Signs of a hernia of the esophagus

Diseases of the digestive system in our time have reached such a prevalence that they are usually spoken about as often as about a cold or allergy. At the same time, mainly stomach and intestinal diseases are taken into account, and we forget about such an important organ as the esophagus - the muscular tube, through which food comes from the oral cavity into the stomach. It would seem that something threatens her, except that it is too sharp or sour food, which passes in passing. Nevertheless, for some reasons, even in the area of this organ, a hernia can form which, if untreated, can develop into cancer or cause inflammation in the stomach. It is difficult to insure against this pathology, therefore it is useful to know the symptoms of a hernia of the esophagus to help doctors in time to help stop the development of the disease and its complications.

What is the hernia of the esophagus?

Before we start to consider the symptoms of the disease, we briefly mention what a hernia of the esophagus is and what are the causes of its appearance. Our body is a strictly structured system where each organ has its own place, and any changes in location are considered pathologies (congenital or acquired). The abdominal and thoracic cavities have a common border along which the muscular plate, called the diaphragm, lies.

The stomach and almost all other digestive organs, except for the upper part of the esophagus, are under the diaphragm. And in order for food through the esophageal tube to get into the lumen of the stomach, a small diameter hole is provided in the muscular plate.

The lower part of the esophagus, just like the stomach or intestine, is under the muscular plate, and normally never protrudes into the thoracic region. If, in the thoracic region above the diaphragm, the lower part of the esophagus is found, some parts of the stomach or even the intestine speak of a hernia. The diagnosis may sound like a "hernia of the esophagus" or "hernia of the esophageal opening of the diaphragm".

The causes of this pathology can be covered both in the developmental defects of the child in the prenatal period (shortened esophagus or the so-called "thoracic" stomach) and in the age-related changes in the tonus of the ligamentous apparatus, which should not allow organ displacement (the disease most often affects people over the age of 50-60 years). But the displacement of organs even with a healthy ligamentous apparatus can cause increased intra-abdominal pressure. The cause of increased pressure in the abdominal cavity may be pregnancy, chronic flatulence or a severe bloating due to the intense secretion of gases in the intestines, trauma and extensive tumor processes.

Displacement of the gastrointestinal organs relative to the diaphragm can also be caused by certain pathologies accompanied by indomitable vomiting or severe painful cough (for example, food poisoning or obstructive bronchitis). Chronic inflammatory and ulcerative diseases of the digestive tract are often characterized by a decrease in the peristalsis of certain structures of the digestive system, and dyskinesia is considered a risk factor for the formation of a hernia, i.e. Displacement of organs with respect to their normal position.

The improper arrangement of the organs, due to which the process of digestion of food is disturbed, and the contents of the stomach can enter the esophagus, causes the symptoms of the hernia of the esophagus, characteristic of the pathology. If the size of the hernia is small, then it can not bring any special discomfort to a person. In this case we are talking about the asymptomatic course of the disease. But with an increase in the hernia there are also unpleasant sensations, which we will discuss in more detail in the next section.

How does the hiatal hernia manifest itself?

Out of the abdominal cavity through the gap in the diaphragm can act and the distal part of the esophagus, and cardiac parts of the stomach, and sometimes even loops of the intestine. It is clear that in these cases, not only the appearance and size of the hernia, but also its symptoms will differ. With a slight protrusion of the lower part of the esophagus, symptoms can not be observed at all, because in the process of digestion such a pathology does not affect in any way.

But if the stomach or intestines begin to protrude through the opening in the diaphragm into the chest cavity, the symptoms will not slow to appear. After all, gastric juice, bile and other digestive enzymes in this case can be thrown back into the esophagus, as in reflux disease. But this body is not designed to contact with such irritating factors, because it does not have special protection. Regular casting of corrosive substances worsens the condition of its walls, causing pain and other unpleasant symptoms.

First, the sphincter of the stomach suffers, which ceases to perform its functions and passes the contents of the stomach back into the esophagus, and then the irritation of the esophagus walls with gastric enzymes causes their inflammation. Gradually the inflammatory process can spread to other organs of the digestive system.

Pain and their nature. Since there is irritation of the walls of the esophagus, and later of the stomach, a person begins to experience pain. How does the hernia of the esophagus hurt? Pain syndrome depends on the type and size of the hernia. If the hernia is small (esophageal or cardiac, when only the lower part of the esophagus or a small part of the upper, cardiac part of the stomach appears in the sternum), there may be no pain at all, as well as other symptoms of pathology. In this case, the disease is detected accidentally during fibroadastroscopy or ultrasound, followed by monitoring the behavior of the hernia.

If the hernia is of considerable size, but the sphincter of the stomach is still functioning normally and does not allow the food to be thrown back into the esophagus, the patient will be tormented by aching pains that, after eating, can become stronger. Relief comes in connection with a deep breath or the passage of air from the gastrointestinal tract (belching).

If the locking mechanisms at the border of the esophagus and stomach are affected, and reflux is observed (the syndrome of cardia deficiency is diagnosed), the pain becomes acute, burning. They are directly dependent on the food intake and the position of the patient's body. The pain becomes stronger in the prone position (horizontal) or while tilting forward. The identical situation is observed after eating when the contents of the stomach are thrown into the esophagus.

The localization of pain is somewhat blurred. It can be an epigastric region and a chest. The pains behind the breastbone can resemble the cardiac ones, in addition, they can be removed by means of the same nitroglycerin. Intercostal pains and pain syndrome in the abdominal cavity may lead to the thought of pathologies of the stomach and liver. Sometimes the pain irradiates in the back between the shoulder blades, which further complicates the diagnosis.

When casting partially digested food with gastric enzymes into the esophagus, it can rise higher to the throat. In this case, patients begin to complain of burning and sore throat, caused by the irritating effect of gastric juice. Some even have a slight cough, while the temperature against the background of the inflammatory process in the upper gastrointestinal tract with hernia of the esophagus can rise to 37-37.5 degrees, which pushes the thought and colds.

Dysphagia and lump in the throat. The irritating effect of acid in the composition of gastric juice and pain caused by squeezing the hernia can lead to difficulty in eating. With a hernia of the esophagus, patients note such a symptom as a lump in the throat, or rather the sensation of some obstacle in the way of food. In fact, we are talking about a nervous reaction that causes a spasm of the esophagus. It is the sensation of a lump in the course of the esophageal tube that leads to the appearance of pain between the scapula and in the region of the heart radiating to the shoulder, as in angina pectoris.

Almost half of patients with large axial hernia have a condition such as dysphagia; difficulty swallowing. An important point is the fact that it is easier to swallow hard food to patients than liquid or semi-liquid. Dysphagia can occur against a background of nervous experiences, intake of too cold or hot food, rush while eating. Increase or restriction of the hernia of the esophagus leads to the fact that spasms appear not on a situational basis, but on an ongoing basis, which leads to an unpleasant sensation of a coma in the throat even outside eating or during the use of solid foods that have to be "pushed" by the liquid.

Indigestion. One of the most popular symptoms of a hernia of the esophagus is heartburn. The frequency of this symptom in the axial hernia, which is considered the most common and characterized by protrusion of the esophagus and cardiac part of the stomach, is even greater than in the pain sensations. The appearance of this symptom is most often associated with eating, although with physical activity and a sharp change in body position, it can remind oneself and an empty stomach.

At night, heartburn with a hernia of the esophagus appears even more often than during the day or in the morning. This is associated with the increase in this period of the tone of the vagus nerve, which goes from the brain to the abdominal cavity, and the general relaxation of the organism and in particular the sphincter on the border of the stomach and esophagus, called the lower esophageal sphincter.

The intensity of the manifestation of the symptom varies. In most cases, it is a mild form, the fight against which is successfully carried out with antacids. But sometimes heartburn can be so strong that it deprives the person of sleep and rest, and a strong agonizing burning sensation in the chest interferes with work, negatively affects the state of health, mood and appetite.

The strength of heartburn is determined not so much by the size of the hernia as by the characteristics of the gastric juice (increased, normal or decreased gastric acidity), ingestion of bile from the duodenal region into the esophagus, and the esophagus stretching during reflux (the amount of spilled food associated with the lower esophageal sphincter operation).

During heartburn a person can feel in his mouth an acidic or bitterish taste, characteristic of the contents of the stomach and duodenum. He may have nausea and bloating. The last symptom is not directly related to heartburn, although it often appears in combination with it. Meteorism is often complained and those patients who do not have severe pain, and there is only a slight discomfort and a feeling of squeezing in the epigastrium.

Belt eruptions are another problem with a hernia of the esophagus, and it can be both a belching of the air, and regurgitation of food, up to vomiting. The feeling of bloating appears in patients not accidentally. It is associated with increased intra-abdominal pressure due to compression of the stomach in the aperture, while spasmodic contractions of the esophagus may sometimes occur and lead to eructation, i.e. Involuntary release of air, and sometimes food. An eructation can occur both during and after food, accompanied by a specific sound, which is another reason for the psychological discomfort in patients, especially since the use of antispasmodics in this case does not give the desired result.

It must be said that the eructation itself, in spite of the unaesthetic nature of its manifestations, in some sense benefits the patients, facilitating their condition. After eructation, pain and heartburn usually decrease. Therefore, it is not surprising that patients often provoke eructation on their own, swallowing a large amount of air and trying to push it out of the esophagus forcibly.

An eructation of food is most often observed immediately after eating or during the adoption of a horizontal position, and sometimes with sharp inclinations. The amount of spilled food can vary, depending on the performance of the esophageal sphincter. With a greatly reduced tone, it can even reach a single vomiting. At the same time, such a symptom as nausea does not accompany eructations, regardless of its strength.

A small percentage of patients also complain of hiccoughs, which torment them for several weeks and even months. Usually the appearance of a symptom is associated with eating and is determined by convulsive contractions of the diaphragm, for which the hernial sac is an irritating factor. Conducted treatment has no effect on the severity and incidence of hiccups.

Clinical picture of hernia of the esophagus depending on the degree and nature of the pathology

Hernia of the esophageal opening of the diaphragm is a generalized concept, because pathology can have different forms of flow and development, depending on which the clinical picture of the disease also changes. So it is customary to distinguish the floating and fixed hernia of the esophagus. The latter is considered a more rare but at the same time more dangerous pathology, which is characterized by frequent complications in the form of infringement of the hernia, perforations of the esophageal tube and bleeding from the gastrointestinal tract, irregularities in the work of the heart, increased risk of oncology of the esophagus.

Floating hernia of the esophagus (also called sliding or axial) is a protrusion into the chest cavity of the distal part of the esophagus and some part of the stomach. Sometimes the entire stomach can fall into the hole, which indicates a large hernia that compresses the chest (lungs, heart), causing disruption to their work and the corresponding symptoms in the form of cough and heart pain.

The stretching of the diaphragmatic opening, into which the esophagus enters, is controlled by the esophagus-diaphragm ligament. With a decrease in its tone and degenerative processes, manifested in the form of thinning of the dense connective tissue, the opening in the diaphragm can increase. With increased intra-abdominal pressure, pregnancy, obesity, age changes, birth defects of the diaphragmatic opening, the cardiac part of the stomach can shift upward relative to the aperture opening, thereby forming a hernia.

The floating hernia of the esophagus is said when, with a change in the position of the body and physical exertion, the stomach along with the esophagus can be displaced in the aperture of the diaphragm. Thus, they are given out to the thoracic area, then they return to their place in the abdominal cavity. With a small hernia and normal functioning of the sphincter, the sliding variant of the pathology proceeds asymptomatically. But with a violation of the tone of the lower esophageal sphincter, the contents of the stomach are reflected in the esophagus (gastroesophageal reflux), which is accompanied by a belching, heartburn, pain syndrome, burning sensation behind the sternum. A clear connection of the emerging uncomfortable symptoms with food intake (especially abundant) and changes in the position of the body, on which the displacement of the esophagus and the cardia of the stomach depends. Infringement of a hernia of an esophagus of such character is not observed.

With a fixed hernia, which is often called para-esophagial, the middle and lower parts of the stomach and even the 12-duodenum can be emptied into the chest cavity, while the position of the esophagus remains fixed. That is, the hernia is formed not along the esophagus, but next to it, and it does not tend to change its size and position. But when the position of the body changes, the hernia can be squeezed (infringed), which is fraught with overstretching of the walls of the dropping part of the stomach and their rupture. In this case, there is accumulation of fluid in the pleural cavity, there are severe acute pain and signs of infection of the blood.

The most characteristic symptoms for this type of pathology are the pressing pain in the spoon and the feeling of heaviness that appears after a tight meal, which causes patients to limit the amount of food, belching, regurgitation of food and vomiting. Violation of the movement of food from the stomach into the intestines provokes the development of a peptic ulcer, which is complicated by perforation of the stomach tissues and active hemorrhages. With a sliding hernia, hemorrhages occur in the esophagus, but they are insignificant and do not appear externally.

Reflux with fixed hernia is not observed, heartburn is rare. However, in the case of a combined hernia, the appearance of such symptoms is not ruled out.

Symptoms of the hernia of the esophagus may vary depending on the degree of the disease, because this pathology is considered progressive, especially if it is caused by age-related changes that adversely affect the tone of the ligament of the diaphragmatic opening and the lower esophageal sphincter. Each of the 3 stages of the disease has its own symptoms, but it is difficult to determine the exact diagnosis without performing an instrumental examination.

A hernia of the esophagus of the 1st degree is the initial period of the disease when the lower part of the esophageal tube penetrates into the opening, and the stomach remains on the other side of the diaphragm plate, snugly adjoining it and forming a kind of dome. Usually at this stage of the disease, patients rarely complain about any symptoms of nedomaganiya. There may be a slight discomfort and weak epigastric pain.

The initial degree of development of a hernia is detected accidentally during instrumental diagnosis of other diseases. Palpator can not be identified. But the treatment of this pathology is usually reduced to adherence to a special diet and monitoring the behavior of the digestive system.

Hernia of the esophagus of the 2nd degree is characterized by penetration into the thoracic part of not only the distal esophagus, but also the lower esophageal sphincter, as well as a small part of the stomach. Symptoms of pathology begin to manifest more clearly. Patients complain of chest pain or epigastric pain, discomfort (feeling of squeezing or bursting), the appearance of belching and burning in the chest area. A little later, there is a feeling of a food lump, a violation of the swallowing process, heartburn (with a sliding hernia).

Treatment of the second stage of the disease, in addition to diet, means medication: taking antispasmodics, enzyme preparations, antacids and drugs that reduce the production of hydrochloric acid.

A hernia of the esophagus of the third degree  is not only an unpleasant, but also a dangerous pathology, which is fraught with various complications. In this case, a significant part of the stomach is displaced to the sternum, and sometimes the intestinal loops, which leads to a disruption in the digestive process. In addition to the symptoms described above, patients complain of severe heaviness in the stomach after eating, a lump in the throat, severe pain in the chest, frequent belching of the air, and sometimes spitting up food. For heartburn attacks, mostly patients with combined hernia of the esophageal opening of the diaphragm complain.

Diet and conservative treatment in this case are relevant only after surgery (laparoscopic surgery to return the digestive system to the abdominal cavity and suturing the diaphragmatic opening, antireflux surgery - fundoplication).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Hernia of the esophagus in children and pregnant women

The hernia of the esophageal opening of the diaphragm is considered by many to be an age-related disease because this pathology is diagnosed in most cases in people over 50 years old. Yes, a decrease in the tone of the esophagus can be facilitated by a metabolic disorder in the muscle and connective tissues, caused by the accumulated diseases over many years of life, and the chronic course of ulcerative-inflammatory pathologies of the gastrointestinal tract. But according to statistics, there is a certain percentage of morbidity caused by congenital anomalies or temporary conditions, leading to an increase in intra-abdominal pressure, which is already higher than the chest pressure.

Hernia of the esophagus in a child, as in an adult, is a pathology characterized by a displacement of the digestive tract from the abdominal cavity to the thoracic cavity. But unlike adults, we are talking about congenital pathology, and not about the disease acquired, so the symptoms of hernia of the esophagus in children can be observed already in the first days of their life.

Diagnosis of pathology is usually already at an early age, for teenagers it is not characteristic (congenital pathology reminds of itself much earlier, and for the acquired is still too early). Hernia of the esophagus in the baby can arise because of insufficient length of the esophageal tube or congenital weakness of the diaphragmatic opening, the causes of which lie in the intrauterine period of the child's development.

At a later age, the cause of a hernia of the esophagus may be a trauma that leads to an increase in intra-abdominal pressure, frequent crying crying, diseases that occur with prolonged excruciating cough, overfeeding and obesity, a tendency to constipation, excessive physical exertion (for example, lifting heavy objects).

The clinical picture of the hernia of the esophagus in small children includes persistent vomiting and regurgitation after eating. With a congenital pathology, these symptoms resemble themselves during the first month, and conceived even in the first week of a baby's life. It is not possible to stop the symptoms with medication, which gives reason to suspect the organic nature of digestive disturbances, not related to the nature and amount of food.

In some cases, doctors diagnose hemorrhagic syndrome. His symptoms are bloody vomiting and the presence of blood in the feces of a child. The loss of blood leads to tissue cyanosis and the development of anemia, which are considered one of the signs of a pathology in the baby who can not yet tell about pain in the abdomen or chest.

The pain behind the sternum, which the older children complain about, and the cyanosis of the tissues, doctors associate with developing reflux esophagitis (irritation and damage to the esophageal mucosa due to the casting of the acid content of their stomach), as well as partial infringement of the hernia.

Unpleasant feelings after eating a child can lead to a deterioration in appetite or refusal to eat, which only aggravates the course of anemia. Vomiting can be accompanied by swallowing disorders and the development of aspiration pneumonia, i.e. Inflammation of the lungs caused by ingestion of food particles into the respiratory tract. With a large hernia, even the symmetry of the chest can be disturbed due to the appearance of an unusual protrusion.

Dysfunction of nutrition and respiratory function due to aspiration pneumonia leads to the fact that the child begins to lag behind in development from peers. After a meal, these children may have shortness of breath and a pulse that increases, which indicates the squeezing and disruption of the cardiovascular and respiratory system.

The severity of symptoms in children may differ, so the disease is not always diagnosed at an early stage. The fact is that reflux and regurgitation in the first months of life are considered normal, and therefore, in the absence of vomiting and frequent eructations on these symptoms, parents and doctors may not give due importance, especially since in childhood, hernia of the esophagus is diagnosed very rarely. Anxiety occurs when the child himself declares that he has a bug in his throat and hurts in his chest. At best, the disease will be discovered by chance and it will be possible to stop its progression in time.

The hernia of the esophagus during pregnancy is not so rare, however, in many cases it occurs without significant symptoms, so it can be seen after the birth. By itself, pregnancy becomes a risk factor for the development of a hernia due to a decrease in the tone of the diaphragm plate and the lower esophageal sphincter (hormonal changes impose an imprint on the metabolism and tissue characteristics), increased intra-abdominal pressure as the baby develops and the uterus increases in size, accompanied by vomiting and the development of reflex esophagus.

True, the hernia of the esophagus does not appear in all pregnant women and give birth to women. At risk are women older than 30 years, who have more than one pregnancy and childbirth.

Symptoms of a hernia of the esophagus in pregnant women do not differ from those of other groups of the adult population. They can also be tormented by heartburn and eructation, pain behind the sternum and upper abdomen, swallowing disorders, regurgitation of food. Some also note increased salivation due to irritation of the food receptors in the mouth by the acidic contents of the stomach that enter it. With hernias of the esophagus and frequent vomiting caused by early toxicosis, women note that their voice becomes hoarse, and the mucous tongue is painful.

Toxicosis and vomiting early in pregnant women is not a novelty, and to the hernia of the esophagus this symptom usually has nothing to do. But frequent vomiting in the last trimester of pregnancy can be one of the obvious symptoms of a hernia. On the development of pathology, anemia can also be indicative at a term of more than 4 months.

Axial hernia of the esophagus, characterized by a benign course and not prone to infringement, is treated during pregnancy by conservative methods and is not a barrier to independent childbirth. But a fixed hernia is a danger to the life of the mother and fetus, requires special control over the course of the disease and involves a cesarean section. After all, during labor with high pressure inside the peritoneum, it can be infringed, accompanied by acute pain until loss of consciousness.

Diagnosis of hernia of the esophagus

As we have already managed to understand, the symptoms of hernia of the esophagus are not very specific. Those who have such diseases as gastritis, pancreatitis, stomach ulcers and some others, can say that all of the above symptoms are familiar to them. Moreover, many patients who have a hernia and do not consult a gastroenterologist who first prescribes diagnostic studies and then, according to their results, makes the final diagnosis, independently conduct a treatment for a non-existent pathology, diagnosing the same gastritis or gastric ulcer, and sometimes even diseases of the heart and lungs.

Diagnose the hernia of the esophageal opening of the diaphragm for only external manifestations is ungrateful, since the symptoms of this pathology are typical for most diseases of the digestive tract. Questioning the patient and prescribing standard blood and urine tests can only push the doctor in the right direction.

The doctor pays attention to any of the following symptoms, but if they are present in the complex, this clearly indicates the existing pathology of the digestive system:

• Dull, aching, or sharp pains in the upper abdomen and chest, changing their intensity with a change in body position and depending on food intake.
• The appearance of excruciating heartburn, which is present for a long time, a burning sensation behind the sternum.
• Regularly repeating belching with air and food, regurgitation after a dense meal or leaning forward.
• Frequent episodes of hiccups lasting for several minutes.
• Appearance of pain and burning in the throat and tongue, change in the timbre of voice, cough, not associated with colds and heart pathologies.

Any of the listed symptoms may speak of ill health, but it is impossible to say what kind of disease is involved, and even if the entire symptom complex is present, it is confident that we are dealing with hernia of the esophagus only. And since the reason for changing the patient's well-being lies inside the body, doctors focus on instrumental diagnostics, which allows to examine the internal structures hidden from the eyes.

A standard diagnostic examination for a hernia of the esophagus and many other pathologies of the gastrointestinal tract is gastroscopy. Fibrogastroduodenoscopy (abbreviated as FGD) is a study of the esophagus, stomach and part of the duodenum from the inside, by inserting through the patient's mouth a flexible tube with a mini-camera at the end. In other words, this is a low-traumatic endoscopic study that allows one to see the state of the internal surfaces of the digestive organs without revealing the inflammatory and erosive-ulcerative processes in them.

FGDS allows you to visually assess the condition of the mucosa, change the shape of the stomach and esophagus, their size, contractile function. What signs during the EGD help to suspect a hernia of the esophagus:

• Insufficient length of esophagus, which in adults varies from 23 to 30 cm, a decrease in the size of its abdominal part and the distance from the lower incisors to the cardia of the stomach.
• Presence of foci of stenosis of the esophagus and stomach and hernial cavity.
• Poor operation of the lower esophageal sphincter, which does not completely close or inactive decreases.
• The transfer of the contents of the stomach into the lumen of the esophagus and the related unevenness of the surface of the mucosa of the lower part of the esophagus.
• Change in the size and severity of the angle between the esophagus and the wall of the stomach (the angle of the Hyis increases and is smoothed out).
• Small expression of the folds of the stomach at the point of its confluence with the esophagus.
• The increased acidity of the gastric juice, which doctors also have the opportunity to measure during the exercise.
• The appearance in the epithelial cover of the esophagus of a non-characteristic cylindrical epithelium that is present in the intestinal mucosa (Barrett's esophagus or Barrett's metaplasia is a precancerous condition caused by gastroesophageal reflux, which is chronic in the hernia of the esophagus).

All of the above points can indicate a hernia of the diaphragmatic esophageal opening only indirectly, but they are the reason for the appointment of a more detailed examination. The change in the location of the digestive organs relative to the diaphragm plate can be seen and evaluated by X-ray.

X-rays to patients with suspicion of a hernia of the esophagus are mandatory, because it is this study that can accurately diagnose this pathology and differentiate it from stenosis, stomach ulcers, short esophagus, reflux disease, etc.

Physicians usually prefer conventional radiography, but since the soft tissues that make up the digestive organs are seen worse on X-rays than solid ones, the study is carried out with contrast (barium sulfate usually acts as a contrast agent).

Axial hernia with fluoroscopy is revealed with great accuracy, since the picture clearly shows the shift of the esophagus and stomach up, with the lower part of the esophagus, the cardia of the stomach and sometimes the whole stomach above the diaphragm. Even with an overview chest radiograph in the shade of the heart, you can see a bright spot in the region of the posterior mediastinum. After the introduction of contrast, a radioscopy in the prone position with increased intra-abdominal pressure in the hernia of the esophagus will show the casting of the barium compound into the esophagus from the stomach cavity, thickening of the arch of the stomach, a change in the angle of the Hisnia, displacement of the esophagus at the time of inhalation by more than three centimeters.

With a less common fixed hernia of the esophagus, the usual radiography is of little informative. In this case, a diagnosis (computer or magnetic resonance imaging) can be assigned to clarify the diagnosis. CT of the hernia of the esophagus allows you to recreate a three-dimensional image of the organs of the gastrointestinal tract, using all the same X-rays and contrasting, so it is prescribed for a controversial diagnosis or the presence of questions that can not be resolved by means of an ordinary X-ray.

Most often the hernia is diagnosed accidentally during a CT scan of the thoracic or abdominal department. In this case, protrusions of the gastrointestinal tract into the chest, an opening of the diaphragm, the presence of an omentum in the area of the hernial sac with a fixed hernia, an inverted stomach that protrudes into the thorax (seen in three-dimensional image) are detected.

MRI of the hernia of the esophagus is also not a popular diagnostic study. Sometimes there is simply no sense in conducting expensive diagnostics if the problem is revealed in budgetary studies such as the x-ray of the esophagus. Nevertheless, it should be noted that with soft magnetic resonance imaging soft tissues are better visualized than with X-rays and CT, and the study itself is considered safer.

Ultrasound of the esophagus and stomach with a hernia of the esophageal aperture of the diaphragm is not sufficient research, although it allows to suspect the patient of this disease. The final diagnosis can be made only after X-rays, CT or MRI of the stomach and esophagus.

With fixed hernias of the esophagus, it is also necessary to carry out a study such as pH-metry, which allows to evaluate the multiplicity and peculiarities of casting the contents of the stomach into the esophagus, to determine the acidity of the gastric juice and the reasons for its increase. The study is carried out over a 24-hour period using a probe inserted through the nose and a portable registrar attached to the belt by a belt. The patient during the study can safely move, eat food that does not affect the acidity of the stomach, relax, etc.

Such a study in time allows you to assess the work of the stomach and lower esophageal sphincter, and not only to fix the static dimensions and location, as in radiography. If there is an increased acidity of gastric juice caused by gastritis or a stomach ulcer, then further treatment of these, accompanying pathologies.

Since the number of symptoms of hernia of the esophagus is included and difficulty in swallowing patients may be assigned such a study as esophagomanometry, which allows to assess the force of contraction of the muscles of the esophagus during swallowing. This study is indicative for violations of the upper GI tract, because it allows you to assess the contractility and the state of the tissues of various parts of the esophagus and stomach. Manometry helps to diagnose the inconsistency of the lower esophageal sphincter, which allows food to move in the opposite direction (reflux).

[11], [12], [13]

Treatment of hernia of esophagus

If you pay attention to the pathology with the appearance of its first symptoms and undergo a proper examination, treatment of the disease is much simplified and gives good results even without surgery. A very important role is played by a diet that helps maintain the normal level of acidity of the gastric juice, which reduces the irritation of the esophagus walls during reflux, and also corrects the volume of food intake, which makes it possible to reduce the frequency of eructation.

Since the bulk of unpleasant symptoms (pain in the chest and epigastrium, heartburn, burning along the esophagus and in the throat, fever to subfebrile values) is associated with reflux-esophagitis (throwing of gastric contents into the esophagus and associated inflammatory-destructive processes), then treatment of hernia of the esophagus as a whole is similar to therapy of this pathology. The purpose of this treatment is to reduce the irritating effect of the contents of the stomach on the esophagus by neutralizing its aggressive components, facilitating the progress of the food lump through the esophagus, increasing the tone of the stomach and lower esophageal sphincter.

Treatment is carried out in a complex way:

• drugs that increase the motility of the gastrointestinal tract (prokinetics) and help to combat such symptoms as reflux, hiccups, regurgitation of food, vomiting,
• drugs that reduce the acidity of the stomach (antacids),
• drugs that reduce the production of hydrochloric acid (proton pump inhibitors),
• blockers of histamine receptors used in gastoenterology (they are similar to previous drugs and are prescribed if they can not be taken).

Sometimes, to prevent stagnation and relieve the severity of the stomach, it is recommended to take enzyme preparations: Mezim, Festal, Creon, Pancreatin and even Cholenzim, which stimulates the production of bile and its transportation to the duodenum, and thereby accelerates the process of digestion of food.

But if other enzyme preparations are often prescribed for various pathologies of the stomach to facilitate its work, since they do not exert an aggressive effect on the mucous membrane, the "Cholenzym" is mostly used in the pathologies of the liver, gallbladder and pancreas and provokes the release of bile, which in case of a hernia esophagus will be of doubtful benefit. Especially when it comes to reflux, when half-digested food can be thrown into the esophagus from the stomach and the initial parts of the intestine, where it will be generously flavored with bile.

Better to help the stomach, however, choose the usual enzyme preparations that are safer for stomach and esophageal pathologies. With constipation, which often accompanies various pathologies of the gastrointestinal tract, it is worth paying attention to the drinking regimen, and if necessary, to take laxatives, as straining at the hernia of the esophageal opening of the diaphragm increases intra-abdominal pressure, which can not be tolerated.

Probably, readers have noticed that among the drugs prescribed for reflux and hernia of the esophagus, there is no indication of analgesics. But pain in the chest and epigastrium is one of the main symptoms of pathology. The similarity of these pains to the cardiac becomes the reason that patients try to stop them with nitroglycerin. This method works, but its side effect is that such treatment strengthens the patient in thinking about the existing disease of the cardiovascular system and distracts from the true cause of deterioration of well-being.

How to relieve pain with a hernia of the esophagus? Pain in reflux and hernia of the esophagus is associated with stagnation of food in the gastrointestinal tract and its transfer to the esophagus. The irritating effect of digestive enzymes causes irritation and inflammation of the walls of the organ, which is accompanied by painful sensations. It turns out that you can stop pain with drugs that reduce the acidity of gastric juice and form a protective film on the walls of the stomach and esophagus. These are preparations in the form of a suspension (Almagel, "Fosfalugel", "Maalox"), which begin to act already during passage through the esophagus, while the tablet forms of drugs require dissolution in the stomach. Preparations, which are prescribed for the control of high acidity of gastric juice, will simultaneously act as an analgesic.

And many alternative means help to combat the unpleasant symptoms of the hernia of the esophagus. Thus, natural floral honey, which is used in the treatment of many diseases, including gastrointestinal diseases, is of great benefit in hernia of the esophagus.

Honey is not a cure for reflux esophagitis, and with exacerbation of the disease it can only increase the irritation of the esophagus if it is used in its pure form. But with a chronic course of the inflammatory process in the esophagus, observed with a hernia, this natural natural medicine will have an antibacterial pi anti-inflammatory effect. It is true to use it better as part of multicomponent recipes or diluted in water (up to 50 ml per day), giving preference to easily digestible lime honey.

For example, to combat heartburn, you can prepare a simple and tasty medicine from equal parts of honey and walnuts, which must be cleaned and crushed beforehand. Use the formula you need after eating 1 tbsp.

To treat heartburn honey can be mixed with other components:

• aloe juice (1: 1 ratio, take before and after eating 1 spoonful),
• warm milk (1 tablespoon honey per 1 glass of milk, drink an hour before the main meal, as well as when painful attacks occur),
• potato juice (1 teaspoon honey on ½ tbs juice, take an hour before eating).

In one recipe, you can combine detoxification and tonic properties of apple cider vinegar and antibacterial, tonic and anti-inflammatory effect of honey. 1 tbsp. Natural apple cider vinegar should be mixed with the same amount of honey and diluted in a glass of water. Take such an unusual medicine regularly before meals, then it helps to prevent the appearance of heartburn, pain and other symptoms of hernia of the esophagus.

To combat eructations, the composition is based on honey, cranberry berries and aloe juice, taken in equal amounts. Berries and peeled aloe leaves should be passed through a meat grinder or chopped in a blender, mixed with honey and poured with boiled water. Insist the remedy for at least 6 hours, after which it should be drunk a little during the day.

It is also useful for flushing the esophagus and flax. Decoction of flax (1 tablespoon per 0.5 liters of water, boil for 3-5 minutes and infuse for at least 2 hours) will create a protective film on the walls of the stomach and esophagus, thereby reducing the likelihood of irritation of the mucous by digestive enzymes. The same agent is considered an effective antacid, because it can reduce the acidity of gastric juice.

Another recipe for a hernia of the esophagus based on flax seed. At 1 tablespoon. We take 3 tablespoons of flax seed. Cool water, leave to infuse for the night. In the morning we heat up to a boil, but do not boil. We consume the whole mixture thoroughly, thoroughly chewing the grains.

Tea with a hernia of the esophagus is a dubious medicine. But this is looking at what tea. If it is a strong hot black tea, then it is better to refuse such a tonic drink, because it will only stimulate the production of digestive enzymes and increase the acidity of the stomach, especially for those who already suffer from this disorder. But the warm green tea dieticians even include the menu with a hernia of the esophagus.

But herbal teas are especially useful in this pathology. The first in the list of healthy drinks for gastrointestinal diseases is anti-inflammatory chamomile tea (1 tablespoon per cup of boiling water). You can drink it both before and after eating without any special restrictions.

A similar effect is also found in the tea of calendula flowers, which are cooked on the same principle, but they drink no more than 4 times a day an hour after eating. You can combine in one drink 2 plants: calendula and chamomile.

Lime tea, which many are accustomed to drinking with a cold and headache, is also useful for hernia of the esophagus. You can consume it without restrictions as a useful drink that does not increase the acidity of the stomach. Especially tasty and useful is lime tea with honey (1 spoonful per cup of drink).

Patients with a hernia of the esophagus can prepare themselves vitamin tea from the leaves and shoots of the blackberry (50 g of crushed vegetable raw materials per 1 cup of boiling water), which can also be drunk without restrictions.

Help fight heartburn and hiccups of mint and lemon balm, yarrow and St. John's wort, licorice root. As a tasty vitamin drink, tea is prepared from leaflets and raspberry fruits. It is very useful to prepare drinks from the collections of the above herbs, adding a little honey before using them.

Life with a hernia of the esophagus

Perhaps, the hernia of the esophagus and delivers some discomfort to the patients, but life does not end with this diagnosis. Diet and medication help reduce the severity of symptoms of pathology. Respiratory gymnastics and special physical exercises that train the muscles of the abdominal and breast press, contribute to the restoration of the normal position of the stomach with a sliding hernia, remove dyspeptic phenomena, reduce the likelihood of reflux. If these measures do not help, and the symptoms of the hernia of the esophagus do not subside, the patient is prepared for surgery.

Any diseases leave a mark on our life. So, the hernia of the esophagus requires certain restrictions from us. And this applies not only to nutrition, but also physical activity of a person, as well as the time of night rest.

The hernia of the esophageal opening of the diaphragm is a pathology in which the esophagus and stomach have an abnormal location, so it is not surprising that with the change in body position the symptoms intensify. So after the patient's acceptance of the horizontal position, the pain sensations increase. But does this mean that a person should sleep in a sitting position? And if not, then on which side can you sleep with a hernia of the esophagus?

The need to sleep standing or sitting with this disease is not, because a full rest is needed to maintain the strength and energy of the body. But here the position of the doctors recommend choosing lying on the right side, which reduces the load on the organs of the digestive tract due to their anatomical location and the probability of pinching. In addition, reflux with this position of the body usually does not arise, and hence there will be no pain either.

But in whatever position a person falls asleep, go to bed no earlier than 2 hours after eating. This applies to healthy people, and for patients with a hernia of the esophagus is especially important.

Unpleasant news is for fans of alcoholic beverages. Herniated esophagus and alcohol are incompatible concepts. The fact is that alcoholic beverages, like coffee or black tea, are products that stimulate the secretion of gastric juice, and increased production of hydrochloric acid causes heartburn. In the case of reflux, it can play a cruel joke, provoking a strong irritation of the walls of the esophagus and even their perforation. And alcohol itself is an irritating factor, not for nothing after taking it inside, a person feels a burning sensation throughout the esophagus.

Another reason for not having to drink alcohol regularly is an increased risk of developing inflammatory liver and pancreatic pathologies that become risk factors for increasing intra-abdominal pressure pushing the digestive organs through the aperture opening into the chest cavity.

Many questions from readers and on the topic of "hernia of the esophagus and the army." Most conscripts consider the presence of a hernia of the esophageal aperture of the diaphragm sufficient grounds for release from service in the army, and when this does not happen, the guys are very surprised. The fact is that only boys with the 3 most serious disease degree are obliged to be exempted from military service (military bills are given to them for health reasons), and for those diagnosed with 1 degree there are no restrictions, they serve on general grounds .

But with a 2 degree hernia of the esophagus may be a problem. According to the law with such pathology, the conscript must be released from service in the army, he is enrolled in the reserve and issued a military ticket for health (Article 60 of the Schedule of Diseases, point "c"). But in practice, in order to obtain such a conclusion, it is necessary to prove the presence of a 2 degree of hernia, i.e. Pass radiography with contrast, which is considered the "gold standard" of diagnosis of hernia of the esophagus. If there is no X-ray result, it will not be possible to get exemption from military service.

Now, with regard to motor activity and sport. Hernia of the esophagus is a pathology that does not require hypodynamia. On the contrary, for the normal functioning of the digestive system you need to move, otherwise you can not avoid stagnation in the stomach and constipation, which, with a hernia of the esophagus, is very dangerous. Stretching increases intra-abdominal pressure, which only complicates the situation, provoking the progression of the disease.

With a hernia of the esophageal aperture, walks in the air, moderate physical activity, special exercises of exercise therapy, yoga, pilates, breathing exercises will be useful. But the sport with hernia of the esophagus is not available in full. For example, the training of the muscles of the breast press, running and swimming with hernial protrusion of harm will not bring, in contrast to weightlifting and other sports that involve the load on the muscles of the abdominal press.

It is clear that in connection with the above, the question whether it is possible to pump the press with a hernia of the esophagus disappears by itself. Such a load raises intra-abdominal pressure, which in turn provokes reflux and even more bulging of the organs in the chest. To increase the tone of the abdominal muscles in the complex DFC there are special exercises that will not provoke complications of the disease.

For the same reason, patients are not recommended to wear bandages, tight elastic bands in pants, and tightly tight belts and belts.

Can I crouch with a hernia of the esophagus? This is a controversial issue. Generally, in the opinion of gastroenterologists squats, cycling and training on a stationary bike are not prohibited if they are engaged in reasonable limits. But squatting with the load (with the load in hand), this is quite another matter. With such exercises, as with lifting weights, the pressure in the abdominal cavity increases, which can not be tolerated with a hernia. Any activity should not provoke an increase in intra-abdominal pressure - this is an important requirement for all athletes and fans of a healthy lifestyle.

If a person after the diagnosis wishes to continue playing sports, he should consult with a doctor in advance, which will help to develop a safe training program and determine the types of sports permitted for this pathology.

And one more important question, is disability possible with a hernia of the esophagus? On the one hand, if the hernia is not treated, over time it can progress and cause serious disturbances in the process of eating. Prolonged irritation and inflammation of the esophagus lead to the appearance of strictures of the esophagus, making it difficult to pass the food lump. But on the other hand, while it does not affect a person's ability to do work, nobody will give him a disability. 

Disability is possible only with the narrowing of the esophagus, which limits the vital activity and performance of the work in full. For example, the need for fractional nutrition in the hernia of the esophagus, complicated by organ stenosis, may be the reason for assigning 3 disability groups, which is considered working. Group 2 can be counted by those who have a grade 2 narrowing of the esophagus or an organ reconstruction operation (for the adaptation period).

And for the 1st group of disability, it is necessary to limit not only vital activity, but also self-service, which is extremely rare with a hernia of the esophagus. The cause may be a strong narrowing of the esophagus and an extreme degree of exhaustion caused by a malnutrition, as well as an operation in which 2 holes (stoma) are made in the neck and stomach to communicate organs and food.

Usually, with proper treatment and diet compliance, the prognosis of axial hernia is favorable. Symptoms of hernia of the esophagus after the course of treatment subsided and the disease does not actually affect the quality of life of patients. But the danger of complications of paresisophageal hernia remains even in the course of active conservative treatment, therefore such patients are shown surgical intervention.

Complications of a hernia of the esophagus

Hernia of the esophageal opening of the diaphragm is a progressive pathology, the symptoms of which become pronounced when the disease is complicated. By itself, the displacement of the peritoneal organs into the thoracic cavity is not the reason for the appearance of severe pain, so most patients indicate discomfort in the epigastrium and dull, aching pain behind the sternum. But the appearance of acute, cutting pains indicates the inflammation of the hernia of the esophagus and the development of erosive and ulcerative processes.

Inflammation of the walls of the esophagus is associated with reflux esophagitis. Regular casting of acid contents of the stomach and duodenum in the lumen of the esophageal tube causes irritation of the walls of the esophagus and inflammation of the tissues. A long-term inflammatory process becomes a risk factor for the formation and increase in the volume of fibrous tissue, which causes the lumen of the esophagus to narrow. And this becomes an obstacle to eating solid food.

Hydrochloric acid and pepsin in the gastric juice can erode unprotected walls of the esophagus with the formation of erosions and ulcers (peptic ulcer of the esophagus). The irritant effect of these substances again leads to a narrowing of the esophagus (peptic strictures).

Erosive-ulcerative lesions of the esophagus can lead to their perforation, and then there are symptoms of a hernia of the esophagus, such as bloody vomiting and a chair of chocolate color. Frequent bleeding on the background of a chronic course of the disease in turn causes the development of iron deficiency anemia.

Chronic inflammatory-erosive changes in the esophagus increase the risk of degeneration of the cells of the organ wall and can cause cancer of the esophagus. Equally dangerous is the infringement of the hernia, in which the patient feels severe pain caused by a violation of the inflow to the body of nutrients and oxygen and damage to nerve fibers.

During the infringement, the movement of food through the esophagus is restricted, which hardly passes through the reduced lumen of the organ or can not get into the stomach squeezed by the diaphragm. This increases pain, causes nausea and vomiting, does not allow a person to eat normally. With complete restriction of the esophagus or stomach in the aperture of the diaphragm, the patient can not even drink, however, this happens extremely rarely and requires urgent care.

During the diagnostic activities, you can see a discoloration of the hernia. It becomes darker or greyish due to necrotic processes occurring in it caused by starvation of tissues and poisoning of the organism by the products of cell decay. Necrotic changes in the tissues of the esophagus and stomach lead to a disruption of functionality and can cause a severe condition provoked by sepsis.

Surgical treatment of the disease gives good results, but can not completely exclude a relapse of the hernia of the esophagus, which according to different data occurs in 12-30% of cases in the long-term period after surgery. To prevent such a complication allows the plastic of the diaphragmatic aperture.

Many patients, noticing the absence of previously observed symptoms, may think that the illness has passed, so on the Internet you can sometimes find questions on the topic, can the hernia of the esophagus disappear on its own? Count on it not worth it. The periodic disappearance and appearance of hernia symptoms is characteristic of the axial kind of pathology, when the stomach and esophagus can be displaced in the aperture of the diaphragm. Depending on this, the symptoms can then appear, then disappear, which does not at all mean getting rid of the disease.

No medications can help restore the original size and tone to the diaphragmatic opening, they only prevent complications caused by reflux and spasm of the esophagus. In the absence of treatment and non-compliance with the diet, the hernia will not only disappear, but will continue to progress.

[14], [15], [16], [17]