What is a hiatal hernia (HH). Hiatal hernia (Hiatal hernia, Diaphragmatic hernia, Paraesophageal hernia)

What kind of disease is this?

Hernia hiatus diaphragm (HHP) is a chronic recurrent disease associated with displacement of the abdominal esophagus, cardia, upper stomach, and sometimes intestinal loops through the esophageal opening of the diaphragm into the chest cavity.

Hiatal hernia is a very common condition. It occurs in 5% of the entire adult population, and in 50% of patients it does not give any clinical manifestations and, therefore, is not diagnosed.

Causes:

Three groups of factors play a decisive role in the reasons for the development of hiatal hernia.
weakness of the connective tissue structures that strengthen the esophagus at the opening of the diaphragm;

upward traction of the esophagus with dyskinesias (impaired motility) of the digestive tract and diseases of the esophagus.

Weakness of the ligamentous apparatus of the esophageal opening of the diaphragm develops with increasing age of a person due to involutive (reverse development) processes, therefore, hiatal hernia is observed mainly in patients over 60 years of age.
In the connecting structures that strengthen the esophagus in the opening of the diaphragm, dystrophic changes occur, they lose elasticity and atrophy. The same situation can arise in untrained, asthenic people, as well as in people with congenital weakness of connective tissue structures (for example, flat feet, Marfan syndrome, etc.).

Due to dystrophic involutive processes in the ligamentous apparatus and tissues of the esophageal opening of the diaphragm, its significant expansion occurs, and a “hernial orifice” is formed, through which the abdominal esophagus or the adjacent part of the stomach can penetrate into the chest cavity. Promotion intra-abdominal pressure plays a huge role in the development of hiatal hernia and can be considered in some cases as immediate cause diseases.

High intra-abdominal pressure contributes to the weakening of the ligamentous apparatus and tissues of the esophageal opening of the diaphragm and the penetration of the abdominal esophagus through the hernial orifice into the chest cavity. An increase in intra-abdominal pressure is observed with pronounced flatulence, pregnancy, uncontrollable vomiting, severe and persistent cough, ascites, the presence of abdominal cavity large tumors, sudden and prolonged muscle tension of the anterior abdominal wall, severe obesity.

Dyskinesia of the digestive tract, in particular the esophagus, is widespread among the population. With hypermotor dyskinesias of the esophagus, its longitudinal contractions cause upward traction of the esophagus and can thus contribute to the development of a hiatal hernia, especially in the presence of weakness of its tissues.
Functional diseases of the esophagus are observed very often with gastric ulcer and duodenum, chronic cholecystitis, chronic pancreatitis and other diseases of the digestive system. This may be why hiatal hernias are often observed in these diseases.

The known triad is Castaing (hiatal hernia, chronic cholecystitis, duodenal ulcer) and Saint's triad (hiatal hernia, chronic cholecystitis, diverticulosis of the colon).

The traction mechanism of the formation of a hiatal hernia is important in diseases of the esophagus such as chemical and thermal ulcers of the esophagus, peptic esophageal ulcer, reflux esophagitis, etc. In this case, the esophagus is shortened as a result of a scar-inflammatory process and traction is upward.

During the development of a hiatal hernia, a sequence of penetration into the chest cavity of various parts of the esophagus and stomach is noted - first the abdominal part of the esophagus, then the cardia and then the upper part of the stomach. IN initial stages A hiatal hernia can be sliding (temporary), i.e., the transition of the abdominal part of the esophagus into the chest cavity occurs periodically, as a rule, at the moment of a sharp increase in intra-abdominal pressure. As a rule, displacement of the abdominal esophagus into the chest cavity contributes to the development of weakness of the lower esophageal sphincter and, consequently, gastroesophageal reflux and reflux esophagitis.

There is no uniform classification of hiatal hernias. The most relevant are the following. Classification based on the anatomical features of the hiatal hernia:

Types:

There are the following three types of hiatal hernia.
1. Sliding (axial, axial) hernia. It is characterized by the fact that the abdominal part of the esophagus, cardia and fundus of the stomach can freely penetrate into the chest cavity through the enlarged esophageal opening of the diaphragm and return back to the abdominal cavity (when the patient’s position changes).
2. Paraesophageal hernia. With this option, the final part of the esophagus and cardia remain under the diaphragm, but part of the fundus of the stomach penetrates into the chest cavity and is located next to the thoracic esophagus (paraesophageal).
3. Mixed version of the hernia. With a mixed hernia, a combination of axial and paraesophageal hernia is observed.

There is also a classification of hiatal hernia (HH) depending on the volume of penetration of the stomach into the chest cavity (I.L. Teger, A.A. Lipko, 1965). This classification is based on the radiological manifestations of the disease.

Degrees of hiatal hernia:

Stage 1 hiatal hernia - the abdominal section is located in the chest cavity (above the diaphragm)
esophagus, and the cardia is at the level of the diaphragm, the stomach is elevated and directly adjacent to the diaphragm.
Grade 2 hiatal hernia - the abdominal part of the esophagus is located in the chest cavity, and part of the stomach is located directly in the area of ​​the esophageal opening of the diaphragm;
Stage 3 hiatal hernia - above the diaphragm are the abdominal esophagus, cardia and part of the stomach (fundus and body, and in severe cases even the antrum).

Clinical classification:

1. Type of hernia:
fixed or non-fixed (for axial and paraesophageal hernias);
axial - esophageal, cardiofundal, subtotal and total gastric;
paraesophageal (fundic, antral);
congenital short esophagus with a “thoracic stomach” (developmental anomaly);
hernias of another type (small intestinal, omental, etc.).

2. Complications:
reflux esophagitis ( morphological characteristics- catarrhal, erosive, ulcerative);
peptic ulcer of the esophagus;
inflammatory-cicatricial stenosis and/or shortening of the esophagus (acquired shortening of the esophagus), the degree of their severity;
acute or chronic esophageal (esophageal-gastric) bleeding;
retrograde prolapse of the gastric mucosa into the esophagus;
invagination of the esophagus into the hernial part;
perforation of the esophagus;
reflex angina;
strangulation of the hernia (for paraesophageal hernias).

3. Suspected reason:
dyskinesia of the digestive tract;
increased intra-abdominal pressure;
age-related weakening of connective tissue structures, etc.

4. Mechanism of hernia occurrence:
pulsion;
traction;
mixed.

5. Concomitant diseases.

6. Severity of reflux esophagitis:
light form(weak severity of symptoms, sometimes their absence (in this case, the presence of esophagitis is determined based on X-ray data of the esophagus, esophagoscopy and targeted biopsy));
average degree severity (symptoms of the disease are clearly expressed, there is deterioration general well-being and decreased ability to work); - severe degree (pronounced symptoms of esophagitis and the addition of complications - primarily peptic structures and cicatricial shortening of the esophagus).

Symptoms of a hiatal hernia:

In approximately 50% of cases, a hiatal hernia can occur hidden with very minor signs and simply turn out to be an incidental finding during an X-ray or endoscopic examination of the esophagus and stomach. Quite often (in 30-35% of patients), heart rhythm disturbances (extrasystole, paroxysmal tachycardia) or pain in the heart area (non-coronary cardialgia) come to the fore in the symptoms of hiatal hernia, which causes diagnostic errors and unsuccessful treatment by a cardiologist.

The most characteristic clinical symptom of a hiatal hernia is pain. Most often, pain is localized in the epigastric region and spreads along the esophagus; less often, irradiation of pain to the back and interscapular region is observed. Sometimes there is girdling pain, which leads to an erroneous diagnosis of pancreatitis. In approximately 15-20% of patients, the pain is localized in the heart area and is mistaken for angina pectoris or even myocardial infarction. It should also be taken into account that a combination of hiatal hernia and coronary heart disease is possible.

It is very important in the differential diagnosis of pain arising from hiatal hernia to take into account the following circumstances:
pain most often appears after eating, especially a large meal, during physical activity, heavy lifting, coughing, flatulence, or in a horizontal position;
the pain disappears or decreases after belching, vomiting, taking a deep breath, moving to a vertical position, as well as taking alkalis and water;
the pain is rarely extremely severe, most often it is moderate and dull;
the pain intensifies when bending forward. The origin of pain during hiatal hernia is due to the following basic mechanisms:
compression of the nerve and vascular endings of the cardia and fundus of the stomach in the area of ​​the esophageal opening of the diaphragm when they penetrate into the chest cavity;
acid-peptic aggression of gastric and duodenal contents;
stretching of the walls of the esophagus with gastroesophageal reflux;
hypermotor dyskinesia of the esophagus, development of cardiospasm;
in some cases, pylorospasm develops.

If complications arise, the nature of pain during a hiatal hernia changes. So, for example, with the development of solaritis, pain in the epigastrium becomes persistent, intense, acquires a burning character, and intensifies with pressure on the projection zone solar plexus, weaken in the knee-elbow position and when bending forward. After eating, there is no significant change in the pain syndrome. With the development of perivisceritis, the pain becomes dull, aching, constant, they are localized high in the epigastrium and area xiphoid process sternum. When the hernial sac is strangulated in the hernial orifice, constant intense pain behind the sternum, sometimes tingling in nature, radiating to the interscapular area.

Also characteristic is a group of symptoms of hiatal hernia caused by cardia insufficiency, gastroesophageal reflux, and reflux esophagitis. With hiatal hernia, gastroesophageal reflux disease naturally develops; this group of symptoms includes:
belching of sour stomach contents, often mixed with bile, which creates a bitter taste in the mouth; occurs soon after eating and is often very pronounced (with a fixed cardiofundal hernia - significantly, with an unfixed cardiofundal or fixed cardiac hernia - less pronounced); belching of air is possible;
regurgitation (regurgitation) - appears after eating, usually in a horizontal position, often at night ("wet pillow symptom"), most often occurs with recently consumed food or acidic gastric contents, most typical for cardiofundal and cardiac hiatal hernias, caused by the esophagus's own contractions, it is not preceded by nausea;
dysphagia - difficulty passing food through the esophagus, may appear and disappear; characteristic of hiatal hernia is that dysphagia is most often observed when consuming liquid or semi-liquid food and is provoked by eating too hot or too hot cold water, hasty eating or traumatic factors;
retrosternal pain when swallowing food - appears when the hiatal hernia is complicated by reflux esophagitis; as esophagitis is eliminated, the pain decreases;
heartburn is one of the most common symptoms Hernia, primarily axial hernia, is observed after eating, in a horizontal position and especially often occurs at night;
hiccups - may occur in 3-4% of patients with hiatal hernia, mainly with axial hernias, characteristic feature hiccups is its duration and dependence on food intake; the origin of hiccups is explained by irritation of the phrenic nerve by the hernial sac and inflammation of the diaphragm;
burning and pain in the tongue are an infrequent symptom of a hiatal hernia, which may be caused by the reflux of gastric or duodenal contents into the oral cavity, and sometimes even into the larynx (a kind of “peptic burn” of the tongue and larynx), which causes pain in the tongue and often hoarseness of the voice;
frequent combination of hiatal hernia with respiratory pathology - tracheobronchitis, bronchial asthma, aspiration pneumonia(bronchoesophageal syndrome).

Among these manifestations, particularly important is the entry of gastric contents into Airways. As a rule, this is observed at night, during sleep, if shortly before bedtime the patient had a large dinner. An attack of persistent cough occurs, often accompanied by suffocation and chest pain. An objective examination of the patient can also reveal another characteristic symptom.

Thus, when the vault of the stomach with the air bubble in it is located in the chest cavity, a tympanic sound can be detected during percussion in the paravertebral space on the left. As the most important clinical picture It is advisable to highlight the anemic syndrome, since it often comes to the fore and masks other manifestations of the hiatal hernia. As a rule, anemia is associated with repeated hidden bleeding from the lower esophagus and stomach due to reflux esophagitis, erosive gastritis, and sometimes peptic ulcers of the lower esophagus.

Complications:

1. Chronic gastritis and ulcer of the hernial part of the stomach develops with a long-term hernial hernia. The symptoms of these complications are masked by the manifestations of the hernia itself. Kay's syndrome is known - a hiatal hernia, gastritis and an ulcer in the same part of the stomach that is located in the chest cavity.
2. Bleeding and anemia. Pronounced acute stomach bleeding observed in 12-18%, hidden - in 22-23% of cases. The causes of bleeding are peptic ulcers, erosions of the esophagus and stomach.

3. Incarceration of a hiatal hernia is the most serious complication. Symptoms of strangulation of a hiatal hernia have the following characteristics: severe cramping pain in the epigastrium and left hypochondrium (the pain is somewhat relieved in the position on the left side); nausea, vomiting with blood; shortness of breath, cyanosis, tachycardia, drop in blood pressure; bulging of the lower part of the chest, lagging behind when breathing; box sound or tympanitis and sudden weakening or absence of breathing in lower sections lungs on the affected side; sometimes the sound of intestinal peristalsis is detected; X-ray can detect a shift of the mediastinum to the healthy side.

4. Reflux esophagitis is natural and a common complication HHH.
Other complications of a hiatal hernia - retrograde prolapse of the gastric mucosa into the esophagus, intussusception of the esophagus into the hernial part - are rare and are diagnosed by fluoroscopy and endoscopy of the esophagus and stomach.

Diagnosis and differential diagnosis:
Hiatal hernias are usually easily detected by X-ray examination. At the same time, identifying small axial hernias requires mandatory examinations in the supine position. Signs of an axial hernia include: unusually high localization of the lower esophageal sphincter, location of the cardia above the esophageal opening of the diaphragm, absence of the subdiaphragmatic segment of the esophagus, the presence of folds of the gastric mucosa in the supradiaphragmatic formation, retention of barium suspension in the hernia, expansion of the esophageal opening of the diaphragm, reduction gas bubble stomach. In a paraesophageal hernia, the cardia is projected under the diaphragm, and the filling of the hernial sac with a suspension of contrast material does not come from the esophagus, as in the case of an axial hernia, but from the stomach.

During endoscopic examination axial hernia are recognized based on the displacement of the esophagogastric line and the gastric mucosa above the diaphragm. Differential diagnosis hiatal hernia is carried out with all diseases of the digestive system, manifested by pain in the epigastrium and behind the sternum, heartburn, belching, vomiting, dysphagia - with chronic gastritis, peptic ulcer, chronic pancreatitis, cholecystitis. Quite often, hiatal hernia must be differentiated from coronary heart disease (in the presence of chest pain, cardiac arrhythmias). However, we should not forget that a combination of coronary heart disease and hiatal hernia is possible and that hiatal hernia can cause its exacerbation.

Treatment of hiatal hernia:


Asymptomatic axial hiatal hernias do not require treatment. In the presence of clinical symptoms gastroesophageal reflux treatment is carried out in accordance with the guidelines adopted in the treatment of gastroesophageal reflux disease (diet, normalization of body weight, sleeping with a high headboard, antacid and antisecretory drugs, prokinetics).

Surgeries for the treatment of axial hiatal hernia are usually performed in cases where there are indications for surgical treatment gastroesophageal reflux disease. Taking into account possible development complications (bleeding, strangulation), paraesophageal hernias are subject to surgical treatment.

The diaphragm is dome-shaped. It is a natural partition separating the chest and abdominal cavities, and consists of muscle and connective tissue. The muscle bundles form an opening called the esophageal opening, through which the esophagus passes: food moves through it from the pharynx to the stomach.

The formation of a hiatal hernia occurs due to its weakening, as a result of which parts of the lower organs penetrate into the upper (thoracic) cavity.

Causes

Pathology is diagnosed in approximately 5% of adults. More than half of the cases occur in elderly age– over 55 years old, which is due to age-related changes– in particular, by the natural process of weakening the ligamentous apparatus.

In many cases, people with asthenic physique and untrained people get sick.

One reason, leading to muscle weakening and the development of a hiatal hernia, no. Many factors matter:

  1. Anatomical features that form during intrauterine development at the stage of formation of the muscular apparatus.
  2. Lifestyle - for example, heavy physical work associated with constant lifting of weights, especially if there is a natural weakness of the diaphragm muscles.
  3. A sharp increase in pressure inside the abdominal cavity creates a favorable background for the development of a hiatal hernia. It can occur as a result of a number of reasons:
  4. In essence, the disease develops due to a defect in the diaphragm, or more precisely: an increase in its opening beyond normal dimensions, as a result of which top part the stomach exits into the abdominal cavity. Weakening of muscle fibers, enlargement of the hernia gate, transition to the mediastinum of the stomach provoke disruption of the lungs and heart.
  5. The cause of the development of pathological protrusion may be a violation of peristalsis (dyskinesia) of the gastrointestinal tract - mainly the esophagus. This phenomenon often accompanies chronic diseases inflammatory in nature:
    • stomach ulcer;
    • duodenal ulcer;
    • pancreatitis;
    • gastroduodenitis;
    • cholecystitis.
  6. In extremely rare cases, a hiatal hernia appears due to the presence of embryonic developmental defects: a short esophagus or thoracic stomach.
  7. The question of the influence of alcoholic beverages and smoking on the development of the disease still remains controversial. In any case, these factors do not have a direct effect on the relaxation of the diaphragmatic muscles.

The indirect effect may be as follows: people who abuse alcohol generally tend to overeat because they are not able to adequately estimate the amount of food they consume. Gluttony is dangerous in itself, regardless of drinking alcohol.

The peculiarity of the structure of the human body is that it requires a specific period of time to process a certain amount of incoming food and transfer it to the intestines. In case of excess intake of food, the gastric chamber becomes overcrowded, and food is not processed as necessary.

Its passage into the intestines, the microflora of which is not adapted to process such a volume, leads to the transmission of a signal to the brain to slow down movement. Thus, food mass is retained in the stomach, leading to unnecessary pressure on the muscle fibers that form the diaphragm.

Classification

The disease occurs in three varieties:

  • axial hernias;
  • paraesophageal;
  • mixed.

In the vast majority of cases (approximately 90%) hiatal hernias are axial, or sliding. In this case, there is free penetration and subsequent return of the abdominal part of the esophagus, the fundic (cardiac) part of the stomach through the enlarged diaphragmatic opening into the thoracic part.

The name of such hernias is associated with the characteristics of the posterior-superior part of the cardiac region of the stomach: it is not covered by the peritoneum and, during the movement of the hernial protrusion into the mediastinum, slides off similar to the exit of the cecum or Bladder for inguinal types of hernias.

Movement occurs mainly during changes in body position. Based on the area being displaced, axial hernias are divided into:

  • cardiac;
  • cardiofundic;
  • total-ventricular;
  • subtotal ventricular.

Fixed forms are available sliding hernias, in which during a change in body position there is no self-reduction protrusions.

With the paraesophageal type, there is no change in the anatomically correct position of the terminal part of the esophagus and cardia. The fundus and greater curvature of the stomach emerge through the esophageal diaphragmatic opening. Having penetrated the thoracic part, they are located close to thoracic esophagus - in other words, paraesophageal. This group in turn, it is also divided into two subspecies:

  • fundal;
  • antral hernias.

The mixed form is characterized by a combination of sliding and paraesophageal mechanisms.

The following are also distinguished as a separate form:

  • omental hernias;
  • small intestinal;
  • gastrointestinal;
  • congenital developmental defect – short esophagus with atypical intrathoracic localization of the stomach.

Based on radiological signs and the degree of movement of the stomach into the chest, three degrees of hiatal hernia are distinguished:

First: the abdominal section of the esophagus passes into the chest cavity, the cardia is localized at the level of the diaphragm, the stomach is somewhat elevated and fits tightly with it.

Second: the abdominal part of the esophagus is displaced into the upper (thoracic) cavity, and the stomach is located in the area of ​​the diaphragmatic esophageal opening.

Third: all the structures located under the diaphragm appear in the chest cavity:

  • abdominal section of the esophagus and cardia;
  • fundus, body of the stomach;
  • antrum (in especially severe cases)

Clinical picture

The disease provokes a failure of the obturator mechanisms located at the junction of the esophagus and stomach, as a result of which the acidic contents of the gastric chamber are thrown back into the esophagus, which leads to the development of another disease - reflux esophagitis.

In approximately 50% of cases, hiatal hernia occurs without symptoms or with minimal symptoms. An asymptomatic scenario develops when the protrusion is small. In this case, it is mainly discovered during a diagnostic examination for another disease.

In the case of a large hernia, but the normal functioning of the obturator mechanisms is sufficient, the main symptom of the disease becomes pain localized in the retrosternal area.

As a rule, they occur in epigastric region, gradually spread along the esophagus, into in some cases may radiate to the back or interscapularis.

The pain syndrome may have a shingles nature - similar to pain with pancreatitis.

Quite often, cardialgia of non-coronary origin occurs - chest pain not associated with cardiac pathologies. They may be mistaken for myocardial infarction or angina.

In approximately 32% of patients with a hiatal hernia, the leading symptom is a heart rhythm disorder such as paroxysmal tachycardia or extrasystoles. Very often these symptoms cause misdiagnosis and long-term unsuccessful cardiac therapy.

Pain from a hiatal hernia can be differentiated based on the following symptoms:

  • pain appears mainly after eating, physical activity, in a horizontal position, with increased gas formation;
  • they soften or disappear after a deep breath, belching, drinking water, changing posture;
  • the pain intensifies as a result of bending forward.

Infringement of the hernial protrusion provokes the occurrence of severe pain of a cramping nature in the retrosternal region. The pain radiates to the interscapular area and may be accompanied by the following phenomena:

  • nausea;
  • bloody vomiting;
  • shortness of breath;
  • cyanosis;
  • hypotension;
  • tachycardia.

The natural transition of a diaphragmatic hernia into gastroesophageal reflux disease leads to the appearance of new symptoms caused by disturbances in the digestive processes:

  • belching stomach contents or bile;
  • belching air;
  • regurgitation of food without prior nausea;
  • In most cases, regurgitation (reverse movement of fluid) appears at night, which is facilitated by the horizontal position of the body.

A pathognomonic (unambiguously describing the disease and being the basis for diagnosis) symptom becomes dysphagia - a condition in which the normal process of passage of food mass through the esophagus is disrupted. Most often it manifests itself in the following cases:

  • when taking liquid or semi-liquid food;
  • while swallowing very hot or cold water;
  • as a result of haste while eating;
  • in the presence of psychotraumatic factors.

Typical symptoms of a hiatal hernia also include:

  • hiccups;
  • heartburn;
  • pain in the tongue, burning sensation;
  • the appearance of hoarseness.

If stomach contents enter the respiratory tract, the following may develop:

  • bronchial asthma;
  • tracheobronchitis;
  • aspiration pneumonia.

Anemic syndrome occurs quite often. It is a consequence of hidden bleeding in the lower parts of the esophagus and stomach, which can be caused by:

  • peptic ulcers of the esophagus;
  • reflux esophagitis;
  • erosive gastritis.

Symptoms of a sliding hernia

In the absence of complications, sliding hiatal hernias do not lead to the development of any clinical manifestations. The appearance of symptoms is associated with the addition of reflux esophagitis and gastroesophageal reflux.

The main complaints of patients are:

  • burning sensation behind the sternum (manifests in 90% of cases)
  • belching;
  • regurgitation;
  • heartburn;
  • pain (increases after eating).

Pain sensations are mainly localized in the left hypochondrium, epigastrium, and heart region. Such pains cannot be confused with ulcerative ones, since their occurrence is directly related to food intake and its quantity. Eating a large meal can lead to painful sensations. Taking medications to reduce stomach acidity leads to significant relief.

In half of the cases, regurgitation is observed, mainly provoked by overeating, while bitterness is felt in the larynx area.

Dysphagia in the case of sliding hernias occurs only in 10% of cases and is a late symptom. The cause of its appearance is spasms of the inflamed distal part of the esophagus. Dysphagia is characterized by periods of appearance and disappearance. As inflammatory changes progress, the frequency of its manifestations increases, as a result it becomes permanent.

Ulcerated areas of the esophagus may bleed. Such bleeding, as a rule, occurs in a latent form.

Signs of paraesophageal hernias

The manifestation of this type of hernia is largely determined by the degree of movement of internal organs into the hernial sac. Gastric or cardiopulmonary symptoms may predominate. Since paraesophageal formations lead to displacement of the stomach, the predominant signs are:

  • dysphagia;
  • epigastric pain;
  • pain behind the sternum.

With this type of hernia, strangulation of the contents of the sac often occurs, often leading to the death of the patient. Compression causes the venous outflow to stop, and then arterial blood in the hernial orifice, as a result, a clinic of true strangulation develops with its dangerous complications.

Infringement can be provoked by:

  • significant physical activity;
  • eating a lot of food;
  • falling from a height;
  • vomiting;
  • strong laughter;
  • overflow of the colon with feces.

Strangulation can occur immediately after the release of internal organs into the pleural cavity or after a certain period of time lasting from several days to several years.

In most cases, one organ is affected. This may be part of the stomach, large or small intestine. The last option is quite rare.

In case of infringement more organs, the disease occurs in a more severe form. Due to kinking or compression of the vessels, the strangulated organ often undergoes necrosis.

Diagnostics

As with any diagnosis, Special attention focuses on the clinical manifestations of the disease.

Hiatal hernias can be detected:

  • during a chest x-ray;
  • with radiography of the stomach and esophagus;
  • during endoscopic examination: gastroscopy or esophagoscopy.

Radiological symptoms of a diaphragmatic hernia include:

  • high localization of the esophageal sphincter;
  • location of the cardia above the diaphragm;
  • absence of the subdiaphragmatic portion of the esophagus;
  • increasing the diameter of the diaphragm opening;
  • retention of barium suspension in the hernia.

Through endoscopic examination are found:

  • movement of the esophagogastric line above the level of the diaphragm;
  • symptoms of gastritis, esophagitis, erosion or ulcer of the gastric mucosa.

Other diagnostic methods:

  • endoscopic biopsy of a mucosal sample, morphological study of the biopsy - carried out to exclude a tumor;
  • stool examination for occult blood - prescribed to detect latent bleeding from the gastrointestinal tract;
  • esophageal manometry makes it possible to assess the condition of the sphincters (cardiac, pharyngoesophageal), contractile activity of the esophagus on different levels(duration, nature and amplitude of contractions), the effectiveness of conservative therapy;
  • pH-metry (intraesophageal, intragastric);
  • impedancemetry;
  • gastrocardiomonitoring.

The last three methods are used to study the environment inside the gastrointestinal tract.

The video shows the diagnostic process in detail:

An esophageal hernia, the symptoms of which will be discussed in this article, or (HHH) is a violation of the position of organs in which the esophagus moves higher through a pathologically enlarged opening of the diaphragm.

The disease occurs due to weakness of the ligamentous apparatus of the diaphragm. Together with part of the esophagus, the stomach may enter the chest cavity, and, less commonly, prolapse of intestinal loops occurs. The first symptoms of a hiatal hernia do not appear immediately; the disease can be detected if it becomes complicated in the case of strangulated protrusion or due to the addition of other diseases, including reflux esophagitis.

Increased intrauterine pressure in case of overeating, pathologies of the gastrointestinal tract and during pregnancy contributes to the appearance of this disease. The cause may also be traumatic injury and the postoperative period.

What are the symptoms of a hiatal hernia (abbreviated as hiatal hernia symptoms)? Let's look at this point in detail.

Symptoms of an esophageal hernia, and they are also signs of a gastric hernia, are as follows:

  • development ;
  • burning in the chest area;
  • belching, hiccups;
  • feeling of heaviness and discomfort after eating;
  • soreness, similar to angina pectoris;
  • dysphagia;
  • constant heartburn.

What are the signs of a hiatal hernia? Symptoms arise only due to the influence of certain factors. This is food intake, injury, stressful situation And accompanying deviations. Externally, the pathology is not determined in any way, which also complicates timely diagnosis. When most of the organ leaves the abdominal cavity, symptoms of pain and a feeling of heaviness already appear. What other symptoms does a hiatal hernia have?

Discomfort increases after eating and when lying down. Severe pain with a hiatal hernia may occur in case of overeating or after severe stress, then the symptom may bother you for several hours or even days. Patients experience a disturbance in the swallowing process and develop dysphagia (when swallowing certain foods).

When the hernial sac begins to compress, the patient notices aching pain in the epigastric region. Esophageal hiatal hernia has different symptoms and constant sign there will be heartburn. It appears due to the development of reflux. The weakness of the obturator mechanism leads to the release of acidic stomach contents into the esophagus.

The walls of the organ become irritated and inflammation begins, which manifests itself as severe heartburn. For a more detailed introduction to the topic “hiatal hernia symptoms,” photos are attached.

Forms of the disease

Basic and indirect signs HH (this is a pressing issue for many) will depend on the form of the disease.

The following are distinguished: types of disease:

  • fixed and non-fixed;
  • sliding and paraesophageal;
  • congenital and acquired;
  • atypical.

Paraesophageal protrusion is characterized by the location of the cardium under the diaphragm near the esophagus.


If a sliding hernia in the esophagus, the symptoms of the pathology are associated with the fact that the protrusion does not have a hernial sac, therefore the defect moves freely from the abdominal cavity to chest. With this form, the cardia is located above the diaphragm and forms the wall of the hernial sac.

With the paraesophageal form, the risk of organ entrapment is much higher.

Associated manifestations

If there is a hiatal hernia of the esophagus, its symptoms also depend on the severity of the disease.

The nature of the pathology that determines the indirect symptoms:

In the case of an asymptomatic course of the pathology, we can talk about such a concept as endoscopic signs The hiatal hernia will tell you what the doctor will tell you. Detection of pathology is possible during instrumental diagnostics. But at the same time, indirect signs of hiatal hernia can be observed, including shortness of breath and chest discomfort.

In rare cases, a cough appears due to a hiatal hernia:

  • during an attack there is pain;
  • there is a feeling of a foreign body in the throat;
  • there is a sore throat;
  • Afterwards, a false sense of well-being occurs.

Protrusion caused by cardia insufficiency syndrome is characterized by heartburn after eating and with a sharp turn of the body. How does a hiatal hernia hurt? She herself does not hurt; only 15% of patients experience the symptom of pain.

Features of pain syndrome with hiatal hernia:

More than 60% of patients experience frequent belching. This is preceded by a feeling of fullness in the stomach. After belching, some relief occurs, the feeling of a foreign body behind the sternum goes away, but not for long.

About 30% of patients experience disruption of food passage. Typically, it is easier for a person to swallow solid food. Problems arise with foods that are too hot or cold.

Hiccups in the axial form of the pathology occur in no more than 5% of patients. A distinctive feature will be a significant duration; a person can hiccup all day or several days in a row. In severe cases, this symptom lasts for weeks.

Hiccups with hiatal hernia are not associated with food intake and do not respond in any way to treatment. This may be accompanied by inflammation of the tongue and a change in voice.


There may be indirect signs of hiatal hernia and complications:

  • inflammation of the mucous membrane or ulcerative lesion stomach;
  • anemic syndrome, internal bleeding;
  • prolapse of the gastric mucosa;
  • entry into the hernial sac of most of the esophagus.

Strangulated hiatal hernia: symptoms

The hiatal hernia itself, the symptoms of which have already been discussed, does not pose a threat to health; if you follow a diet and a regimen of gentle physical activity, it does not affect the quality of life. This disease is considered dangerous at the moment when there is a risk of strangulation of the contents of the hernial sac. It is important to immediately identify the signs of this disorder.


If a hiatal hernia is strangulated, the symptoms are:

  • pronounced pain in the chest;
  • change in skin color of the affected area;
  • strong burning in the area of ​​the esophagus;
  • difficulty swallowing;
  • the appearance of a sour taste in the mouth.

Useful video

The best way to get acquainted with the issue of hiatal hernia is the symptoms of the photo and video that are in our article.

Diagnostics

Before identifying a hiatal hernia using instrumental research methods, the doctor performs an external examination. Condition is being assessed skin, the presence is determined excess weight. The doctor collects an anamnesis of the patient’s life, taking into account dietary habits and the level of physical activity in everyday life.

When interviewing a patient, the doctor takes into account the following complaints:

Instrumental diagnostics includes the following procedures:

  1. Fibrogastroduodenoscopy. The examination is indicated to assess the underlying and concomitant diseases of the gastrointestinal tract. Pathology will be indicated by weakness of the sphincter, thickening of the Gubarev valve, decrease abdominal region esophagus.
  2. Radiography. The study is informative for fixed protrusion. Pathology will be indicated by the absence of the angle of His or its smoothness; the image also shows part of the organ that has penetrated the diaphragm.
  3. pH-metry. Acidity is determined gastric juice for the diagnosis of concomitant reflux esophagitis.
  4. Ultrasonography. It is additionally prescribed for suspected diseases of the hepatobiliary system, which may accompany a hernia of the pancreas.


Additionally, material may be collected during an endoscopic examination in order to exclude malignant process. The diagnosis is confirmed solely by the results x-ray examination with contrast.

All the most important things regarding the symptoms of a hiatal hernia have been discussed and, we hope, the reader has no questions left.

And about how it should be carried out competent treatment HHH, told.

Hiatal hernia is a common and quite dangerous diseases. Between the chest and abdominal cavities of a person there is a respiratory muscle - the diaphragm. It has the shape of a dome with several openings, through one of which the esophagus passes.

Due to the impact on the body of various external and internal factors there is a displacement of structures located in the upper abdominal cavity. The result of such changes may be the entry into the chest area of ​​parts of internal organs that are normally located under the diaphragm.

Types of hiatal hernia

A diaphragmatic hernia is a serious pathology that causes many symptoms in humans. IN medical practice The disease is usually divided into several types. Each of them has its own anatomical features and flow patterns. Hiatal hernia is classified according to several criteria.

Sliding

Sliding or, as they are also called, wandering hernias are distinguished by the absence of a hernial sac. The disease is acquired or congenital. This type of pathology has weak signs on early stages development, most often the disease is diagnosed accidentally during examination of other internal organs.

Sliding hernias are characterized by protrusion of part of the stomach into the sternum area. A characteristic feature The pathology is that with certain postures of the patient, organs that have gone beyond the diaphragm fall into place.

Fixed

Fixed (axial) hernias are similar to the previous type, but here parts of the organs do not correct themselves. That is why this type of pathology is called fixed. Often, axial hernias are a complication of vagal hernias.

Nutritional hernia axial type has big sizes. Pathology provokes symptoms that significantly reduce the patient’s quality of life.

Mixed

Symptoms of hiatal hernia mixed type It is customary to call simultaneously manifestations of fixed and sliding types of the disease.

There is a congenital type of pathology and an acquired form. A congenital hernia occurs against the background of a short esophagus with an atypical intrathoracic location of the stomach.

Causes of pathology

A hiatal hernia (HH) can occur under the influence of various provoking factors. The causes of esophageal hernia include:

  1. Increased abdominal pressure.
  2. Digestive motility disorders.
  3. Weakening of the ligaments and loss of muscle tone of the diaphragm.

Most often, the reasons described above are a consequence of anatomical aging of the body, when irreversible changes begin to occur in the tissues of the diaphragm and stomach. degenerative changes.

Factors that increase the risk of developing pathology include:

Slouching can cause hiatal hernias

Often, a hiatal hernia is diagnosed after receiving abdominal injuries, with intense physical activity on the abdominal area. The disease often occurs in pregnant women.

Main signs of the disease

Symptoms of a hiatal hernia in many cases are mild or absent altogether. This is explained by the small size of the protrusion.

Most often, the manifestation of pathology is observed in patients with large hernias. Signs of the disease include:

  • heartburn (occurs after eating);
  • pain in the sternum;
  • belching, feeling of fullness in the stomach;
  • prolonged hiccups;
  • difficulty passing food through the esophagus.

Symptoms of a hiatal hernia such as burning of the tongue (glossalgia), sour taste in the mouth, pain when bending or turning the body are often observed. Many patients complain of a feeling of a lump in the throat, increased salivation, attacks of sudden coughing, especially at night.

The appearance of hernias can provoke painful sensations in the area of ​​the heart. Such signs make it difficult to diagnose the disease, as patients mistake the pathology for cardiac disorders.


 One of the symptoms of a hiatal hernia is heartburn.

Against the background of the formation of the disease, patients are diagnosed with anemia. The disease is a consequence of hidden internal bleeding in the esophagus and upper stomach.

Diagnosis of a hiatal hernia, as well as treatment of the pathology, must be timely, since the disease can provoke many Negative consequences for human health.

Diagnostics

To provide necessary treatment hiatal hernia must be performed correct diagnosis diseases. To do this, the patient is prescribed a series of procedures to determine the size of the protrusion and associated disorders in organism.

The first stage of diagnosis is collecting anamnesis. Based on the patient’s complaints, the specialist prescribes the necessary laboratory tests and procedures. These include:

  1. Radiography.
  2. Esophagoscopy (examination of the esophagus using a bronchoesophagoscope).
  3. Biopsy of samples of mucous tissue of the esophagus.
  4. Examination of stool for the presence hidden blood.
  5. Gastrocardiomonitoring (performed to assess the environment of the gastrointestinal tract).
  6. Laboratory research urine and blood.

After taking the necessary measures, the patient is diagnosed, which allows treatment of esophageal hernias in accordance with the type of disease and the characteristics of the course of the disease.

Possible complications of the disease

A hiatal hernia often causes serious consequences for human health and life. One of the most common complications is considered to be strangulation of internal organs within the hernial sac. Incarceration causes severe pain, increased body temperature, gagging (vomiting is impossible), as well as the risk of developing tissue necrosis of the injured organ.

As a result of numerous studies, it became known that such a disease can not only carry the risk of strangulation of internal organs, but also cause functional disorders related to the functioning of the digestive organs, respiratory system, work of the heart muscle.

Complications of the disease include:


 Failure of heart rhythm with hiatal hernia
  • development of anemia;
  • internal bleeding;
  • shortening of the esophagus;
  • heart rhythm disturbances;
  • bronchial spasms;
  • acute course diseases;
  • hemoptysis;
  • the phrenic nerve is affected.

An esophageal hernia requires competent and timely treatment. Necessary measures Treatment of pathology will help to avoid complications of the disease and concomitant diseases.

Therapy methods

Symptoms and treatment of hiatal hernias are pressing issues in modern medical practice. The disease is quite common and requires immediate treatment. Used to get rid of illness A complex approach, which includes drug treatment, dieting, use special gymnastics, as well as such a radical type of therapy as hernia removal surgically.

Each treatment method is selected by a specialist based on medical history, as well as data from the methods used to diagnose the disease. Self-medication is strictly prohibited, as it can cause serious consequences for human health.

Use of medications

Treatment of a hiatal hernia with synthetic drugs is carried out to eliminate the main symptoms of the pathology.

Therapy includes the following groups of drugs:

  1. Medicines that reduce acidity (Rennie, Gaviscon, Almagel).
  2. Means that help neutralize excess of hydrochloric acid(Omeprazole, Pantoprazole).
  3. Prokinetics that help normalize gastrointestinal motility (Cisapride, Domperidone).
  4. H2 histamine receptor blockers - help reduce the secretion of hydrochloric acid (Famotidine, Ranitidine).
  5. To relieve pain, antispasmodics (Spazmalgon, No-Shpa) are prescribed.

In severe forms of the disease, additional medications may be prescribed. Anemia with internal bleeding requires the use of hemostatic agents. These include Vikasol, Dicynon.

The development of the disease with manifestations of the gag reflex and frequent release of intestinal contents requires the use of drugs that break down bile, as well as agents that reduce irritation of the mucous membrane of the digestive organs.

Diet for hiatal hernia

When answering the question of how to treat a hiatal hernia without surgery, you should pay due attention to compliance proper nutrition with the development of pathology. In addition to introducing recommended foods into your diet, as well as excluding prohibited foods, you should adhere to preventive measures aimed at eliminating complications and alleviating the patient’s condition. These include:

  1. Meals should be small, and you should never overeat.
  2. It is forbidden to eat before bedtime. The last meal should be 2-3 hours before going to bed; foods should be low-calorie and easily digestible.
  3. It is forbidden to lie down for several hours after eating. The horizontal position increases pressure on the diaphragm.
  4. It is not recommended to perform physical activity (squatting, running, bending) after eating.


If the patient has overweight doctors recommend getting rid of excess weight. Normalization of body weight can be achieved through diet and certain physical exercises.

Strictly contraindicated in case of illness alcoholic drinks. Alcohol consumption can aggravate the course of the pathology and provoke complications of the disease.

For the normal functioning of the entire digestive system and to avoid exacerbation of hiatal hernia, the patient’s diet should include foods low in fat and carbohydrates. You should avoid sour, spicy, salty foods.

Food is best prepared by boiling, stewing or baking. Permitted products include:

The principle of nutrition during illness is to eat light foods and avoid overeating.

Esophageal hernia provokes a violation normal processes digestion. To eliminate unnecessary load on digestive system, as well as to avoid complications of pathology, the following should be excluded from the diet:

  • drinks containing caffeine;
  • ice cream;
  • tea too hot;
  • pickles;
  • garlic and leeks;
  • carbonated drinks;
  • fatty types meat and fish;
  • sweet pastries, baked goods;
  • dairy products with a high percentage of fat;
  • hot sauces, ketchups, seasonings.


The diet for esophageal hernia does not have a strict framework. The patient’s diet can be varied and rich various dishes. By adhering to simple recommendations, it is possible to eliminate many of the negative consequences of the disease.

Physiotherapy

One of the methods of treating the disease is the use special exercises aimed at strengthening the muscles of the diaphragm. Physical education includes breathing exercises, and physical exercise. It is recommended to perform physical exercise on an empty stomach, 2 hours after eating.

A set of breathing exercises

To strengthen muscles and reduce the manifestations of pathology, you can perform the following complex:

  1. Lying on your right side, do a slow deep breath, while sticking out your stomach, and then gradually exhale, relaxing your abdominal muscles. Perform 2-5 approaches on the right and left sides.
  2. In a standing position, with your feet shoulder-width apart, tilt your body to the left, while taking a deep breath, then return to the starting position, exhaling slowly. Repeat the exercise on the other side.
  3. Lying on your back, perform body crunches. When turning to one side, inhale, when returning to the starting position, exhale.

All movements should be performed slowly, avoiding sudden movements. During gymnastics, you should carefully monitor your condition. If pain, dizziness or other alarming symptoms occur, exercise should be stopped immediately.

Surgical treatment of hernia

A small hiatal hernia does not require surgical intervention, treatment of uncomplicated types of pathology is carried out mainly by medication, as well as through diet and necessary preventive measures. During development severe complications, therapy is carried out through surgery.

Using various techniques, organs that extend beyond the diaphragm are reset to their natural place. Indications for surgical intervention may become a protrusion, causing tachycardia and difficulty breathing, the risk of strangulation of internal organs, ineffectiveness conservative treatment, the presence of erosions and bleeding.

Postoperative period requires careful monitoring of the patient's condition by medical personnel. Complications include recurrence of the hernia, discrepancy surgical sutures, bleeding, change in voice timbre, discomfort in the sternum.

At timely treatment disease, taking measures aimed at preventing relapse, the prognosis for recovery is quite favorable. In most cases, it is possible to get rid of the pathology without consequences for health.

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