The diaphragm is a muscular plate that separates the organs of the thoracic and abdominal cavities. The esophagus passes through the aperture in the diaphragm, which in the normal state corresponds exactly to its diameter. But if the elasticity of the muscular tissue of the diaphragm is disturbed, the organs can move from the abdominal to the thoracic cavity. This phenomenon is called a hernia of the esophageal aperture of the diaphragm, or in common speech - a hernia of the esophagus.
Types of hernia of the esophagus
Depending on the mechanism of formation and features of anatomy, the diaphragmatic hernia is divided into sliding, paraeophagous and mixed hernias of the esophagus:
- Slipping (it is wandering, axial or axial) hernia of the esophagus - the most common form of the disease. With such hernias, the lower sphincter of the esophagus (cardia), the abdominal part of the esophagus and the upper part of the stomach penetrate into the thoracic cavity, and then return to their place, for example, with a change in position. The wandering hernia of the esophagus is divided into cardiac, cardiofundal, subtotal and total stomach gastric. In some cases, such hernias may not be capable of self-correction and, as a result, become fixed.
- A parasophagial (near-esophageal or fixed) hernia of the esophagus occurs when the cardia and the lower esophagus do not change their position, but the penetration of the bottom of the stomach into the aperture of the diaphragm occurs, and it is located near the upper part of the esophagus. Unlike sliding, these hernias are often infringed. Symptoms of such hernias of the diaphragm of the esophagus are severe pain, difficulty moving food through the esophagus, nausea, vomiting.
- With mixed hernias, the mechanisms of the formation of sliding and fixed hernias are combined.
Symptoms and treatment of hernia of the esophagus
At small sizes, especially if it is a sliding hernia, it may not manifest itself. Otherwise, the symptoms depend on the size of the hernia, its type, as well as the presence of complications and concomitant diseases:
- Heartburn . The most common symptom, from barely noticeable to painful, up to disability. Most often occurs after meals and at night.
- Pain behind the sternum , less often in the hypochondrium and upper third of the abdomen. About half of patients are observed, and more often with a fixed hernia.
- Dysphagia is a difficulty in passing food through the esophagus. It is observed when almost any type of food is passed, and is especially pronounced in hot, cold food or in large quantities.
- Belching. It can occur both by air and by the contents of the stomach. In the latter case, an acidic or bitter taste can be observed in the mouth by casting the contents of the stomach into the esophagus, which can be caused by the hernia of the esophagus.
- Hiccough . It is observed rarely, but has a long (up to several weeks) character.
In the case of a sliding hernia, symptoms are observed only when the contents of the stomach are thrown into the esophagus. It can be heartburn, belching, nausea.
Treatment of a hernia of the esophagus can be conservative and surgical.
Surgical intervention is necessary in case of infringement of a hernia, a hernia of the esophagus, complicated by a peptic ulcer, and in case of especially large hernias, more than 1/3 of the stomach.
In other cases, treatment is carried out conservatively. It is, first of all, in the right diet, which helps to avoid overfilling the stomach and throwing its acidic contents into the esophagus. Nutrition is recommended fractional, 5-6 times a day, in small portions. The use of fatty, roasted, sweet, spices, carbonated drinks, products promoting increase of gas formation, in particular - legumes is limited. Within one and a half hours after eating, it is not recommended to take a horizontal position. Also, heavy physical exertion, especially those associated with slopes and sudden changes in body position, should be avoided.