Hernias occur proportionately to age. Signs of a hernia at the age of 40-50 years are noted only in 10% of patients with gastroenterological pathologies, and by the age of 70 years - already in 60-70%. Women often suffer, although the symptoms may be subtle, and the hernia is not recognized.

Causes.

Hernia of the esophagus of the diaphragm can be congenital or acquired. Congenital forms are associated with malformations, and symptoms occur early, requiring surgical correction at an early age.

The main causes of acquired hernia are usually due to the aging process of tissues, including in the area of ??the ligamentous apparatus in the region of the esophageal opening of the diaphragm. In this case, the elasticity and tone of the tissues. This leads to excessive stretching of individual areas in the diaphragm zone and its ligaments.

The hernia of the esophageal opening may be in such conditions as:.

Marfan syndrome;.

flat feet;.

varicosity;.

diverticulosis;.

hemorrhoids.

The risk factors for the development of the disease are all situations of increasing intra-abdominal pressure:.

permanent constipation;.

indomitable vomiting;.

increased gassing;.

swelling in the abdominal cavity;.

weight lifting;.

constant slopes of the body;.

abdominal trauma;.

severe obesity;.

pregnancy;.

cough for chronic bronchitis or asthma.

Promote the development of hernia diseases of the digestive system - violations of esophageal motility, ulcerative processes, gastroduodenitis, pancreatitis or cholecystitis with the formation of stones. Hernia can also cause cicatricial shortening of the esophagus due to its cicatricial or inflammatory deformity.

Clinical classification.

According to anatomical features:.

sliding or axial;.

paraesophageal;.

mixed hernia.

Slipping hernia manifests itself with free movement of the lower part of the esophagus, part of the stomach or its body, and sometimes of the intestine into the chest cavity with a change in the position of the body. In this case, the content is then also easily returned back. Sliding or axial hernia, depending on what moves into the cavity of the hernial sac, is divided into:.

cardial;.

cardiofundal;.

subtotal;.

total gastric.

The parasophageal hernia is the finding of the lower part of the esophagus and the cardia of the stomach under the diaphragm zone, and part of the stomach is displaced into the thoracic cavity, located near the esophagus.

The mixed form has the symptoms of both forms.

According to the degree of retention of the hernial contents in the area of ??the hernial sac, there are:.

completely fixed hernia;.

fixed in part;.

non-fixed hernia.

Symptoms of a hernia of the esophageal opening of the diaphragm.

The main symptoms are manifested only in half the cases. These include pain in the region of the stomach, giving back to the region of the esophagus or back, interscapular area. There may be shingles,. There may be a violation of the rhythm of the heart (tachycardia or extrasystole). Many patients with hernias undergo cardiologist treatment for heart problems.

A distinctive sign of pain in hernia is pain intensification during or after food, after exercise, during coughing or bloating, in lying position. They decrease after eructation, deep breathing or vomiting, changes in body position, fluid intake. When infringement of hernia, the pains become cramped, they are given between the shoulder blades, nausea with vomiting and blood impurity, dyspnea and cyanosis, a decrease in pressure with tachycardia.

There are symptoms of digestive disorders - belching with the contents of the stomach or bile, bitterness in the mouth. There may be nausea and belching of the air. There is dysphagia, a violation of swallowing and passage of food through the esophagus, especially when taking liquid, semi-liquid, cold food. There may be heartburn, hiccoughs, burning in the tongue, hoarse voices.

Diagnostics.

An hernia can be suspected by typical signs, although the diagnosis of a hernia of the esophageal aperture of the diaphragm is based on X-ray data. A chest image with a contrast medium is performed, supplemented by data from the EHFDS. If necessary, a biopsy of the mucosa. The study is complemented by an analysis of stool for occult blood and coprograms.

Also in the research cycle includes esophagus manometry with an assessment of its motor function and sphincter condition. To investigate the environment inside the esophagus, esophageal and gastric pH measurements are performed with gastrocardiomonitoring and impedanceometry.

Methods of treatment.

Treatment of a hernia begins with conservative therapy - eliminates the phenomenon of reflux of gastric contents into the cavity of the esophagus. Antacids, proton pump inhibitors and H1-histamine receptor blockers are used. A specific diet is shown - fractional food in small volumes, in a warm form. Physical exercise is limited, special exercises are recommended - breathing and methods of therapeutic physical training.

Operative treatment is used when conservative measures are ineffective and progressive hernia, complications arise, cicatricial changes in the esophagus.

Are applied:.

surgery with suturing the hernial gates and strengthening the ligaments;.

operation for fixing the stomach;.

operation to restore the angle between the bottom of the stomach and the lower part of the esophagus.

With uncomplicated hernia of the esophageal aperture, the prognosis is favorable. In case of infringement or complications, an unfavorable. Required operations for resection of organs.

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