Hiatal hernia without surgery. Diaphragmatic hiatal hernia: symptoms and treatment Stage 1 hiatal hernia treatment

The diaphragm is a powerful organ that consists primarily of muscles and separates the chest cavity from the abdominal cavity and is also involved in the act of breathing. In the central part of the diaphragm there are natural openings through which large vessels (aorta) and organs (esophagus) pass; it is in these places that hernias often form.

Hiatal Hernia A hiatal hernia occurs when the upper stomach, lower esophagus, or intestines move into the chest cavity. Other organs, such as the spleen, the left lobe of the liver, and the greater omentum area, can move in the same way.

A little anatomy

The diaphragm is attached to the inner surfaces of the ribs, spine and sternum. It has two domes, the central part of which consists of strong connective tissue. Directly above the domes of the diaphragm are the lungs and heart, and below them are the abdominal part of the esophagus, stomach and liver.

Schematic representation of the stomach The esophagus has the shape of a tube and connects the pharynx to the stomach, its length is about 25 cm. A small part of the esophagus lies on the neck, then it descends into the chest, located between the lungs, and then, penetrating through the esophageal opening of the diaphragm, connects to the stomach. In the abdominal cavity, the length of the esophagus is about 3-4 cm, gradually passing into the cardiac part of the stomach. It is in this place that the angle of His is formed, which is of great importance when choosing a method of surgical treatment of a hiatal hernia. The stomach is divided into the following parts:

cardiac;
fundus of the stomach;
body of the stomach;
pyloric region;
pylorus (sphincter that separates the stomach from the duodenum).

Causes of hernia development

In children, a hiatal hernia often occurs with a short esophagus, a congenital malformation in which the cardiac part of the stomach is located in the chest cavity. If this pathology is detected, surgical intervention is performed.

Hiatal hernias also develop due to other reasons, including:

age-related weakening of the ligamentous apparatus of the stomach and esophagus;
diseases associated with congenital anomalies of the ligamentous apparatus (Marfan syndrome, varicose veins of the lower extremities, diverticulosis of the sigmoid colon);
inflammatory diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, chronic gastroduodenitis, calculous cholecystitis, pancreatitis);
diseases of the esophagus (esophagitis, diverticula and burns of the esophagus, Barrett's esophagus, strictures, varicose veins of the esophagus);
traumatic damage to the diaphragm and esophagus;
prolonged increased pressure in the abdominal cavity (hard physical labor, weightlifting, continuous vomiting, prolonged constipation, flatulence, obesity, ascites, tumor diseases).

When exposed to the above factors, the esophageal opening of the diaphragm expands, as a result of which the ligamentous apparatus is stretched, and the abdominal organs move into the chest cavity.

Classification

There are 4 types of hiatal hernia:

Sliding (axial) hernia occurs when the abdominal part of the esophagus and the fundus of the stomach freely penetrate into the chest cavity. At the same time, the angle of His (formed between the esophagus and the fundus of the stomach) from 20 gradually reaches 180 degrees, and incompetence of the lower esophageal sphincter occurs. This type of hernia occurs in 85-90% of cases and is almost never strangulated.
Paraesophageal (paraesophageal) hernia occurs less frequently - in 15-10% of cases. With this hernia, the esophagus is fixed in its typical place, and the fundus of the stomach or other organs protrude freely through the esophageal opening of the diaphragm into the chest cavity. This type of diaphragmatic hernia tends to become strangulated, which requires immediate surgical intervention.
Mixed hernia combine the properties of the two previous types of hernias.
Acquired short esophagus is formed due to injuries to the abdomen and chest or inflammatory diseases in which the esophagus is affected, which leads to a shortening of its length. In this case, the stomach is pulled into the mediastinum (the space between the two lungs). This requires plastic surgery on the esophagus.

There are three stages of hiatal hernia:
Stage I. The abdominal part of the esophagus is immersed in the mediastinum, and the fundus of the stomach closely touches the diaphragm.
Stage II. The cardiac part of the stomach and the fundus of the stomach are located in the esophageal opening of the diaphragm.
Stage III. The mediastinum contains the abdominal part of the esophagus, the cardiac part, and the fundus and body of the stomach.

Symptoms

It is generally accepted that hiatal hernias exist asymptomatically for decades and can be discovered incidentally during a routine medical examination.

Among the main abdominal symptoms are:

heartburn It occurs very often and has a pronounced character; patients are disturbed by a burning sensation in the chest. This occurs more often after eating, while lying down, when bending (tying shoelaces, doing housework), and during physical activity. Heartburn is an early sign of gastroesophageal disease.
pain behind the sternum and in the epigastrium. They are associated with compression of organs that protrude through the esophageal opening of the diaphragm. These pains can be unbearable when the hernia is strangulated. They can also masquerade as heart disease (angina pectoris, myocardial infarction).
belching. This symptom is accompanied by a feeling of bitterness and acidity in the mouth.
dysphagia. Accompanied by a violation of the movement of food through the esophagus, it occurs after a rushed meal, drinking heavily, consuming spicy and fried foods.
hiccups, periodic vomiting.

Cardiac symptoms:

pain in the heart area;
tachycardia;
cough;
cyanosis of the facial skin after eating.

Having discovered 3 or more of these symptoms, the patient should consult a doctor and undergo a full course of examination to confirm or refute the presence of a hiatal hernia.

Diagnostics

Among the most effective examination methods that help to accurately diagnose a hiatal hernia are the following:

Fluoroscopy and radiography. This is an old but reliable research method that shows the relief of the internal surface of the digestive tract. The patient needs to drink a contrast barium mixture, while taking a series of x-rays in different projections, where the presence of a protrusion into the esophageal opening of the diaphragm can be detected and the stage of development of the disease can be determined. On standard photographs of the chest, you can see the gas bubble of the stomach, which is located in the chest cavity, displacement of the heart and mediastinum to the unaffected side.

Fibroesophagogastroscopy. Using a fiberscope, you can visually examine the mucous membrane of the esophagus and stomach for erosions, ulcers, strictures (scar narrowing of the organ), diverticula (a separate pocket of the esophagus) and anatomical deformities.

Ultrasound. Ultrasound examination can reveal a defect in the diaphragm, displacement of the borders of the heart and mediastinal vessels.

SKT. Computed tomography is the “gold standard” in diagnosing hiatal hernia. Using this method, it is possible to detect with sufficient clarity the size of the defect, its contents, blood supply and the relationship of the organs of the abdominal and pleural cavities.

Esophageal manometry. This method allows you to evaluate the functionality of the sphincters of the esophagus and the cardia of the stomach and the effectiveness of the treatment.

Complications

Preoperative complications of hiatal hernia include:

Reflux esophagitis is a complication and one of the first symptoms of this type of hernia

infringement. Most often, the stomach is pinched, which can cause purulent inflammation and death. Patients complain of severe pain in the upper abdomen, hiccups, heartburn, vomiting, chest pain and general weakness. In such cases, it is necessary to immediately perform an operation, free the stomach from the infringement and monitor the patient in the future.
reflux esophagitis. Often this is the very first symptom of a hernia, when the patient comes to the doctor. In this case, the patient feels heartburn after eating, exercising, and in a horizontal position.
erosions, ulcers of the esophagus and stomach. When the stomach and esophagus are in the hernial sac for a long time, these organs cease to function normally, the sphincters weaken and the acidic contents of the stomach begin to flow into the esophagus. This leads to the appearance of erosions and then ulcers of the mucous membrane, which bring pain, a feeling of acidity in the mouth and heartburn.
gastrointestinal bleeding. It often has a hidden nature and occurs against the background of ulcers and erosions of the stomach. It manifests itself as vomiting mixed with blood or in the form of “coffee grounds”, general weakness, pale skin, and sometimes loss of consciousness. This complication can be managed with conservative treatment.

Treatment of hiatal hernia

Treatment without surgery

Treatment of a hiatal hernia should begin with conservative methods, especially at stages 1-2.

It is necessary to adhere to a dietary diet, namely:

eat food 5-6 times a day in small portions;
after eating, do not lie down on the bed for 1 hour;
dinner should be 2-3 hours before bedtime;
You can eat grated fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups;
before meals, drink 1 tablespoon of sunflower or olive oil;
It is forbidden to eat fried, fatty, salty foods;
Smoking is prohibited.

When heartburn, belching, and abdominal pain begin to bother you, you can resort to drug treatment. At night, it is recommended to take drugs that reduce acidity in the stomach (omeprazole, esomeprazole), H2-histamine blockers (ranitidine, famotidine), antacids (aluminum hydroxide). Also effective are drugs that stimulate peristalsis of the stomach and esophagus, namely metoclopramide and domperidone.

Surgical treatment

A sliding hernia should be operated on only in severe clinical manifestations of reflux esophagitis that do not respond to conservative therapy. Both access from the abdomen and the chest are used.

Removal of a hernia according to Nissen Currently, operations are widely used that can eliminate reflux (reflux of stomach contents into the esophagus). One such operation is Nissen fundoplication, during which the esophageal opening of the diaphragm is narrowed with interrupted sutures. During the operation, part of the stomach is wrapped around the abdominal esophagus, sharpening the angle of His, which prevents the reflux of acidic contents. The esophageal opening of the diaphragm partially narrows, making it impossible for organs to protrude into the chest cavity. This type of operation can be performed either open or laparoscopic.

Paraesophageal hernias are characterized by strong fixation of the cardiac part of the stomach to the diaphragm, while the fundus of the stomach or intestinal loops enter the chest cavity through the dilated esophageal opening. This type of hernia is rare, but very often leads to complications - strangulation or bleeding. Therefore, such hernias are operated on much more often than sliding ones. The basic principle that surgeons adhere to is to reduce the esophageal opening and fix the fundus of the stomach to the diaphragm.

Postoperative period

For uncomplicated hernias, this period takes a total of 7-8 days.

On the first day after surgery, the patient has a tube in the stomach to remove gastric contents. The patient is given infusion therapy (injection of saline solutions into a vein), and is prohibited from drinking and, especially, eating.

On the second day, saline solutions or glucose are administered through a probe to stimulate intestinal function. The patient can sit, stand and move little by little.

On the third day, you are allowed to drink water in small quantities and only in a sitting position; the tube is removed from the stomach. From the 4th day it is allowed to eat jelly, vegetable soup, baked apples, meatballs, distributing meals over 5-6 times.

In the late postoperative period, you need to adhere to a diet, stop smoking and coffee, and limit heavy physical activity.

Hiatal hernia (HH) belongs to the category of fairly common pathologies, the risk of which increases in patients in proportion to their age.

Thus, in patients under forty years of age, they occur in 8% of cases, while in patients who have crossed the seventy-year mark, their number increases to 70%, and women are more susceptible to them.

In almost half of the patients, this pathology is completely asymptomatic and remains unrecognized. Patients can be under the supervision of a gastroenterologist for years and treated for concomitant diseases (stomach ulcer, chronic gastritis, cholecystitis) with similar clinical symptoms.

The concept of pathology

In the international classification of diseases, hiatal hernia is assigned code K44.9.

The essence of this disease is that a number of organs of the digestive tract - the abdominal section of the digestive tube, the cardiac part of the stomach and even part of the intestinal loops - change their usual location and move from the abdominal cavity to the thoracic cavity through the esophageal opening of the diaphragm.

Diaphragmatic hernia is accompanied by severe chest pain, arrhythmia, dysphagia (difficulty in passing food through the esophagus), heartburn, regurgitation (belching) and hiccups.

Classification

Based on anatomical features, hiatal hernias are divided into:

Sliding.
Paraesophageal.
Mixed. Pathologies of this type combine the manifestations of two mechanisms: paraesophageal and axial.

sliding

A sliding hernia (also called axial or axial) of the esophageal opening of the diaphragm is characterized by free movement of the abdominal portion of the esophagus (the so-called small - about two centimeters long - piece of the esophageal tube located under the diaphragm), cardia (ring-shaped sphincter located between the stomach and esophagus) and the bottom of the stomach into the chest cavity and the equally free independent return of the listed organs to the abdominal cavity.

The reason for such movements may be a normal change in body position.

Axial

Axial hiatal hernias are formed as a result of weakening of the surrounding diaphragmatic muscles.

Not being fixed, they do not appear constantly, but only under the influence of certain factors. Of primary importance are body position, degree of stomach fullness and intra-abdominal pressure.

Weakened diaphragm muscles allow the lower part of the esophageal tube and part of the stomach to slide freely both into the chest cavity and in the opposite direction. Axial hernias are the most common pathologies.

The volume and level of elevation above the diaphragm of the displaced areas allows us to divide them into:

Cardiac.
Cardiofundal. Hernias of this type are characterized by free movement of the upper stomach.
Subtotal and total gastric. With these types of hernias, either most of the stomach or its entire body appears above the level of the diaphragm.

Cardiac

With this type of pathology, only the cardiac sphincter, separating the esophagus from the stomach, slips through the esophageal opening of the diaphragm.

Of the entire mass of axial hernias, 95% of cases are due to pathologies of the cardiac type. The remaining 5% is distributed between cardiofundal, subtotal and total gastric hernias.

Paraesophageal

Cases of paraesophageal hiatal hernia are relatively rare.

Their radical difference from sliding type hernias is that the movement of the greater curvature of the stomach, its fundus, as well as part of the loops of the small or large intestine into the area of the epithelial tracheoesophageal septum occurs with a fixed position of the cardiac valve: it continues to remain under the diaphragm.

As a result of displacement, the above organs are infringed. This often results in serious mechanical complications.

As a result of the migration of the peritoneal sac surrounding the stomach into the chest, there is a gradual movement into it first of the fundus of the stomach, and then of its greater curvature. During the ascent, the greater curvature turns upward, and the lesser curvature, held by the cardiac valve, continues to maintain a lower position.

Over time, the entire stomach (along with the tissues of the parietal pleura) can move into the chest cavity. Despite the movement of the stomach and a number of abdominal organs to the chest area, fixation of the gastroesophageal junction continues to maintain its normal subphrenic position.

In very rare cases, when migration of the gastroesophageal junction into the chest cavity is observed, they speak of the presence of a mixed hernia, often accompanied by insufficiency of the cardiac sphincter (cardia).

Complications of paraesophageal hernias very often end in death, therefore, despite their asymptomatic course, patients are recommended to undergo surgical treatment before complications develop. An indication for immediate surgery is a condition when up to 68% of the stomach moves into the chest area.

Fixed

A fixed hiatal hernia is a pathology in which the cardiac part of the stomach moves to the chest area and constantly (without sliding back) remains in the area of the new localization.

This explains not the transient, but the permanent nature of the clinical symptoms accompanying this pathology.

A fixed hernia is a fairly rare, but much more dangerous (than axial hernia) form of pathology, much more often leading to complications that require immediate assistance from a qualified specialist.

A strangulated hernia usually requires surgery.

Unfixed

An unfixed hiatal hernia (also called sliding or axial) is a chronic disease in which free movement (migration) of the abdominal segment of the esophageal tube, lower esophageal sphincter and stomach from the abdominal cavity to the chest occurs through the above-mentioned opening.

Being a less complex type of disease than the pathology described above, an unfixed hernia, however, requires equally serious and immediate treatment.

Reasons for development

Cases of hiatal hernia are detected in 6% of the adult population, and half of these cases occur in people over fifty-five years of age, in whose bodies age-related changes (atrophy, dystrophic processes and loss of elasticity) have led to a significant weakening of the ligamentous apparatus that holds the esophageal tube in the correct position. position

Weakening of the ligamentous-muscular apparatus and the formation of hiatal hernias can occur under the influence of:

Anatomical features of the body formed during the period of intrauterine development of the fetus at the stage of formation of muscle structures.
Concomitant diseases caused by weakness of connective tissues. This group of ailments may include: hemorrhoids, flat feet, intestinal diverticulosis, Marfan syndrome, varicose veins. In such patients, a hiatal hernia is often accompanied by an umbilical, femoral and inguinal hernia and a preperitoneal lipoma (hernia of the white line of the abdomen).
A sharp increase in intra-abdominal pressure due to:
- flatulence;
- uncontrollable vomiting;
- abdominal dropsy – a condition accompanied by the accumulation of fluid in the abdominal cavity;
- constipation (chronic constipation);
- large tumors localized in the abdominal cavity;
- abdominal injuries;
- pregnancy;
- sharp bends;
- heavy physical activity;
- lifting an excessively heavy object at once;
- extreme obesity;
- prolonged and very severe cough that occurs in patients suffering from any nonspecific lung disease (for example, bronchial asthma or chronic obstructive bronchitis).
Dyskinesia - impaired peristalsis of the esophageal tube and other organs of the gastrointestinal tract - a phenomenon accompanying chronic gastroduodenitis, gastric and duodenal ulcers, calculous cholecystitis and chronic pancreatitis.
Longitudinal shortening of the esophageal tube, resulting from scar-inflammatory processes resulting from thermal or chemical burns, reflux esophagitis or the presence of a peptic (esophageal) ulcer.
Pathologies resulting from malformations of intrauterine development of the fetus. These include a “chest” stomach and a too short esophagus.

Symptoms

In half of patients, hiatal hernia is either asymptomatic or with a minimal set of clinical manifestations. Hernial protrusions of small sizes are asymptomatic.

As a rule, they are detected completely accidentally during diagnostic tests undertaken for other diseases.

With a hernia that has reached an impressive size, but is accompanied by normal operation of the obturator valves, the main clinical symptom is spasmodic pain emanating from the sternum area. Occurring in the stomach area, they gradually spread along the esophageal tube, in some cases radiating (spreading) between the shoulder blades or into the back.
When girdle pain appears, the hiatal hernia can masquerade as chronic pancreatitis in the acute stage.
A hiatal hernia can lead to cardialgia - pain localized in the left side of the chest and having nothing to do with pathologies of the heart muscle. A person not related to medicine may mistake them for a manifestation of angina pectoris or myocardial infarction.
In approximately a third of patients suffering from hiatal hernia, the main manifestation of this disease is the presence of an abnormal heart rhythm, reminiscent of extrasystole or paroxysmal tachycardia. Due to this symptom, patients are often given an erroneous cardiac diagnosis. All attempts to cure non-existent heart disease end in failure.

To avoid errors in diagnosing the disease, when differentiating pain, you should focus on a number of specific signs. For hiatal hernia:

the appearance of pain is observed immediately after eating, serious physical exertion, taking a horizontal position and in the presence of flatulence;
a sharp increase in pain occurs when the body is tilted forward;
Alleviation or complete disappearance of pain occurs after a change in posture, a deep breath, a few sips of water, or the appearance of a belch.

When a hernia is strangulated, very strong cramping pain occurs behind the sternum, radiating to the area of the shoulder blades and accompanied by the appearance of:

nausea;
shortness of breath;
vomiting blood;
tachycardia – a condition characterized by an increase in heart rate;
cyanosis of the mucous membranes and skin (cyanosis);
hypotension – low blood pressure.

The development of GERD - gastroesophageal reflux disease - an invariable companion of hiatal hernia provokes the emergence of a new set of clinical symptoms. The patient appears:

Belching of bile or stomach contents.
Regurgitation (regurgitation of food not preceded by nausea), occurring at night as the patient assumes a supine position. A late and very heavy dinner contributes to the occurrence of this symptom.
Air burp.

The most characteristic (pathognomonic) manifestation of hiatal hernia, which gives rise to a diagnosis, is the presence of dysphagia - a pathology characterized by all sorts of disorders that occur during the passage of a food coma through the esophageal tube.

The appearance of dysphagia is promoted by: eating too hot foods, too cold drinks, the bad habit of hastily, without chewing, swallowing food or drinking liquids, taking one large sip.

No less specific signs of hiatal hernia can be considered the presence of:

severe heartburn;
painful and persistent hiccups;
burning and pain at the root of the tongue;
hoarse voice.

Patients suffering from a hiatal hernia usually have an anemic syndrome, characterized by a combination of clinical signs (pallor of the skin, increased fatigue, tachycardia, weakness, dizziness) and laboratory indicators of anemia, indicating a low content of hemoglobin and red blood cells in the blood.

As a rule, anemia develops due to internal bleeding from the stomach and lower parts of the esophageal tube, which occurs under the influence of:

erosive gastritis;
peptic ulcers;
reflux esophagitis.

Degrees of the disease

The basis for distinguishing the degrees of hiatal hernia is the data of an x-ray examination, which allows us to judge what part of the stomach (together with the adjacent structures) is above the level of the diaphragm.

The easiest one is the first one– the degree of pathology is characterized by the transition into the chest cavity of only the abdominal part of the esophageal tube. The dimensions of the esophageal opening of the diaphragm are such that the stomach is not able to pass through it, therefore, at this stage of the pathology, the main digestive organ retains its normal physiological position.
Second degree disease is accompanied by movement into the chest cavity of not only the abdominal segment of the esophagus, but also the upper part of the stomach: it is localized at the level of the esophageal opening of the diaphragm.
For third degree illness there is a migration into the chest cavity of all organs that were previously located in the abdominal cavity - under the diaphragm. The group of these organs consists of the abdominal section of the esophageal tube, the cardiac valve and the entire stomach (its body, fundus and antral structures).

Diagnostics

A hiatal hernia can be detected by:

Plain radiography of the chest organs.
X-ray contrast diagnostic examination of the stomach and esophagus.
Esophagoscopy is an endoscopic examination of the esophageal tube, carried out using an optical apparatus - an esophagoscope.
Esophagogastroscopy is a diagnostic technique that allows you to assess the condition of the mucous membranes of the stomach and esophagus. All manipulations are performed using a flexible optical tube - a fibroesophagogastroscope.

Photo of a hiatal hernia on an x-ray

Radiological signs of hiatal hernia include:

high localization of the pharyngeal sphincter;
location of the cardiac valve above the level of the diaphragm;
movement of the subphrenic segment of the esophagus into the chest cavity;
increasing the size of the diaphragmatic opening;
retention of radiopaque substance in the structures of the hernial protrusion.

The results of endoscopic studies usually indicate:

movement of the esophagus and stomach from the subphrenic space;
the presence of symptoms of esophagitis (a disease accompanied by inflammation of the mucous membranes of the esophagus) and gastritis.

To exclude the presence of esophageal tumors, it is carried out on the mucous membranes, subjecting the tissue of the taken biopsy to morphological examination. To identify hidden bleeding from the gastrointestinal tract, the patient's stool is examined for hidden blood.

Of great importance in the diagnosis of hiatal hernia is esophageal manometry - a diagnostic technique that studies the contractile activity of the esophageal tube and the coordination of its motility with the work of the sphincters (pharyngeal and cardiac). When assessing the motor functions of the esophagus, the amplitude, duration and nature (it can be peristaltic or spastic) of its contractions are taken into account.

The results of esophageal manometry allow us to draw conclusions about how successful conservative treatment is.

To obtain data on the nature of the environment in the gastrointestinal tract, diagnostic techniques are used:

Intraesophageal and intragastric pH-metry. In the course of these studies, designed to evaluate the secretory activity of the gastrointestinal tract, the acidity of gastric juice is measured in different parts of the digestive system, and they also study the dynamics of the acid-base balance under the influence of certain medications.
Impedance measurements are studies of the functions of the stomach and esophagus, based on measurements of the impedance (resistance) that occurs between the electrodes of a special probe inserted into the upper parts of the gastrointestinal tract through the oral cavity.
Gastrocardiomonitoring is a combined electrophysiological study that combines electrocardiography (a method for recording electric fields arising during the work of the heart muscle) and measurements of the acidity of digestive juice.

Endoscopic signs

Endoscopic signs of hiatal hernia indicate the presence of:

Reduced distance from the central incisors to the cardiac sphincter.
Incomplete closure or gaping of the cardiac sphincter.
Pathological formation (called prolapse of the gastric mucosa into the esophagus) - a fold formed by the mucous membranes of the stomach and displaced towards the esophageal tube.
Gastroesophageal reflux of stomach contents.
Hiatal narrowing of the esophagus, called the “second opening” to the stomach.
Manifestations of gastritis and esophagitis.
Hernial cavity.

How to treat a hiatal hernia?

At the first stage, conservative treatment methods are used.

To eliminate the clinical manifestations of all concomitant diseases of the digestive system (gastritis, gastroesophageal reflux, ulcers, dyskinesia and erosions), an individual program of complex drug therapy is developed for each patient, including the use of:

Antacids(represented by almagel, maalox and hastal).
Proton pump inhibitors(esomeprazole, omeprazole, pantoprazole).
H2-antihistamines(most often ranitidine).
Prokinetics, improving the condition of the mucous membranes of the esophagus (ganatone, motilium, trimebutine, motilac).
B vitamins, capable of accelerating the restoration of gastric structures.

To relieve pain, patients can be prescribed non-steroidal anti-inflammatory drugs (represented by paracetamol, ibuprofen, nurofen). In some cases, taking these medications can provoke an increase in clinical manifestations characteristic of gastroenterological diseases.

To enhance the effectiveness of drug treatment, patients are recommended to:

adhere to a gentle diet;
start normalizing your weight;
during night sleep, take a semi-sitting position (thanks to the raised head of the bed);
avoid any physical activity.

Surgery

Indications for the need for surgical intervention are the presence of:

complete failure of drug treatment;
complicated forms of diaphragmatic hernia;
precancerous (also called dysplastic) changes in the mucous membranes of the esophagus.

There are quite a large number of options for surgical treatment of diaphragmatic hernias. For convenience, they are usually divided into groups, which include operations aimed at:

For suturing the hernial opening (called the hernial orifice) and strengthening the esophageal-diaphragmatic ligament. This group of surgical interventions includes crurorrhaphy (suturing the legs of the diaphragm) and repair of diaphragmatic hernia.
To restore the acute angle between the abdominal part of the esophageal tube and the fundus of the stomach. Fundoplication surgery solves such problems. During its execution, the fundus of the stomach is wrapped around the esophageal tube. The result is a cuff that prevents stomach contents from refluxing into the esophagus.
To fix the stomach. During gastropexy - this is the name of this type of surgery - the stomach is sutured to the posterior or anterior abdominal wall.
To remove a significant part of the esophagus (within healthy tissue) during its resection.

In modern clinics, preference is given to laparoscopic operations, which make it possible to permanently eliminate a diaphragmatic hernia through small (5-10 mm long) punctures in the skin. To prevent relapses, the patient's abdominal wall is strengthened using a special mesh implant.

Diet after surgery

A strict postoperative diet is recommended for eight weeks.

After this, they move on to a softer diet, which should be followed for six months. Further, the need to follow a diet and take medications, as a rule, disappears. However, the question of the possibility of returning to the previous way of eating can only be decided by the attending physician.

Treatment of esophageal hernia without surgery is carried out in 90% of cases of people developing this pathology. The disease occurs in patients with weak muscle walls or in cases of disturbances in the functioning of the stomach and intestines. The greatest danger may be a strangulated hiatal hernia, which could not be detected in a timely manner.

Symptoms of the disease

When a hiatal hernia is detected, it is necessary to pay attention to some symptoms that are uncharacteristic for this disease, and only in their absence can conservative treatment begin. You should immediately visit your doctor if you have the following symptoms:

feeling of discomfort in the diaphragmatic area;
shortness of breath and difficulty breathing;
the appearance of pain in the stomach after eating;
prolonged hiccups:
chest pain and heartburn:
tachycardia.

All of the above symptoms may indicate not only the presence of a hiatal hernia, so you need to visit a doctor who can make an accurate diagnosis. When diagnosing a non-strangulated hiatal hernia, conservative treatment can begin.

In this case, the patient does not require surgical intervention, but it should be remembered that self-medication without prior consultation with the attending physician can only worsen the situation.

How to get rid of a hiatal hernia without surgery? This is a question that concerns most patients. Treatment of an esophageal hernia consists of complex therapy, including physiotherapeutic procedures, the use of medications and traditional medicine. To the main treatment, you can also add a set of special effective exercises that can eliminate pain, normalize digestion and increase the patient’s muscle tone.

Treatment of a hiatal hernia is conventionally divided into several main stages:

Drug treatment aimed at eliminating pain.
Specialized breathing exercises that help strengthen muscles and eliminate breathing problems.
Therapeutic exercises for prevention, which improves blood circulation and increases muscle tone.
Refusal of bad habits (overeating, unhealthy diet, sleeping after eating).
The use of traditional medicine to eliminate symptoms such as heartburn, high acidity and others.
Following a special diet during which it is necessary to avoid eating certain foods. In some cases, successful treatment of a hiatal hernia depends primarily on compliance with this point.

Treatment of hiatal hernia with medications

Medicines are one of the main components of competent non-surgical hernia treatment. Tablets and special solutions can remove most of the symptoms of the disease. When this disease is detected, the attending physician usually prescribes the following medications:

medications aimed at reducing the secretion of hydrochloric acid (Famotidine, Nizatidine);
medications that bind acid, which causes irritation of the patient's gastric mucosa (Gastal, Rennie, Almagel);
drugs that reduce acid production (Omeprazole);
medications that normalize esophageal motility (Metoclopramide).

If the patient, in addition to the hiatal hernia, has other diseases of the gastrointestinal tract, then additional drug treatment may be necessary. If internal bleeding occurs, the attending physician prescribes hemostatic medications.

In any case, drug treatment is selected by a specialist individually for each individual patient.

Traditional medicine for the treatment of hiatal hernia

Drug treatment can be accompanied by the use of traditional medicine.

To eliminate heartburn, it is recommended to prepare an effective remedy from baking soda and plain water. You need to take 1 tsp. soda and dissolve it in 0.4 liters of water. This product should not be used by pregnant girls due to the high salt content.

You can prepare a medicinal solution using medicinal herbs. You need to take two parts of gooseberries and chamomile flowers, one part of mint leaves and caraway seeds. All ingredients must be placed in a blender and blended thoroughly. From the resulting slurry, take 1 tsp. and brew it with a glass of boiling water. The finished decoction should be taken in small portions throughout the day, daily until the symptoms of the disease completely disappear.

Instead of such a decoction, you can buy chamomile tea at the pharmacy and drink it instead of regular black tea every day or when a characteristic burning sensation appears in the esophagus.

Flaxseeds, coltsfoot leaves, elm bark and marshmallow root will help get rid of flatulence and discomfort by improving digestion. To prepare such a decoction you will need two parts marshmallow and coltsfoot, one part seeds and bark. All ingredients must be mixed and 1 tbsp. l. Pour 1 liter of hot boiled water into this herbal mixture. The container with the decoction must be placed in a dark place for about an hour, and then taken instead of ordinary black tea every day. Treatment should be continued until all signs of the disease disappear.

You can prepare a very effective and pleasant-tasting mint herbal tea. You need to take a few dry mint leaves and brew them with boiling water, adding a little sugar if desired. The finished tea should be drunk in small sips throughout the day and after a few days the pain in the esophagus will disappear.

Apple cider vinegar is also used to treat hiatal hernia. Under no circumstances should it be consumed in its pure form, but must be diluted with plain water (at the rate of 2 teaspoons of vinegar per 100 ml of water). It is advisable to add a little linden honey to the diluted vinegar.

Carrot seeds can soothe the walls of the esophagus. To prepare the product from them you will need to take 1 tbsp. l. ingredient and fill it with 300 ml of cool water. The container with the mixture must be placed on the fire, brought to a boil, removed from the stove and cooled slightly. The warm broth should be drunk in small sips, carefully chewing any carrot seeds that may be in it. It is advisable to use this remedy every day after the morning meal for 4 weeks.

If the disease is in the acute stage, you can eat a small handful of almonds every day.

If you have a hiatal hernia, drinking lemon juice is very beneficial. This remedy is capable of forming an alkali in the stomach, which perfectly neutralizes the negative effects of acid on the walls of the stomach. Add 1 tsp to half a glass of plain, not hot water. lemon juice and drink this liquid when heartburn occurs.

Celery juice (no more than 50 ml per day) or a small piece of it will relieve burning in the esophagus area. This remedy is perfect for girls who are expecting a baby, since many of the above recipes cannot be used by pregnant women.

Surgery can be avoided if ginger is used to treat hiatal hernia. When heartburn occurs, you should drink ginger juice, add it as a seasoning to various dishes, or chew the root in its pure form.

Natural yogurt and kefir will help get rid of the characteristic pain in the chest area and nausea, the appearance of which is provoked by a hernial sac. It will be enough to eat a couple of spoons of yogurt or drink a glass of fermented milk product when one of the symptoms appears. This method is perfect for treating hernia in pregnant women.

Despite the fact that traditional medicine recipes seem quite safe, before you start using them, you should consult with a specialist.

Special diet for hiatal hernia

A balanced diet and adherence to a special diet for a hiatal hernia are a must in the treatment of this disease. Thanks to a therapeutic diet, the patient will be able to get rid of this disease much faster.

Portions for this diet should be small, the patient should under no circumstances overeat and overload the stomach. To trick the body and feel satisfied with less food, you need to eat slowly, in small pieces, chewing the food thoroughly. One serving should be eaten within 10 minutes and then the stomach will quickly receive a signal of saturation.

It is necessary to include in the diet foods that can reduce the acidity of gastric juice. That is why it is necessary to completely exclude spicy foods from the daily menu, and also reduce the consumption of spicy, sweet, smoked and fried foods to a minimum. Such dishes provoke active production of juice, which is released into the patient’s esophagus, thereby causing inflammation.

A large accumulation of gases aggravates a hiatal hernia. If you have problems with bowel movements, it is necessary to exclude harmful foods from your diet, which include corn, carbonated water, yeast-based flour products, beans and cabbage.

Without a special diet, which a specialist will help you create, treatment for a hiatal hernia can be significantly delayed, and in some cases, the disease even begins to progress, worsening the patient’s condition every day.

Contraindications to self-treatment of hiatal hernia

If there is at least a minimal risk of complications, you cannot relieve pain arising from this disease on your own. Signs of a complicated hiatal hernia are:

severe nausea and vomiting mixed with blood and feces;
enlargement and thickening of the abdomen;
problems with bowel movements for several days;
blood in the stool;
severe pain in the chest area;
respiratory failure and tachycardia.

If any of these symptoms occur, you should immediately seek help from a doctor.

(HH, esophageal hernia) is diagnosed in approximately 1/3 of patients with gastrointestinal problems. If it is small, only conservative treatment is used, without surgery. If the size of the hernia is large, if it is strangulated, bleeding occurs, perforation occurs, severe, then the problem is eliminated exclusively with the help of surgical intervention.

Causes of hiatus hernia

The combination of many external and internal reasons leads to the emergence and development of hiatal hernia. First of all, this is a weakening of the esophageal ligaments at the point of attachment to the diaphragm, the abdominal muscles and the connective tissue around. As a result, the opening in the diaphragm is greatly enlarged compared to its normal anatomical size.

In addition, a hiatal hernia occurs in the presence of the following risk factors:

obesity;
heavy physical activity immediately after eating;
carrying unacceptable weights;
pregnancy;
chronic constipation;
abdominal injuries;
burns of the mucous membrane of the esophagus;
poor nutrition;
congenital malformations of organs, including the esophagus.

The disease is most often diagnosed in people over 50 years of age. As a result of the influence of these reasons (several or all at once), the normal anatomical location of the internal organs changes, and due to the difference in pressure in the abdominal and thoracic cavities, part of the stomach and even intestines enter through the stretched opening of the diaphragm into the chest.

As a result, a protrusion of the walls or a hiatal hernia is formed.

Hernia treatment without surgery

Despite the fact that the most effective method of treating hiatal hernia is considered to be, according to statistics, it is used only in every tenth case. As a rule, we are talking about the removal of a hiatal hernia in an advanced form, which threatens not only the health, but also the life of a person. For example, a fixed hiatal hernia is dangerous due to possible pinching, so in this case it is best to resort to a surgical method. Pronounced esophagitis with ulcers and erosions, scars and stricture of the esophagus is difficult to treat with medications.

In other cases, complex conservative treatment is used. The complex includes medication treatment, dietary nutrition, breathing exercises and exercise therapy, the formation of healthy habits and the abandonment of bad habits. And it's not just cigarettes and alcohol. This is the fight against overeating, excess weight (if such a problem exists), refusal of heavy exercise, and fast food.

Drug treatment of hiatal hernia

Treatment of a hiatal hernia with medications is necessary to relieve the patient of the main symptoms accompanying the disease. If the hernia is in the initial stage of development and is small in size, then this can be successfully done with the help of medications.

Antacid preparations based on aluminum compounds eliminate heartburn, thanks to their enveloping properties, protect the esophageal mucosa from chemical burns with acid and neutralize it. These are Phosphalugel, Almagel, Gaviscon, Maalox.

It is very important to constantly maintain normal motility of the stomach, esophagus and intestines. For this purpose, the drugs Cerucal and Motilium are used. Cerucal also relieves nausea and prevents vomiting.

To reduce the production of hydrochloric acid, drugs that inhibit the proton pump are used - inhibitors: Omeprazole, Pantoprazole, Esomeprazole and others.

If the disease is already complicated by internal bleeding, anemia due to organ compression, digestive disorders and poor absorption of iron, hemostatic and anti-anemic medications are prescribed. For pain, it is recommended to take analgesics. When duodenal contents - bile - are thrown into the esophagus, it is necessary to take specific drugs to break it down.

Before prescribing a course of medications, before issuing prescriptions, it is necessary to interview the patient about concomitant diseases, additional medications taken, and the presence of allergic reactions. The doctor should carefully consider these side effects and the combination of medications with each other. It should also be taken into account that such patients must take some medications for life.

Breathing and therapeutic exercises

A complex of breathing exercises and physical therapy helps to successfully treat a hiatal hernia. Correct, gentle, but effective exercises, developed by specialists, and the abdominal wall, increase their tone, improve blood circulation, prevent the occurrence of symptoms characteristic of the disease or eliminate existing ones.

You should do gymnastics and breathing exercises on an empty stomach or 2-3 hours after eating, so as not to intensify the discomfort or cause it with greater force.

Breathing exercises for a hiatal hernia are necessary to master diaphragmatic breathing, which helps strengthen its muscles. First, lying on your side, you learn to breathe correctly, calmly, and deeply. In this case, when you inhale, the stomach protrudes, and when you exhale, it relaxes, but does not retract. The exercise can be repeated 4-5 times within 10 minutes. The second stage of mastering diaphragmatic breathing - as you exhale, the stomach is drawn in, and the inhalation becomes stronger.

All other exercises for hiatal hernia should be performed against the background of correct, deep, but calm breathing:

turns the body from the starting position - lying on your back;
while kneeling, tilt left and right, alternately, but not sharply;
the same exercise is done standing, bending - inhale, starting position - exhale.

Training for a hiatal hernia is not carried out in case of bleeding, pain, or exacerbation of the disease. It is recommended to do physical therapy and breathing exercises under the supervision of a physical therapy doctor, in order to avoid deterioration of well-being, and to adjust the training program.

For the treatment of a hernia of the pancreas, some parts of yoga can be recommended with caution. It can also be therapeutic or supportive, without complex poses, but with proper breathing. There are even yoga exercises for pregnant women that mainly focus on breathing.

Diet food

The goal is to exclude from the patient’s diet foods and dishes that provoke negative phenomena in the gastrointestinal tract: bloating, constipation, heartburn, belching, vomiting. Conservative treatment of a hiatal hernia can only be effective in combination with proper dietary nutrition and a healthy lifestyle. Therefore, the patient should strictly follow the instructions of the gastroenterologist, which relate to food intake, its quality, quantity and composition.

The following must be excluded from the menu:

carbonated and alcoholic drinks;
spicy, fried, smoked dishes;
cabbage, legumes;
hot, spicy seasonings;
fresh milk;
sour juices;
tomatoes, grapes, apples.

Too sweet, salty, fatty foods, fresh baked goods, butter, fried vegetable oil, some fermented milk products are also excluded or severely limited in the patient’s diet. The doctor will definitely recommend 5-6 meals a day in small portions. The preferred method of cooking is steaming, boiling, stewing, baking in the oven without fat, for example, in a sleeve. The menu includes a larger number of liquid, semi-liquid, pureed dishes. Food should be warm and drinks should be at room temperature. Cold and hot are not allowed. You can eat lean meat - veal, lean pork, poultry. Slimy porridges are recommended - from buckwheat, rice, oatmeal, millet, cooked in water or skim, diluted milk.

It is not advisable to lie down for an hour immediately after eating. But if it is impossible without this, then the upper part of the body should be raised to avoid the reflux of stomach contents into the esophagus. For the same reason, moderate physical activity is needed - walking, without heavy physical exertion and bending the body after eating.

Traditional medicine recipes

Treatment of hiatal hernia without surgery using traditional medicine methods is possible only as an auxiliary treatment, along with other conservative methods. Folk remedies partially relieve symptoms and have anti-inflammatory, hemostatic, bactericidal, and restorative effects. But it is prohibited to take them without the permission of the attending physician, in order to avoid side effects or aggravation of the condition.

crush or grind flaxseed, pour boiling water overnight, strain in the morning and drink the decoction, which has an enveloping, protective effect on the mucous membrane of the esophagus and stomach;
Fresh celery juice will help get rid of heartburn, but not more than 30 g per day;
decoctions of herbs, tea from the leaves and flowers of medicinal plants - chamomile, nettle, mint, St. John's wort, coltsfoot in various combinations, with a small amount of honey relieve bloating, constipation, reduce heartburn, relieve inflammation;
dill seeds and valerian root in a decoction are good for getting rid of flatulence;
A decoction of orange peels with licorice root is considered original, but effective; it eliminates heartburn;
cranberries, aloe juice and a little honey added to tea relieve annoying belching.

In addition to the doctor’s advice on the use of certain herbs, it is also necessary to be able to correctly select medicinal herbs, prepare infusions, decoctions, and decoctions in order to preserve the medicinal properties of all ingredients. We have to admit that modern high-quality pharmaceuticals are much more reliable, more effective, and have fewer side effects than witchcraft drugs.

Conclusion

A hiatal hernia can be treated without surgery using an integrated approach to treatment. We are talking only about small protrusions without complications. Patients are afraid of surgery. But you can often do without it. This requires properly prescribed conservative treatment in combination with diet and exercise therapy. The patient is required to carefully follow all instructions and recommendations for treatment, nutrition, exercise and a healthy lifestyle.

Self-medication with such a diagnosis is unacceptable and deadly. In cases where long-term medical therapy for a hiatal hernia does not bring relief, when new symptoms and manifestations of the disease arise against its background, the doctor prescribes surgery. But this happens quite rarely. Especially if you undergo a medical examination by a gastroenterologist on time and identify a hiatal hernia at an early stage.

The information on our website is provided by qualified doctors and is for informational purposes only. Don't self-medicate! Be sure to consult a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.

The diaphragm is a large and wide muscle that separates the chest cavity from the abdominal cavity. It is, as it were, “stretched” between the sternum, ribs and lumbar vertebrae, to which it is attached. 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.

In most cases, small hiatal hernias (HHH) do not cause problems. If the hernia is large, stomach contents back up into the esophagus, causing heartburn, belching, dysphagia and chest pain.

Causes

A hiatal hernia (abbreviated as hiatal hernia) is diagnosed in approximately 5% of adults. More than half of the cases occur in old age - over 55 years old, which is due to age-related changes - in particular, the natural process of weakening of the ligamentous apparatus.

Most often, a diaphragmatic hernia develops due to the fact that the tissues whose task is to limit the esophageal opening of the diaphragm become much more elastic than necessary. Many people don’t even know that such a hernia is possible. Meanwhile, this is a fairly serious problem that requires qualified medical care.

Causes:

Abdominal and chest injuries;
Increased intra-abdominal pressure;
Attacks of prolonged coughing (asthma, chronic bronchitis);
Connective tissue diseases: Marfan syndrome, systemic scleroderma, systemic lupus erythematosus, dermatomyositis;
Asthenic physique;

Paraesophageal hernia can be congenital or acquired. A hiatal hernia in children is usually associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age.

Those at risk include those who have the following diseases:

Phlebeurysm
Obesity.

Also, the development of a hiatal hernia is predisposed by impaired motility of the digestive tract with hypermotor dyskinesia of the esophagus, accompanying duodenal and gastric ulcers, chronic gastroduodenitis, chronic pancreatitis, and calculous cholecystitis.

Symptoms of a hiatal hernia

HH is a chronic disease that affects the digestive system, which is in 3rd place among other diseases, such as the duodenum and chronic cholecystitis. A hiatal hernia is a condition in which the stomach slides upward toward the esophagus.

Symptoms of hiatal hernia:

a sign of a diaphragmatic hernia is pain, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back
chest pain can lead the patient to a cardiologist by mistake in diagnosis;
pain can occur after eating or physical stress, with intestinal tract and after a deep breath;
heartburn, burning in the throat, hiccups, attacks of nausea, vomiting, hoarseness;
cyanosis, vomiting with blood indicate strangulated hernia;
in some cases, blood pressure may increase.
At night, severe coughing attacks are observed, accompanied by suffocation, and increased salivation.

The causes of pain with a hernia of the diaphragm are compression of the nerves and vessels of the stomach when its cardiac part enters the chest cavity, the effect of the acidic contents of the intestines and stomach on the esophageal mucosa and stretching of its walls.

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.
Sometimes the pain can be tingling in nature, resembling pancreatitis.

Typical symptoms of a hiatal hernia also include:

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

Contact an ambulance immediately if:

you feel nauseous
you were vomiting
you cannot have a bowel movement or pass gas.

Types of hiatal hernia

There are the following main types of hernias: sliding food hernia (axinal) and fixed (paraesophageal) hernia.

Sliding (axial) hernia

An axial hiatal hernia is a protrusion of organs located below the diaphragm through a natural opening. In the vast majority of cases (approximately 90%) hiatal hernias are axial, or sliding.

With a sliding (axial, axial) hernia, there is free penetration of the abdominal part of the esophagus, cardia and fundus of the stomach through the esophageal opening of the diaphragm into the chest cavity and independent return (when changing body position) back into the abdominal cavity.

An axial hiatal hernia begins to develop with reduced elasticity of muscle connective tissues and weakening of their ligaments. Depending on the area being displaced, they can be cardiac, cardiofundal, subtotal or total gastric.

Axial hernia under the esophagus is characterized by different etiologies. The following etiological factors are distinguished:

Dysfunction of the digestive system
Weakness of the ligaments and other connective tissue elements
High abdominal pressure
The presence of chronic pathology of the stomach, liver, diseases of the respiratory tract, accompanied by intense cough.

Among all diseases of the digestive system, this pathology ranks third, representing serious “competition” with such pathological conditions as gastric ulcer and.

Fixed hiatal hernia

Fixed (paraesophageal) hiatal hernia is not that common. In this case, part of the stomach is pushed out through the diaphragm and remains there. As a rule, such hernias are not considered a serious disease. However, there is a risk that blood flow to the stomach may be blocked, which can cause serious damage and require immediate medical attention.

Patients with a fixed hernia may experience a symptom such as belching. It appears as a result of air entering the esophagus. Sometimes it gets there with an admixture of bile or gastric juice. In this case, the belching will have a characteristic taste and smell.

Quite often, patients with paraesophageal hernia complain of intense pain in the heart area. This is not surprising, because the pain in the thoracic region that they feel really imitates heart pain.

Degrees of hiatal hernia

It is important to remember that early diagnosis of hiatal hernia will help to avoid complications, and treatment of hiatal hernia will be more effective. In the first stages, you can do without surgery.

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 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 - a significant part of the stomach, sometimes up to its pylorus, which passes into the duodenum, moves into the chest cavity.

Complications

Complications that may occur with hiatal hernia:

A hiatal hernia may be complicated by the development of gastrointestinal bleeding. The causes of bleeding are peptic ulcers, erosions of the esophagus and stomach.
Another possible but rare complication of a hiatal hernia is strangulation and perforation of the stomach wall.
Anemia is a common complication of hiatal hernia.
is a natural and frequent complication of hiatal hernia.

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.

It is quite obvious that in the listed situations of complications of hiatal hernia, the central goal is to treat the underlying disease.

Diagnostics

To make a diagnosis of a hiatal hernia, you need to describe your complaints to the doctor in detail and undergo a series of examinations. Since this disease is sometimes asymptomatic, a hernia can be detected during a random examination for other complaints.

The diagnosis of hiatal hernia is made on the basis of specific complaints and data from instrumental research methods.

These include X-ray examination with contrast, endoscopic examination and manometry, which allows you to measure pressure in different parts of the esophagus.
Additionally, a general blood test is prescribed to exclude a potential complication of a hernia - gastrointestinal bleeding.
When, in addition to a diaphragmatic hernia, a patient has cholelithiasis, he needs to undergo an ultrasound examination of the abdominal cavity.
Since a diaphragmatic hernia is often accompanied by symptoms similar to those of heart disease, an additional electrocardiogram will have to be done.

In any case, studies are prescribed individually, taking into account the characteristics of the patient’s body and the collected medical history.

Treatment of hiatal hernia: drugs and surgery

Treatment of diaphragmatic hernia begins with conservative measures. Since in the clinic of hiatal hernia the symptoms of gastroesophageal reflux come to the fore, conservative treatment is aimed mainly at eliminating them.

Based on the pathogenetic mechanisms and clinical symptoms of the esophageal opening of the diaphragm, the following main tasks of its conservative treatment can be formulated:

reduction of the aggressive properties of gastric juice and, above all, the content of hydrochloric acid:
prevention and limitation of gastroesophageal reflux;
local medicinal effect on the inflamed mucous membrane of the esophagus, hernial part of the stomach,
reduction or elimination of esophageal and gastric:
prevention and limitation of trauma in the hernial orifice of the abdominal segment of the esophagus and the prolapsing part of the stomach.

Drugs for hiatal hernia

Your doctor may prescribe the following medications for you:

antacids to neutralize stomach acid
H2-histamine receptor blockers, which reduce acid production
Proton pump inhibitors (PPIs) are antisecretory drugs for the treatment of acid-related gastric diseases.
Medicines – proton pump inhibitors and histamine blockers (omez, omeprazole, gastrazole, ranitidine, pantoprazole).
Prokinetics to improve the condition of the mucous membrane of the stomach and esophagus, optimize their motility, relieve nausea, pain (Motilak, Motilium, metoclopramide, Ganaton, itomed, trimebutine).
B vitamins to accelerate the regeneration of stomach tissue.

As a rule, treatment of diaphragmatic hernia without surgery is 99% identical to the treatment tactics for reflux esophagitis. In fact, all actions are aimed solely at eliminating symptoms. The patient can take medications prescribed by the doctor, follow a special diet, and adhere to all the doctor’s instructions.

Surgery for hiatal hernia

Currently, surgery is the only radical and most effective way to treat hiatal hernia. It is also indicated in the absence of results from drug therapy.

Diaphragm surgery for hiatal hernias is usually planned and performed after careful examination and preparation. Emergency operations are not very often performed for complicated hernias (strangulation, perforation or bleeding from a compressed organ).

Operations for hiatal hernia are carried out in different ways. Nissen fundoplication is gaining popularity. During this operation, a cuff is made from part of the stomach wall, which is fixed around the hole where the diaphragm expanded.

Doctors operate in two ways, such as:

removal through an open abdominal incision;
laparoscopy with several small incisions and the use of an endoscope with a camera and optics.

Contraindications for surgery:

Acute infectious diseases.
Exacerbations of chronic diseases.
Heart diseases in the stage of decompensation.
Severe lung diseases with respiratory failure.
Uncompensated diabetes mellitus.
Blood diseases with clotting disorders.
Kidney and liver failure.
Pregnancy.
Oncological diseases.
Recent abdominal surgery.

In the postoperative period, antibiotics, painkillers are prescribed, and if gastrointestinal motility is impaired, prokinetics (cerucal, motilium) are prescribed. The sutures are removed on the 7th day, after which the patient is discharged from the hospital under the supervision of a gastroenterologist.

In the first months, it is necessary to significantly reduce physical activity associated with active body movements.

The most common complications after surgery to remove a hiatal hernia are:

relapse of the disease;
cuff slippage;
feeling of discomfort in the chest area;
pain;
difficulty swallowing;
inflammatory processes;
divergence of seams.

The diet after surgery should be liquid and will need to be followed for approximately 3 to 5 days. Clear liquids consist of broth, water or juice. If after 3-5 days the liquid is well tolerated, the diet will switch to a soft diet.

A soft diet consists of foods that are easy to chew and swallow such as foods softened by cooking or pureing, canned or cooked soft fruits and vegetables, or tender meats, fish and poultry. If the soft diet is tolerated for three weeks, then you can switch to a regular diet.

Diet and nutrition

You need to eat food in small portions. There should be 4-5 meals a day. After eating, it is not advisable to rest in a lying position. It's better to sit or even walk. The movement will stimulate the speedy passage of food from the stomach to other parts of the digestive system.

The diet for hiatal hernia and the menu suggest the introduction of:

yesterday's bakery products made from wheat flour;
slimy cereal soups;
sour-milk cuisine;
porridge, pasta;
meat, fish, boiled, baked, steamed;
oils of vegetable and animal origin.

It is prohibited to use seasonings and sugar in dishes for patients with a diaphragmatic hernia, as this provokes increased acidity of the gastric juice and creates a risk of injury to the esophagus.

It is necessary to adhere to a dietary diet, namely:

eat food 5-6 times a day in small portions;
after eating, do not lie down on the bed for 1 hour;
dinner should be 2-3 hours before bedtime;
You can eat grated fruits and vegetables, boiled meat and fish, cereals, jelly, vegetable soups;
before meals, drink 1 tablespoon of sunflower or olive oil;
It is forbidden to eat fried, fatty, salty foods;
Smoking is prohibited.

How to treat a hiatal hernia with folk remedies

For diaphragmatic hernia, herbal treatment against the background of traditional therapy can improve the patient’s condition as a whole and eliminate symptoms. The recipes described below accelerate the secretion of gastric juice, make food move faster through the esophagus, and also eliminate the causes of constipation.

A simple remedy is goat's milk, which should be drunk warm twice a day after meals. A single quantity is 0.5 cups.

Treatment is carried out using a decoction of aspen bark - take a large spoon of the raw material and brew 200 ml of boiling water, infuse and filter. Drink 2 large spoons up to 5 times a day before meals.
You can also use branches of young aspen and cherry. They need to be poured with a liter of boiling water and simmered over low heat for half an hour. Then let it cool and take half a glass.
No less effective, according to traditional healers, is the most common mint tea. To prepare it, simply add a few dried leaves of the plant to boiling water; you can add sugar to taste (although it is better to abstain if possible). Drink in small sips throughout the day and soon you will forget that you were tormented by pain and heartburn.
You can mix flax seed, anise fruit, marshmallow and gentian roots, and fenugreek in equal parts. The components are crushed, mixed, and a small spoon of powder is taken three times a day. It can be mixed with honey.
Chamomile decoction is a good remedy for any manifestations of diaphragmatic hernia. It not only soothes the stomach, but also helps improve digestion. An excellent remedy that can safely be called a panacea for all ills.
Calendula tea is also effective. It can be brewed with chamomile. This tea should be drunk no more than four times a day, always no earlier than an hour after meals.

People with this disease are advised to follow the following recommendations:

Patients must follow a special diet that excludes foods that cause intestinal irritation;
Take food in fractional portions every few hours;
Avoid bending the body forward, sudden changes in body position - this can cause pain in the sternum and heartburn;
Patients should not lift weights exceeding 5 kg
You should not tighten your belt too tightly or wear clothes that are tight to your stomach - this creates additional pressure in the abdominal cavity;
Avoid heavy physical activity, but at the same time regularly perform physical therapy exercises that strengthen the muscle corset and restore the tone of the diaphragm;
It is recommended to eat your last meal no later than 2.5-3 hours before going to bed;
Normalize stool - constipation and diarrhea increase intra-abdominal pressure and contribute to the formation of a hiatal hernia.
Before and after meals, it is recommended to drink a teaspoon of unrefined vegetable oil;

Prevention

In addition to the basic measures to prevent gastroenterological diseases (healthy lifestyle, avoidance of stress, proper nutrition), it is necessary to strengthen the muscular wall of the peritoneum - play sports, therapeutic exercises, and pump up the abs. Patients with a diagnosed hiatal hernia are subject to clinical observation by a gastroenterologist.

This is all about hiatal hernia (HH): what kind of disease it is, what are its symptoms, treatment features. Do not be ill!