Large hiatal hernia. Esophageal hernia

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Many people believe that a hernia is a formation that appears under the skin of the abdomen, in the groin, or even lower. Indeed, this is how the “classical” forms appear: umbilical, inguinal, femoral, hernia of the white line of the abdomen.

Each of them has a hernial sac, contents in the form of intestinal loops, as well as a hernial orifice, in which the contents can be strangulated. There is even a special branch of surgery - herniology, which studies surgical methods for the treatment of hernias, as well as various methods of plastic surgery of the hernial orifice.

But there is a hernia, the signs of which are invisible, since it is completely formed inside the body - this is a hernia of the esophageal opening of the diaphragm (abbreviated as hiatal hernia).

HHH - what is it?

photo diagram of the hiatal hernia

It is known that between the organs of the chest and the organs of the abdominal cavity there is a thoraco-abdominal barrier - the diaphragm, which is also a large respiratory muscle. When it is lowered, a vacuum occurs due to the appearance of negative pressure in the chest cavity, and inhalation occurs. When it rises, exhalation occurs.

It is interesting that men breathe through the diaphragm; they have an abdominal type of breathing. Women have mastered the chest type - they breathe due to the expansion of the intercostal spaces.

The esophagus passes through the diaphragm, and there is a special opening in it, which is called the esophagus. Normally, the diaphragmatic muscle tightly covers the esophagus, and when a bolus of food passes through it, the diaphragm “passes” it, and the opening narrows again.

If the tone of the diaphragm is low and the pressure in the abdominal cavity is high, then through this enlarged opening the esophagus and even the edge of the stomach can be “squeezed out” into the chest cavity. Thus, it is an incomplete hernia because the hernial sac is missing.

But there is a gate - this is an opening in the diaphragm, and the contents are part of the bottom of the stomach, which is sometimes called the fornix (fundus et fornix).

Causes of hiatus hernia

Despite the same location, hernias arise from various causes. The most common ones include:

Pathological changes in the ligamentous apparatus, which attaches the anastomosis between the esophagus and stomach to the opening of the diaphragm. Often this disorder occurs during the prenatal period of development;
Age-related changes. The ligaments begin to lose elasticity, just as an old shock absorber becomes stiff;
Connective tissue diseases: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
Asthenic physique;
Situations in which a sharp increase in intra-abdominal pressure occurs. These include chronic constipation, episodes of uncontrollable vomiting, heavy lifting, or inappropriately high sports loads, for example, during weightlifting;
Pregnancy, especially repeated pregnancy, and difficult spontaneous childbirth;
Abdominal and chest injuries;
Attacks of prolonged coughing (asthma, chronic bronchitis);
Chronic diseases of the esophagus that impair its motility (achalasia, diverticulosis, dyskinesia), stenosis, cicatricial deformity, for example, after burns.

Degrees of hiatal hernia

Hiatal hernia can be classified according to the degrees of development:

In the first, mildest degree, a section of the esophagus rises into the chest cavity, which is normally located in the abdominal cavity (abdominal). The size of the hole does not allow the stomach to rise up, it remains in place;
In the second degree, the upper pole of the stomach already appears in the opening;
In the third (most severe degree) a significant part of the stomach, sometimes up to its pylorus, which passes into the duodenum, moves into the chest cavity.

A grade 1 hiatal hernia, as a rule, can occur with minor symptoms or be completely asymptomatic. To normalize the situation and move the abdominal part of the esophagus into place, surgery is most often not required: conservative treatment methods are quite sufficient.

As mentioned above, signs of hiatal hernia in the first and even second degree of the disease may not be detected at all. In extreme cases, the patient experiences mild discomfort.

In total, this happens in about 50% of all cases. Of course, this is because most of them occur in a mild form of the pathological process.

If the patient has complaints, then the symptoms of the hiatal hernia most often manifest themselves as follows:

Attacks of pain occur. Most often, they accompany food intake and are painful and spasmodic in nature. They are localized in the epigastric region, but can also radiate between the shoulder blades, sometimes simulating an exacerbation of chronic pancreatitis;
In rare cases, pain is localized behind the sternum. In old age, this is very reminiscent of an attack of myocardial ischemia and therefore nitroglycerin can be prescribed, which, of course, will not help;
A characteristic symptom of this disease, especially in severe cases, is compression of the heart lining (pericardium) by protrusion of the stomach. As a result, various types of arrhythmia arise;

A hernia can be suspected if pain is associated with eating, or if it occurs after eating, or if there are episodes of increased pressure in the abdominal cavity.

The pain intensifies after straining during bowel movements, when coughing, sneezing, after attacks of nausea and vomiting, and even after taking a deep breath. A characteristic symptom of a hernia is increased pain when bending forward.

Characteristic increased pain of the hiatal hernia photo

The second group of symptoms is associated with disruption of the gastrointestinal tract. They are called symptoms of gastric dyspepsia and include:

Belching of air, sour or rotten, depending on the acidity of the gastric contents;
Feeling of heartburn, bitterness in the mouth;
Nocturnal regurgitation occurs. This is what is called regurgitation of food, especially in a horizontal position. This symptom occurs especially often if the patient goes to bed after a hearty dinner;
Dysphagia occurs - difficulty swallowing, as well as a violation of the movement of the food bolus down the esophagus. Most often, it manifests itself with “extreme” stimuli - drinking ice water, hasty swallowing, eating hot food, as well as hasty swallowing with a “big gulp”.

The third group of symptoms is associated with possible irritation of the long phrenic nerve: phrenicus appears - symptoms:

Persistent, painful hiccups, burning pain occurs at the root of the tongue, and hoarseness may occur.

Finally, with a complicated course of the hernia, inflammation develops, in which gastric juice is thrown into the esophagus: reflux develops - esophagitis. In this case, erosions and bleeding ulcers occur, and small but constant blood loss occurs.

Therefore, laboratory symptoms arise that indirectly indicate damage to the gastrointestinal tract: anemia appears, positive tests for occult blood in the feces occur.

Treatment of hiatal hernia - drugs, diet and surgery

Most patients do not need surgery, therefore, after consulting an abdominal surgeon, they return to a gastroenterologist, who treats the hiatal hernia. The main goals of therapy are:

Prevention of the development of reflux esophagitis, as the most common complication;
Relief of symptoms of inflammation of the esophageal mucosa;
Prevention of progression of the degree of hernia;
Elimination of unpleasant and painful symptoms.

The basic principles of proper therapy are adherence to the regimen, proper diet and medication.

Diet for hiatal hernia

The main thing in therapeutic nutrition is to reduce the portions entering the esophagus and provide thermal, physical, mechanical and chemical rest for the wall of the esophagus and stomach. You need to swallow in small portions, slowly. Food should not be spicy, hot, cold, or rough.

Animal fats, canned food, sausages, smoked meats, vegetables and fruits with coarse fiber, fizzy and carbonated drinks are also limited. Without going into details, we can say that the diet for a hiatal hernia and for a gastric ulcer are almost the same.

Mode

When following the regime, it is important to pay attention to the following:

Do not go to bed and do not take a horizontal position of the body earlier than 3 hours after eating, raise the head end of the bed;
Try not to cause an increase in intra-abdominal pressure. In addition to consciously limiting physical activity, for example, a laxative is prescribed to facilitate bowel movements;
Quitting bad habits - smoking and drinking alcohol.

Drug therapy and drugs

Treatment uses antispasmodics to relieve pain, antiulcer drugs, and proton pump inhibitors. With concomitant erosive gastritis, coating substances and antacids are prescribed, and, if necessary, Helicobacter pylori infection is eradicated according to existing regimens.

With concomitant digestive insufficiency, prokinetics and enzyme preparations are used to facilitate the functioning of the pancreas.

Methods of surgical correction

If conservative treatment does not give the expected effect, then the hiatal hernia is removed. Also, indications for surgery are complications in the form of bleeding, the formation of a giant ulcer, the appearance of scar structures with clinical obstruction.

The operation is a radical treatment for a hiatal hernia. In order to prevent relapses, surgeons have come up with many types of strengthening the site of the hernia defect.

For example, transthoracic esophagofundoplication is popular. During this operation, the stomach is brought down, a constant acute angle between the cardia and the vault of the stomach is restored, after which the organs are fixed with special sutures to the diaphragm.

With modern techniques, the relapse rate usually does not exceed 10%, and then with insufficient adherence to the regimen in the postoperative period.

Surgical treatment of hiatal hernia is effective in the second and third stages of the disease.

Prognosis and complications

It has already been noted that the most common complication is reflux esophagitis with hiatal hernia, treatment of which is carried out for preventive purposes in any case. Other, less common complications are:

The occurrence of ulcers of the esophagus and stomach;
Scar narrowing, or stricture;
Bleeding, both acute, requiring surgery for emergency reasons, and chronic;
Eversion of the gastric mucosa into the esophagus (intussusception).

Perforation of the esophageal wall may also occur, with an extensive ulcerative defect, as well as possible strangulation and necrosis of part of the stomach. These complications lead to the development of peritonitis and mediastinitis, with high mortality when seeking medical help late.

The prognosis in general for this disease is certainly favorable for life and for subsequent recovery, but with one condition - with timely treatment and careful compliance with all doctor’s instructions.

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 blunt trauma to the abdominal area, sudden bending, backbreaking physical labor and the 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 is giving up bad habits, a balanced diet and regular exercise.

In rare cases, the development of a hiatal hernia is caused by congenital anomalies of the upper gastrointestinal tract. Patients with a short esophagus and the so-called thoracic stomach (congenital shortening of the esophagus) are at risk.

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 of 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 through the esophagus.

With a large hiatal hernia, reflux esophagitis, or gastroesophageal reflux disease, often develops - inflammation of the walls of the esophagus caused by constant irritation of the mucous membranes by an 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 esophagus, which leads to anemic syndrome. Patients complain of weakness, headaches, fatigue and low blood pressure; Blueness of the mucous membranes and nails is often noticeable.

When the hernial sac is pinched, the pain sharply intensifies and takes on a cramping character. At the same time, signs of internal bleeding appear: nausea, vomiting with blood, cyanosis, a sharp decrease in blood pressure.

About a third of patients with a hiatal hernia have cardiac complaints - retrosternal pain radiating to the scapula and shoulder, shortness of breath and heart rhythm disturbances (paroxysmal tachycardia or extrasystole). The differential sign of a diaphragmatic hernia in this case is 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 allows us to identify reliable signs of a hiatal hernia: enlargement 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 a contrast agent is administered, 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 indicators of electrostatic resistance between the electrodes of the esophageal probe. Impedancemetry is considered the most reliable way to recognize 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 in the presence of cardiological complaints, it may be necessary to consult a cardiologist and conduct gastrocardiomonitoring - combined daily monitoring of stomach acidity and Holter ECG.

Treatment of hiatal hernia

With a small hernia, medical tactics are usually limited to pharmacotherapy of gastroesophageal reflux, aimed at relieving inflammation, normalizing pH, restoring normal motility and mucous membranes of the upper gastrointestinal tract. The therapeutic regimen includes proton pump inhibitors and histamine receptor blockers; in case of increased acidity, antacids are prescribed - aluminum and magnesium hydroxides, carbonate and magnesium oxide.

The patient must maintain a gentle daily routine, refrain from smoking and alcohol, and avoid stress and excessive physical activity. For severe chest pain, it is recommended to raise the head of the bed.

During treatment, you should adhere to diet No. 1 according to Pevzner. The eating regimen is also important: the daily diet is 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 esophageal wall, the presence of complications and concomitant diseases, various methods of surgical treatment of hiatal hernias are used:

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. Aspiration pneumonia accounts 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 sections 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 surgery, the likelihood of recurrence 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 size of the hernia is small and there is a good response to drug therapy, there is a chance of achieving a complete 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 the normal functioning of the gastrointestinal tract and limit the consumption of foods that irritate the 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.

The most favorable products for restoring the mucous membranes of the esophagus and stomach are considered to be fine-grained cereals, white rice, low-fat milk and meat, ripe sweet fruits without skins and seeds, puddings, soft-boiled eggs, steamed omelettes and boiled vegetables. The healing effect increases many times over if you stick to small portion meals and find time for walking after an 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.

Video from YouTube on the topic of the article:

The main respiratory muscle in humans is the diaphragm, located on the border between the thoracic and abdominal cavities. Due to its location, a number of organs and large vessels pass through the muscle and tendon layers, including the esophagus. In various conditions, through the existing openings, the organs of the abdominal cavity pass into the thoracic cavity, causing a number of unpleasant symptoms. Especially often, a hiatal hernia is diagnosed, associated with its movement, together with part of the stomach, outside the abdominal area.

Diaphragmatic hernia

Causes

The development of diaphragmatic hernia is associated with both congenital and acquired factors. The first group of causes includes: congenital shortening of the esophagus, in which its abdominal section and part of the stomach quietly pass into the chest cavity and cause characteristic symptoms, as well as disturbances in the development of connective and muscle tissue in the area of the openings of the diaphragm.

Hernias appear against the background of known predisposing factors; therefore, it is necessary to carefully monitor your health.

Acquired factors include both individual diseases and a number of features of a person’s lifestyle:

During the aging process, physiological weakening of the muscular and ligamentous apparatus occurs, which creates the prerequisites for the formation of hernias of various locations, including hernias of the esophageal diaphragm.
Sudden weight loss can lead to changes in the position of internal organs and reduce the degree of their fixation; this also occurs during pregnancy, due to increased intra-abdominal pressure.
Dyskinesia of the esophagus, that is, disturbances in its motor activity, predisposes to the formation of hernias.
Surgical operations on the esophagus, stomach and diaphragm can cause weakness in the musculo-ligamentous system and help increase the mobility of organs.
Traumatic injuries to the abdomen, both penetrating and non-penetrating, cause displacement of internal organs and may be associated with a violation of the integrity of the anatomical openings.

Typically, one patient has several coexisting factors that together lead to the development of a diaphragmatic hiatal hernia.

Types of hiatal hernia

Types of hiatal hernias

There are a large number of medical classifications of hiatal hernias. However, most of them are useless for the common man and are used only in medical institutions.

It is necessary to distinguish two large groups of the disease: non-traumatic and traumatic hernias. The latter arise as a result of penetrating injury or any other damage to the chest and abdominal cavities. In addition, each of these groups is divided into two more types: true and false.

A true diaphragmatic hernia is characterized by the fact that there is a formed hernial sac, consisting of abdominal organs (stomach, initial parts of the small intestine, greater omentum), which are covered with peritoneum. Such hernias can lead to such a serious complication as strangulation with the development of serious consequences for the patient’s health.
A false hernia does not have a hernial sac and is often observed when there is a violation of the localization or fixation of organs. Very often, a false hernia is associated with the entry into the chest cavity of the abdominal esophagus or the initial parts of the stomach.

In addition, all hernias are divided into two large groups according to the time of occurrence: congenital, characteristic of newborns, and acquired, appearing throughout life.

Complaints and symptoms

Symptoms of a hiatal hernia depend on the mechanism of its occurrence (traumatic or not), time of occurrence (acute or chronic), with or without strangulation.

In the acute occurrence of an uncomplicated hiatal hernia, the following symptoms appear:

Pain behind the sternum, aggravated by any muscle tension and coughing.

One of the manifestations of the disease is chest pain

Heartburn and a feeling of discomfort in the lower part of the chest, which is associated with the reflux of gastric juice into the esophagus. Heartburn becomes more intense after eating and when the patient is lying down.
Sour belching is typical for all patients with hiatal hernia, and is associated with the entry of gastric juice into the oral cavity. Patients especially often experience a sour taste after sleep.
Swallowing problems, sensation of a “lump” behind the sternum when drinking water or eating liquid food. In this case, solid food easily passes through the esophagus and does not cause these symptoms.
Due to the disruption of the movement of the food bolus, bloating and flatulence may occur.
Patients complain of cough associated with compression of the lungs by the hernial sac.
In case of large hernias, patients complain of shortness of breath, difficulty breathing and other symptoms of damage to the respiratory system.
After eating, palpitations or “fluttering” of the heart are felt.
There may be rumbling or “gurgling” in the chest.

In case of chronic diaphragmatic hernia, the patient does not experience any discomfort and does not complain for a long time. However, as the disease progresses, the symptoms described above appear.

One of the most serious complications of any hernia is strangulation of the hernial sac in a modified anatomical opening. The following symptoms appear:

Severe pain occurs in the chest, usually on the left, which can be incorrectly interpreted as an attack of angina or a developing myocardial infarction.
There is nausea, possibly with vomiting.
Abdominal bloating develops with the development of intestinal obstruction.

If a strangulated hernia is suspected, the patient requires urgent hospitalization

The development of infringement requires immediate hospitalization and medical care in a medical hospital.

Diagnosis of hernias

The initial diagnosis can be made based on a survey of the patient and his external, physical examination. A hiatal hernia can be suspected based on:

Inspection - the participation of half of the chest in the act of breathing decreases, which is associated with compression of the lung by the protruded abdominal organs as part of the hernial sac.
Palpation of the abdomen - in the upper sections there is muscle tension and pain when pressing on the abdominal wall.
Auscultation (listening) - rumbling and “gurgling” characteristic of the intestines can be clearly heard in the chest cavity.

To confirm the diagnosis, additional examination methods are used:

X-ray examination of the chest. The most accessible, but uninformative research method. Allows you to detect a picture of “intestinal loops” with fluid levels that is uncharacteristic for the chest. In addition, you can notice a displacement of the heart and other mediastinal organs to the side.
X-ray examination using a contrast agent can detect a hiatal hernia in most cases. The contrast agent (barium sulfate) is given to the patient to drink and serial images are taken at certain intervals. Detection of contrast in the chest cavity, outside the anatomical location of the esophagus, allows us to identify the fact of a diaphragmatic hernia.

Barium is used as a contrast agent for fluoroscopy of the esophagus.

An ultrasound examination may reveal the presence of loops of intestine or stomach in the chest cavity. The method is easy to perform and does not require any special preparations on the part of the patient or doctor.
Computed tomography and magnetic resonance imaging make it possible to visualize the organs of the thoracic and abdominal cavity layer by layer and identify various anomalies in their location, including hernias.

Only the attending physician should prescribe diagnostic measures and determine treatment tactics.

Treatment methods

The formation of esophageal hernias in the openings of the diaphragm requires surgical treatment, since the available medical methods cannot provide recovery, but only temporarily remove the existing symptoms. Early surgery after diagnosing a hernia is the key to a positive course of the postoperative period and reducing the risk of relapses and various complications. As a rule, such surgical treatment is performed routinely after a thorough examination of the patient and preoperative preparation.

During the operation, the abdominal organs are returned “to their place”, as well as plastic surgery of the esophageal opening of the diaphragm. The last point is the most important, as it allows you to avoid repeated relapses.

In addition to surgical treatment, it is very important to change the patient’s lifestyle and prescribe auxiliary medications.

Lifestyle and diet

Any patient with a diaphragmatic hernia of the esophagus, as a rule, also has a number of concomitant diseases of the digestive tract, such as peptic ulcer of the stomach and duodenum, gastroesophageal reflux disease and reflux esophagitis. These conditions that worsen the course of a hiatal hernia require correction. For this purpose, the patient is given the following recommendations:

Eliminate from your diet all foods that can linger in the stomach for a long time or lead to increased gas formation: legumes, fatty foods, cabbage, mushrooms.
Remove from food all foods that increase the acidity of gastric juice, that is, spicy and fried foods, coffee, strong tea, herbs and spices.
Completely stop drinking alcohol and smoking.

Use of Medicines

In addition to changing lifestyle and diet, all patients are prescribed medications that help reduce the acidity of gastric juice and protect the mucous membranes of the esophagus and stomach. Such means include:

Antacids (Almagel, Maalox), covering the mucous membrane with a thin protective layer and ensuring the neutralization of hydrochloric acid in the gastric juice.
Proton pump inhibitors (Omez, Rabeprazole) and H2-histamine receptor blockers (Ranitidine) reduce the acidity level and aggressiveness of gastric juice by reducing the production of hydrochloric acid.
Prokinetics (Ondansetron, Domperidone) facilitate the passage of food through the esophagus and stomach, preventing their stretching and the formation of a hernial sac.

Drugs for conservative treatment of hiatal hernia

Complex therapy of diaphragmatic hernia is the key to successful treatment and full recovery.

Hiatal hernias are very common, and in most cases they occur for a long time without any obvious symptoms. Therefore, the appearance of any complaints about the functioning of the upper digestive system (heartburn, difficulty swallowing, chest pain) should be accompanied by seeking medical help from your doctor. Early diagnosis and adequate treatment can quickly get rid of all symptoms and prevent their reappearance in the future.

Hiatal hernia is a common condition among older people. The pathology is characterized by a change in the anatomical location of some organs in the abdominal cavity. The functioning of the ligamentous apparatus located in the opening of the esophagus is disrupted when the diaphragm expands. As a result, organs are displaced. Is it possible to treat a hiatal hernia without surgery?

Basic therapy methods

Many experts believe that in most cases, hiatal hernia can be treated without surgery. Only one in ten patients requires surgery. As for other cases, to eliminate the disease, you can resort to conservative methods of therapy, which include:

use of a certain number of medications;
performing physical therapy and gymnastics for the respiratory system;
compliance with dietary nutrition;
maintaining a healthy lifestyle.

This complex of therapeutic measures allows you to get rid of the disease and significantly alleviate the patient’s condition.

What is drug therapy?

Treatment of a hiatal hernia without surgery involves taking a certain number of synthetic drugs. Their main purpose is to eliminate symptoms of the disease (for example, belching, heartburn, pain and discomfort in the chest) after eating food. Therefore, the patient may be prescribed:

Antacid drugs, for example, Almagel, Rennie, Maalox, Gastal, etc. Such medications bind hydrochloric acid, which is part of the gastric juice. It is this that irritates the esophageal mucosa and leads to its damage.
Proton pump inhibitors. These include the drugs "Esomeprazole", "Pantoprazole", "Omeprazole". Medicines of this type can reduce the production of hydrochloric acid in the stomach.
Prokinetics, for example, Cisapride, Domperidone, Metoclopramide. The drugs help normalize the motility of the esophageal canal. This, in turn, prevents stomach contents from refluxing into the esophagus.
H2-blockers of histamine receptors. Such drugs include Roxatidine, Nizatidine, Famotidine, Cimetidine, Ranitidine. Medicinal compositions can reduce the secretion of acid, as well as reduce its entry into the gastric juice.

Therapy for complications

Is it possible to treat a hiatal hernia without surgery in case of complications? In this case, therapy is accompanied by additional recommendations from specialists:

If a patient experiences chronic blood loss, the risk of developing iron deficiency anemia increases. In this case, the doctor may prescribe antianemic and hemostatic agents.
If the contents of the duodenum are regularly thrown into the esophagus, then taking ursodeoxycholic acid is recommended. Preparations based on it reduce irritation on the mucous membranes of the gastrointestinal tract.
If the esophagus is narrowed, long-acting antacid medications, as well as local anti-inflammatory drugs, can be prescribed.
If other gastrointestinal diseases of a chronic nature have been diagnosed, then therapy should first of all be aimed at eliminating them.

In order for the listed methods of treating a hiatal hernia to give a positive result, it is worth informing the attending physician about the presence of any chronic diseases. This is due to the body’s reaction to some synthetic medications. In certain cases, it may be necessary to select analogues with few side effects.

Breathing gymnastics

Treating a hiatal hernia at home may not be limited to just taking medications. With this disease, it is recommended to carry out breathing exercises. Exercises should be performed 3 hours after eating. The whole complex of such gymnastics:

Lie on your side. The legs should be 15 cm below the head. Inhale, protruding your stomach as much as possible, and then exhale, relaxing and not retracting your stomach. The exercise should be performed in 4 sets of 10 minutes each. At the same time, each time the breath should become deeper. After a week of training, the exercise can be complicated by drawing in the abdomen as you exhale. The number of approaches does not change.
Get on your knees and carefully bend in both directions. In this case, you should follow the breathing technique. When bending, inhale, and when returning to the starting position, exhale. Then perform the exercise while standing on your feet.
Lie on your back and make turns in both directions, while observing the rules of breathing.

If you constantly perform the listed exercises, after several months of training you will be able to improve your condition. You can supplement this treatment for a hiatal hernia with the most effective folk remedies, after consulting with a specialist.

The use of physical therapy

Traditional treatment for hiatal hernia is not only the use of decoctions and infusions. This disease requires therapeutic exercises. This method is also approved by traditional medicine. It is recommended to perform gymnastics on an empty stomach, about 40 minutes before eating.

Set of exercises

Lie on your back with your upper torso on a raised surface, such as a pillow. Place your index and middle fingers under the ribs of the midline of the abdomen on both sides. Initially, the skin should be shifted upward towards the head, to the right side. As you exhale, gently plunge your fingers deep into the abdominal cavity. Move the stomach with extension movements down and to the left. Repeat the exercise up to 6 times. If you did everything correctly, the pulling sensation in the throat area will decrease and the pain will decrease.

Sit and take a pose so that a slight bend forms in the thoracic spine. The exercise should be performed in a relaxed state. Place the fingertips of both hands under the costal arches so that they touch each other through the skin and are positioned horizontally. In this case, 2 to 5 should be parallel to the midline of your body. As you inhale, move the skin with your thumbs towards the head, and as you exhale, apply pressure towards your back and legs for 7 seconds. Do the exercise 3-6 times.

Nutrition rules

How is a hiatus hernia treated without surgery? Treatment with diet for this disease is of particular importance. Compliance with all the rules will not only alleviate the patient’s condition, but also speed up the recovery process.

First of all, strict adherence to the diet is recommended. You should not completely satisfy your hunger in one meal. This leads to increased stress on the stomach. To trick your brain, eat slowly, in small portions, spreading the meal out over 10 minutes. This time is enough to send a signal that the body is full. You can eat a lot in 10 minutes if you eat quickly. This is not recommended. A full stomach will cause discomfort and lead to pain.

What products are prohibited

Symptoms of a hiatal hernia and treatment with folk remedies or traditional methods are interrelated. After all, the concentration of hydrochloric acid in the stomach can be reduced or increased. The patient's diet depends on this indicator. In any case, with this disease, you should give up sweet, smoked, spicy, hot and fried foods. Such food can provoke an increase in the concentration of hydrochloric acid in the gastric juice, which will be thrown into the esophagus. As a result, the soft tissues of the gastrointestinal tract will be irritated, which will lead to an inflammatory process.

A hiatal hernia is also aggravated by the accumulation of a large amount of gas in case of constipation. Therefore, if you are ill, it is not recommended to consume yeast, legumes, soda, corn and cabbage, with the exception of cabbage juice.

It is worth noting that without a diet correctly prepared by a doctor, the patient’s condition can become worse and worse every day. The negative consequences of thoughtless eating can result in serious complications requiring surgical intervention.