Esophageal hernia: symptoms, treatment, diet, surgery

Among the most serious diseases gastrointestinal esophageal hernia occupies a leading position. For successful treatment it is necessary to make a diagnosis in a timely manner, accurate diagnosis.

The type and methods of rehabilitation are elected depending on the stage of the disease, taking into account the patient's general condition. In conjunction with the medical and surgical treatment may be a variety of recipes of traditional healing. After completing the course of treatment appointed sparing diet, limited exercise.

Causes of

As we initially noted the appearance of esophageal hernia contributes to a number of reasons. Meanwhile, as most often the factors that determine their appearance, are the following:

1. Particular type endocrinopathies;
2. Simultaneous chronic or, conversely, the systematic chronic sudden rise in pressure in the abdominal cavity. The reasons that lead to abnormal rise in pressure, is isolated blunt abdominal trauma, severe generic activity, chronic constipation, a significant exercise in which a heavy load is lifted at the same time slope, etc .;
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3. Age-related changes, provoked by certain degenerative processes, resulting in a thinning of the exposed connective ligaments;
4. The presence of chronic diseases that are directly related to the digestive system, in which the broken motility of the stomach, the gallbladder, the duodenum;
5. Bad habits, and old age - these reasons are also identified as factors that predispose to the occurrence of esophageal hernia.

Classification

Depending on the characteristics of physicians identify several species of pathologies. For each type you need individual treatment. Incorrect diagnosis leads to ineffective treatment, the appearance of opportunistic diseases.

1. Sliding (wandering) hernia. Agencies, consisting hernial protrusion are moved in different planes at each change of body position. Thus a thin sheath of connective tissue (hernial sac).
2. Paraesophageal (periesophageal) hernia. The chest cavity moves the bottom of the stomach, bowel loops and omentum.
3. Symptoms sliding and fixed pathology characteristic of the mixed hernia.
4. Congenital hernia. When congenital abnormalities short esophageal cardia gastric department is located in the sternum. The mucous membrane of the stomach is located in the distal esophagus.
5. Fixed (axial) hernia. Shifting all of the stomach or a portion thereof on a vertical axis occurs. Changing position does not affect the size of protrusion not reduce a self.

By volume is divided by the protrusion hernia grade 3:

1. Hiatal hernia is 1 degree - the stomach slightly raised in the aperture includes a small portion of the lower esophagus;
2. For grade 2 characterized cardia relatively small displacement of the diaphragm in all the sternum is lower intestinal tract;
3. In step 3 cardia, lower esophagus, stomach body bottom and create hernial protrusion.

symptoms

In 5-50% of the time data hernias completely no clinical manifestations of abnormalities detected by chance (during ultrasound, X-ray abdominal or thoracic cavity).

The main symptoms of esophageal hernia:

1. Pain - a vivid symptom of esophageal hernia. Most patients are familiar with the pain, which often manifests itself when bending and horizontal position of the body. The pain may be localized behind the breastbone, in hypochondria, abdomen, in the heart. Painful sensations are usually aching character. After the meal, they are amplified, weakened after a burp or a deep breath.
2. The most common symptom that accompanies almost all known types of the disease, is heartburn. It can disturb the patient when stooping, after eating, often worse at night. Bouts of heartburn can cause severe physical exertion, overeating or excessive drinking. Sometimes the symptom is manifested in the form of light, and does not affect the patient's health. Observed to severe heartburn, when the patient is difficult to tolerate the burning sensation in the chest. This condition can be supplemented with flatulence, nausea and a bad taste in the mouth. When the contents of the stomach is the esophagus, heartburn becomes acidic or bitter. All these manifestations are reflected on the psychological and physical health. Disturbed sleep, the patient loses appetite and efficiency (See also: The causes and symptoms of heartburn, how to get rid of heartburn?).
3. In 35% of patients with a diagnosis of "hiatal hernia" observed regurgitation. The reasons are the same: the meal, the slopes, the horizontal position. This symptom is typical for medium-sized entities and brings a lot of inconvenience. Ingoda amounts of vomit are quite large, so the patient has to be reserved and to carry special tanks to vomit.
4. To the common symptoms associated with esophageal hernia include dysphagia or swallowing disorder. This phenomenon may provoke hasty in the absorption of food is too hot (cold) drinks, neurogenic factors. Dysphagia can occur rarely, and could become permanent. Usually this is due to the addition of complications. At an exacerbation of the disease can be a complete or partial obstruction upotreblonnoy food. This symptom is usually accompanied by heartburn. When filling of the esophagus the patient simply can not swallow food. This unpleasant difficulties cause anxiety and nervousness. Over time, the discomfort increases, which can lead to rejection of food consumption and serious consequences.
5. Burp. This symptom may be caused by spasms of the alimentary canal, the active operation of the stomach and increased intra-abdominal pressure. Involuntary emission of air can occur during conversations and eating. Often the attack is accompanied by a distinctive sound and smell. Belching can be released not only the air but also the contents of the stomach. Admission spazmalgetikov used by some patients to relieve symptoms, rarely brings investment, so patients are often on their own cause belching and thus free themselves from discomfort. (See also: Causes and types of burp after a meal).

Depending on the variety of hernia clinical presentation may vary. When sliding hernial formation of esophageal diverticulum out in the hernial sac. Symptoms of the disease are manifested only when the contents of the stomach enters the esophagus. In medicine, this phenomenon define the concept of "gastroesophageal reflux disease". The patient may be concerned about heartburn and pain between the ribs, there are frequent belching and regurgitation.

complications

The disease sometimes leads to a number of complications, and it will not depend on the classification and the reasons for its origin. This can be accompanied by hernia esophageal bleeding esophageal junction in the so-called "hernial sac" or mucosa stomach, inflammation of the gastric mucosa, the shortening of the esophagus, strangulated hernia (then surgical intervention will be inevitably).

strangulated hernia of the esophagus characterized by increased pain, swelling, and low stress abdomen wall, the appearance of long-term, do not respond to anything vomiting. In such a case, the extra phrenic suturing holes to normal size after reduction of the esophagus into the abdominal cavity.

Diagnostics

The first step in detecting diaphragmatic hernia is the search for the characteristic symptoms of the patient and possible causes. Thereafter, it is necessary to proceed to a direct inspection, in which the following can detect signs of disease:

1. Palpation of the abdomen (palpation) - he becomes dense in the upper abdominal wall, because of the strong muscle tension. It is also possible the emergence of pain on palpation;
2. Inspection - esophageal hernia chest hardly moves during respiration, due to violations of the diaphragm function. If a person for a long time suffering from this disease, the stomach becomes a "sunken". This symptom can not observe an increased body weight in humans;
3. Auscultation (listening stethoscope) - diaphragmatic hernia characteristic feature is the appearance of intestinal noise in the thoracic cavity. Normal breathing sound while usually absent or significantly reduced.

These symptoms is enough to suggest the diagnosis. However, reliably confirm the presence of esophageal hernia is only possible with the help of instrumental methods of diagnosis.

therapies

How to treat oesophageal hernia, jointly decide the gastroenterologist and celiac surgeon. To compile the correct method of therapy is important appearance and features of the pathology (fixed or sliding hernia, there are no bodies of infringement).

The main treatment takes place in the home and includes four methods:

• diet
• taking medication,
• LFK,
• traditional methods.

When these complications resort to surgical intervention:

• strangulated hernia;
• bleeding;
• the introduction of one organ to another hernia;
• into the chest cavity has got a large number of bodies, and they compress the heart.

In other cases, the operation is carried out planning (implementation period is not limited, but it is recommended for a few weeks) in a specialized unit "thoracic surgery".

medication

Treatment of hiatal hernia without surgery, that is, with the help of medical exposure, justified with moderate symptoms or in advanced stages as a preparatory phase before surgery treatment.

For treatment of esophagitis hernia using 3 main groups of drugs:

• Antisecretory drugs - proton pump blockers, histamine receptors.
• Antacids.
• Prokinetic drugs action.

Gastroenterologists worldwide recognized as the gold standard in the treatment of inflammation of the esophagus and stomach use of blocking protonic channels. It omeprazole rameprazol, lansoprazole. Funds are very effective with minimal side effects. They reduce gastric aggression and contribute to the regeneration of the mucous.

Antacids are a means to an ambulance with a strong heartburn and do not require regular use. Prokinetics - metoclopramide - treat dysmotility underlying the occurrence of a hernia and peptic esophagitis. consumption rate - less than a month.

Preparation for elective surgery

Before surgery the anesthetist / surgeon detailed scans of the patient about his health, the presence of allergies, migrated in the past blood transfusions, etc. The patient is assigned to a number of studies, which will evaluate the function of major organs: general blood and urine tests, biochemical analysis of venous blood, acid-base condition, the ECG.

If necessary, the patient's condition improved somewhat (to stabilize the pressure, heart activity, breathing function, etc.). Immediately before the operation is performed purgation (if no infringement oesophageal hernia), bladder and cannulated administered medications required.

Surgery for esophageal hernia

There are different methods of surgical intervention:

1. Operation Belsen. It will occur if the hernia is large. It is performed through an incision in the sixth intercostal space, the left side of sternum. The essence of the operation in that the lower esophagus and esophageal sphincter separated fastened to the diaphragm.
2. Nissen fundoplication. One of the most common operations. It is carried out by using an open technique or laparoscopic technique. In this case, the upper third of the stomach wrap around the esophagus. This "lip" does not fall into the contents of the stomach into the esophagus.
3. Allison technique. The incision is performed in the seventh and eighth intercostal space. At the same hernial sutured.
4. Gastrokardiopeksiya. It is carried out through an incision above the umbilicus, in midline. The upper third of the esophagus and the stomach is sutured to poddiaragmalnym structures.

The goal of surgery to restore the anatomical structure of the esophagus to create an antireflux mechanism that will prevent having thrown gastric contents.

Diet

The main purpose of the diet with hiatal hernia - a struggle with heartburn. Dietary recommendations:

• It is better to eat during the day is often, in small portions.
• Avoid foods that cause heartburn, such as chocolate, onions, spicy foods, citrus fruits and tomato-based products.
• Avoid drinking alcohol.
• The last meal should be no later than 2-3 hours before bedtime.
• Maintain a healthy weight. You need to lose weight, if you are overweight or obese.
• Give up smoking.
• Raise the head end of your bed so that it was 15 cm above the foot.

Authorized products:

• Sweets - honey, jellies, jelly, dried fruits.
• Bread can be eaten only in dried form.
• Porridge should be viscous and mashed. Vegetable dishes only cooked foods.
• Spices that reduce swelling and improve digestion - caraway, dill, fennel, rosemary, thyme.
• Drinks can be special or green tea, natural sweet juices.
• Dairy products - cheese, yogurt day. Meat and fish should be steamed or boiled.

Prohibited products:

• Fried, spicy, spicy food, sweet pastries, confectionery increase the level of acidity. The same properties have citrus, sour grapes, bananas.
• From the diet is necessary to eliminate foods that trigger flatulence - cabbage, beans, whole milk, kvass, and products made from dough.
• Foods with a high content of fat and connective tissue - radish, hard fruit, meat stringy, cartilage.
• Pasta, semolina, refined rice, walnuts - foods that cause constipation.
• Marinated, salted products, too hot, and cold foods irritate the stomach.

Proper nutrition - an integral part of the complex of therapeutic measures. For the smooth passage of food you need to eat often, regularly, in small portions. The food must be soft, frayed, heat-treated.