After the diagnosis, the doctor prescribes a suitable treatment for a particular case. Two methods of patient therapy are practiced: medicamentous and surgical. The patient is prescribed a number of drugs that neutralize the increased acidity of the stomach and envelop her mucous. If such treatment does not lead to the expected results, resort to surgery.
For medicamentous treatment of diaphragmatic hernia use the following drugs:
- antacids (maalox, almagel, phosphalugel) to neutralize the excess of hydrochloric acid in the stomach.
Maalox - reduces acidity, adsorbs acid and gases, envelops mucous membranes, has a protective and analgesic effect. Produced in tablets and suspensions, packaged in sachets or bottles. Take an hour and a half after eating. One or two tablets are placed under the tongue and dissolve. The dose of the suspension is a packet or a tablespoon. Contraindicated in severe renal pathology. Possible side effects in the form of development of phosphorus deficiency;
- prokinetics (domrid, cerulek, motilium) to restore the correct direction of food movement through the digestive tract.
Domrid - exists in tablets and suspensions. Promotes increased motility of the esophagus, stomach. Antiemetic means. It is recommended for reception for 20-30 minutes before meal: 1 tablet or the dose measured by the doctor measured by the doctor three times a day. If necessary, the dose increases, but not more than 80 mg per day. Taking the drug can cause anxiety, insomnia, headache, cramps, impaired bowel movement, heart rhythm disturbance, allergies. It is not prescribed in tablets to children under 12 years of age, patients with kidney and liver disorders, with gastrointestinal disturbances;
- blockers of histamine receptors (famotidine, roxatidine, ranitidine) to reduce the production of hydrochloric acid.
Famotidine - tablets, inhibit its secretion, reduce the activity of the enzyme pepsin. Appointed individually, on an average tablet 4 times a day. May cause dizziness, dyspepsia, increased fatigue, bronchospasm, arrhythmia. Has contraindications for pregnant women, during lactation, with allergies to components;
- proton pump inhibitors (nolpase, omeprazole, contra), their effect is similar to the previous group, but with less side effects.
Nolpaz - in the form of tablets, in the morning before ingestion one tablet is swallowed whole, the course of treatment lasts 2-4 weeks. If necessary, they can assign 2 pieces. In most cases, the drug is well tolerated, but occasionally there may be nausea, excess of the norm of liver enzymes, swelling, visual impairment. Has contraindications in case of individual intolerance, neurotic dyspepsia. It is not prescribed until age 18, pregnant and lactating women due to lack of research on the effect of the drug on this category;
- bile acids (urochol, ursofalk), neutralize bile acids, thrown into the stomach.
Urochol is a drop, a herbal preparation that enhances bile secretion, which removes inflammation. Before meals, three to ten times a day, 10-20 drops drips into a small volume of water and is drunk. Up to 12 years, pregnant and lactating mothers are not recommended. Among the side effects are nausea, vomiting, allergic manifestations.
The hernia of the esophagus requires a balanced diet, saturated with vitamins, microelements. Food rich in vitamin A, promotes the production of glycoproteins, neutralizing the corrosive effect of hydrochloric acid in the gastric juice, and therefore help to eliminate heartburn. Butter, fish, liver, carrots, dark green greens contain this vitamin and will be useful for such a diagnosis.
Treatment is more effective when patients follow a diet . It has a gentle nature, the essence of it is the elimination of irritation of the mucous membrane, the removal of pressure inside the peritoneum due to the small volume of consumed food, the exclusion of coarse food. Peculiarities of nutrition are the same as in gastritis with high acidity, esophagitis: it should be frequent, small portions, so that the food can go through the digestive tract without difficulty, to digest and not to return back. Unacceptable temperature contrasts are both hot and cold food. In the diet of the patient with hernias of the esophagus, such foods are included: dried rolls and bread, mucous soups (without meat, fish, mushrooms, vegetables), cereals, pasta, milk food. Cooking should be done by boiling, baking or steaming. Use sunflower and butter, remove from the diet products with coarse fiber, enhancing the formation of gas: cabbage, mushrooms, legumes, as well as fatty foods. You can eat fresh cucumber, after removing the skin from it. What you can not eat? Alcohol, sour juices, fatty, spicy, peppery, marinades do not eat, tk. They increase acidity. Fasting with a hernia of the esophagus is not recommended.
Eating after operation of hiatal hernia
Nutrition after operation of hernia of the esophagus does not differ from the diet in other cavitary operations. Depending on the severity of the operation in the first days, it is even possible to feed through the probe. With a favorable development of events on the first day, it is permissible to drink only 1-1.5 glasses of water. The second shows the wiped food in the form of soups, puree low calorie, mucous broth rice, weak meat broth. Drink can be infusion of dogrose, kissel, mineral without gas or plain water. Then, add small portions of mashed cereal, steam amlets, soufflé from dietary scrolled meat, breadcrumbs of white bread of own production, increasing daily calorie content to 1500kcal. In the following six months it is necessary to adhere to the diet number 1, intended for patients with peptic ulcer of stomach, duodenum, gastritis with high acidity.
Daily diet menu
The diet menu for the day can be as follows:
- breakfast: milk porridge (rice, buckwheat, oatmeal, semolina), 2 boiled soft-boiled eggs, tea with milk;
- 2 breakfast: defoaming low-fat cottage cheese, sweet potato jelly;
- lunch: vegetable soup, meat steamed meatballs with mashed potatoes, baked apple;
- Afternoon snack: rose hips infusion, croutons;
- dinner: boiled fish, slimy rice garnish, tea with milk, biscuit biscuits;
- 2 hours before bedtime: a glass of warm milk.
Some recipes for cooking dietary foods:
- soup-mash: potatoes, carrots, zucchini cut into cubes, pick up cauliflower on inflorescences, add water, add salt and cook until ready. Using a blender to grind, add low-fat cream or butter, there is a warm;
- steam cutlets: chicken meat, veal (in equal parts), a few oatmeal flakes, pre-filled with milk, twist, add salt, add a raw egg and form cutlets. Cooking on steam;
- lazy vareniki: combine cottage cheese, eggs (for 0.5 kg of cottage cheese 2 eggs), sugar. Add flour until a rather thick mass is obtained. Roll out the sausage, cut with a knife into strips of 1.5 cm thick, boil in slightly salted water. There are watering with fresh, low-fat sour cream;
- baked apples: make a groove on top of the fruit, put a teaspoon of honey and bake in the oven.
Physiotherapy treatment involves hydrotherapy, the use of amplipulse, electrosleep, information-wave therapy, short-pulse electroneurostimulation. There is also a special gymnastics to strengthen and relax the muscles of the anterior abdominal wall. Exercises can be:
- lying on the right side (head and shoulders are raised relative to the trunk, on the pillow) when inhaling inflate the stomach, on exhalation to relax. In a week, pull the belly out while exhaling;
- kneeling on inspiration to lean to the sides, to exhale in the initial position;
- lying on his back, perform body twists, breathing in the air.
Alternative means of treatment of hernias most often consist in the use of medicinal herbs, helping to eliminate the main symptoms of the disease:
- when heartburn is combined the root of licorice and orange crusts, pour boiling water, allow to brew for 30 minutes, take after eating. Tea of gentian helps, infusion of flax seeds, juice from grated carrots and raw potatoes;
- with belching, they prepare an infusion of ashberry, blackberry leaves, juice from cranberry berries, honey and aloe juice;
- when the abdomen is swollen, dill water is effective (1 tablespoon of seeds per liter of boiling water, insist 3 hours, take 100g 15 minutes before meals), infusions of cumin, chamomile flowers, dandelion; brewed herbal collections of yarrow, cucumbers, St. John's wort. Another collection: peppermint, fennel fruits and valerian root;
- with constipation will help infusion of leaves of hay, buckthorn, rhubarb root, fennel, field field.
The operation is shown only in extreme cases, when either conservative treatment is ineffective, or a large hernia, or there are life-threatening complications, etc. The choice of a surgical method for solving the problem depends on the nature of the disease. Based on the reason for the formation of a hernia and its kind, the operation can consist of:
- in suturing the esophageal aperture of the diaphragm to a normal diameter of 4 cm;
- the formation of a "cuff" for the esophagus from the walls of the stomach;
- the creation of an artificial valve in the upper part of the stomach;
- strengthening the ligament between the diaphragm and esophagus.
The appearance of the laparoscopic method in the 90s of the last century made it possible to conduct surgical intervention with minimal harm to the patient's health. If the rehabilitation period after abdominal surgery is almost 3 months, then after laparoscopy the patient rises already for 2-3 days, and after 3 weeks starts to work.