Hiatal hernia — the offset into the chest cavity through a hiatal of the lower esophagus, the stomach, and occasionally intestinal loops. Normally ligaments hiatal, Subdiaphragmatic adipose tissue and the natural anatomical location of the abdominal cavity prevent movement of bodies lying under the diaphragm into the chest cavity.
The cause of the hernia may be weakened ligaments. It is present in 5% of the adult population and approximately 50% — over the age of 50 years (age-related weakening of the ligaments), is more common in untrained, adynamic people. Another factor that provokes the development of this disease, is a significant increase in intra-abdominal pressure due to pronounced bloating, pregnancy, injury, or large tumors of the abdomen, attacks of uncontrollable vomiting or persistent cough (eg, patients with chronic obstructive bronchitis). Biliary (abnormal peristalsis) of the digestive tract, including the esophagus, which often occur with chronic inflammatory diseases (peptic ulcer and 12 duodenal ulcers, gastro, pancreatitis, cholecystitis), can also lead to the development of a hernia. In rare cases, the reason for its occurrence are embryonic malformations (short esophagus, thoracic stomach).
A hiatal hernia results in failure mechanisms obturator, located on the border of the stomach and esophagus, and thus provokes throwing of acid in the stomach esophagus and development of reflux esophagitis. The small hernia may not show any symptoms and is found, as a rule, during the diagnostic testing associated with another disease.
In cases where the hernia is large, but the obturator mechanisms at the border of the esophagus and the stomach still function adequately, the main manifestation of the disease are pain in the chest, in the heart or in the epigastric region. Pain occur immediately after a meal when lifting weights or the stress can last from a few minutes to several days. Often there is dysphagia (swallowing violation of food). If the hernia sac is compressed, then there are a dull aching pain in the epigastric or epigastric region or behind the breastbone.
When the obturator failure mechanisms of the main symptom of a hiatal hernia is heartburn. It occurs after eating, sudden change in body position, more often — at night, due to increased vagal tone. Having started as a searing heartburn, discomfort may become painful.
Hernia hiatal can cause pain and coronary really due to irritation of the vagus nerve and subsequent spasm of the coronary vessels of the heart, such a situation is fraught with the development of serious cardiovascular events up to myocardial infarction. Another extremely unpleasant symptom is regurgitation gastric contents or air. If you spit up a large amount of gastric contents, especially at night, it can lead to aspiration pneumonia. Regurgitation is not preceded by nausea or stomach reduction, it is due to the reduction of the esophagus.
Diagnosis of hiatal hernia is difficult because its symptoms are very diverse, it is often combined with other diseases of the gastrointestinal tract and flows with complications. No wonder this disease is figuratively called "masquerade of the upper abdomen." In order to perform X-ray diagnosis of the esophagus with barium sulfate konstrastirovaniem explore the motility of the esophagus using ezofagomanometrii, conduct daily pH-meters.
Treatment and prevention
Because the clinical picture of the disease in the majority of cases opredeleyaetsya reflux of gastric contents, then the treatment is given is the same as in reflux esophagitis.
In severe cases, and failure of medical therapy performed surgery (herniorrhaphy, the strengthening of esophageal hiatal ligament, the different methods of fixing the stomach to the abdominal cavity, fundoplication). After completion of the basic course of treatment, all patients should be placed on a clinical account with a gastroenterologist.