Hernia of the esophagus
The content of the article:
- Esophageal hernia causes and risk factors
- Forms of the disease
- Symptoms of a hernia of the esophagus
- Diagnostics
- Treatment of hernia of the esophagus
- Diet for hernia of the esophagus
- Possible complications and consequences
- Forecast
- Prevention
A hernia of the esophagus (hiatus hernia, diaphragmatic hernia) is a chronic recurrent disease in which the initial abdominal part of the digestive tube is displaced into the chest cavity through the esophageal opening of the diaphragm.
Source: lechenie-simptomy.ru
Hernia of the esophagus affects the elderly, in the age group up to 40 years, pathology is diagnosed in 10% of cases, and in people over 70 years old - in 70%. Women get sick more often than men. Hernia of the esophagus is more common in developed countries, which is presumably associated with eating habits. In patients with gastroenterological pathology, hernia of the esophagus is detected 6 times more often than in the rest.
The lower esophageal sphincter (cardia) separates the esophagus and stomach and prevents chemically aggressive gastric and duodenal contents from being thrown into the esophagus. The angle of His (an acute angle of the esophagus entering the stomach) also contributes to the one-way movement of the food bolus. The distal part of the esophagus is fixed by the diaphragmatic-esophageal ligament, which also prevents the cardiac part of the stomach from moving into the chest cavity during the longitudinal contraction of the stomach. Maintaining the esophagus in a normal position is facilitated by the subphrenic fatty layer and the natural location of the abdominal organs.
The chest and abdomen are separated by a diaphragm, which is composed of muscle, fibrous tissue and has a domed structure. The esophagus, blood vessels, and nerves pass through the holes in the diaphragm. On the left side of the diaphragm is the esophageal opening, which normally corresponds to the outer size of the esophagus. With the expansion of the esophageal opening, part of the anatomical structures that are normally located under the diaphragm protrude into the chest cavity.
Esophageal hernia causes and risk factors
The causes of hernia of the esophagus are the weakening of the ligamentous apparatus, which fixes the cardiac part of the stomach, and an increase in intra-abdominal pressure.
Risk factors include:
- genetic predisposition;
- violation of the motility of the gastrointestinal tract;
- overweight;
- chronic flatulence;
- frequent constipation;
- pregnancy (especially repeated);
- excessive physical activity;
- strong prolonged cough in chronic obstructive pulmonary disease, bronchial asthma, etc.;
- ascites;
- indomitable vomiting;
- large neoplasms of the abdominal cavity;
- connective tissue dysplasia;
- abdominal trauma;
- chemical or thermal burns of the esophagus;
- advanced age;
- incorrect posture.
Forms of the disease
Depending on the anatomical features, the following forms of hernia of the esophagus are distinguished:
- sliding (axial, axial) - free penetration of the fundus of the stomach, cardia and abdominal part of the esophagus through the esophageal opening of the diaphragm into the chest and self-return to the abdominal cavity;
- paraesophageal - the distal part of the esophagus and the cardia are located under the diaphragm, part of the stomach is displaced into the chest cavity and is located next to the thoracic esophagus;
- mixed;
- congenital short esophagus - the length of the esophagus does not correspond to the height of the chest, while part of the stomach is located above the diaphragm in the chest cavity, the lower esophageal sphincter is absent.
Sliding hernias of the esophagus, depending on the displaced site, are divided into total gastric, subtotal, cardiofundal or cardiac.
Paraesophageal hernia of the esophagus can be antral or fundus.
Source: myshared.ru
Symptoms of a hernia of the esophagus
The clinical picture is polymorphic and depends on the shape and size of the hernia.
Often, hernias of the esophagus do not manifest themselves in any way or have mild clinical symptoms. A severe course is characteristic of large hernias of the esophagus, in which most of the stomach and intestines penetrate into the posterior mediastinum.
The main manifestation of a hernia of the esophagus is pain syndrome. Pain sensations can be noted in the region of the heart, left hypochondrium, epigastric and interscapular region, spread along the esophagus, while the pain is usually aggravated immediately after eating (especially when overeating), physical exertion, bending of the body, and subsides when taking a horizontal position of the body. In some cases, the pain mimics an attack of angina pectoris. In about 35% of cases, patients with hernia of the esophagus have paroxysmal tachycardia and extrasystole.
Common signs of a hernia of the esophagus include heartburn, which appears after eating, with a sharp change in body position, and also at night. Other symptoms: vomiting (often mixed with blood), episodes of holding breath during sleep, periodic cyanosis of the skin, difficulty swallowing and passing food through the esophagus (can be triggered by eating cold or hot food, fast food, psychological factors), pain and burning sensation in the tongue, hoarseness, prolonged hiccups, cough, swelling of the left side of the chest, a feeling of fullness in the epigastric region, belching. Nocturnal regurgitations, which usually occur with medium-sized hernias of the esophagus, can cause the development of tracheobronchitis, aspiration pneumonia. Spitting up food, as a rule, is not preceded by nausea, and stomach contractions are also absent. The contents of the stomach are thrown into the oral cavity due to contractions of the esophagus, and when the position of the body changes, it can be poured out.
When squeezing the hernial sac (infringement of the hernia), there are constant dull or intense cramping pains behind the sternum and in the epigastric region, radiating to the interscapular region. At the same time, the severity and irradiation of pain depends on which part of the digestive tract was restrained in the hernial orifice, as well as on the state of the restrained organ.
With the progression of the pathological process, violations of the obturator function of the cardia increase, which leads to the appearance of signs of gastroesophageal reflux disease. In patients with a hernia of the esophagus, anemic syndrome may occur due to latent bleeding from the lower esophagus.
Diagnostics
Approximately a third of small hernias of the esophagus, which do not have pronounced clinical manifestations, are an accidental diagnostic finding during examination for another reason.
The main methods for diagnosing a hernia of the esophagus are X-ray examination and esophagogastroduodenoscopy. During endoscopic examination, an unchanged esophagus is found; the diaphragm rhythmically closes around its lower part in time with the respiratory movements. The cardiac part of the stomach is visualized, which bulges circularly into the lumen of the esophagus. However, these signs may be the result of gagging caused by passing the endoscope through the pharynx, this becomes the reason for the erroneous diagnosis of a hernia of the esophagus. Thus, esophagogastroduodenoscopy in most cases allows to establish only the reflux of stomach contents into the esophagus.
Source: medweb.ru
X-ray examination for suspected hernia of the esophagus is carried out in several stages. First, a survey radiography of the abdominal organs is performed, while the shadow of the esophagus, the location of the gas bubble of the stomach and domes of the diaphragm are recorded. Further - X-ray of the esophagus and stomach with the introduction of radiopaque substances in a vertical position. At this stage, the rate of passage of the X-ray contrast agent through the digestive tube and the rate of gastric emptying are assessed. After that, radiography is performed in a horizontal position of the patient's body and with the head end lowered. In clinically healthy individuals, reverse movement of contrast into the esophagus is not observed, and gastroesophageal reflux is noted in the presence of a hernia of the esophagus. Then the patient returns to an upright position with further examination of the position of the gas bubble, the presence or absence of a radiopaque substance in the esophagus.
To confirm the diagnosis, it may be necessary to manomertize the esophagus, during which the state of the lower sphincter is assessed, its ability to relax when swallowing, episodes of relaxation outside the act of swallowing are found.
To detect latent bleeding, a fecal occult blood test is used.
To differentiate a hernia of the esophagus with other diseases, an ultrasound scan, computed or magnetic resonance imaging, electrocardiography, general and biochemical blood tests may be needed. Differential diagnosis is carried out with lesions of the nerves of the thoracic spinal cord, conditions accompanied by esophagitis, relaxation (often relaxation of the left dome) or paralysis of the dome of the diaphragm, Saint's syndrome, angina pectoris, myocardial infarction, neoplasms of the esophagus.
Treatment of hernia of the esophagus
Treatment of a hernia of the esophagus usually begins with conservative measures. The patient is advised to avoid wearing tight belts and girdles, sleep with the head end raised, and, if necessary, normalize body weight.
Medical treatment of hernia of the esophagus is primarily aimed at preventing the development of gastroesophageal reflux disease. For these purposes, proton pump inhibitors are used in a gradually decreasing dose for a course of up to two months, followed by the transfer of the patient to antacids. According to indications, prokinetics may be included in the treatment regimen.
Conservative treatment of new patients with a hernia of the esophagus, as a rule, is carried out in a hospital, where a thorough examination of the patient is easier than on an outpatient basis. With the development of a relapse, drug therapy begins on an outpatient basis, and hospitalization is indicated only if the treatment is ineffective.
When treating a hernia of the esophagus against the background of other diseases of the gastrointestinal tract (chronic cholecystitis, pancreatitis, gastric ulcer and duodenal ulcer), the leading pathology is firstly determined and corrected.
In the case of the development of severe forms of gastroesophageal reflux disease, torpid reflux esophagitis, not amenable to conservative therapy, Barrett's esophagus, patients are shown surgical treatment.
The operation for hernia of the esophagus can be performed both open and laparoscopic access. Among the surgical methods of treatment, the most widespread are surgical interventions that are aimed at suturing the hernial orifice and strengthening the diaphragmatic-esophageal ligament (cruroraphy), fixing the stomach in the abdominal cavity (gastropexy), eliminating gastroesophageal reflux (fundoplication), restoring the acute angle of His.
Contraindications to surgical treatment of esophageal hernias are concomitant pathologies that can cause severe complications in the postoperative period (for example, chronic cardiovascular diseases in the stage of decompensation).
Source: opischevode.ru
Since paraesophageal hernias of the esophagus are relatively rare, the tactics of treating this form of the disease have been worked out less. In general, preference is given to the surgical treatment of such hernias (primarily in young and middle-aged patients). Elderly people, especially in the presence of complications, are recommended to correct their lifestyle (in particular, limiting certain types of physical activity) and adherence to a diet (excluding foods that contribute to the development of flatulence from the diet) in order to reduce the risk of hernia infringement.
After the course of treatment, the patient is shown dispensary observation by a gastroenterologist for the purpose of prevention, timely detection and correction of relapses of the disease, as well as preventing the development of complications. Preventive examination is carried out on an outpatient basis at least twice a year.
The ability to work in patients with esophageal hernia is usually limited. The patient should avoid activities associated with excessive physical exertion and torso bending. Patients with a hernia of the esophagus, whose occupation is associated with a long stay in a sitting position, are advised to change jobs.
Diet for hernia of the esophagus
Patients with hernia of the esophagus are shown adherence to a sparing diet and a fractional diet. The last meal should take place no later than 3 hours before going to bed. The diet excludes products that can mechanically or physically irritate the mucous membrane of the gastrointestinal tract, contributing to gas formation, the development of constipation (fatty, fried, spicy, smoked foods, alcoholic and carbonated drinks, strong tea and coffee, milk, cabbage, peas, boiled eggs, grapes). The diet should include a sufficient amount of fiber, lean meats and fish, baked apples without peel. It is recommended to boil food, stew or bake.
Possible complications and consequences
A hernia of the esophagus can be complicated by the development of esophageal ulcers, peptic ulcers of the stomach, esophageal or gastric bleeding, perforation of the esophagus, cicatricial narrowing of the esophagus, reflux esophagitis (catarrhal, erosive or ulcerative), entrapment of the hernial sac in the hernial orifice, reflex age of facial angina pectoris (especially), esophageal cancer.
Severe pain, which occurs in some patients after eating, can cause aversion to food and, as a result, weight loss up to exhaustion.
Forecast
With timely diagnosis and properly selected treatment, the prognosis for life is favorable. After surgical treatment of a hernia of the esophagus, relapses are extremely rare.
Prevention
In order to prevent the development of a hernia of the esophagus, it is recommended:
- timely treatment of diseases that contribute to the development of this pathology;
- regular preventive examinations of persons belonging to the risk group;
- rejection of bad habits;
- balanced diet;
- strengthening the muscles of the anterior abdominal wall;
- avoiding excessive physical exertion.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
