What is an axial disc herniation?

Among diseases of the digestive system, not the last place is occupied by axial hernia of the esophageal opening of the diaphragm , which, according to medical observations, occurs in 5% of the adult population , has severe symptoms, and requires immediate medical attention. In the gastroenterological practice of doctors, such a disease can often be found with the term "axial vital hernia", "HH" or the simplified name "hernia of the esophagus". The disease has a chronic relapsing course, characterized by protrusion of the lower esophagus and displacement of part of the stomach into the chest cavity. What is a hiatal hernia, what are its causes, symptoms, how dangerous is the disease and what methods of treatment does modern gastroenterology offer?

Description of the disease

Axial hernia of the esophagus develops when the muscles of the diaphragm around the esophagus are weakened. Such a pathological condition leads to the fact that part of the stomach after eating or physical exertion enters the chest cavity, but after a while it returns to its previous state. At the initial stages of the development of the disease, the clinic may be absent or manifested by minor signs, but as it progresses, the symptoms become pronounced and require immediate medical intervention.

As practice shows, a hernia is most often manifested in women, less often in men. It can be congenital or acquired.

According to morphological features, a hernia of the esophagus is divided into several stages and classifications, each of which has its own characteristic features. In practice, the most common sliding (axial) hernia, which is diagnosed in 90% of patients. It got its name, a sliding axial hernia, due to the fact that it is able to slip into the upper stomach and lower food sphincter, penetrate into the sternum and return freely.

Causes

There are several reasons and predisposing factors that can provoke the development of hiatal hernia, but in 50% of cases the disease is not an independent disease, but manifests itself against the background of progressive dystrophic changes in the esophagus and connective tissue. The following causes and factors can act as a trigger for the development of the disease:

Sedentary lifestyle.
Asthenic physique of a person.
Flat feet.
Scoliosis.
Haemorrhoids.
Increased intra-abdominal pressure.
Hacking cough.
Obesity.
Hard physical labor.
Pregnancy period.
Reflux esophagitis.

In addition to the above reasons, gastritis, gastric ulcer, cholecystitis, pancreatitis and other diseases can provoke the development of a hernia. Regardless of the etiology of the disease, treatment should be started as soon as possible, this will help reduce the risk of complications and surgery .

Classifications and stages of development

Axial hiatal hernia is divided into three main types:

Sliding (non-fixed) - able to move from the lower part of the esophagus to the upper and sternum;
Paraesophageal (fixed) - only the cardial part of the organ moves into the chest cavity, which does not descend back. This type of disease is much less common, but fixed hernias are more dangerous, often requiring immediate surgical intervention.
Combined - accompanied by two signs of the first two options.

Depending on the spread of a hernia in the chest, I distinguish three stages :

First degree - the abdominal esophagus is above the diaphragm, the stomach is raised and tightly pressed against it. At grade 1, clinical signs are invisible, and minor disorders of the gastrointestinal tract often go unnoticed.

The second - the esophagus is present in the sternum, the stomach is located at the level of the diaphragmatic septa. When diagnosing the 2nd degree of the disease, the symptoms are pronounced, require medical intervention.

The third stage - above the diaphragm is part of the esophagus. This is the most severe degree of the disease requiring surgical intervention.

It is known that the first degree of the disease is often accompanied by other concomitant diseases of the digestive tract, so at this stage it is difficult to recognize a hernia. Most often, the underlying disease is treated.

Clinical signs

In almost 30% of cases, an axial hernia causes no symptoms, but only until such time as it acquires more serious stages of development. Often the symptoms can resemble other diseases, which makes it difficult to diagnose. Clinical manifestations increase as the hernial sac increases.

The main symptom of the disease are pain in the chest, back, abdomen. The intensity of the pain syndrome is quite different, from weak and aching pain to acute and unbearable. The pain often gets worse after eating, exercising, coughing, turning or bending over.

In addition to pain, there are other symptoms, including:

Bad burp.
Nausea, vomiting.
Difficulty swallowing food and liquids.
Severe heartburn.
Hoarseness of voice.
Sore throat.
Discomfort in the epigastrium.
Dyspeptic disorders.
Increased fatigue.
Frequent headaches.
Low blood pressure.

When the hernial sacs are infringed, the symptoms become more pronounced, the patient's condition deteriorates sharply, and the risk of internal bleeding increases. Such symptoms require immediate hospitalization of the patient in a hospital , where he will be provided with proper medical care.

Possible Complications

Lack of timely treatment can lead to unpleasant, and sometimes irreversible processes. The most common complications include:

aspiration pneumonia;
chronic tracheobronchitis;
infringement of a hernia;
reflex angina;
increased risk of myocardial infarction;
stomach bleeding;
perforation of the esophagus;

With a long-term course of the disease, the risk of developing malignant tumors increases. Given the complexity of the disease and its possible consequences, the only way to prevent complications is timely diagnosis and properly administered therapy.

Diagnostics

If an axial hernia of the esophageal opening of the diaphragm is suspected, the doctor prescribes a number of laboratory and instrumental research methods, including:

X-ray examination.
Computed tomography of the chest cavity.
Laboratory analysis of urine, blood.
Endoscopic examination (esophagogastroscopy).
Esophagomanometry.

The results of the examinations will allow the doctor to get a complete picture of the disease, assess the patient's condition, the stage of the disease, make the correct diagnosis, and prescribe the necessary treatment. In addition, the patient will be assigned to consult with other specialists, in particular a pulmonologist, a cardiologist, an otolaryngologist.

Treatment Methods

Axial hernia can be treated conservatively or surgically. With the tactics of treatment, the doctor is determined based on the results of the diagnosis, the general condition of the patient. Conservative therapy consists of taking several groups of symptomatic drugs, as well as following a strict diet.

Drug treatment will not be able to eliminate the problem, but only stop the pronounced symptoms of the disease. The doctor may prescribe the following drugs:

Enzymes - Mezim, Pancreatin, Creon .
Antacids - Rennie, Phosphalugel, Maalox .
Drugs that normalize peristalsis - Domperidone .
Proton pump inhibitors - Omeprazole, Rabeprazole .

If necessary, the doctor may prescribe other medications, the dose of which, as well as the duration of administration, is determined individually for each patient.

When the disease is advanced or conservative treatment does not bring the desired results, the doctor will prescribe a planned or unscheduled operation. Surgical treatment will help restore the natural anatomical structure and arrangement of organs, reduce the risk of recurrence, and improve the patient's quality of life.

The choice of operation directly depends on the capabilities of the clinic, the degree of axial hernia.

Important in the treatment is therapeutic nutrition, which must be followed at any stage of treatment. The patient is prescribed fractional meals, up to 6 times a day. Portions should be small, food only at medium temperature. From the diet you need to exclude fried, spicy, fatty and smoked foods, as well as alcohol, coffee, strong tea. A sample menu for the patient will be the attending physician or nutritionist.

Prevention

To reduce the risk of developing a hernia of the esophagus, prevention should be carried out far before the first manifestations of the disease. It includes compliance with the following rules and recommendations:

rejection of bad habits;
rational and balanced nutrition;
healthy lifestyle;
moderate physical activity;
control over body weight;
timely and correct treatment of all concomitant diseases.

By following the elementary rules, you can not only reduce the risk of developing a hernia, but also other diseases of the gastrointestinal tract. Self-medication in any case should be excluded. The sooner a person seeks medical help, the greater the chance of a successful prognosis.