Symptoms and diagnosis of hernia of the esophagus

A hernia of the esophageal opening of the diaphragm (HH) is a chronic disorder in which the abdominal part of the esophageal tube and the cardia of the stomach exit into the chest cavity. Such a disease is often asymptomatic, it has no external signs, and many do not even suspect about it until complications appear. Diagnosis of a hernia of the esophagus can be an accidental discovery, even for a doctor during a chest or gastrointestinal examination for another abnormality.

HH is associated with the pathology of the musculoskeletal system, the abdominal organs under pressure are pushed through the diaphragm into the chest. Although the disease is asymptomatic in most cases and does not always require surgical treatment, it leads to disruption of the functioning of many organs, which can already lead to serious consequences. Esophageal hernia can occur at any age in both women and men.

What is a hernia

In the body of a healthy person, each organ takes its position and does not change it throughout life. This ensures the smooth operation of each system. But under the influence of some environmental factors and internal mechanisms, there is a violation of the situation, which affects not only the work of internal organs, but also the quality of life.

POD hernia is characterized by the exit of the esophageal tube and cardia outside the abdominal cavity through a weakened muscular ligament of the diaphragm. The formed defect can either move freely from one cavity to another, or be fixed at the level of the diaphragm, causing constant discomfort to the patient.

A hernia of the esophagus is easily confused with many other disorders of the gastrointestinal tract, and the presence of pathology can only be determined by instrumental research methods, using endoscopic and radiological methods.

The stomach, esophagus, diaphragm, heart and lungs suffer from pathology. The organs of the chest can be squeezed by the hernial sac, from which there are signs of a hernia of the esophagus, similar to angina pectoris, shortness of breath, and respiratory diseases. Obvious manifestations of HH will be symptoms of esophagitis, swallowing disorder and dyspepsia.

Diagnosis of a hernia of the esophageal opening of the diaphragm is almost never carried out on time, unless the patient immediately consults a doctor at the slightest disturbance from digestion.

Diaphragmatic hernia symptoms

A slight protrusion of the esophagus through the diaphragm does not make itself felt by any symptoms. Rarely, a patient may feel heartburn and discomfort in the sternum after a heavy meal. The asymptomatic form of the disease is the most common, therefore it is not surprising that half of all people with a hernia of the POD have never consulted a doctor for help and have not been examined, not to mention treatment.

At some point, the disease may manifest itself. This happens when HH becomes complicated or other disorders join. More often you can observe indirect signs - heartburn, hiccups, an unpleasant sour taste in the mouth.

Common symptoms of hiatal hernia:

1. Heartburn is the main symptom, it can disturb both with a minor defect and during the period of HH complication. There is a symptom after eating, when the patient assumes a horizontal position and leans forward. Heartburn will disturb after taking alcohol, smoking, strong physical exertion. This symptom is often not associated with a hernia, trying to eliminate it yourself, but it plays a decisive role in the diagnosis of the disease.
2. Pain is a vivid manifestation of HH, but not all patients are concerned. The symptom resembles angina pectoris, occurs after eating, exercise, in a stressful situation. Discomfort is felt in the chest area, under the ribs, in the region of the heart and shoulder blades. The pain is often aching in nature, intensifies during an increase in intrauterine pressure.
3. Regurgitation - a symptom that worries about 40% of all patients, the provoking factors are all the same reasons: leaning forward, overeating, resting on the couch after eating. Some patients spit up a large amount of vomit, this can occur so often that you always have to have some kind of container or bag with you. But in most patients, this symptom is mild.
4. Belching - occurs against the background of increased intra-abdominal pressure, accompanied by bad breath. During belching, particles of undigested food may be released. The patient tries to remove the symptom with antispasmodics, but this rarely gives a result.
5. Swallowing disorder or dysphagia - this disorder is common, provoked by haste during eating and poor chewing. Too hot or cold food can cause a symptom. For some people, dysphagia is only a temporary disorder, while for others, this disorder is permanent.

Reflux esophagitis

Gastroesophageal reflux disease is the regular reflux of stomach contents into the esophagus, which is caused by a weakened sphincter and increased intra-abdominal pressure. Reflux esophagitis is defined as a lesion of the lower esophageal tube. Inflammation with regular irritation can be a complication of a hernia or an independent disease. The disorder is of interest because it has symptoms similar to HH or is associated with the disease.

How does a hernia of the esophagus with reflux esophagitis manifest itself:

• frequent eructation of acidic contents - unlike HH without esophagitis, this symptom always appears with reflux and disturbs almost after every meal;
• bronchial obstruction - a violation in which the bronchi become clogged with a viscous secret, which provokes frequent coughing, especially at night;
• pain behind the sternum - an obligatory symptom when a diaphragmatic hernia is complicated by reflux, appears after eating, especially sour and spicy foods;
• dental diseases - due to the constant release of acidic contents into the esophagus, it enters the oral cavity, and enamel and mucous membranes suffer from this, esophagitis is often accompanied by stomatitis, increased tooth sensitivity, caries;
• rhinitis and pharyngitis - appear as complications associated with acid reflux, which irritates the mucous membrane, which leads to chronic inflammation, often manifesting a runny nose without a specific reason, can be associated with gastrointestinal pathologies;
• dysphagia - appears when trying to swallow a large portion of food at a time, can be a temporary phenomenon and a permanent deviation.

The following factors can contribute to the appearance of signs of reflux:

• undergone surgery on the gastrointestinal tract;
• congenital pathologies - diverticula, Barrett's esophagus, stenosis, atresia;
• smoking, drinking alcohol, inhaling or ingesting drugs;
• peptic ulcer of the stomach and duodenum;
• pregnancy and overweight.

Types of HH and their signs

There are three types of diaphragmatic hernias:

Type of GPOD	Main clinical features
Axial	The stomach is displaced through the opening of the diaphragm vertically, most of it or only the cardia penetrates into the chest cavity
sliding	Organs move freely from the abdominal cavity to the chest, they are in the hernial sac of connective tissue
Paraesophageal	Above the diaphragm and near the esophagus are located simultaneously the fundus of the stomach, omentum and loop of the intestine

 

Etiology of a hernia

Hernia is treated conservatively in most cases, therefore it is important to identify the main factor in its development in order to eliminate it in the course of therapy. Various causes can aggravate the symptoms, so they need to be known and try to avoid.

1. Muscular weakness of the diaphragm and high elasticity.

This factor is already important in old age, when physiological aging occurs, tissues lose their elasticity and activity, nutrition is disturbed, which leads to a defect in the diaphragmatic opening. Muscle weakness contributes to the expansion of the natural orifice under pressure. This factor explains the predisposition to HH after the age of 55, which is often exacerbated by an inactive lifestyle and bad habits.

2. High intra-abdominal pressure.

This happens with constant overeating, constipation, during pregnancy. The pressure can rise once or constantly stay at a high level. The cause may be ascites, chronic cough, hard physical work. Each factor in the increase in intra-abdominal pressure (overeating, constipation) can be the main cause of hiatal hernia.

3. Shortening of the esophagus and impaired peristalsis.

Some diseases can lead to a physiological increase in the level of the esophagus, which at the same time leads to an increase in its function, therefore, pressure increases in the organ. The cause of the violation is such pathologies as pancreatitis, ulcers, polyps, cicatricial changes, stenosis, chemical and thermal burns.

4. Diaphragm injury.

The reason for the expansion of the opening of the diaphragm may be its open or closed damage. The muscular-ligamentous apparatus may suffer from a bruise, wound with a knife or other piercing and cutting objects.

How is it diagnosed

To confirm the diagnosis, instrumental diagnostics is performed. First, the doctor collects an anamnesis, finds out what are the factors for the appearance of a hernia, which could be the main cause. External examination usually does not give any idea of ​​​​the disease, unless the patient has suffered a chest injury. Diagnosing HH is very simple, the defect is visible on x-rays with the introduction of a contrast agent. Additionally, laboratory tests are prescribed to determine the inflammatory process and monitor the dynamics of the disease.

To identify HH, the following research methods are carried out:

• radiography with contrast is the main method for diagnosing a hernia, it is prescribed for everyone if a disease is suspected, the pictures allow you to identify the defect itself and other disorders of the esophagus, stomach, diaphragm, but with a fixed hernia, the x-ray is uninformative;
• fibrogastroduodenoscopy - an endoscopic examination shows the condition of the esophageal mucosa, allows you to evaluate the walls of the stomach and intestines, is prescribed for almost everyone with suspected HH;
• Ultrasound is an optional method for a hernia of the esophagus, it is performed with suspicion of hidden pathologies of the esophageal tube and stomach, which could become a factor in HH;
• pH-metry - the method measures acidity, which is important with concomitant reflux esophagitis, the disease is always accompanied by an increase in the acidity of gastric juice.

Consequences

Without treatment, the esophagus is constantly exposed to acid and high pressure, the symptoms subside and reappear, which can lead to complications.

What is dangerous hernia of the esophageal opening of the diaphragm:

• erosion and peptic ulcer - are detected in approximately 9% of patients with HH against the background of increased acidity of gastric juice and irritation of the inflamed esophagus with solid and hot food;
• shortening of the esophageal tube - occurs due to chronic inflammation, the hernia is aggravated as a result of this complication and the esophagus and cardia are fixed at or above the diaphragm;
• cicatricial stenosis - narrowing of the esophagus occurs in the process of scarring of the inflamed esophagus with ulcers or erosions;
• cancer - a hernia cannot become the main cause of oncology, but it will be a risk factor, because there is constant inflammation, the mucosa does not heal for a long time, ulcers and erosion first appear, which, with a genetic predisposition, can result in a malignant process;
• internal bleeding - occurs when the ulcer is perforated, this is the most dangerous complication of HH, which will manifest itself in the form of vomiting with blood.

Treatment Methods

The main goal of treating uncomplicated HH is to eliminate reflux esophagitis. Drug therapy is aimed at reducing the production of gastric juice to minimize contact of the esophageal mucosa with aggressive hydrochloric acid.

With a hernia of POD, treatment includes taking the following groups of drugs:

1. Antacids - Phosphalugel, Rennie, Alma-Gal . Indicated for acid neutralization.
2. H2 blockers - Nizatidine, Famotidine . Reduce acid production.
3. Bile acids - Allochol, Festal, Urochol . Neutralize stomach acid.
4. Antispasmodics and painkillers - No-Shpa.

With the signs of HH, folk remedies help to cope well:

• with heartburn - a decoction of orange peels and flax seeds;
• with belching - an infusion of cranberries with honey and a few drops of aloe juice;
• with bloating - a decoction of yarrow with mint, chamomile infusion;
• for constipation - dried fruit compote, rhubarb decoction and infusion of hay leaves.

Indications for surgery

Surgical treatment of HH is an extreme measure to eliminate the defect. An operation is prescribed for severe complications that can no longer be dealt with by conservative methods.

When a decision is made about the radical treatment of a hernia of the esophagus:

• paraesophageal hernia with the risk of strangulation;
• damage to the hernial sac and gate;
• deterioration in the background of esophagitis;
• ineffectiveness of conservative therapy;
• accession of complications - polyps, ulcers, bleeding.

Prevention of complications

With a hernia of the esophagus, doctors give the following recommendations:

• review nutrition, remove from the diet foods that contribute to bloating, constipation, increased acidity of gastric juice;
• try to do less torso forward, which provokes symptoms;
• take heartburn remedies, anti-inflammatory and enveloping agents;
• give up hard physical work, but do breathing exercises;
• do not endure severe heartburn and pain, but consult a doctor for treatment.

With a hiatal hernia, it is useful to do exercises to strengthen the abdominal wall and relax the muscles. These can be the usual turns of the torso and chest to the sides, as well as a slow protrusion and retraction of the abdomen in the prone position.

A prerequisite for prevention is sparing nutrition, the main rule of which will be eating food at a normal temperature in small portions. Overeating is the main enemy with a hernia of the esophagus. It will also be useful to get rid of the habit of resting lying down after eating.