Axial hernia of the esophagus in the diaphragm is represented as congenital and acquired disease. Otherwise, it is called a sliding hernia, because the “slides” on the human body and into the organs located in the abdominal cavity to the chest.
Axial hernia hiatal is a chronic disease, in which the displacement of abdominal organs: cardia of the stomach, abdominal esophagus, and in some cases loops of the small intestine.
The reasons for the development of the disease
Scientists in the field of medicine identified several reasons for developing axial hernia of the esophagus.
- 1Dyskinesia of the esophagus or stomach. With psoriasis disturbed motility of the gastrointestinal tract, which causes scarring of the esophageal wall.
- 2Decrease in elasticity of connective tissue, regulate the tone of the diaphragmatic muscle, or weakening it. The cause of the disease is inherited or occurs in humans with age. For this pathology there is an incomplete closure of the esophageal opening, causing a possible protrusion of the upper part of the stomach.
- 3Lack of strength of the ligaments. Often due to age, but sometimes occurs in young people (if the weakness of the ligamentous apparatus is associated with a congenital disease).
- 4Reflux-gastritis, which is accompanied by a shortening of the esophagus. If reflux-gastritis is present in humans for a long time, the body progresses the inflammatory process, resulting in the formation of scars on the walls of the esophagus.
The causes of the disease are:
- chronic liver disease and pancreas;
- spasm of the esophagus;
- increased intra-abdominal pressure;
- the disruption of the duodenum;
- problems with motor function of the stomach;
- pregnancy and childbirth;
- disruption of the respiratory system, which are accompanied by a persistent cough;
- damage of the diaphragm;
- bad habits;
- old age.
In addition, people who do very little physical activity at risk of getting the disease. This is due to the fact that in untrained people, weak ligaments, General lack of muscle tone.
It is believed that suffer most from the thin axial bulge hiatal because they have thinning of the fat layer.
Axial hiatal hernia in 40% of cases not recognized by the patient immediately.
This disease has several common characteristics, including:
- 1Heartburn, which is burning sensation behind the rib cage. This sign of the presence of axial convexity is most common. It means that in the digestive tract from the stomach got food due to gastroesophageal reflux. The occurrence of this condition is associated with weakness of the lower esophageal sphincter. Heartburn axial hernia of the oesophagus occurs at night during sleep and when a person is in a horizontal position.
- 2Burp associated with the ingested with food of air in the stomach. Normally, the air slowly out through the mouth. If a person has an axial bulge hiatal, is an increase in pressure inside the abdominal cavity, which entails the rejection of air from the digestive system with some effort. With gastric contents there is a sour bite. This is due to the high acidity of the digestive juice that occurs when a person has hiatal (axial) hernia.
- 3Hiccups that appear when irritation of the phrenic nerve that is formed by the diaphragmatic bag. Axial hernia hiccups long-term in nature and associated with the beginning of the meal.
- 4the Appearance of pain in the abdomen, which have a compressive effect on the internal organs. Arise with gases.
- 5Pain of the chest, which has a burning character.
- 6Dysphagia – a violation of swallowing, in which there is a difficulty with the absorption of liquid food, hence the name paradoxical dysphagia.
- 7Anemia related to the occurrence of internal bleeding in hiatal hernia. If anemia is observed, the dizziness, the skin becomes pale, there is a ringing in the ears.
Diagnosis of a sliding hernia begins with the examination of the patient by the radiologist. This allows the doctor to determine the nature of the disease in the patient.
X-ray is done in 2 positions:
- in the Trendelenburg position when the patient’s pelvis is raised.
Hernia of small size is in the supine position. To determine the nature of the hernia (paraesophageal or axial) introduced a special contrast agent.
In addition to the x-ray is computer tomography, which allows to study the layers of the organs of the chest. This method of diagnostics is used to detect diseases of the heart, lungs and diseases occurring in the intestine.
Most often a hernia is detected after passing the patient’s blood test that indicates the patient has anemia or inflammation.
Esophagogastroscopy is one of the methods of examination for suspected bulge of the esophagus. Endoscopic examination is to study using a flexible endoscope to the mucosa of the esophagus.
Another way to detect the disease – esophagomanometry – measurement of intra-abdominal pressure.
X-ray, esophagogastroscopy and esophagomanometry the most accurate methods for diagnosis of axial bulge hiatal.
The types and extent
In medical practice there are 3 types of hernia of the esophagus.
|Type of hernia||Distinctive features|
|Paraesophageal hernia||In the chest gets only a fraction of the esophagus or stomach, at the same anatomical position of the digestive tract remains unchanged, that is this kind of hernia is fixed.|
|Axial (sliding) hernia||This hernia is not fixed, as it “glides,” that is, the abdominal organs fall into the chest, but can come back. In this disease in the chest, the esophagus penetrates completely.|
|Combined (cardiac) hernia||Occurs when moving the gastro-esophageal joint and cardiac region of the stomach.|
There are several types of complications that entails hiatal hernia of the esophagus:
- the occurrence of reflux esophagitis, which is caused by reflux into the chest of the stomach contents;
- a peptic ulcer of the esophagus;
- scar formation in the structure of the digestive tract;
- shortening of the esophagus;
- Barrett’s esophagus (a precancerous disease);
- internal bleeding.
Conservative therapy is carried out when the hernia has complications. The goal of treatment is to protect the wall of the esophagus from stomach acid, to prevent the occurrence of ulcers and inflammation in the digestive tract.
Doctors ‘ recommendations boil down to several points:
- healthy lifestyle;
- good sleep;
- avoid heavy physical exertion;
- proper nutrition.
Proper nutrition is one of the most important factors in the treatment of hernia. It is necessary to reduce the acidity of gastric juice, omitting the spices, meats, sweets, spicy dishes and condiments.
Not to use plant fiber (beans, radish, peas). To reduce swelling, added to food fennel and cumin.
For quick recovery it is recommended to use:
- lean meat and fish;
- baked potatoes;
- porridge on the water;
Sliding hiatal hernia treated by conservative methods, and operational. Doctor prescribed medicines which neutralize the hydrochloric acid produced by the stomach. To prevent reflux of bile into the esophageal hole is assigned to the Ursofalk.
Of complications, axial hernia surgery is used, for example, if the esophagus is constricted, strangulated hernia, or develop precancerous condition.
The most common method of treatment – Nissen fundoplication, which is performed open or via laparoscopy.
Surgeons prefer laparoscopic surgery because it provides a visualization of all the necessary organs for the monitor to facilitate the process of surgical intervention.
There are several alternative methods of surgical treatment of hernia hiatal: operation Belsi and gastrocardialny according to the method of hill.
The pathology of food the size of the aperture is a dangerous disease.
To prevent its occurrence, doctors recommend to carry out a number of activities:
- adhere to a healthy lifestyle – give up bad habits;
- eat a healthy diet;
- to respect the day;
- to provide daily the body to moderate physical activity.
Physical activity must be present, but not in excess. Eat often but small amounts; it avoid overeating, and do not eat before bedtime.
Sometimes this pathology occurs due to excess or insufficient weight. This means that you need to normalize the weight in accordance with the established medical body mass index.