban includes spicy, fatty, fried and salty foods, rich broths, smoked meats, alcohol, tomatoes, radishes, cabbage, onions, legumes and citrus fruits, as well as wholemeal bread and cereals rich in fiber. Also, do not get carried away with chocolate, delicacy hard and mold cheeses, red meat and cream cakes.

Most favorable products to restore the mucous membranes of the esophagus and stomach, fine-grained cereals are considered, white rice, low-fat milk and meat, ripe sweet fruits without skin and seeds, puddings, soft-boiled eggs, steamed omelettes and boiled vegetables. Health effect increases many times over if you stick to fractional portion meals and find time for hiking after the evening meal.

For patients who are prone to obesity, it is advisable to bring their weight into line with the physiological norm. If you have a history of hernia diseases, intense power loads are contraindicated, but exercises in exercise therapy groups have a good effect.

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Article publication date: 06/03/2015

Article updated date: 11/08/2018

The diaphragm is the main respiratory muscle in humans. If a hole or thinning of some area appears in it, and through it the organs of the abdominal cavity penetrate or protrude into the chest cavity (less often, vice versa), this is a diaphragmatic hernia.

This hernia is dangerous because the intestines, stomach or esophagus that have penetrated into the chest cavity compresses and prevents the heart and lungs from working normally. Also, this position of the organs has a bad effect on the digestive organs themselves, since they are easily pinched in the tendon or muscle ring of the diaphragm through which they exited.

A diaphragmatic hernia can be acute or chronic. A chronic hernia may not bother the patient for a long time. Then there are following symptoms(they are also signs of an acute hernia): chest pain, heartburn, belching, difficulty breathing, burning sensation behind the sternum. These manifestations of the disease definitely prevent a person from leading a full life.

Diaphragmatic hernia various types– a very common disease of the digestive system. It occurs in every tenth young person, and from the age of 50 it is found in every second. It is also diagnosed in 7–8% of people who complain of chest pain and cardiac dysfunction.

It is simple to cure such a hernia: the surgeon performs an operation in which the protruded organs are put back into place, and the diaphragm defect is sutured and strengthened. Medicines They do not fight the problem, but only eliminate the symptoms and prevent complications of the disease.

What happens with a diaphragmatic hernia (anatomical information)

The diaphragm is a large parachute-shaped muscle that is located below the lungs and attaches to the costal arches. It has a peripheral muscle and a central tendon part. The vena cava passes through the tendon part to the heart, and in the muscular part there is an opening for the esophagus.

Click on photo to enlarge

The opening for the esophagus is the “weak spot” where diaphragmatic hernias most often form (they are also called hiatal or hiatal hernias). Through it, the esophagus, stomach, and sometimes the intestines exit into the chest cavity.

Normally healthy person The esophagus is secured by muscular and fibrous ligaments. But if muscle tone decreases, if the left lobe of the liver decreases (atrophies), or a person loses weight so much that the fatty tissue located under the diaphragm disappears, then the esophageal opening “stretches.” Because of this, the ligaments holding the esophagus weaken and the angle at which the esophagus enters the stomach increases (this causes the reflux of gastric contents upward).

The diaphragm is conventionally divided into three parts: lumbar, costal and sternal. In each of them, muscle fibers have their own direction. At the junction of these parts there are triangular sections that are quite pliable. This creates the conditions for the intestines to come out or protrude here. These are already different diaphragmatic hernias.

The structure of the diaphragm and muscles of the posterior abdominal wall.
Click on photo to enlarge.

Types and classification of hernias

There are two main types of diaphragmatic hernia: traumatic (develop under the influence of penetrating wounds and surgical interventions) and non-traumatic.

Each of this species is divided into two more subspecies:

True, when there is a hernial sac (that is, the protruding organs are wrapped in a thin film - peritoneum or pleura). This way, either a loop of intestine or a section of the stomach flowing into the duodenum, or both of them, can exit. These hernias can be strangulated.

False hernia - without a hernial sac. The gastrointestinal organs simply exit through the hole in the diaphragm muscle. This condition is possible for the esophagus or the initial parts of the stomach.

There are also non-traumatic hernias:

congenital;
neuropathic - caused by a violation of the nervous control of the diaphragm area, due to which this area is greatly relaxed;
hernias of the natural openings of the diaphragm: esophagus, aorta and vena cava.

The symptoms of various types are not very specific, allowing a diagnosis to be made only by signs. For appointment to a person proper treatment and classification is needed.

Causes of the disease

Predisposing factors to the development of hernia	Provoking factors
Diaphragm injuries	Sports and industries where you need to lift weights
Connective tissue weakness (congenital or acquired)	Pregnancy
Dystrophy of muscular-ligamentous structures	Long difficult labor
Age over 50 If at least one of these conditions is present, then diaphragmatic hernias very easily appear under the influence of provoking factors from the right column.	Chronic constipation
	Constant overeating
	Obesity
	Diseases of the stomach and intestines
	Diseases of the lungs and bronchi that cause frequent coughing
	Drinking alcohol or chemical compositions which cause burns and scarring of the esophagus

Characteristic symptoms

The symptoms of a hernia will differ depending on whether it is a traumatic hernia or not.

Symptoms also depend on:

whether the disease developed acutely (quickly),
or hernia long time penetrated from the abdominal cavity into the chest cavity (chronic course),
or the hernia has been strangulated (compressed) in the hole from which it came out.

Acute diaphragmatic hernia most often manifests itself with the following symptoms:

Chest pain that gets worse when coughing.
Heartburn (feeling of heat behind the lower part of the sternum and acidic contents in the mouth). It intensifies when lying down, when bending forward or down. Heartburn also appears if you lie down immediately after eating.
Belching with air or sour contents, which appears even during sleep and can be the cause of frequent bronchitis and pneumonia (due to food fragments entering the respiratory tract with air expelled from the stomach).
Difficulty swallowing (a “lump” appears not in the throat, but in the sternum area) of liquid food, water; It is especially acute when eating in a hurry. In this case, solid food most often goes well.
Bloating.
Constant cough.
Difficulty breathing (a person feels that he cannot “catch his breath” or that he does not have enough air).
A burning sensation behind the sternum.
Rapid heartbeat after eating.
Rumbling or "gurgling" in the chest.

If a person has developed chronic diaphragmatic hernia, he does not feel anything for a long time. Subsequently, the same symptoms develop as in the acute version.

Symptoms of a strangulated diaphragmatic hernia:

severe pain in one half of the chest (most often in the left),

loss of appetite,

bloating,

gases stop passing.

How to make a diagnosis

In order for the prescribed treatment to be adequate, it is necessary not only to make a diagnosis, but also to determine the type of hernia (which organs go through and where, whether there is a hernial sac or not). To do this, 4 examinations are prescribed:

X-ray examination of the chest and abdominal cavities. Before the procedure, you cannot eat for 6 hours, and 10–20 minutes before you need to drink a barium mixture, which you are given and asked to drink in front of the radiography room. This method allows you to monitor in real time the movement of barium through the esophagus into the stomach.

Fibrogastroscopy (FGDS) is a study in which the patient will need to swallow a special probe (tube) equipped with a camera at the end. The study is carried out on an empty stomach. Only according to FGDS, the diagnosis of “hernia” is not made, but the degree of damage to the mucous membranes of the esophagus, stomach, and duodenum by hydrochloric acid is determined; establish the fact of bleeding from the vessels of the gastrointestinal tract located in the hernial sac.

pH-metry – measurement of acidity in the stomach and esophagus. The procedure is carried out using a thin probe.

If necessary, during FGDS a biopsy of the esophageal mucosa is performed.

If the doctor suspects a strangulated diaphragmatic hernia, an X-ray of the abdominal and chest cavity without barium injection. If the diagnosis is confirmed, the patient is prepared and operated on as an emergency.

X-ray of a patient with a hiatal hernia. The arrow indicates the part of the stomach that has penetrated into the chest

Hernia treatment methods

A diaphragmatic hernia can be completely cured only through surgery, especially if the hernia is true and can be strangulated at any time. But in 4 out of 10 cases after such treatment, the hernia appears again, so surgical method rarely resorted to (2–15% of cases).

More often carried out conservative therapy(for example, due to contraindications or the patient’s disagreement with the operation).

Therapy without surgery

Conservative treatment does not cure diaphragmatic hernia, but it helps:

reduce the degree of reflux of gastric contents into the esophagus, and intestinal contents into the stomach;

reduce the acidity of gastric juice;

cure gastritis, ulcers;

start the normal direction of peristalsis (intestinal movements through which food moves).

Conservative treatment involves following a daily routine, diet and taking medications.

Diet

Meals should contain 1800–2000 kcal/day.

Six diet rules:

Eliminate simple carbohydrates(sweets, baked goods) and foods that cause fermentation (legumes, white cabbage, carbonated drinks and beer) so as not to provoke the release of swollen intestinal loops or stomach into the chest cavity.

Remove acidic foods from your diet (sour juices, pomegranates, lemons, cherries, raw apples), which can aggravate the disease and provoke the development of ulcers or erosion of the mucous membrane of the stomach or esophagus.

Avoid foods that cause excessive secretion of gastric juice or pancreatic enzymes: smoked, fried, peppered foods, dishes with spices, pickled vegetables, barbecue.

Be sure to include foods in your diet that will make your intestines work and prevent the development of constipation: boiled beets, prunes, dried fruits.

It is useful to drink 100 ml of alkaline mineral water half an hour before meals: “Borjomi”, “Slavyanskaya”, “Polyana Kvasova”, “Jermuk”.

Eat small portions, often. Never go to bed after eating.

Based on reviews from people who have used conservative treatment, they not only had to eat at least 3-4 hours before bed, but also slept only in a semi-sitting position, without leaning on pillows. To sleep, they either bought a functional bed with a headrest whose height could be changed, or placed 1–2 bricks under the legs of the bed at the head.

Medicines

Diaphragmatic hernia is treated with the following drugs:

(if the table is not completely visible, scroll to the right)

Group name	Example of a drug	What is it used for?
Anticholinergics	Atropine, platiphylline	Reduces the production of gastric juice
Antispasmodics	No-shpa, riabal, papaverine, halidor	Eliminate hypertonicity of the muscles of the stomach and intestines, reduce pain
Drugs that reduce the production of hydrochloric acid	Ranitidine, famotidine, omeprazole, nolpaza	Reduces the synthesis of hydrochloric acid in gastric juice
Enveloping	De-Nol, vikair	Prevents the destructive effect of hydrochloric acid on the cells of the stomach or esophagus
Aluminum and magnesium preparations	Almagel, phosphalugel, Maalox	Neutralizes excess gastric acidity

Surgical intervention

This treatment, although it is the only “healing hernia”, is still rarely used: in 2–15% of cases due to frequent relapses diseases. Surgery is absolutely indicated for ulcers of the esophagus that have led to either narrowing or bleeding.

Surgeons perform 3 types of operations:

Suturing the opening (hernial orifice) from which the organs emerge with special sutures, followed by strengthening it with a polypropylene mesh.

Fixation of the stomach to the anterior wall of the abdomen after “putting it in place.”

Suturing the fundus of the stomach to the wall of the esophagus.

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