Treatment of axial hernia of the esophageal opening of the diaphragm
Esophageal hiatal hernia is the protrusion of part of the stomach into the chest cavity, which occurs through the esophageal hiatus (OSH). A hernia occurs as a result of the stretching of the fascial ligaments between the esophagus and the diaphragmatic opening through which the esophagus passes. Diagnosis of a hernia of the esophageal opening of the diaphragm includes an X-ray examination with a contrast agent (barium sulfate), esophagoscopy (endoscopic examination of the esophagus), and esophageal manometry. In most cases, a diaphragmatic hernia does not cause any symptoms, it is most often discovered accidentally during a routine X-ray examination of the chest organs.
The etiology of the pathology is unknown. The main risk factors are obesity, serious injuries, scoliosis. The incidence increases with age: about 60% of people aged 50 and older suffer from a diaphragmatic hernia. The cause of the disease can be increased pressure in the abdominal cavity caused by lifting weights, strong coughing, frequent sneezing, vomiting.
Symptoms of a sliding hernia of the esophageal opening of the diaphragm
The most common type of diaphragmatic hernia (95%) is a sliding hernia: the gastroesophageal junction and part of the stomach (usually the bottom) are located above the diaphragm. When the cardiac part of the stomach is displaced into the chest cavity, it is called a cardiac hernia.
Degrees of cardiac hernia of the esophageal opening of the diaphragm:
- I degree - the abdominal part of the esophagus is located above the diaphragm, at the level of the diaphragm - the cardia (sphincter between the cavity of the stomach and the esophagus), the stomach is adjacent to the diaphragm;
- II degree – the abdominal part of the esophagus is located in the chest cavity, and a fragment of the stomach is located in the area of the esophageal opening of the diaphragm;
- III degree – above the diaphragm is the abdominal part of the esophagus, the cardia, the bottom and body of the stomach.
Symptoms of a sliding hernia of the esophageal opening of the diaphragm are similar to the manifestations of gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LFR). First of all, it is heartburn, sour taste in the mouth, problems with swallowing (dysphagia), chest pain. A hernia can also cause shortness of breath due to its effect on the diaphragm, rapid heartbeat associated with irritation of the vagus nerve.
If the gastroesophageal junction is located normally, and part of the stomach in the diaphragmatic opening is adjacent to the esophagus, then we are talking about a paraesophageal diaphragmatic hernia. In the vast majority of cases, patients with a paraesophageal diaphragmatic hernia do not feel any discomfort and do not even suspect the pathology.
Fixed and non-fixed SOD hernias are also distinguished. In the first case, the organs displaced into the chest cavity do not return to the abdominal cavity. Endoscopic signs of a fixed hernia of the esophageal opening of the diaphragm are incomplete closure of the cardia and the presence of a hernial cavity.
Treatment of SOD hernia
If the disease is asymptomatic, treatment is not required. If the patient feels pain or discomfort, doctors advise avoiding stress, sleeping on a bed with a high headboard, not going to bed immediately after eating, reducing weight and eating right.
Medical treatment of axial hernia of the esophageal opening of the diaphragm is required in patients with concomitant GERD. The drugs of choice are proton pump inhibitors, H2-histamine receptor blockers, prokinetics, antacids. Patients with a diagnosis of SOD hernia should avoid taking medications that lower esophageal sphincter (lower esophageal sphincter) pressure. Read more about how to treat a hernia of the esophageal opening of the diaphragm on our website Dobrobut.com.
In case of severe clinical manifestations of paraesophageal hernia and the ineffectiveness of conservative therapy, surgery is recommended. A large number of methods aimed at eliminating the hernial gate and preventing the displacement of the esophagus and stomach into the chest cavity have been proposed. Recently, operations to remove an unfixed hernia of the esophageal opening of the diaphragm are most often performed laparoscopically. Unlike cavitary operations with thoracic or abdominal access, laparoscopic operations have a relatively low number of complications, quick recovery and more favorable long-term results.
Diet menu for esophageal diaphragmatic hernia
Nutrition for SOD hernia is fractional (5-6 times a day), food is chopped, foods that cause fermentation or heartburn should be excluded from the diet. An important point: it is desirable to take food in a calm environment, slowly, chewing thoroughly.
Diet menu for esophageal diaphragmatic hernia:
- cereals on water (except those that cause heartburn);
- puree soups;
- grated cheese, casseroles;
- lean meat and fish;
- boiled and mashed vegetables (potatoes, cauliflower, zucchini, carrots);
- omelettes;
- bananas, apples.
It is important to follow the drinking regime. It is advisable to drink 1.5–2 liters of still water per day.
Related services:
Gastroenterologist consultation
Videogastroduodenoscopy
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