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Can a hiatal hernia cause arm pain: Heart Attack or Hiatal Hernia? Differences in Symptoms and Signs


Hiatus Hernia FAQs (Frequently Asked Questions)

These are questions we are often being asked specifically on Hiatus Hernia, together with our answers. It should be read in conjunction with the page specifically on Hiatus Hernia.

Nothing here is to be taken as medical advice. If in any doubt at all, please consult your family doctor in the first instance.

My last attack lasted 6 hrs and the pain was so bad I thought I was having a heart attack. When does a hiatus hernia become dangerous?

The symptoms can mimic those of a heart attack well enough to fool many a doctor. The excruciating pain, the pain in the jaw, the left arm – classic signs. Most unpleasant. Of course, as it is not a heart attack, that in itself is not as dangerous at all. The worst danger facing most sufferers relates to reflux. That is where the stomach contents are squeezed up into the oesophagus, aka the gullet or ‘food pipe’. That can cause two really dangerous issues:

  1. The reflux material can come up the oesophagus and be aspirated (breathed back in), down the airways. That alone is bad enough, but being acidic, it can trigger a horrible spasm rendering the sufferer unable to clear the airway.                                 .
  2. The acid burning the oesophageal lining over extended periods can cause permanent damage to the tissue, sometimes change the nature of the cells and lead to other very nasty conditions.

Aspirating reflux is possibly the most ‘dangerous’ risk of untreated Hiatus Hernias as it can be fatal. Note though that reflux can arise from causes other than Hiatus Hernia.

Best advice: If you suffer long-term heartburn or indigestion, or prolonged attacks of reflux (awake or asleep) consult your family doctor. He may well refer you to a gastro-enterologist for tests to establish the cause and recommend treatment before it becomes a serious danger.

How long before bed to stop eating would be a nice guide.

I’m sitting here at 4am after just waking with yet another bout of reflux and it was hours ago I last ate. Great page, thank you!

For what to eat and when, ‘little and often’ tends to alleviate symptoms best in most cases. Sadly, even a glass of water before bed can bring it on. If you are having such reflux not having eaten for ‘hours’, then make an appointment to see your family doctor now. Yours is a case in need of proper investigation.

Would be nice to have a link to somewhere (if there is anywhere!) that tells you what to look out for after so much acid burning the throat so many times and aspirating the acid.

First of all, ‘acid burning your throat so many times’ and ‘aspirating the acid’ are BOTH serious symptoms (see the first FAQ above).

Understand that burning really is BURNING. If you look down an endoscope you would see the signs of actual burns. This is very serious and you MUST stop it from continuing.

For immediate relief, many sufferers find products like Gaviscon very effective. However, this is NOT a long term solution to what you describe AT ALL! Your doctor IS.

Health Complications from GERD | Everyday Health

Q1. Would you get arm pain with an attack of GERD?

Mary, Michigan

Arm pain is not a common symptom of GERD (gastroesophageal reflux disease), although it can occur in rare cases. In general, GERD involves the reflux of stomach contents into the esophagus. While many patients have no symptoms, heartburn is the most common complaint. However, other patients have more atypical symptoms such as chest pain, which can mimic heart attack; and sore throat, hoarseness, or a bad taste should stomach contents reach the mouth.

GERD causes inflammation within the esophagus and does not directly irritate the diaphragm or the phrenic nerve that innervates (stimulates) it. Paraesophageal hernias, where part of the stomach is squeezed up into the chest beside the esophagus, may potentially lead to pain.) In terms of arm pain, here’s the likely scenario: Sometimes the contents of your stomach make their way into the trachea (or windpipe, which runs next to the esophagus), and then reach the lungs, causing exacerbations of asthma and occasionally pneumonitis or infectious pneumonia. Should that occur, the diaphragm (the big muscle under your lungs that helps you breathe) may become inflamed. Since the diaphragm is innervated by the phrenic nerve, which starts near the cervical spine, regions that are also served by spinal nerves can be affected, e.g., the arms and shoulders.

Keep in mind that left arm pain is often associated with heart disease, so if you haven’t yet been evaluated for your pain, you should see a physician soon.

Q2. My 8-year-old daughter has been complaining of nausea for about a month now. It began while she was eating some candy at the movies when she suddenly didn’t feel so well. Our family doctor said not to worry, but her symptoms have steadily progressed. She complains of heartburn about twice a week and says she’s nauseated after eating in the morning. She also has developed a rash on her chest and back. Any advice?

It is difficult for me to diagnose your daughter without examining her and getting more detailed information about her symptoms. However, there are several common causes of prolonged nausea in children. You mentioned one common cause — heartburn, also known as “gastroesophageal reflex disease,” or GERD. Patients with GERD experience an uncomfortable sensation when acidic contents from the stomach reflux backwards up into the esophagus. Symptoms of reflux include pain in the middle of the abdomen or chest, nausea, and sometimes even a bad taste in the mouth after eating. This is a very common problem that is often treated with diet modifications such as eating fewer fatty foods, eating smaller meals, and not lying down after eating. Medications which lessen the acidity of the contents in the stomach are often used to treat symptoms. There are a variety of medications available ranging from Tums and Maalox, to Pepcid and Nexium.

Another possible cause of prolonged nausea is inflammation of the stomach, called gastritis. The source of inflammation varies. Sometimes after a viral infection people will develop gastritis that can last anywhere from a week to a couple of months. Some people who experience gastritis are infected with Helicopylori, a bacteria that can cause gastritis, and other problems including ulcers.

There are other causes of prolonged nausea that are not related to the stomach or the gastrointestinal system at all, such as stress. Children quite often report nausea and stomach pain when they are stressed. For instance, children who become stressed about school will experience nausea in the morning, but will feel better in the evenings and on vacation.

As I noted initially, I would certainly need more information to diagnose your daughter. However, in light of her symptoms worsening and her developing a rash, I can recommend that your daughter return to her doctor and have her nausea investigated further. Your daughter may even need to see a doctor who specializes in gastrointestinal issues. Good luck!

Hiatal Hernia | Cedars-Sinai

Not what you’re looking for?

What is a hiatal hernia?

A hernia is when part of an organ goes through an opening in the muscle wall around it.

In a hiatal hernia, part of your stomach pushes up into an opening (the hiatus) in your diaphragm. The diaphragm is the muscle between your stomach and your chest.

In most cases, your food pipe (esophagus) goes through the hiatus and joins your stomach. But with a hiatal hernia, the top part of your stomach moves up through that opening into your chest.

The top part of your stomach gets pinched. Stomach acid can back up (reflux) through the opening. This may cause heartburn and other symptoms.

There are 2 types of hiatal hernias: sliding and paraesophageal.

Sliding hiatal hernia

This type of hernia:

  • Is most common
  • Happens when part of the stomach, and the place where the stomach and esophagus meet, slide up into your chest through the opening (hiatus)

Paraesophageal hernia

This type of hernia:

  • Is less common but can be more serious
  • Happens when part of your stomach pushes up through the opening (hiatus) into your chest and is next to your esophagus

What causes a hiatal hernia?

Experts don’t know what causes hiatal hernias. Some causes may include:

  • Coughing
  • Vomiting
  • Straining while having a bowel movement
  • Sudden physical effort
  • Pregnancy
  • Obesity

Who is at risk for a hiatal hernia?

You may be at greater risk for a hiatal hernia if you:

  • Are age
    50 or older
  • Are overweight or obese
  • Are pregnant
  • Smoke

What are the symptoms of a hiatal hernia?

In many cases a hiatal hernia has no symptoms.

Some people do have symptoms. These may include:

  • Burping
  • Feeling nauseous
  • Vomiting
  • Backflow (reflux) of acid or stomach contents into the esophagus or throat
  • Heartburn
  • Regurgitation
  • Trouble swallowing

Paraesophageal hernias may have more severe symptoms. These can include:

  • Having trouble swallowing sometimes, most often with solid foods
  • Feeling full after eating only a small amount of food
  • Belly (abdominal) or chest pain
  • Abdominal bleeding
  • Blood loss (anemia)

In some cases a paraesophageal hernia can lead to a medical emergency. The stomach or abdominal organs may turn or twist, causing very bad pain. There is a danger that the stomach’s blood supply may be cut off (strangulation). This is an emergency. You will likely need surgery right away.

The symptoms of a hiatal hernia may look like other health problems. Always see your healthcare provider to be sure.

How is a hiatal hernia diagnosed?

healthcare provider will give you a physical exam. They will look at your past

You may also have tests including:

  • Chest
    This may show that you have a hiatal hernia.
  • Upper
    endoscopy, also called EGD (esophagogastroduodenoscopy).
    This test looks at
    the lining of your food pipe (esophagus), stomach, and the first part of your small
    intestine (the duodenum). It uses a thin lighted tube, called an endoscope. The tube
    has a camera at one end. The tube is put into your mouth and throat. Then it goes
    into your esophagus, stomach, and duodenum. Your healthcare provider can see the
    inside of these organs.
  • Upper GI
    (gastrointestinal) series or barium swallow.
    This test looks at the organs of
    the top part of your digestive system. It checks your food pipe (esophagus), stomach,
    and the first part of your small intestine (the duodenum). You will swallow a
    metallic fluid called barium. Barium coats the organs so that they can be seen on an
  • Esophageal
    This test checks the strength of your esophagus muscles. It can
    see if you have any problems with reflux or swallowing. A small tube is put into your
    nostril, then down your throat into your esophagus. This measures the pressure that
    your esophagus muscles make at rest.

How is a hiatal hernia treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on
how severe the condition is.

most cases you won’t need treatment. But you may need medical care if your hernia:

  • Is at
    risk of being twisted so much that blood supply is cut off to your stomach
  • Is more
    difficult because of severe GERD (gastroesophageal reflux disease)
  • Is more
    difficult because of redness and swelling (inflammation) of your esophagus

healthcare provider may suggest medicines to:

  • Weaken
    or neutralize stomach acid (antacids)
  • Reduce
    the amount of acid your stomach makes (H-2 blockers or proton pump inhibitors)
  • Strengthen your lower esophageal sphincter (LES) – the muscle that stops stomach
    acid from backing up into your esophagus

severe cases surgery may also be needed to:

  • Make
    your hernia smaller
  • Stop
    loss of blood flow to your stomach (strangulation) by closing the opening in your

What are possible complications of
a hiatal hernia?

In most cases a hiatal hernia won’t lead to other health problems.

In some cases it can cause other problems such as:

  • Severe GERD (gastroesophageal reflux disease)
  • Lung problems or pneumonia because stomach contents have moved up into your esophagus and into 1 or both lungs
  • Strangulation of the hernia, cutting off blood flow to your stomach (medical

What can I do to prevent a hiatal hernia?

Health experts don’t know what causes hiatal hernias. They don’t know how to stop them from happening.

Living with a hiatal hernia

Follow your healthcare provider’s advice for treating and managing your hiatal hernia. You may need to make some lifestyle changes, such as:

  • Losing weight if you are overweight or obese
  • Not eating for 3 to 4 hours before going to bed
  • Not bending over right after eating
  • Quitting smoking

When should I call my healthcare provider?

Call your healthcare provider if your
symptoms come back after treatment has stopped them. Let them know if symptoms get worse
or you have new symptoms.

Key points about hiatal

  • A hiatal hernia is when part of your stomach pushes up into an opening (the hiatus) in your diaphragm.
  • There are 2 types of hiatal hernias: sliding and paraesophageal.
  • Paraesophageal hernias are less common but can be more serious. You may need surgery.
  • Experts don’t know what causes hiatal hernias.
  • In most cases there are no symptoms.
  • In most cases no medical care is needed.

Next steps

Tips to help you get the most from a visit to your health care

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember
    what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any
    new medicines, treatments, or tests. Also write down any new instructions your
    provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it
    will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results
    could mean.
  • Know what to expect if you do not take the medicine or have the
    test or procedure.
  • If you have a follow-up appointment, write down the date, time,
    and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Not what you’re looking for?

Hiatal Hernia the Great Mimicker

Hiatal Hernia: An Overlooked Cause of Disease
Steven H. Horne 1997-2001

About three years ago Jack Richardson, a naturopathic physician, corrected a health problem I must have carried since childhood–a hiatal hernia. The impact this simple maneuver has had on my health has amazed me. I immediately noticed a difference in my lung capacity and my digestion and in the months that followed I began to put some muscle on my skin and bones frame and gain newfound strength and stamina.

Dr. Richardson tells me that this is a common health problem and my own observations as well as those of others confirm this fact. But this is more than a personal observation as the American Digestive Disease Society has estimated that nearly half of all adults–some 60 million people–have a hiatal hernia.

It occurs more often in women than in men. It affects people of all ages, but is most prevalent in people over 50 and highly likely in people over 65.

The Great Mimic
Hiatal Hernia has been called the “great mimic” because it mimics many disorders. A person with this problem can get such severe pains in their chest that they think they are having a heart attack. They may think they have an over acid stomach because they will regurgitate stomach acid after they eat, or their stomach may hurt so badly they will think they have an ulcer. This is just a sampling of the symptoms that may occur from this disorder.

What is a Hiatal Hernia?
When you swallow, your food passes down a long tube known as the esophagus into the stomach. This tube must pass through a muscle known as the diaphragm, which is located near the bottom of your rib cage. This opening in the diaphragm, which permits the esophagus to pass through, is regulated by a sphincter muscle (or “valve”) which relaxes and opens when we swallow to permit the food to pass through the diaphragm and into the stomach. This sphincter then closes to prevent stomach acid from coming back up into the throat. A hiatal hernia occurs when the top of the stomach rolls or slides up into this opening and becomes stuck there.

Naturally, when part of the stomach is forced into this opening, the sphincter cannot close properly. Thus, stomach acid may travel back up into the esophagus causing burning sensations (heartburn), esophageal spasms, inflammations and ulcers.

The cramped position of the stomach can also stress the vagus nerve, which stimulates the release of hydrochloric acid. This can cause both over and under secretion of hydrochloric acid and stomach enzymes. It may also affect the sphincter or valve at the bottom of the stomach so that digestive secretions “leak” out of the stomach and are lost before they have completed their job.

The hiatal hernia will also interfere with the movement of the diaphragm muscle. This muscle normally pulls downward to expand the chest capacity and inflate the lungs. Since the hiatal hernia interferes with this movement, the person may be restricted to shallow breathing, or will resort to using the chest and shoulders to expand the lung capacity and take a deep breath.

The esophagus may also “kink” in the throat, which will irritate the thyroid gland and may cause some difficulty in swallowing. Often persons with hiatal hernias will have difficulty in swallowing capsules or tablets as they get the sensation that they are “sticking” in their throat.

The irritation on the vagus nerve can cause reflex irritations throughout the body. The vagus nerve comes from the medulla and goes to the heart, esophagus, lungs, stomach, small intestines, liver, gall bladder, pancreas and colon. It also has links to the kidney, bladder, and external genitalia. Thus, a hiatal hernia may start imbalances in the system such as decreased stomach acid and pH imbalance in the intestines and elsewhere.

If a person develops poor stomach digestion due to a lack of hydrochloric acid, they will have difficulty digesting and assimilating protein and most minerals. It will also contribute to food putrefaction in the intestines, causing greater toxicity in the body. This lack of nutrition and toxic condition may contribute towards food allergies, constipation, anemia and immune and glandular system weaknesses.

Two other problems that a hiatal hernia may contribute to are asthma and heart disease. Since the hernia reduces the lung capacity by interfering with natural breathing, it could be a factor in asthma. The hernia may also put pressure on the heart. Gas in the intestines may put pressure on the hernia and push it against the bottom of the heart, which may be one way in which a heart attack can be triggered. None of this spells immediate fatality, but it does point to a major contributing factor in degenerative illness.

The causes of a hiatal hernia are speculative and unique to each individual. However, there are a number causes. First of all there may be a mechanical cause. Improper lifting, hard coughing bouts heavy lifting, sharp blows to the abdomen (the kind that “knock the wind out of you”), tight clothing and poor posture may contribute to the development of this problem. Improper lifting may be the biggest mechanical cause of this disorder. If the air is not expelled out of a person’s lungs while lifting, it will force the stomach into the esophagus.

Secondly, there are dietary causes. Hiatal hernia just about always accompanies a swollen ileocecal valve. The ileocecal valve is the valve between the small and large intestines which permits material to enter the colon from the large intestine, but prevents material in the colon from moving back into the small intestine. When this valve becomes swollen and irritated it cannot close properly. This allows material from the colon to leak back into the small intestine. This is analogous your sewer backing up into your kitchen. This creates gas and indigestion, which puts pressure on the stomach and presses it tighter against the diaphragm.

The relationship between the ileocecal valve and the hiatal hernia is a chicken/egg situation … it is hard to know which comes first. However, it is clear that the ileocecal problem aggravates the hernia. Hence, the things which irritate that valve may be causal factors. These are the basic causes of digestive problems: poor food combining, overeating, drinking with meals, overeating and eating when upset.

Lastly, there are emotional causes. According to one applied kinesiologist text a hiatal hernia comes from repressed anger. A person “swallows their anger” and “can’t stomach it.” When you get angry, you suck your breath upward. If you fail to release this anger, your stomach stays up. I have observed that most of the people with severe hiatal hernias have a great deal of emotional stress and hold a lot of it inside.

The easiest way to tell if you or someone you know has a hiatal hernia is to place your fingers on the solar Plexus, just below the breastbone. Then take a deep breath. You should feel the solar plexus expand and move outward. If there is no movement at the solar plexus and you have to lift your chest and shoulders to take a deep breath, then you probably have a hiatal hernia. You should be able to take a deep abdominal breath without lifting your shoulders.

There are other, more complicated, methods of determining if you have a hiatal hernia, such as muscle testing, but this is a fairly simple and reliable method.

Since a hiatal hernia is primarily a mechanical problem, the easiest and best way to correct it is mechanically. Medical doctors have attempted surgery to correct this disorder, but the results tend to be poor. Cutting into this area can further weaken it so that the hernia will return in short order. A better method is to manipulate the stomach and bring down the hernia by hand. Unfortunately, you can’t do this to yourself. You will need to find a good chiropractor, applied kinesiologist or massage therapist who understands this problems and knows how to correct it.

If you want to learn how to do this adjustment to others, you will have to find someone who does it and have them show you how since it is impossible to adequately describe the technique(s) in writing. They have to be learned through demonstration and practice. ..

There are some self-help adjustment techniques. They aren’t as effective as having someone else perform the adjustment, but they may help. The best one I’ve tried is to drink a pint of warm water first thing in the morning, then stand on your toes and drop suddenly to your heels several times. The warm water helps to relax the stomach and diaphragm and puts some weight in the stomach. By dropping down suddenly, the weight of the water helps to pull the stomach down. In a mild case, this might be enough to bring the hernia down. In a more severe case it may loosen the stomach and make it easier for someone else to bring it down. It will also help you to keep the stomach down once mechanical corrections have been made.

Nutritional Aids
Until the problem is corrected mechanically, there are some nutritional therapies which may be of help. Immediate, but temporary, relief of pain and discomfort can often be achieved by the use of a mucilaginous herb like slippery elm or comfrey. These herbs absorb the digestive secretions and help to prevent their traveling back up the esophagus and burning it. They also help to prevent irritation of the ileocecal valve. Comfrey can also speed the healing of this problem once mechanical adjustments have been made. Okra pepsin is a good combination for this problem as well.

Marshmallow is also helpful in soothing the mucous membranes for hiatal hernias and other ulcerations in the gastrointestinal system.

A digestive aid will help the person obtain the nutrients they need when the hernia is interfering with digestion.

This may take the form of a hydrochloric acid supplement or a food enzyme tablet, or perhaps an herbal digestive aid such as papaya and peppermint, chamomile tea, safflowers, ginger root and so forth.

Other food or herb products that have been used to help people with hiatal hernias include: raw cabbage juice (where ulcerations have occurred), balm, barley water, brown rice, celery, coriander, gentian, hops, licorice, marshmallow and passion flower.

Dietary modifications may be necessary to relieve the problem and to keep it from reoccurring once it has been corrected. Since the pressure of abdominal gas can push the stomach upward, it would be advisable to avoid gas forming foods like beans. It would also be wise to watch food combinations carefully and to avoid overeating. Dr. Jack Ritchason recommends that people with hiatal hernias avoid eating any heavy meals after 3 pm.

Symptoms of a Hiatal Hernia

What is a Hiatal Hernia?

A hiatal hernia occurs when the top of the stomach rolls or slides up into the opening in the diaphragm which the esophagus passes through and becomes stuck there.

This condition may create difficulty with digestion (and hence general nutrition and well-being) as well as breathing difficulties, nervous problems, circulatory problems and glandular imbalances. All of the following symptoms have been connected with a hiatal hernia. If you have some of these symptoms especially those marked with an asterisk (*) you may wish to consider being checked for this condition.

*Belching, *Bloating, *Heartburn, *Difficulty digesting meat/high protein foods, Tension or pressure at the solar plexus, Sensitivity at the waist, Intestinal gas, Regurgitation, Hiccups, Lack or limitation of appetite, Nausea, Vomiting, Diarrhea, Constipation, Colic in children, Difficulty in gaining weight or overweight, Ulcers.

*Difficulty with deep abdominal breathing, *Difficulty in swallowing capsules, *Asthma, *Inability to take a deep breath from diaphragm, Overall fatigue, Tendency to swallow air, Allergies, Dry tickling cough, Full feeling at base of throat, Pain or burning in upper chest, Pressure in the chest, Pain in the left side of chest, Pressure below breastbone, Lung pain, Rapid heartbeat, Rapid rise in blood pressure, Pain in left shoulder, arm or side of neck.

TMJ (Temporo-Mandibular Joint Pain), Bruxism (Grinding teeth in sleep), Joint pain, Localized or overall spinal pain, Headaches.

*Suppression of anger or other emotions, *Living with or having lived with a quick-tempered person, Dizziness, Shakiness, Mental Confusion, Anxiety attacks, Insomnia, Hyperactivity in children.

*Open ileocecal valve, *General weakness, *Difficulty in getting and/or staying healthy, Overactive thyroid, Cravings for sugar or alcohol, Candida Albicans, Menstrual or prostate problems, Urinary difficulties, Hoarseness.


Nature’s Field, Vol.17 No.3, May/June 2001
Steps for Manual Manipulation of a Hiatal Hernia
Laura McCready, N.D.

This procedure can be performed on yourselfafter being shown the technique by your natural health practitioner.

Perform this procedure every morning for at least one month, two months for large or long-term hernias. Steps one and two are optional but should be done for tense individuals or stubborn hernias. This procedure can be performed anytime the stomach seems to be displaced but best results are achieved if this is done with an empty stomach.

  1. Five minutes before the procedure, take a dropperful (15-20 drops) each of Lobelia Essence (stock # 1765-8) and Stress-J Liquid (stock # 3163-3) in 2 ounces of warm water to relax the diaphragm and vagus nerve.
    Magnesium Complex (stock # 1859-8) can also be taken daily to promote muscle relaxation.
  2. Massage Tei Fu Oil (stock # 1618-7), Lavender Essential Oil or Chamomile Essential Oil into the stomach area before the procedure.
  3. Lie on your back on a hard flat surface or the floor. Take a deep breath and remember what it feels like. (You should be able to breathe deeper and easier when the procedure is over.)
  4. Place both hands just beneath the breastbone. Palms are against the body and fingers are touching so that the thumbs meet just below (1″-2″) where the ribs come together.
  5. Take a deep breath and as you slowly and forcefully exhale, push thumbs inward and downward about two inches with a steady, heavy pressure. Do not lift your hands or release the pressure on your abdomen at the end of the breath.
  6. Maintaining constant pressure with the thumbs, take another breath and repeat the procedure until you reach the waistline. This will take a total of about 3-5 breaths.
  7. Hold your left thumb in place and move your right thumb over to shut the ileocecal valve. Using your right thumb this valve is found by locating the front, upper point of the right hip bone and moving the thumb toward the center of the body two inches and then down two inches. (This valve must be closed in order for the gastroesophageal valve to remain closed.)
  8. As your right thumb applies pressure to the ileocecal valve in an inward and upward direction (toward the stomach) move the left thumb over to assist with the pressure. Hold this pressure for 30 seconds. Release with a slight wiggling, massaging motion.
  9. Repeat the entire procedure (steps 4-8) three times.
    Take a deep breath and see how much better you feel.
  10. To Avoid pressure on the stomach, DO NOT rise as if you were doing a sit-up. Roll onto your side and push yourself to a sitting position using your arms rather than lifting yourself using your abdominal muscles.


Health Parameters Research site.
Abdominal Massage
Pat Block, N.D., 2000.

Cincinnati Ohio Hiatal Hernia Treatment and Relief | Symptoms


A Hiatal Hernia or Hiatus Hernia is a health condition where part of the stomach protrudes up into the chest area through a small opening in the diaphragm muscle. The diaphragm muscle is located just under your lungs and is used for breathing. When you take breathes, you are contracting and relaxing your diaphragm muscle.

The small opening in the diaphragm muscle is for the esophagus. The esophagus is the “food tube” extending from the mouth to the stomach. When you eat or drink, the food or liquid travels through the esophagus to the stomach. This small opening in the diaphragm is called the hiatus. When a part of the stomach pushes up through the hiatus, it’s called a hiatal hernia.

A hiatal hernia may lead to problems with such things as acid reflux and heartburn. These conditions can be discomforting, painful and make it difficult to eat and drink.

At Baker Chiropractic and Wellness, we have been helping patients with hiatal hernias for over 25 years. We do this using our safe and effective chiropractic care. We do not use prescription medications or surgery.

If you have developed a hiatal hernia, please contact us. Schedule an Appointment here on our website at any one of our Cincinnati area clinic locations.

Hiatal Hernia Symptoms

A small hiatal hernia typically will not cause pain or discomfort. However, as the hiatal hernia gets larger, the following symptoms may surface:

(1) Chest Pain

(2) Heartburn

(3) GERD – Gastroesophageal Reflux Disease

(4) Difficulty Swallowing

(5) Frequent Belching

Types of Hiatal Hernias

There are two main types of hiatal hernias:

(1) Sliding Hiatal Hernia

(2) Paraesphogeal Hiatal Hernia

A Sliding Hiatal Hernia is the more common type of hiatal hernia. With a sliding hiatal hernia, the stomach and the part of the esophagus that connects to the stomach slide up into the chest through the small hiatus opening in the diaphragm.

With a Paraesphogeal Hiatal Hernia, the stomach and esophagus stay in position, but a part of the stomach squeezes through the hiatus (small opening in the diaphragm) and pushes against the esophagus. When this happens, there is a risk of the blood supply to the stomach being reduced or shut off.


There is no exact cause for a hiatal hernia. Increased pressure on the diaphragm and the small hiatus opening in the diaphragm from such things as pregnancy and obesity are contributing factors.

Hiatal hernias are common in women, people who are overweight and people older than 50 years of age.

Impact on Vagus Nerve

The Vagus Nerve is a major nerve within the human body that runs from the brain, down through the neck, chest, heart, and lungs. From there, it branches out into the abdomen.  A hiatal hernia can cause irritation to the vagus nerve leading to a variety of abnormalities with the stomach, heart, and lungs as a result of the stress on the vagus nerve from the hiatal hernia.

Our Approach To Hiatal Hernias

Our chiropractic care focuses on the health and function of the body’s central nervous system. When the body’s central nervous system is optimized and 100% healthy, all systems within the body perform properly. When there are interferences (known as subluxations) in the central nervous system, the systems of the body are not able to function at peak levels which can lead to numerous health issues. Chiropractic adjustments remove subluxations and restore the health of the central nervous system.

Our training and experience with the central nervous system allows us to diagnose and target the underlying causes of health conditions such as hiatal hernias. Once we determine the cause, we are able to treat the condition with our safe and effective chiropractic care.

The best part of our chiropractic care is that it does not require the use of expensive prescription medications or risky surgery.

Real-Life Hiatal Hernia Treatment Stories

Here are just a couple of the numerous real-life stories from patients who came to us looking for help and relief from the pain, discomfort, and uncertainty caused by hiatal hernias:

Dr. Paul Baker and Ethan Stanley

Ethan’s Story

After having significant pain in my abdomen due to a hiatal hernia for many months, and not receiving a clear treatment plan from traditional medical protocol, I called Dr. Paul Baker to see if he could help.

Dr. Paul told me that he could treat and completely treat the hiatal hernia through adjusting my stomach out of my esophagus and that my wounded abdomen would heal on its own.

This was a simple but surprising solution since many of my friends thought that surgery was the only solution for any kind of hernia.

I am now about finished with my treatment and feel completely healed, back to normal, and pain-free.

Thanks so much!

– Ethan Stanley



Terri’s Story

It started on February 16th when I went to a local area medical clinic with symptoms of extreme fatigue, fever, and coughing. I was examined, swabbed and diagnosed with Type B Flu.

The following Sunday, I was experiencing severe chest pains and pressure. I was taken to the ER where they took two chest x-rays, an EKG and did blood work. They diagnosed me with Pleurisy which is inflammation of the tissues that line the lungs and chest cavity. I was told the Pleurisy was a result of my coughing from the Flu.

Nearly three weeks later on March 13th, I went to Urgent Care with severe chest pains, pressure, and shortness of breath. I had two more chest x-rays taken, another EKG and more blood work. I was then sent back to the hospital for a CT scan with a dye to check for blood clots in my lungs. After all of these tests, x-rays, and scans, the diagnosis was once again Pleurisy from the coughing associated with the Flu even though the coughing had stopped.

A week later, the same symptoms I had been experiencing were getting worse. It felt at times as if I were having a heart attack. The ER doctor sent me to a cardiologist where I had a stress test on a treadmill and an ultrasound of my heart. Nothing was found and again I was diagnosed with Pleurisy.

After dealing with all this for well over a month, I was desperate to find out why I kept having shortness of breath, pain, and tightness in my chest. It almost felt like a balloon was being blown up in my chest.

I called Dr. Paul Baker at Baker Chiropractic and Wellness on a Saturday afternoon and left a message that I needed his advice. He called me back Saturday evening very concerned and suggested I meet him on a Sunday at his office for an evaluation. Within five minutes of my visit, Dr. Baker diagnosed a hiatal hernia. He explained how the hiatal hernia was the source of the pressure in my chest. He also described how acid reflux from the hiatal hernia was causing sharp pains.

Dr. Baker confidently assured me he could treat the hernia but warned it would be a bit uncomfortable. With both of his hands, he put pressure under my ribcage and slowly pushed the hernia back down thru my diaphragm. When I stood up, I had instant relief! Both the pain and pressure I had felt for over a month was gone.

After many sleepless nights in fear that I was having a heart attack, after multiple visits to the hospital, urgent care, and even a cardiologist, Dr. Baker diagnosed and treated the pain that I was having in one 20-minute Sunday afternoon visit to his office! He continues to check my hernia when I come in for my regular visits and it seems to be fine.

In thinking back when I had the flu, I remember coughing so hard at one point that it felt like something ripped in my stomach. I’m now convinced this was the start of the hiatal hernia.

I am both amazed and extremely disappointed that with all of the x-rays, CT scans, blood work and series of other tests over a period of 40+ days, a correct diagnosis could not be made. Equally shocking were my medical bills. The cost of following traditional medical care guidance and instructions exceeded $30,000!!! This doesn’t take into account the cost of the mental anguish of not knowing what was wrong with me, thinking I was having a heart attack and the constant worry and stress placed on our entire family.

I am very grateful to Dr. Paul Baker for his incisive diagnosis and his immediate and successful treatment of my hiatal hernia.

– Terri B.

If you or someone you know has developed a hiatal hernia, please schedule an appointment at any one of our three greater Cincinnati area clinic locations by calling (513) 561-2273 or schedule an appointment any time day or night here on our website.


Hiatal Hernia: Signs, Symptoms, and Complications

A hiatal hernia, also known as a stomach hernia, most often affects people over 50. As many as 90 percent of people with one will experience no symptoms. Among those who do, heartburn, abdominal discomfort, throat irritation, belching, and regurgitation are common. While symptoms like these can be aggravating, they are usually not serious. With that being said, on rare occasion, large herniations can develop, causing severe complications and requiring emergency treatment.


Frequent Symptoms

Generally speaking, small herniation of the stomach is not inherently harmful and is unlikely to cause any direct pain or discomfort. What a hiatal hernia can do is alter the structures and mechanisms that keep food and acids where they belong.

Key to this problem is a structure called the lower esophageal sphincter (LES). When a hiatal herniation occurs, it can change the position of this valve, allowing the contents of the stomach to backflow into the esophagus (known as reflux). Related, intermittent symptoms can include:

  • Heartburn
  • Regurgitation
  • Belching or hiccuping shortly after eating
  • A stinging sensation in the throat
  • A sour or bitter taste in the mouth
  • Bad breath

Generally speaking, it is only when a hernia gets larger that it can manifest in this way. If the LES weakens even further, as it can happen with age, related symptoms can get progressively worse.

People with a hiatal hernia are more likely to develop gastroesophageal reflux disease (GERD), a chronic form of reflux that can interfere with quality of life. The persistence of GERD symptoms can lead to a chronic cough, chest pain, asthma, and progressive damage to your tooth enamel.


Broadly speaking, there are two types of hiatal hernia: a sliding hiatal hernia and a paraesophageal hernia. While a sliding hernia is the most common, accounting for around 95 percent of all diagnoses, a paraesophageal hernia is potentially the more serious of the pair.

With a sliding hiatal hernia, the junction of the esophagus and stomach (referred to as the gastroesophageal junction) will protrude through a hole in the diaphragm, called the hiatus. This is the space through which the esophagus passes. It is called “sliding” because the herniated part of the stomach can slide in and out of the chest cavity as you swallow.

With a paraesophageal hernia, only the stomach bulges through. While many paraesophageal hernias are simply the progression of a sliding hernia, others can occur suddenly if there is a structural weakness in the diaphragm.

Unlike a sliding hernia, a paraesophageal hernia doesn’t readily slide in and out of the hiatus. Rather, it can get progressively larger and slip even further into the chest cavity as time goes by. It is at this latter stage that the complications can become serious and, in rare cases, life-threatening.

Complications may include esophageal compression, gastric obstruction, strangulation, and an extremely rare condition known as an intrathoracic stomach.

Esophageal Compression

Compression of the esophagus can occur as the hernia presses against the wall of the feeding tube. When this happens, food can get stuck in the esophagus, causing chest pain after eating and difficulty swallowing (dysphagia). While esophageal compression is not considered a medical emergency, it may require medications to alleviate or prevent the worsening of symptoms.

Incarcerated Hiatal Hernia

Incarceration occurs when the herniated portion of the stomach becomes trapped ​during the hiatus. In some cases, the symptoms of incarceration may be chronic but minimal (mostly a sensation of chest pressure as food passes through the upper digestive tract). In others, it can cause obstruction or impede blood circulation. Incarceration itself is not a medical emergency unless a severe obstruction occurs.


Volvulus is when a herniated stomach twists more 180 degrees, causing severe gastric obstruction. While it can occur with hiatal hernia, it can also occur without it and is very uncommon. Symptoms may include dysphagia, chest pain after eating, belching, and vomiting.

If symptoms are allowed to progress, they can cause upper abdominal pain and distention, vomiting leading to nonproductive retching, and gastric bleeding (due to the abnormally increased blood pressure). Acute symptomatic volvulus generally occurs in people over age 50 and is considered a medical emergency with a 30 percent to 50 percent risk of mortality.


Strangulation describes the cutting off the blood supply to the stomach, either due to volvulus or incarceration. This, too, is considered a medical emergency as the blockage can result in rapid cell death (necrosis) and organ damage.

Symptoms include a sudden, sharp chest pain; fever; fatigue; bloating; vomiting; an inability to pass gas; constipation; warmth or redness over the herniation; rapid heart rate; and bloody or tarry stools (due to gastrointestinal bleeding). If not treated immediately, strangulation can lead to gangrene, shock, and death.

Intrathoracic Stomach

An intrathoracic stomach is a rare condition in which the stomach slips entirely into the chest cavity. Oddly, not all cases cause symptoms. The most common signs are a shortness of breath (dyspnea) and a feeling of chest fullness and pressure. Other symptoms can include vomiting, retching, dysphagia, gastrointestinal bleeding, and aspiration pneumonia (caused when food is coughed up into the lungs).

The enlarged hiatal gap can cause other organs to slip into the chest cavity, including the pancreas, liver, or colon. Surgery in the only means to correct this rare but serious complication.

When to See a Doctor

The vast majority of hiatal hernias can be easily managed with over-the-counter medications, weight loss, and an adjustment to your diet. Hiatal hernias generally do not to need to be medically managed unless the symptoms are persistent or worsening.

With that being said, you should see if a doctor if your symptoms fail to improve despite treatment. In some cases, stronger prescription drugs and other interventions may be needed.

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On the other hand, you should seek immediate medical care if reflux symptoms are accompanied by high fever (over 100.4 degrees), severe chest pain, rapid heart rate, non-productive retching, or bloody stools. These may be the signs of a severe and potentially life-threatening hernial complication.

Esophageal Spasm | Michigan Medicine

Topic Overview

What is esophageal spasm?

Normally, contractions of the esophagus (the tube that connects the mouth and the stomach) move food from the mouth to the stomach with a regular, coordinated rhythm.

Esophageal spasm means that contractions of the esophagus are irregular, uncoordinated, and sometimes powerful. This condition may be called diffuse esophageal spasm, or DES. These spasms can prevent food from reaching the stomach. When this happens, the food gets stuck in the esophagus.

Sometimes the squeezing moves down the esophagus in a coordinated way, but it is very strong. This can be called nutcracker esophagus. These contractions move food through the esophagus but can cause severe pain.

Esophageal spasm is not common. Often, symptoms that may suggest esophageal spasm are the result of another condition such as gastroesophageal reflux disease (GERD) or achalasia. Achalasia is a problem with the nervous system in which the muscles of the esophagus and the lower esophageal sphincter (LES) don’t work properly. Anxiety or panic attacks can also cause similar symptoms.

What causes esophageal spasm?

The cause of esophageal spasm is unknown. Many doctors believe it results from a disruption of the nerve activity that coordinates the swallowing action of the esophagus. In some people, very hot or very cold foods may trigger an episode.

What are the symptoms?

Most people with this condition have chest pain that may spread outward to the arms, back, neck, or jaw. This pain can feel similar to a heart attack. If you have chest pain, you should be evaluated by a doctor as soon as possible to rule out or treat cardiac disease.

Other symptoms include difficulty or inability to swallow food or liquid, pain with swallowing, the feeling that food is caught in the center of the chest, and a burning sensation in the chest (heartburn).

How is esophageal spasm diagnosed?

Your doctor can often find out the cause of esophageal spasm from your medical history by asking you a series of questions. These include questions about what foods or liquids trigger symptoms, where it feels like food gets stuck, other symptoms or conditions you may have, and whether you are taking medicines for them.

The diagnosis can be confirmed with tests, including esophagus tests (such as esophageal manometry) or a barium swallow. Esophageal manometry uses a small tube attached to instruments (transducers) that measure pressure. A barium swallow is done using X-rays.

Other tests may be done to find out whether chest pain may be caused by gastroesophageal reflux disease (GERD), the abnormal backflow (reflux) of food, stomach acid, and other digestive juices from the stomach into the esophagus.

How is it treated?

Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as gastroesophageal reflux disease (GERD). GERD is usually treated with changes to diet and lifestyle and medicines to reduce the amount of acid in the stomach.

Other treatment for esophageal spasm may include:

  • Changing the foods you eat. Your doctor may tell you to eat certain foods and liquids to make swallowing easier.
  • Dilation. In this treatment, a device is placed down your esophagus to carefully expand any narrow areas of your esophagus. You may need to have the treatment more than once.
  • Surgery. Surgery is sometimes used in people who have a problem that affects the lower esophageal muscle (achalasia).
  • Medicines. If you can’t have dilation or surgery, your doctor may suggest medicines, such as botulinum toxin, to relax the muscles in the esophagus.

Hernia of the esophageal opening of the diaphragm – (Clinic Di Center)

Hernia of the esophageal opening of the diaphragm

A hiatal hernia is a displacement into the chest cavity through the esophageal opening of the diaphragm of the lower part of the esophagus, part of the stomach, and sometimes intestinal loops. Normally, the ligamentous apparatus of the esophageal opening of the diaphragm, subphrenic adipose tissue and the natural anatomical arrangement of the abdominal organs prevent the movement of organs lying under the diaphragm into the chest cavity.The disease promotes the throwing of acidic stomach contents into the esophagus, so heartburn is its main symptom. A hernia exists in every twentieth adult, and over the age of 50 – in every second.

What are the causes of a hernia?

The cause of a hernia may be a weakening of the ligamentous apparatus. It is present in 5% of the entire adult population and in about 50% over the age of 50 (age-related weakening of the ligamentous apparatus), more often found in untrained, asthenic people.Another factor provoking the development of this disease is a significant increase in intra-abdominal pressure due to severe flatulence, pregnancy, trauma or large tumors of the abdominal cavity, bouts of indomitable vomiting or persistent cough (for example, in patients with chronic obstructive bronchitis). Dyskenisia (disturbances of peristalsis) of the digestive tract, in particular the esophagus, which are often observed against the background of chronic inflammatory diseases, gastric ulcer and duodenal ulcer, gastroduodenitis, pancreatitis, cholecystitis), can also lead to the development of a hernia.In rare cases, it is caused by malformations of embryonic development (short esophagus, pectoral stomach).

What are the symptoms?

A hernia of the esophageal opening of the diaphragm leads to insufficiency of the obturator mechanisms located at the border of the stomach and esophagus, which means that it provokes the throwing of the acidic contents of the stomach into the esophagus and the development of reflux esophagitis. A small hernia may not show any symptoms and is usually detected during a diagnostic examination associated with another disease.

In cases where the hernia is large, but the obturator mechanisms at the border of the esophagus and stomach are still functioning adequately, the main manifestation of the disease is pain in the chest, in the heart or in the epigastric region. Pain occurs immediately after eating, when lifting weights or against a background of stress, and can last from several minutes to several days. Dysphagia (violation of food swallowing) is often noted. If the hernial sac is compressed, then there are dull aching pains in the epigastric or epigastric region or behind the sternum.

In case of insufficiency of the obturator mechanisms, the main symptom of a hiatal hernia is heartburn. It occurs after eating, a sharp change in body position, more often at night, which is explained by an increase in the tone of the vagus nerve. Starting as burning heartburn, discomfort can turn into painful sensations.

What complications can a hernia cause?

A hernia of the esophageal opening of the diaphragm can indeed cause coronary pain due to irritation of the vagus nerve and subsequent spasm of the coronary vessels of the heart, this situation is fraught with the development of serious cardiovascular complications up to myocardial infarction.Another extremely unpleasant symptom is belching of stomach contents or air. If a large volume of gastric contents is regurgitated, especially at night, this can lead to the development of aspiration pneumonia. Regurgitation is not preceded by nausea or stomach contractions; it occurs by contraction of the esophagus.

Diagnostic examinations

Diagnosis of a hiatal hernia is difficult, since its symptoms are very diverse, it is often combined with other diseases of the gastrointestinal tract and proceeds with complications.No wonder this disease is figuratively called “masquerade of the upper abdomen.” To make a diagnosis, an X-ray of the esophagus is performed with barium sulfate construction, esophageal motility is examined using esophagomanometry, and daily pH-metry is performed.

Hernia treatment and prevention

Since the clinical picture of the disease in the overwhelming majority of cases is determined by reflux of gastric contents, the treatment is the same as for reflux esophagitis.

In severe cases and if drug therapy is unsuccessful, surgical treatment is performed (suturing the hernial orifice, strengthening the esophageal-diaphragmatic ligament, various methods of fixing the stomach in the abdominal cavity, fundoplication). After completing the main course of treatment, all patients should be registered with a gastroenterologist.

Hernia of the esophageal opening of the diaphragm – Surgical department – Clinical departments – Departments and specialists – Central Clinical Hospital “Russian Railways-Medicine”

Hernia of the esophageal opening of the diaphragm – the result of displacement through the esophageal opening of the diaphragm into the chest cavity of any organ of the abdominal cavity, more often the stomach.It occurs in almost 50% of elderly people, accompanied by peptic ulcer disease, chronic cholecystitis. For the formation of a hernia of the esophageal opening, it is enough to develop weakness of the muscle and connective tissue of the diaphragm with age, which will lead to the expansion of the opening through which the esophagus passes from the chest cavity to the abdominal cavity, or with a frequent increase in pressure in the abdominal cavity due to heavy physical exertion, cough, constipation, overeating.

Symptoms and course

Often, a hernia does not manifest itself in any way and is defined as a “find” when examining the stomach for other diseases.The classic version is represented by reflux esophagitis syndrome: spontaneous or when leaning forward pains in the lower third of the sternum or behind it, give up or in the back, heartburn of varying intensity in the patient’s lying position, which disappears if he sits down or stands up, hiccups, belching with air. The most serious complications are hernia infringement and bleeding from ulcers of the esophagus or stomach.

Types of hernias

Sliding hernia:

  • cardiac;
  • cardiofundal;
  • subtotal gastric;
  • total gastric.

Paraesophageal hernia:

  • fundic;
  • antral;
  • intestinal;
  • stuffing box.


An important condition for treatment is compliance by patients with the general and dietary regimen. Hard physical work, wearing tight belts, bandages that increase intra-abdominal pressure are contraindicated for them. The patient should sleep with the head end of the bed raised.Shown mechanically and chemically sparing diet, fractional (5-6 times a day) meals. The last time the patient should take food 3-4 hours before bedtime. Smoking, alcohol abuse, coffee is contraindicated (they reduce the tone of the lower esophageal sphincter).

Surgical treatment is recommended in the following cases:

  1. in the absence of the effect of conservative therapy in patients with pronounced symptoms of the disease;
  2. with severe reflux esophagitis, accompanied by bleeding, anemia, ulcerative esophagitis;
  3. with peptic stricture of the esophagus;
  4. with a giant (subtotal and total) gastric hernia;
  5. when a sliding hiatus hernia is combined with other diseases of the upper digestive tract that require surgical treatment (cholelithiasis, peptic ulcer, etc.)).

According to the literature, about 10–20% of patients with this pathology undergo surgical treatment. As for the essence of surgical interventions used to eliminate sliding hernias, they are aimed primarily at restoring the closure function of the cardiac stomach and closing the hernial defect. The most successful option for solving this problem is the Nissen fundoplication operation: creating a 360 ° cuff from the bottom of the stomach around the cardiac esophagus and fixing it to the sutured legs of the diaphragm.This operation has recently been performed laparoscopically.

Benefits of Laparoscopic Surgery

Pain in the postoperative period is insignificant, and, as a rule, is noted only on the first day.

The patient immediately after coming out of anesthesia (a few hours after the operation) can walk and take care of himself.

The length of stay in the hospital is much reduced (up to 1–4 days), as well as the terms of restoration of working capacity.

The number of incisional hernias is reduced by several times.

Laparoscopic surgery is a cosmetic surgery, after a few months the scars after punctures in most patients become almost invisible

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Hernia of the esophageal opening of the diaphragm. How the methods of treatment in the clinic


Hernia of the esophagus (hernia of the esophageal opening of the diaphragm) is the movement of the stomach (less often of other organs) through the opening in the diaphragm, which passes the esophageal tube into the abdomen from the abdominal cavity to the chest.Part of the stomach can be fixed in this opening (fixed hiatal hernia), or moved to the posterior mediastinum and back (sliding hiatal hernia). Other types of hiatal hernia are rare. Often this pathology is combined, or rather is one of the causes, gastroesophageal reflux disease (GERD).

The patient suffering from this disease is associated with two main reasons:

  • The first reason is the “breakdown” of a complex locking mechanism, which does not allow the contents of the stomach to enter the esophagus and even the pharynx.In this case, there are:
    • Painful burning sensation behind the breastbone
    • Bitterness in the mouth
    • Unexplained cough at night – in a horizontal position, stomach contents flow more easily into the esophagus
  • The second reason is the entrapment of an internal organ in the opening of the diaphragm, which causes chest pain. This pain is very similar to the pain of a heart attack, but it occurs both during physical exertion, which is typical for “heart” pains, and at night at rest

The path of a patient with a “diaphragmatic hernia” to the surgeon is often long and complicated.This is due to the fact that conservative treatment has been carried out for a long time, not always with the correct diagnosis. A practical definition of the moment when, without the help of an operation, treatment loses its prospects, is possible only by a surgeon who constantly deals with this pathology. Despite the rather clear indications for surgical treatment, the decision should be strictly individual.

If you suffer from heartburn and / or chest pain, conservative treatment does not work – seek advice.Not all patients need surgical treatment, but with clear indications for surgical treatment, the operation either completely eliminates suffering or dramatically improves the quality of life.



Cardialgia pain in the region of the heart, differing in its characteristics from angina pectoris.

Etiology and pathogenesis

Any pain in the left side of the chest can be regarded as cardialgia until the diagnosis is clarified. Cardialgia occurs in a number of clinical syndromes and pathological conditions. As a rule, cardialgias do not stop after taking nitrates. The presence of cardialgia does not exclude the existence in some patients of atherosclerosis of the coronary arteries of the heart and can sometimes be interspersed or combined with true attacks of angina pectoris.

Clinical picture

Cardialgia with lesions of the peripheral nervous system. Cervical osteochondrosis and herniated discs can cause compression of the nerve roots; cardialgic syndrome can also be a consequence of irritation of the sympathetic plexus of the vertebral artery.In the first and second cases, the appearance of pain in the left half of the chest is associated with certain positions and movements of the arm, head, but not with physical stress; pains can intensify or occur at night, when the cervicothoracic roots are pulled (abducting the hand behind the back, stretching it to the side). In the third case – when the sympathetic plexus of the vertebral artery is compressed – swelling of the hand sometimes joins the described symptoms, which is associated with a violation of sympathetic innervation; when bending the head turned to the side of the lesion, pain occurs.

Cardialgia can be a consequence of cervicobrachial syndrome resulting from compression of the subclavian arteries, veins and brachial plexus with an additional cervical rib or pathological hypertrophy (“syndrome”) of the anterior scalene muscle. The peculiarities of the pain syndrome in these cases include the appearance of pain when carrying small weights in the hand, when working with raised arms.

Cardialgia can occur with left-sided intercostal neuralgia, shingles, neurinoma of the roots (in the latter case, the pain can be very intense).

Cardialgia can be observed with a high standing of the diaphragm, caused by swelling of the stomach or intestines, obesity, etc. Pain occurs often after eating, if the patient lies, but disappear when moving to an upright position, when walking; sometimes they are combined with real angina pectoris.

Cardialgia can be caused by a diaphragmatic hernia, which occurs more often in old age when the esophageal opening of the diaphragm is stretched, as well as with a traumatic rupture of the dome of the diaphragm.Aching pains, retrosternal or other localization, arise as a result of displacement of the mediastinal organs or entrapment of the stomach, or with the formation of an ulcer in the prolapsing part of the stomach. Pain appears immediately after eating or in a horizontal position, sometimes at night (with late meals). The pain disappears when walking, after belching, when moving to an upright position. When a hernia is infringed, a severe chest pain may appear soon after eating, which does not stop from the use of conventional analgesics, nitrates, but disappears suddenly when the position of the body changes (usually in an upright position).

Peptic ulcer of the esophagus, cardiospasm, esophagitis may be accompanied by cardialgia, a distinctive feature of which is a clear connection with the passage of food through the esophagus. When the transverse colon is located over the liver, there may be either severe pain to the right of the sternum (with infringement of the intestine), or aching chest pain (with bloating).

Cardialgic syndrome can be observed with primary pulmonary hypertension, pulmonary infarction (it can be accompanied by an attack of angina pectoris), parapneumonic pleurisy.Aching and stabbing pains in the heart area can occur with myocarditis (one of the signs of rheumatic heart disease), pericarditis. Dyshormonal cardiopathy is observed in the treatment of adenoma or prostate cancer with sex hormones.

Cardialgia , ventricular premature beats occur during puberty (pubertal heart). With this syndrome, both vegetative and behavioral features of the dyshormonap state are observed, although they are significantly less pronounced than with menopause.All the features of climacteric cardiopathy can be observed before the onset and in the first days of menstruation – premenstrual syndrome.


ECG. Magnetic resonance imaging of the spine (with suspicion of osteochondrosis of the spine, herniated discs). Consultation with a neurologist. Esophagogastroduodenoscopy (EGDS), X-ray of the stomach with suspected diaphragmatic hernia, esophageal ulcer. Consultation with a gastroenterologist.


Cardialgia with lesions of the peripheral nervous system, with left-sided intercostal neuralgia, herpes zoster, neurinoma of the roots.Treatment of the underlying disease is necessary.

With an additional cervical rib in case of severe pain syndrome and compression of the subclavian vessels, removal of this rib is indicated; in the syndrome of the anterior scalene muscle in mild cases, pain relievers, NSAIDs are prescribed, with severe lesions, drugs are injected into the hypertrophied anterior scalene muscle. In very severe cases, it is necessary to resort to muscle dissection.

moshirurg.ru – Department of Faculty Surgery No. 2 MGMSU

Pancreatic cancer (malignant tumor of the pancreas) is most often seen in people over 60 years of age.If the diagnosis is made at an early stage, then surgery to remove the tumor offers a chance of recovery. In general, the more advanced the stage of the cancer (tumor size and prevalence), the less likely it is that treatment will lead to recovery. However, treatment can often slow the progression of cancer.

What is the pancreas?

The pancreas is located in the upper abdomen and lies behind the stomach and intestines. In shape, the pancreas resembles a tadpole, thus it has a head, body and tail.The part that lies closest to the duodenum is called the head (the part of the intestine immediately after the stomach).

The pancreas produces a fluid containing enzymes (chemicals) needed for digestion. Enzymes are produced by pancreatic cells and enter the thin ducts (tubes). The ducts join together like branches of a tree and form the main pancreatic duct. Through it, the liquid rich in enzymes enters the duodenum.The enzymes in the pancreas are in an inactive form (otherwise they would have digested the gland itself). They are activated in the duodenum to digest food.

Along the pancreas are scattered groups of specific cells called islets of Langerhans. These cells produce the hormones insulin and glucagon. Hormones are released (secreted) directly into the bloodstream and control blood sugar levels.

The bile duct carries bile from the liver and gallbladder.It connects to the pancreatic duct just before it opens into the duodenum. Bile also enters the duodenum and is involved in the digestion of food.



What is cancer?

Cancer is a disease of the cells in the body. The body is made up of millions of tiny cells. There are many types of cells in the body, and there are also many types cancer originating from different types of cells.Common to all types of cancer is that all cancer cells are abnormal and are able to divide uncontrollably.

Malignant tumor is an overgrowth of tissue made up of cancer cells that continue to divide. Malignant tumors invade adjacent tissues, causing damage. Malignant tumors can also spread to other parts of the body. This happens when some cells are detached from the primary tumor and carried by the bloodstream or lymph to other parts of the body.These small groups of cells can grow and form secondary tumors (metastases) in one or more organs. These secondary tumors can also grow, invade adjacent tissues, damage them, and spread again.

Some types of tumors are more serious than others, some are easier to treat than others (especially if diagnosed early), some have a better prognosis than others. So cancer is not just one disease.In each case, it is important to know exactly what type of cancer is developing, how large is tumor and how widespread it is. This will give you reliable information about treatment options and prognosis.

What is pancreatic cancer?

Pancreatic cancer is a relatively rare disease. For example, in the UK, it develops in about 1 in 10,000 people a year. There are several types of pancreatic cancer , but 9 out of 10 cases are ductal adenocarcinoma.

Ductal adenocarcinoma of the pancreas

This type of cancer develops from malignant cells of the pancreatic duct . They divide and tumor develops in and around the duct. As the tumor grows :

·> It can block the bile duct or the main pancreatic duct . This stops the flow of bile and / or pancreatic juice into the duodenum.>

·> The tumor grows deep into pancreas . It may once pass through the wall of the pancreas and invade adjacent organs such as the duodenum, stomach or liver.>

·> Some cells may enter the lymphatic ducts or the bloodstream. Thus, the tumor can spread to nearby lymph nodes or to other areas of the body (metastasize).>


Other types of pancreatic cancer

There are several rare cancer types that originate from other cell types pancreas .For example, pancreas cells that produce insulin or glucagon can become malignant (insulinomas and glucagonomas). They behave differently than ductal adenocarcinoma. For example, they can produce too much insulin or glucagon, which can cause various symptoms.

The remainder of this article discusses only pancreatic ductal adenocarcinoma .

What causes pancreatic cancer (pancreatic adenocarcinoma)?

Cancer starts with an abnormal cell.The exact reason why the cell becomes cancerous is unclear. It is believed that something damages certain genes in a cell. This makes the cell abnormal and leads to its uncontrolled division.

Many people develop pancreatic cancer for no apparent reason. However, there are some risk factors that increase the likelihood of developing pancreatic cancer . Namely:

·> Aging. It is more common in older people.In most cases in persons over 60 years of age.>

> Smoking.>

·> Diet. A diet rich in fat and meat increases the risk.>

> Obesity.>

·> Chronic pancreatitis (persistent inflammation of the pancreas ). In most cases, chronic pancreatitis occurs due to alcohol abuse. There are other more rare causes.>

·> Diabetes. Note : Diabetes is common and the vast majority of people with diabetes do not develop pancreatic cancer .>

·> Chemicals. Exposure to certain pesticides, dyes and chemicals used in metal cleaning increases the risk.>

> Jaundice>

Genetic and hereditary factors

Most cases of pancreatic cancer are not familial. However, in some families there is an incidence of pancreatic cancer higher than the average.It is believed that about 1 in 10 cases of 90,047 pancreatic cancers are due to a hereditary gene abnormality. If you think that pancreatic cancer is common in your family , consult your doctor. You may be offered screening tests to identify pancreatic cancer at an early stage when there is a high likelihood of a cure. A research group from the University of Liverpool, called the European Registry of Hereditary Pancreatic Cancer and Hereditary Pancreatitis (EUROPAC), is investigating the causes of pancreatic cancer .EUROPAC coordinates government research on screening for pancreatic cancer in high-risk individuals.

What are the symptoms of pancreatic cancer?

Symptoms Bile duct blockages

In about 7 out of 10 cases , tumor develops in the head of the pancreas . Small tumors are initially asymptomatic.As grows, tumor begins to block the biliary tract. This stops the flow of bile into the duodenum, leading to:

> Jaundice ( yellow skin coloration due to the entry of bile into the bloodstream due to blockage)>

> Darkening of urine – caused by filtration of blood with an increased content of bile acids by the kidneys.>

·> Pale faeces – as bile does not enter the faeces, which causes them to be normal brown in color.>

> Generalized itching caused by the entry of bile into the bloodstream.>

Pain is often not the first sign. Therefore, painless jaundice is often the first symptom pancreatic cancer . Nausea and vomiting are also rare symptoms .

Other symptoms

As tumors grow in pancreas , the following symptoms may appear :

·> Pain in the upper abdomen.Pain can also radiate to the back.>

·> General poor health and weight loss. These symptoms often appear first when cancer develops in the body or tail of the pancreas (when the bile duct is not blocked)>

·> Poor digestion of food, as the amount of pancreatic juice may decrease. This can lead to fetid, pale feces and weight loss.>

·> In rare cases, when almost all gland is affected by tumor , diabetes develops.>

·> In rare cases, tumor can trigger inflammation in the gland – acute pancreatitis. This can cause severe abdominal pain.>

If cancer spreads to other parts of the body, a variety of other symptoms may develop.

How is pancreatic cancer diagnosed and evaluated?

Initial assessment

There are many causes of jaundice and other symptoms listed above.For example, a blocking gallstone or hepatitis (inflammation of the liver). Therefore, if you have jaundice or other symptoms mentioned above, do some basic tests. This is usually an abdominal ultrasound scan and some blood tests. These basic tests can usually give a good clue if jaundice is caused by a blockage in the head pancreas .

Estimated volume and prevalence 900 05

If pancreatic cancer is confirmed or it is highly likely to follow from the main tests, then the following studies should be carried out to estimate the prevalence.For example:

·> CT (computed tomography) is a common test used to evaluate pancreatic cancer . This is a special X-ray examination that can give a fairly accurate picture of the internal organs.>

·> MRI is sometimes done. MRI gives an image by means of magnetic resonance. MRI uses a powerful magnetic field and radio waves to create a computer image of tissues, organs, and other structures in the body.>

·> Endoscopic ultrasound examination (endo-ultrasound). An endoscope (gastroscope) is a thin, flexible telescope. It is injected through the mouth, esophagus, and stomach, and into the duodenum. The endoscope contains fiber optic channels that conduct light so doctors or nurses can see what’s going on inside. Some endoscopes have miniature ultrasound scanners at the end, which allow imaging of structures located behind the intestine, such as pancreas .>

> Chest X-ray.>

> Laparoscopy . This is a procedure to look into the abdomen using the laparoscope . Laparoscope looks like a thin telescope with a light source. It is used to illuminate and magnify abdominal structures. The laparoscope is inserted into the abdomen through a small incision in the skin.>

Separate tabs / links provide more detailed descriptions of each procedure.

This assessment is called cancer staging . Staging tasks are to search for:

·> How much has the tumor of the pancreas grown , and also partially or completely it has grown in the wall of the gland .>

> Whether the cancer has spread to local lymph nodes.>

> Does cancer spread to other organs (metastasis)>

Staging Cancer helps the physician determine the best treatment option.It also provides sound outlook (forecast) data. For more information see separate tab / link staging and ranking cancer .


A biopsy is the removal of a small sample of tissue from a part of the body. The sample is then examined under a microscope to look for abnormal cells. If a biopsy is needed, one way to obtain pancreatic tissue is to obtain a tissue sample at the time of endoscopy.This is done by passing a small grasping instrument through the side channel of the endoscope (gastroscope). Or, sometimes the biopsy can be done at the same time as the scan. It can take up to two weeks to wait for the biopsy results.

What are the treatment options for pancreatic cancer?

Potential treatment options include operative treatment , chemotherapy and radiotherapy. Treatment in each case depends on various factors such as stage of cancer (size of cancer and its prevalence) and general health.

You should discuss this with a specialist who knows your case. He or she will be able to provide the pros and cons, the likely success rate, potential side effects, and other data on possible treatment options for your cancer type .

It is also necessary to discuss with the specialist the goals of treatment . For example:

·> The target treatment could be cure cancer . Some pancreatic cancers can be cured if treated early in the disease.(Doctors prefer to use the word “remission” rather than “cure.” Remission means there are no signs of cancer after treatment. If you are in remission, you may be cured. However, in some cases cancer appears again for months or years later, so doctors sometimes avoid using the word “cure.”)>

·> The target of treatment could be to control cancer . If a cure is not feasible, then treatment with can often limit the growth or spread of tumor to slow progress.It can relieve symptoms of for a while.>

·> The target Treatment may be to relieve symptoms . If no cure is possible, then treatment can be performed to reduce the size of tumor , which can relieve symptoms such as pain . If cancer is in advanced stage, then treatment such as nutritional supplements, analgesics or other means to relieve pain and other symptoms may be required.>


Surgical treatment

If cancer is at an early stage, then there is a small chance that the operation will lead to cure . (Early stage means a small size tumor , which does not go beyond the pancreas and has not spread to the lymph nodes or other areas of the body).

·> If tumor is located in the head of the pancreas , then operation is possible to remove the head.This is a long and complicated operation , as the surrounding structures such as the duodenum, stomach, bile duct, etc. must be reconstructed after removal of the pancreatic head.>

·> If tumor is in the body or in the tail of the pancreas , in some cases it is possible to remove the affected areas.>

The reason the probability is low is that in many cases it is believed that the stage is early, but some cells have already entered other parts of the body, but cannot yet be detected by scanning or other research methods.Over time, secondary tumors grow out of them.

If cancer is at an advanced stage, then the operation cannot cure the disease. In these cases, specific surgical techniques can be used to relieve symptoms. For example, jaundice caused by a blockage of the bile duct can be reduced. Bile duct shunting and stenting can be used. (A stent is a small, rigid tube made of plastic or metal designed to keep a duct or channel open.Usually inserted by an instrument attached to the endoscope.)

Related Discussions


Chemotherapy is a treatment for cancer with anti-cancer drugs that kill or stop cancer cells from dividing. If chemotherapy is used in addition to surgery, it is called adjuvant chemotherapy . For example, after the operation, a course of chemotherapy is prescribed.It is needed to kill cancer cells that could have spread beyond the original tumor .

Radiation therapy

Radiation Therapy is a treatment using high-energy beams of radiation that focus on tissue with cancer . This kills 90,047 cancer cells or stops them dividing. Radiotherapy is rarely used in the treatment of pancreatic cancer .

What is the forecast (outlook)?

If pancreatic cancer is diagnosed and is treated at an early stage, there is a small chance that the operation will lead to a cure. As a rule, the smaller the tumor and the earlier the tumor is diagnosed, the better the prognosis . Some tumors developing in the head of the pancreas are diagnosed very early because they block the bile duct and jaundice develops quite early.This symptom entails research, leading to operation , which leads to a cure for small tumors .

However, in most cases pancreatic cancer progresses for a long time until the moment when symptoms appear and the diagnosis is made. In most cases, a cure is unlikely. However, treatment can slow the progression of cancer .

Cancer treatment is a growing field of medicine.The development of new methods of treatment continues, therefore information on the forecast is very generalized. The case specialist can provide more accurate information regarding the individual prognosis , as well as whether cancer of a particular type and stage will respond to therapy .


The body reacts to most disorders and failures with pain and other unpleasant sensations.The first reaction to them is unambiguous – the sore spot indicates the disease itself.

Commentary for the Domashny Ochag magazine was given by Evgeny Avetisov, general practitioner, medical director of the European Medical Center.

“The right shoulder hurts, it means that it blew or turned awkwardly.” Did you know that a diseased liver can give an alarm in this way? And pain in the liver area, quite possibly, is caused by renal colic. By the way, liver diseases are often manifested by the so-called chronic fatigue syndrome, and the liver itself, as an organ devoid of nerve endings, suffers “silently”.

Or, for example, cardiac arrhythmias, as well as depression, indigestion, insomnia, excessive sweating, hair loss, impaired nail growth, skin changes can be caused by dysfunction of the thyroid gland. This disease is generally a very difficult situation, because the thyroid gland affects all metabolic processes, it can touch any organ. It is with this that such a variety of manifestations in the form of a wide variety of symptoms is associated, which can mask or mimic many diseases.

We asked an expert about some of the symptoms that can mislead us (but not attentive doctors!).

Symptom: Chest pain

At first glance: heart problems.

In fact: very often heart problems cause pain not in the chest at all, but for example, in the left shoulder, in the left elbow, in the left hand, on the left side of the neck, etc. And real chest pains can be the result of intercostal neuralgia.Or lung disease – if a sharp chest pain is accompanied by shortness of breath, this may be a sign of pneumothorax, when a sudden rupture of the lung occurs for no apparent reason. A person can live without being aware of the structural features of their lungs, and suddenly – after active sports or a strong attack of coughing – there is a sharp pain in the chest, cough, shortness of breath – a feeling of lack of air. One lung stops functioning.

Acute chest pain can be caused by Tietze syndrome, an inflammation of the joints of the ribs with the sternum.Such malaise occurs quite often, it is not dangerous to health, although it is accompanied by painful sensations, in this case, the diagnosis is usually easy.

Pain in the middle of the sternum sometimes indicates problems with the esophagus – inflammation, damage from a sharp bone, such as a fish bone, as well as a hernia of the esophageal opening of the diaphragm.

Symptom: Low back pain

The most obvious: sciatica (“lumbago”).

Actually: May be a sign of kidney disease such as pyelonephritis, a gynecological disorder in women, most commonly spinal problems or muscle spasms. There is even such a special diagnosis – pain in the lower back.

Symptom: Pain in the upper abdomen

The most obvious: stomach diseases (gastritis), especially if the pain is associated with food intake, the symptoms of duodenal ulcer manifest themselves in a similar way.

In fact: such pain can be a sign of a heart attack, if the process develops in certain parts of the heart, the pain is “redirected” to the stomach area. It can also be a sign of gallbladder disease, rarely inflammation of the pancreas (pancreatitis) or intestines. And also – a manifestation of radiculitis or lower lobe pneumonia. To make a diagnosis, the doctor needs to consider other additional manifestations.

Symptom: Shoulder pain

The most obvious: a disease of the shoulder itself – damage to the joint, ligaments due to overload or injury.

Fact: Shoulder pain causes damage to the cervical spine. It can also be a sign of heart or lung disease. By the way, pains in the cervical spine sometimes imitate a heart attack – they can cause severe pain in the heart.

Changes in the cervical spine help to accurately diagnose MRI.

If we talk about the right shoulder, it is rare, but it happens – when the pain indicates a problem with the gallbladder, which radiates to the right shoulder joint.And pain in the left shoulder is a possible irradiation of pain in the stomach or lungs.

Symptom: Headache

The most obvious: increased blood pressure, vascular problems, migraine.

In fact: in 90% of cases, the cause-and-effect relationships are also broken here. The pressure rises with any discomfort – a headache, especially severe, especially if the person is anxious; it rises because the head hurts, and not vice versa! You need to know that a headache due to high blood pressure occurs only when the numbers are very high.At a pressure of 140/90, there may be no headache.

More often, headache occurs due to problems with the upper spine, neuralgia of the occipital nerve is associated with its exit to the first vertebrae. Very often it gives headaches, especially in the back of the head, temples.

Inflammation of the sinuses – sinusitis, frontal sinusitis – are also likely culprits of headache, which is localized in the forehead, eye sockets and cheekbones. Headache can be caused by a viral infectious disease, for example, herpes lesions of the nerves: occipital, trigeminal.

Vision problems also provoke headaches – people with myopia and astigmatism, especially pronounced, often have severe pain in the forehead and temples, when they have to read a lot, work at the computer, due to visual overload.

Headache may be associated with anemia (lack of hemoglobin), but this is rare.

As for the increase in intracranial pressure, we make this diagnosis quite often: in order to deliver it, you actually need to insert a probe or do a spinal tap.

Symptom: Joint pain

Most obvious: joint inflammation (arthrosis).

In fact: on the one hand, indeed, pain is often caused by degeneration of the articular cartilage. As well as the inflammatory process that develops right in the joint.

But it can also be a sign of reactive changes when the infection develops elsewhere, for example, in the genitourinary organs or in the gastrointestinal tract. Due to the functioning of the immune system, this inflammation does not manifest itself in any way in the intestines (there is no diarrhea or disturbances), and the pain is “transferred” to the joints.In this case, it is simply pointless to treat only the joints – it will only help to relieve the symptoms for a while, and then the process resumes.

Joint pain is sometimes caused by chlamydial infection, salmonella, shigella – different pathogens that “dig in” in different places, even without causing the classic symptoms of their disease – shigellosis or salmonellosis.

Psychotherapist commentary

Natalia Rivkina, Head of the Psychotherapeutic Clinic of the European Medical Center:

Stone on the heart

Feelings of physical discomfort that seem to be caused by a physical illness can in fact be caused by neurotic conditions or mental stress.The likely cause is depression. One of the symptoms of moderate to severe depression is chest pain, a feeling of heaviness in the region of the heart. Often, these symptoms are confused with heart disease, manifestations of angina pectoris. How can this connection be explained? When depression occurs, such states as mental anguish, and it gives this feeling, which in everyday life we ​​call “a stone in the heart.” Often, such experiences can be accompanied by a sensation of physical pain in the region of the heart. Pain is a subjective sensation.A person really feels it and experiences suffering.

Often, abdominal pain and discomfort can be caused by neurotic situations, stress, in any case, such symptoms require a full medical examination. And only when gastrointestinal diseases are excluded, we can talk about the psychoemotional causes of such conditions. Somatic discomfort caused by emotional factors requires, first of all, an analysis of the factors provoking such symptoms, and the selection of an individual, adequate psychotherapeutic treatment.

signs and causes of pathology, forms of the disease and clinical picture, concomitant manifestations and features of pain syndrome

A hernia of the esophagus, the symptoms of which will be discussed in this article, or a hernia of the esophageal opening of the diaphragm (hiatal hernia) is a violation of the position of organs in which the esophagus is displaced higher through the pathologically enlarged opening of the diaphragm.

The disease occurs due to the weakness of the ligamentous apparatus of the diaphragm. Together with a part of the esophagus, the stomach can enter the chest cavity, less often intestinal loops fall out.The first symptoms of a hernia of the esophagus do not appear immediately, the disease can be identified with complications in the case of infringement of the protrusion or due to the addition of other diseases, including reflux esophagitis.

Increased intrauterine pressure contributes to the appearance of this disease in case of overeating, with pathologies of the gastrointestinal tract and during pregnancy. The cause can also be traumatic injury and the postoperative period.

Hernia of the esophageal opening of the diaphragm: symptoms

What are the symptoms of a hernia of the esophagus of the diaphragm (abbreviated as symptoms of hiatal hernia)? We deal with this moment in detail.

Symptoms of a hernia of the esophagus, and they are also signs of gastric hernia, are as follows:

  • development reflux esophagitis ;
  • burning sensation in the chest area;
  • belching , hiccups;
  • feeling of heaviness and discomfort after eating;
  • soreness , similar to angina pectoris;
  • dysphagia ;
  • permanent heartburn .

What are the signs of a hernia of the esophagus? Symptoms arise only due to the influence of certain factors.These are food intake, trauma, stressful situation and accompanying deviations.

Outwardly, the pathology is not determined in any way, which also complicates timely diagnosis. When leaving the abdominal cavity, most of the organ is already accompanied by symptoms of pain and a feeling of heaviness.

What other symptoms does a hernia of the alimentary opening of the diaphragm have?

Discomfort worse after eating and lying down. Severe pain with a hernia of the esophagus can appear in case of overeating or after severe stress, then the symptom can disturb for several hours or even days.In patients, there is a violation of the swallowing process, dysphagia develops (when swallowing certain food).

When the hernial sac begins to squeeze, the patient notes aching pain in the epigastric region. Hernia of the diaphragm of the esophagus has different symptoms and heartburn will be a constant sign. It appears due to the development of reflux. The weakness of the obturator mechanism leads to the release of the acidic contents of the stomach into the esophagus.

The walls of the organ are irritated at the same time, inflammation begins, which manifests itself as severe heartburn.For a more detailed acquaintance with the topic “hiatal hernia symptoms” photos are attached.

Forms of the disease

The main and indirect signs of HHP (which is an urgent question for many) will depend on the form of the disease.

There are the following types of disease :

  • fixed and non-fixed;
  • sliding and paraesophageal;
  • congenital and acquired;
  • atypical.

Paraesophageal protrusion is characterized by the location of the cardia under the diaphragm near the esophagus.

If a sliding hernia in the esophagus, the symptoms of pathology are associated with the fact that the protrusion does not have a hernial sac, therefore the defect moves freely from the abdominal cavity to the chest. With this form, the cardia is located above the diaphragm and forms the wall of the hernial sac.

Associated manifestations

If there is a hiatal hernia of the esophagus, its symptoms depend on the severity of the course.

The nature of the pathology that determines indirect symptoms:

asymptomatic course of the underlying disease;

  • HHOD with manifestations of cardia insufficiency;
  • hernia with concomitant signs of a violation of the surrounding tissues.

In the case of an asymptomatic course of the pathology, we can talk about such a concept as endoscopic signs of hiatal hernia that the doctor will tell it. Identification of pathology is possible when carrying out instrumental diagnostics. But at the same time, you can observe indirect signs of HH, including shortness of breath and discomfort behind the breastbone.

In rare cases, a cough appears with a hernia of the esophagus:

  • soreness is noted during an attack;
  • there is a foreign body sensation in the throat;
  • there is a sore throat;
  • after there is a false relief of well-being.

Protrusion due to cardia insufficiency syndrome, characterized by heartburn after eating and with a sharp turn of the trunk. How does a hernia of the esophagus hurt? She herself does not hurt, only 15% of patients experience a symptom of pain.

Features of pain syndrome in HH:

Appearance when lying down and after overeating;

  • cutting or stinging character;
  • is accompanied by regurgitation.

More than 60% of patients experience frequent belching.This is preceded by a feeling of fullness in the stomach. After belching, there is some relief, the feeling of a foreign body behind the sternum disappears, but not for long.

About 30% of patients experience a violation of the passage of food. Tellingly, it is easier for a person to swallow solid food. Problems arise with food that is too hot or cold.

Hiccups in the axial form of pathology occurs in no more than 5% of patients. A distinctive feature will be a significant duration, a person can hiccup all day or several days in a row.In severe cases, this symptom lasts for weeks.

Indirect signs of a hiatal hernia and complications may join:

  • inflammation of the mucous membrane or gastric ulcer;
  • anemic syndrome, internal bleeding;
  • prolapse of the gastric mucosa;
  • entering the hernial sac of most of the esophagus.

Infringement of hernia of the esophagus: symptoms

The hernia of the diaphragmatic opening of the esophagus itself, the symptoms of which have already been considered, does not pose a threat to health; if a diet is followed and a regimen of sparing physical activity, it does not affect the quality of life.This disease is considered dangerous at the moment when there is a risk of infringement of the contents of the hernial sac. It is important to immediately identify the signs of this disorder.

If the hernia of the esophageal diaphragm is impaired, the symptoms are as follows:

  • severe pain in the chest;
  • discoloration of the skin of the affected area;
  • strong burning in the esophagus;
  • Difficulty swallowing ;
  • Sour taste in the mouth.

The best way to get acquainted with the issue of hernia of the esophagus, the symptoms of the photos and videos that are in our article.


Before determining the hernia of the esophagus by instrumental methods of research, the doctor makes an external examination. The condition of the skin is assessed, the presence of excess weight is determined. The doctor collects the patient’s life history, taking into account the dietary habits and the level of physical activity in daily life.

When interviewing a patient, the doctor takes into account the following complaints:

Frequent hiccups and belching;

  • heartburn and chest pain;
  • discomfort when bending;
  • nausea and intermittent vomiting;
  • Burning tongue and sour taste.

Instrumental diagnostics includes the following procedures:

  1. Fibrogastroduodenoscopy . The examination is indicated to assess the main and concomitant diseases of the gastrointestinal tract. Pathology will be indicated by the weakness of the sphincter, thickening of the Gubarev valve, and a decrease in the abdominal esophagus.
  2. Radiography . The study is informative for a fixed protrusion. Pathology will be indicated by the absence of the His angle or its smoothness; the picture also shows a part of the organ that has penetrated through the diaphragm.
  3. PH-metry . The acidity of gastric juice is determined to diagnose concomitant reflux esophagitis.
  4. Ultrasound . It is prescribed additionally in case of suspicion of diseases of the hepatobiliary system, which may accompany a PID hernia.

Symptoms of hernia of the esophagus

Asymptomatic course of the disease

The disease in question is more often detected in persons who are over 60 years old.The risk group includes women. The HHH clinic is polymorphic depending on the size and types of hernia.

The external symptoms of the disease vary due to frequent complications. Specialists distinguish between several clinical forms of hiatal hernia:

  • asymptomatic;
  • with or without the presence of cardia insufficiency syndrome;
  • concomitant gastrointestinal disease;
  • para-esophageal form;
  • congenital short esophagus.

Asymptomatic pathology is detected by chance (in 5-40% of cases).Food and cardiac HPOD is a type of asymptomatic form of pathology. With this diagnosis, a small hernia is detected. In this case, there are no signs of cardia insufficiency.

If the pathology is accompanied by a similar clinic, the patient complains of heartburn that occurs after eating. A hernia of the diaphragm with a clinical picture of cardiac insufficiency is detected in 87% of cases of all HH. For the manifestation of nocturnal heartburn, the tone of the vagus nerve must increase. At the same time, the lower esophageal sphincter relaxes.

In diaphragmatic hernia, the symptom may be perceived as an occupational disease. In its origin, the degree of sensitivity of the inflamed mucosa to various stimuli is of great importance.

Patients with the ailment in question complain of pain syndrome, which is observed in 45% of cases. At the same time, not all patients can determine the pain, confusing them with heartburn. This is due to the similarity of provoking factors.

With a hernia of the esophagus, the pain is accompanied by the “lace symptom”.To eliminate complex symptoms, it is recommended to change the position of the body or take alkali.

Additional Developments

The above picture indicates that there is no border between heartburn and chest pain. Pain in the region of the heart is noted in 10% of patients. With the help of anamnestic techniques, the relationship between the cause of the onset of this symptom and food intake is revealed.

In this case, there are no electrocardiographic changes, but there are endoscopic signs of the disease.Reflux esophagitis is considered an indirect symptom of the disease. In elderly patients, HHH may be accompanied by cardiac ischemia. In such cases, the correct diagnosis is established on the basis of data obtained from a comprehensive examination.

The disease in question may be accompanied by coronary pain if the irritated vagus nerve affects the VVS. The patient is experiencing severe pain syndrome, which can provoke a heart attack. Particular attention is paid to elderly patients.

If spastic waves of high amplitude are recorded on the esophagotonogram during an attack of chest pain, then this indicates its esophageal genesis.But in medical practice, such a coincidence is rare.

Factors provoking a retrosternal pain symptom of a hernia of the esophagus:

  • peptic aggression, which is manifested by gastric or duodenal contents;
  • EHD;
  • distended esophageal walls on the background of GH.

The nature of the pain syndrome

Compressive and pressing chest pain that radiates to the neck and jaw is a consequence of esophagus spasm. Pain against the background of overeating, when the trunk is tilted, with bloating is associated with reflux.

If the syndrome manifests itself due to a displacement of the cardia, then additional signs of a diaphragmatic hernia appear, associated with impaired functioning of the main organ. For the first time such a symptom complex was investigated by Bergman.

Reflux is common in patients with HH and epiphrenal syndrome that occurs at night.

The patient’s condition worsens if ulcers appear at the same time. Pain between the shoulder blades caused by esophagospasm can be wired.

A patient diagnosed with a food hernia may regurgitate air or stomach contents. Distension in the epigastric region is preliminarily observed. This indicates aerophagia.

A similar condition occurs after eating or during conversations. Therapy with analgesics or antispasmodics is not effective. Relief occurs only when belching with a large volume of air. Often this phenomenon is caused artificially. After it, epigastric or retrosternal pain appears.

The degree to which belching is expressed is related to the type of hiatus. With the cardiofundal form, the maximum severity of belching is noted. In the manifestation of this symptom, antiperistalsis and increased stomach tone play a role. If there is a suspicion of non-stopping belching, differentiation is made for the presence of hysterical genesis.

Regurgitation is observed in 36% of cases. It manifests itself after eating, changing the position of the body. The composition of the regurgitated mass is an acidic liquid.Nocturnal regurgitations, which can cause aspiration pneumonia, are considered significant in number. Regurgitation is a symptom of cardiac and cardiofundal hernia of the esophagus. Regurgitation accompanies only medium-sized hernias.

No nausea before regurgitation. The release of food through the esophagus into the oral cavity occurs due to muscle contraction. Rumination is a type of regurgitation, which is characterized by the penetration of the regurgitated contents into the mouth, where it is chewed and swallowed again.This phenomenon is rare.

How does dysphagia progress?

Obstructed passage of food through the esophagus is diagnosed in 35% of all patients with HH. In this case, dysphagia requires constant examination by an oncologist.

In a mild course of diaphragmatic hernia, which is accompanied by a violation of esophageal transit, dysphagia is changeable. Solid food passes better than watery food.

Dysphagia in these patients appears while taking hot or cold water.

If dysphagia is provoked by other reasons, then a specific clinic of its manifestation is observed. Atony of the esophagus disrupts the passage in the supine position. If the symptom is accompanied by some complications, then the dysphagia is organic.

It can be relieved by fluid intake, but sublingual nitrate intake does not relieve the patient’s condition. Additionally, chest pain may appear, indicating a complication such as reflux esophagitis. The disturbed passage may be associated with swelling and inflammation of the mucosa.By treating esophagitis, pain and dysphagia can be reduced.

Its distinctive feature is its long duration and relationship with food. Hiccups can last for weeks or months. However, she does not respond to therapy.

In its genesis, special attention is paid to inflammation of the diaphragm and irritation of the nerve by the sac. Of the additional symptoms, a burning sensation of the tongue stands out. The origin of this trait is unknown.

Scientists suggest that if the burning sensation of the tongue is accompanied by hoarseness of the voice, as well as symptoms of esophagitis and reflux, then such a clinic can be triggered by throwing stomach contents into the mouth and larynx.

Absence of cardiac insufficiency syndrome

In 12% of cases with axial hernia, there are no instrumental symptoms of lower sphincter insufficiency. The diagnosis is made on the basis of manifested esophageal dyskinesia. The patient complains of epigastric pain syndrome that occurs after eating. The pain lasts for several minutes or days. It is stopped with a non-narcotic analgesic.

To alleviate the patient’s condition, it is recommended to change the position of the body by drinking liquid.If the pain is associated with squeezing the sac in the hernia, then it is solar in nature. In this case, complications develop.

With solaritis, persistent epigastralgia is observed, which intensifies during pressure on the solar plexus region. Eating food does not affect the patient’s condition. Overeating is an exception.

If the patient does not follow the preventive recommendations of the attending physician related to preventing the increase in the size of the hernia, the cardia will be disrupted.In addition, symptoms of reflux and esophagitis will appear.

Development of concomitant gastrointestinal diseases

Diaphragmatic pathology in 35% of cases is accompanied by gastroenterological ailment (ulcer, cholecystitis, pancreatitis). The diagnostic results indicate that HHH is more often accompanied by a duodenal ulcer. Less commonly, a stomach ulcer is detected.

In young patients with hernia, duodenal ulcer is a complication of the pathology under consideration. Epigastralgia is food-dependent.Additionally, dysphagia, belching, heartburn develops. Instrumental diagnostics reveals functional disorders of the esophagus, which can cause traction of the cardia in the chest.

Diaphragmatic hernia affects the exocrine function of the pancreas, provoking a relatively persistent spasm of the sphincter. Patients who have the above-described clinic are subject to qualified diagnostics for the detection of diaphragmatic hernia.

Large paraesophageal hernia can cause esophageal compression in the esophagus, which can lead to dysphagia.

The latter symptom is organic in nature, but can be aggravated by the consumption of dry or dense food. Only in isolated cases does pathology cause a clinic of esophagospasm.

A strangulated hernia provokes pain, which is localized in the epigastric region and chest. Its intensity depends on the part of the gastrointestinal tract blocked at the gate. The substrate of the disease is the bottom and antrum of the stomach. Insufficient cardia for the paraesophageal form of the disease is uncommon.

When examining a patient, doctors may find a small congenital esophagus.Under this diagnosis, 2 anomalies are described:

  • the presence of a cardiac stomach in the chest;
  • intrathoracic localization of the whole stomach, there is no sac in the organ, such an anomaly was described by Harrington.

In the second case, the gastric mucosa is contained in the esophagus, while the muscular wall and serous membrane have a normal structure.

The symptomatology of such conditions practically does not differ from the clinic of axial hernia, which is accompanied by cardio-esophageal insufficiency.Congenital pathology is detected on the basis of anamnesis data.

But the true diagnosis is established only during surgery or as a result of an autopsy.

Hernia of the esophagus: causes, symptoms, treatment and diet

Hernia of the esophagus (HH) is a protrusion of the lower part of the esophageal opening of the diaphragm, through which both the esophagus and the upper part of the stomach begin to move.

This provokes reflux (back movement of gastric or intestinal contents), inflammation of the gastrointestinal tract tissue, peptic ulcer and cicatricial stenosis (narrowing of the lumen).All of these complications are dangerous, therefore, you cannot engage in self-treatment at home.

If symptoms of a hernia appear, you need to go to a gastroenterologist, who will draw up a drug therapy plan or refer you to a surgeon.

Why does a hernia of the esophagus appear

The disease is of two types – acquired and congenital. In the latter case, during the embryonic development of the fetus, a too short esophagus is formed. Also, congenital dystrophy of the connective tissue can be observed, in which the walls of the organ cannot cope with the load and are displaced.

Acquired causes of hernia of the esophagus are divided into the following types:

  • Age-related hernia: diagnosed mainly in patients over 60 years of age. The reason is age-related weakening of the musculo-ligamentous structures of the esophagus.
  • Postpartum protrusion: occurs after long difficult labor. It can also appear in women during pregnancy due to increased abdominal pressure or hypermotility of the esophagus (due to frequent vomiting during toxicosis).
  • Hiatus hernia in obesity (when the body mass index is greater than 30): the cause is an increase in internal pressure due to excessive overeating and too much stress on the walls of the gastrointestinal tract.

A hiatal hernia may occur in obesity.

  • Pathology caused by diseases of the respiratory system. For example, every second patient with chronic bronchitis develops a traction floating hernia. The provoking factor for the mixing of internal organs is a frequent strong cough.
  • Post-alcohol damage to the esophagus: occurs due to the fact that ingested alcohol causes burns of internal tissues and their subsequent scarring.
  • Secondary hernia: develops against the background of ulcers, chronic constipation, cholecystitis, gastroduodenitis, pancreatitis and other diseases.

How does a hernia of the esophagus manifest

Heartburn is a characteristic symptom of a hernia. It occurs in patients:

  • Within half an hour after eating (for example, after taking hot sauces, citrus fruits, chocolate, coffee, etc.).
  • With sudden movements (excessive activity, sports will cause severe exacerbations).
  • At night (due to natural muscle relaxation and increased reflux esophagitis).

In addition to heartburn, common symptoms of esophageal hernia are belching and difficulty swallowing (dysphagia). With uncomplicated pathology, such violations occur periodically, manifest themselves rather weakly. If the disease is started, then the symptoms will bother the patient constantly, become a real torment, and sometimes cause a loss of working capacity.

Another characteristic symptom is pain.It occurs in about 43% of cases of esophageal hernias. Appears in the same situations as heartburn. Often the symptoms occur simultaneously with each other or at first there is heartburn, gradually increasing, causing pain.

In different forms, the symptom may have the following character:

  • Drawing pain in the central part of the chest.
  • Pain in the abdomen, in the Schoffard-Minkowski area (just above and to the right of the navel).
  • Chest pain radiating to the lower part of the face, between the shoulder blades.
  • Pseudo-coronary pain in the diaphragm: radiated to the region of the heart.

It should be noted that spasms in the region of the heart may not always have a pseudo-coronary nature.

Sometimes in patients over 50 years of age with a hernia of the esophagus, a viscero-visceral reflex and spasm of the coronary vessels of the heart muscle occur. If you do not provide emergency assistance, then this can result in a heart attack.

That is why in case of chest pain and lack of air, everything cannot be attributed to possible “irradiation”, and when an alarming symptom appears, immediately call an ambulance.

Hiccups occur with hernias affecting the cardiac regions of the esophageal opening. Appears when very hot or cold water is swallowed, often accompanied by difficulty swallowing. A distinctive feature of hernial hiccups is that it is difficult to get rid of it. There have been cases when patients suffered from this symptom of the disease for 5-7 days.

How is esophageal hernia determined

If any of the above symptoms occur, consult a gastroenterologist.At the appointment, the doctor will take an anamnesis, for which he will ask questions about the state of health, complaints, and will also carry out palpation to identify pain syndromes.

To clarify the diagnosis, the patient is sent for instrumental and laboratory examinations. Diagnosis of a hernia of the esophagus includes the following methods:

  • Esophagomanometry – examination of the esophagus through a catheter inserted into the mouth. Now this is the surest way to diagnose the disease. Allows you to establish the shape and stage of the protrusion of the esophagus, as well as determine whether it is possible to treat a hernia without surgery.
  • Barium chest and abdominal radiology. Helps to observe the movement of contrast along the esophagus and to notice protrusions.
  • Fibrogastroscopy. Allows you to detect damage to the mucous membranes of the esophagus, stomach, identify bleeding.
  • PH-metric measurement of gastric acidity. Helps to select the appropriate treatment methods, to determine the most effective drugs.

How to cure a hernia of the esophagus

Initially, doctors try medication to cope with a hernia – they use drugs.Treatment without surgery includes the following drugs:

Initially, doctors try medication to cope with a hernia – they use drugs.

  • Treatment with H-2-blockers of histamine receptors (Nizatidine, Cimetidine, Roxatidine, Famotidine). They reduce acid production, which protects the esophagus from damage.
  • Taking antacid drugs (Rennie, Topalkan, Maalox, Gastal, Relzer, Almagel) or proton pump inhibitors (Omez, Emanera, Rabeprazole, Dexrabeprazole, Omeprazole, Esomeprazole).They bind acid from the stomach, reduce its irritating effect, and eliminate hernia symptoms (including heartburn and pain).
  • Treatment with prokinetic drugs (Cisapride, Motilium, Eglonil, Metoclopramide). They prevent reflux and normalize esophageal motility.

In case of development of concomitant complications of the gastrointestinal tract, the patient may be prescribed additional methods of treatment. For example, if a complicated hernia of the esophageal region is accompanied by internal bleeding, then hemostatic and antianemic drugs are prescribed.

It is allowed to add alternative methods to the course of therapy for the disease. But they cannot be used as a substitute for medication for hernia of the esophagus. Various herbal decoctions and infusions will only help to remove symptoms faster. Here are some recipes:

To remove heartburn and improve swallowing will help a decoction of the leaves of coltsfoot.

  • A decoction of coltsfoot leaves, flax seeds, mint, and marshmallow root will help remove heartburn and improve swallowing. A handful of herbs should be poured with 1 liter of water, left for 50 minutes.Drink half a glass, pre-warmed.
  • For pain, a decoction of honey, cranberry, aloe juice will help. Everything must be crushed, mixed, filled with water, stirred and drunk.
  • Effective treatment of heartburn and belching with milk with honey and a small amount of valerian.

If medication is unsuccessful, only surgery will help the patient. Surgical intervention has strict indications:

  • Ulcerative esophagitis (caused by excessive release of contents from the intestines and stomach).
  • Infringement of a hernia of the esophagus (occurs mainly with a paraesophageal hernia).
  • Progressive anemia, narrowing of the esophagus and other complications of hernia.
  • Bleeding of the stomach or esophagus.
  • Kay’s syndrome (a combination of a hernia with gastritis and an ulcer that prolapses into the upper stomach).
  • Barrett’s esophagus (when, with a neglected hernia, the epithelial layer is replaced, which is a harbinger of cancer).

The operation is performed using an open method or invasively using laparoscopic equipment.The tasks of surgical treatment are: reduction of the hernial opening, strengthening of the diaphragm ligaments, elimination of reflux. As a result, the full valve and conductive function of the digestive system should be restored.

Upon completion of the main course of treatment, all patients with hernia of the esophagus must be registered with a dispensary. It is recommended to undergo a routine examination by a gastroenterologist 2-3 times, to carry out prophylaxis to prevent complications and relapses.

Nutrition rules for illness

In the treatment, recovery (including postoperative) and prevention of hernia of the esophagus, great attention is paid to proper nutrition. The patient’s diet excludes fermented milk products, cabbage, fresh bread, legumes, grapes, citrus fruits, hot spices from the diet – this food irritates the walls of the esophagus, exacerbates the symptoms of the disease.

It is imperative to monitor the portion sizes. When the esophageal opening is deformed, a large amount of food will put unnecessary stress on the diaphragm and provoke an increase in hernia symptoms.A portion should be no more than a third of a plate, but you can eat 4-5 times a day with a break of 2-3 hours. Swallow little by little, chew food thoroughly.

In case of a hernia of the esophagus, it is forbidden to drink alcohol, coffee and strong tea!

As for drinks, the diet excludes any alcohol-containing products (even low-alcohol ones like kvass or beer), coffee and strong tea. During treatment of the esophagus, you should not drink carbonated drinks. It is best to quench your thirst with plain water. Moreover, do not drink very cold and hot liquid, this will cause dysphagia or hiccups.

What is the danger of a hernia of the esophagus

Long-term treatment of hernia. Symptoms decrease immediately, but general improvement occurs only a couple of months after starting the medication. If the patient underwent surgery, then recovery takes at least 6-8 weeks. The treatment itself is not easy – you have to take a lot of funds, monitor your diet, and carry out various examinations. But if this is not done, complications will arise:

  • Pinching of the esophagus, cardia of the stomach, or upper intestines (squeezing causes blood flow to stop, causing anemia).
  • Ulcer that can cause internal bleeding of the esophagus.
  • Cicatricial narrowing of the esophagus (with prolonged cicatricial stricture, food stagnates in one place, undergoes chemical and bacterial decomposition there, which provokes inflammation).
  • Development of esophageal cancer due to persistent reflux esophagitis (due to the erosion of tissues by acid coming from the stomach).

The listed complications are not only painful, but also threaten the patient’s life.It is better not to take the situation to extremes and take medications at the first symptoms of a hernia of the esophagus, and if conservative therapy does not help, then agree to surgical treatment.

Restrained diaphragmatic hernia

Injured diaphragmatic hernia – an emergency condition that occurs when a narrow ring of hernial gates is compressed by anatomical structures located in the region of the diaphragm. Pathology is accompanied by severe pain, more often in the left half of the chest and abdomen, repeated vomiting, constipation, flatulence.As the symptoms increase, hypotension, tachycardia, shortness of breath, impaired consciousness develop. It is diagnosed on the basis of a surgical examination, X-ray data of the chest and abdominal organs. Treatment is surgical: dissection of the hernial orifice, release of the pinched organ and hernioplasty are performed.

Restrained diaphragmatic hernia occurs when the hernial sac with its contents is compressed in the hernial orifice. As a result, the blood circulation of the constricted organ is disrupted, ischemia develops, and then necrosis of the restrained tissues.

The hernial bursa may include the abdominal segment of the esophagus, the loops of the small and large intestines, the stomach, and the greater omentum. Up to 20% of all diaphragmatic hernias are infringed, more often – hernias of traumatic and congenital genesis.

The greatest danger due to pronounced cardiorespiratory disorders is the infringement of false congenital hernias of the diaphragm that do not have a hernial sac.

The probability of infringement does not depend on the size of the hernia and the diameter of the hernial ring.All types of diaphragmatic hernias (paraesophageal, congenital, etc.), with the exception of axial hiatal hernia, tend to be compressed. There are factors, as a result of which the risk of developing pathology increases:

  • Injury . A restrained hernia occurs as a result of open or closed thoracoabdominal trauma (stab wounds to the abdomen and chest, falls from a height, severe accidents). At the time of physical impact, a diaphragm defect appears, through which organs (stomach, intestines, etc.)) move into the chest cavity and when the muscles of the abdominal muscles are strained (for example, as a result of pain), they are infringed.
  • Operations . Compression of organs can occur after surgical interventions on the esophagus (esophagectomy), diaphragm (removal of the tumor, resection of the dome of the diaphragm) as a result of a surgical error and leaving a muscle defect in the diaphragm. Subsequently, through the formed hole, nearby anatomical structures are exited and infringed.
  • Increased intra-abdominal pressure .Infringement can provoke a sharp jump in pressure inside the abdominal cavity as a result of coughing, heavy physical exertion, difficult childbirth, repeated vomiting, chronic constipation. With an increase in pressure, the diaphragm defect is stretched and the hernial contents are released into the pleural cavity. After the pressure returns to the initial level, the hernial ring narrows – there is a compression of the hernial sac.

When the hernial contents are infringed, a closed cavity is formed in the hernial bursa, which may contain various anatomical structures (esophagus, part of the omentum, stomach, intestine).Compression is accompanied by insufficient blood supply in the restrained area of ​​the organ and the formation of a strangulation groove at the site of clamping.

As a result of malnutrition, stagnation of venous blood and lymph develops, which contributes to the appearance of edema of the wall of the compressed organ. Ischemization leads to the gradual death of the restrained structure and the formation of necrosis.

There is a sweating of plasma and diapedesis of leukocytes, erythrocytes into the hernial bursa, which is accompanied by the appearance of initially transparent, and then pink or brown transudate.With the infringement of the digestive tract, there is a gradual decomposition and putrefaction of the contents of the stomach or intestines.

The wall of the affected organ becomes thinner, toxic decay products diffuse into the hernial sac, as a result of which the transudate of the hernial sac becomes infected and becomes purulent.

Compression of a diaphragmatic hernia can be primary or secondary. Primary arises with a simultaneous physical overload or injury. As a result, a previously non-existent hernia is formed and strangulated.

Secondary infringement occurs against the background of an already formed diaphragmatic hernia. According to the degree of overlap of the lumen of a hollow organ in gastroenterology, complete and incomplete strangulations are distinguished.

Based on the mechanisms of the development of pathology, there are two types of infringement:

  • Elastic . It is formed as a result of the release of the most mobile organs (intestine, stomach) through a diaphragm defect under the influence of increased intra-abdominal pressure or as a result of trauma.The internal organs located in the hernial sac do not adjust on their own, and when the hernial ring narrows, they are impaired. This type is accompanied by a vivid clinical picture and rapid tissue necrosis.
  • Feces . It is formed by excessive filling and stretching of the adductor part of the intestine located in the hernial sac. At the same time, the abducting region of the intestine is compressed in the hernial orifice. Necrosis forms more slowly than with elastic impingement, symptoms of intestinal obstruction are predominant.More often occurs with a prolonged course of a hiatal hernia.

The clinical picture depends on the mechanism of infringement and the organ involved in the pathological process. The main symptom of the disease is a sharp severe pain in the epigastric region, the left half of the abdomen and chest, the hypochondrium on the left.

Painful sensations can be cramping in nature and radiate to the scapula, back, subclavian region. Pathology is accompanied by repeated vomiting, which does not bring relief, the nature of which depends on the level of strangulation.

When the esophagus is pinched, vomiting occurs immediately after a sip of liquid, stomach – vomiting with a fountain mixed with bile or blood (vomiting “coffee grounds”). Compression of the small intestine is accompanied by a large amount of fetid vomiting, colon – rare “fecal” vomiting.

With complete compression of the stomach, vomiting is absent, patients complain of painful vomiting.

Many patients develop a typical pattern of intestinal obstruction: constipation, bloating, dry tongue coated with a brown coating.The general condition of the patient is deteriorating, symptoms of intoxication are increasing: there is severe shortness of breath, tachycardia, a decrease in blood pressure, acrocyanosis appears first, and then diffuse cyanosis, cold sweat. Consciousness is suppressed to the level of stunning and stupor.

Infringement of the intestine is accompanied by intestinal obstruction, which, in the absence of emergency treatment, can lead to infectious toxic shock. With perforation of the restrained part of the intestine, the transition of inflammation to the peritoneum or pleura, peritonitis or pleurisy occurs, respectively.

A particular danger is the formation and perforation of the phlegmon of the hernial sac, which can be accompanied by the penetration of infection into the bloodstream and the development of sepsis.

Death with a strangulated hernia occurs in 20-40% of cases, depending on the etiology of the disease, the nature of complications and the timing of emergency care.

Errors during the diagnostic search are associated not so much with the difficulty of diagnosis as with the rarity of the pathology and the poor acquaintance of thoracic and abdominal surgeons with the clinic of a restrained hernia of the diaphragm.To verify the diagnosis, the following examinations are performed:

  • Surgeon’s examination . It is possible to suspect a strangulated hernia already at the stage of collecting an anamnesis. The specialist pays attention to injuries, operations in the past, the presence of a diaphragmatic hernia. With the help of percussion and auscultation of the chest, the doctor determines the tympanic zones, the weakening or absence of vesicular breathing, the lag of the affected half during the act of breathing.
  • Chest X-ray .During the study, it is possible to detect a horizontal liquid level above the diaphragm, a large gas bubble. In severe cases, a compressed lung and displacement of the mediastinal organs to the healthy side are visualized.
  • Radiography of the abdominal organs. During a plain X-ray, swollen bowel loops, Kloyber’s bowls (with intestinal obstruction) are determined. With a contrast study of the gastrointestinal tract, it is possible to detect the level of compression (at the level of strangulation, a “contrast breakage” occurs).

In severe or doubtful cases, MSCT of the thoracic and abdominal organs is performed. If there is suspicion of intestinal infringement, an endoscopic examination of the intestine (intestinal examination, colonoscopy) is performed.

Differential diagnosis should be carried out with various diseases that have a similar clinical picture and intense pain syndrome: acute pathology of the pancreas (pancreatic necrosis, pancreatitis), mesenteric thrombosis, intestinal obstruction, acute coronary syndrome.

Pathology must be differentiated from gastric volvulus, which can occur with large diaphragmatic hernias and relaxation of the diaphragm.

This disease refers to an emergency pathology and requires urgent surgical intervention, which can be carried out by transthoracic and transperitoneal access. During the operation, the hernial ring is dissected and the hernial contents are carefully released.

Evaluate the viability of the restrained tissue.With necrosis, the affected organ is resected (parts of the stomach, intestines, omentum). The hernial sac is tied up in the cervical region and excised, then the diaphragm defect is sutured with plastic hernia orifice.

In case of suppuration, hernioplasty is performed without the use of alloplastic methods. At the final stage of the operation, drains are installed into the chest and abdominal cavity.

Throughout the entire period of treatment, the patient is shown detoxification, antibacterial, anti-inflammatory, analgesic therapy.

The prognosis of the disease depends on the extent of the affected organ lesion, the time of the diagnostic search and the timing of the start of treatment. With timely treatment of patients, timely surgical intervention and careful observation during the rehabilitation period, the prognosis is favorable.

Neglected cases with the development of extensive necrosis, intestinal obstruction and complications (peritonitis, sepsis) significantly worsen the course of the disease and can be fatal.

The basis of prevention is the timely planned treatment of diaphragmatic hernia and the elimination of risk factors that can provoke infringement.

Hernia of the esophagus – symptoms and signs, diagnosis, treatment and nutrition – Stomach pain

Hernia of the esophagus is a chronic disease in which the position of the esophagus and stomach inside the body changes. Pathological hernial protrusions are formed from their walls.

The process is due to relaxation of the muscular and ligamentous apparatus, expansion of the diaphragmatic ring. An esophageal hernia consists of the following parts: hernia gate, hernial sac, hernial contents.

The diaphragm ring most often serves as a gate. The hernial sac is formed from the wall of the organ. Hernial contents – everything that enters the hernial sac: food, adjacent walls.

The disease appears and progresses in old age. It is extremely rare in young people, only with congenital pathologies. Risk of development in people over 60 years of age.

What causes a hernia of the esophagus

The following reasons are distinguished:

  • Congenital malformation of the esophagus.A hernia is diagnosed immediately after birth or in young children. The percentage of its development is not significant.
  • Age-related relaxation and stretching of the ligaments of the esophagus, diaphragm.
  • Obesity, overweight. At the same time, intra-abdominal pressure increases, the internal organs are displaced, which causes hernial protrusions.
  • Dramatic weight loss. Over 20 kg per month is considered critical.
  • Chronic processes in the liver with a change in its size: hepatitis, cirrhosis.
  • Excessive overeating.
  • Strength physical activity.
  • Surgical interventions on internal organs, especially the esophagus, stomach, trachea, heart.
  • Accumulation of fluid in the abdominal cavity – ascites.
  • Sometimes during pregnancy.
  • Constipation.
  • Organic lesions of the esophagus.
  • Burns of the insides with salts, acids.
  • Post-stroke condition.
  • Blunt abdominal trauma.

Symptoms and signs of illness

If the pathological focus is not large and is in the early stages, then the disease may practically not manifest itself.When the hernial protrusion becomes larger, the functions, innervation, blood supply are impaired, complaints appear in patients.

What can serve as symptoms of an esophageal hernia:

A hernia manifests itself individually in each patient, but there are still common characteristics. The pain is sudden, severe, pulling or aching in nature, sometimes tingling is felt.

Localized in the epigastric region, “under the spoon” or in the left hypochondrium. Gives to the left arm, back, intercostal spaces.It increases with physical activity, rapid breathing, during or after eating.

Pain can disappear when changing body position, swallowing cold water.

  • Difficulty swallowing. The patient has difficulty swallowing the lump of food.
  • Severe heartburn.

This is a burning sensation in the esophagus. It occurs due to a violation of the motility of the esophagus and the reverse flow of hydrochloric acid from the stomach into the esophagus. The symptom is constant, worries patients even at night.Medicines remove it for a few hours.

  • Belching with food recently eaten.

May be belching with air, sour.

Appears not due to problems in the lungs, but due to compression of the trachea by a displaced esophagus or hernial formation. It has a dry, permanent character, comes from the throat, but with it there is no phlegm, so it is rather difficult to cough up.

Cannot be treated with antitussive drugs. With a prolonged course of such a cough, more than 2 months, a doctor’s consultation is necessary.

  • Bitterness in the mouth, bad breath.
  • Hiccup.

Appears due to an infringement of the vagus nerve. At the same time, the diaphragm begins to contract chaotically.

Patients often induce induced vomiting to relieve symptoms.

  • Dyspeptic disorders.
  • Most often it is a stool in the form of diarrhea.
  • Difficulty passing food through the esophagus.
  • If several symptoms appear, it is necessary to consult a specialist in order to diagnose and prescribe the necessary treatment.


Characterized by a slight protrusion, a minor lesion. The functions of the organs are practically not violated. The innervation and blood supply are not affected, and symptoms may not be present. They are discovered during routine examinations by accident.

With a hernia of the 1st degree, it is imperative to see a doctor, he will prescribe the necessary treatment. This includes adherence to the daily regimen and nutrition, diet, and the appointment of drug therapy. No surgical intervention is required.

Larger mass, characteristic symptoms appear: complaints of pain, discomfort, heartburn, belching. The functions of the esophagus and stomach begin to suffer. Treatment is prescribed only by a doctor based on the results of diagnostic manipulations.

Neglected and late form of the disease. It is manifested by severe symptoms. The patient is tormented by severe pains of an acute nature, severe heartburn and belching, refusal to eat.

The digestive features of the gastrointestinal tract are affected.This condition requires urgent therapy and hospitalization in a hospital, complex treatment.

A hernia surgery is performed first. Stretched ligaments are sutured, a retaining mesh is applied, after which drug treatment is prescribed.

Drugs of choice are antispasmodics, proton pump inhibitors, antacids, prokinetics. A strict sparing diet must be followed: exclude hot, fatty, fried and spicy foods.

Allowed to take liquid or mushy food, boiled, steamed, grated.

Why the disease is dangerous

The most dangerous complication of a hernia of the esophagus is its infringement. It is detected after a long process without the necessary therapy or acutely, suddenly, as the first manifestation of pathology.

How it manifests itself:

  • Sudden, sharp, sharp pain in the upper abdomen or in the middle of the chest. Reminiscent of the nature of angina pectoris or heart attack. Always gives to the shoulder blade, collarbone, neck, tongue on the left. The attack worsens after eating or physical activity, the pain becomes unbearable, the patients may lose consciousness.It is not eliminated by drugs.
  • Vomiting occurs at the height of the pain. It does not take a long time, up to several days, does not bring relief. There may be blood impurities. In case of such signs, consult a doctor immediately.
  • Bloating and distention in the abdomen.
  • Increased heart rate, high rise in blood pressure.

If these symptoms appear, the patient should be urgently taken to the hospital.

In addition to infringement, the following dangerous conditions are distinguished:

  • Formation of erosive or ulcerative esophagitis.
  • Peptic ulcers of the esophagus.
  • Stenosis and cicatricial changes in the esophagus, narrowing of its lumen.
  • Internal bleeding.
  • Malignancy.
  • Perforation of the organ wall.
  • Accession of a secondary infection, peritonitis.


In order to determine the required range of studies and make an accurate diagnosis, you should contact a qualified specialist. First, the doctor interrogates the patient and examines him.This helps to detail complaints, to collect the necessary information.

On palpation of the abdomen, one can immediately detect a protrusion of the hernia. After that, general clinical studies are prescribed: a general urine test, a general blood test, a feces for a coprogram.

There may be anemia and minor inflammatory changes in the blood. The coprogram assesses the digestive and enzymatic functions of organs. Followed by instrumental research methods.

Radiography with the introduction of a contrast agent.An X-ray image allows you to assess the location of structures, detect a hernia.

Signs of a hernia will be:

  • Displacement of the abdominal esophagus.
  • High position of the dome of the diaphragm.
  • The presence of a hernial sac.
  • Expansion of the diaphragm ring.

Endoscopic methods are prescribed for detailing the signs. Fibrogastroduodenoscopy with a hernia of the esophagus allows you to assess the condition of the mucous membranes, movement of organs, the size of the protrusion, the expansion of the folds and holes.Based on it, you can make a final diagnosis.


Refers to both diagnostic and therapeutic methods. It is prescribed when there is insufficient collection of information about the patient’s state of health.

Laparoscopy is a type of surgical technique characterized by making small punctures in the abdomen. Cameras and the necessary instruments are introduced through these punctures, all in the form of metal tubes.

From cameras the image is displayed on the computer monitor.If a hernia is found, it is dissected, examined and sutured. The operation is not long-term, minimally invasive, not traumatic.

After it there are no complications and huge scars, the recovery period is short. This method is actively used in surgery.

How and how to treat a disease

Treatment of a hernia of the esophagus comes down to several options:

  • Diet therapy.
  • Conservative medication;
  • Surgical operational;
  • Mixed combined.

Is it possible to cure a hernia without surgery

Treatment without surgery is possible. The following conditions are met:

  • The hernial protrusion should be small.
  • It should not interfere with the functioning of internal systems.
  • Blood flow is not disturbed.
  • The patient is concerned about minor signs.
  • The severity of symptoms is not acute.
  • The patency of the esophagus is preserved.
  • Conservative therapy is carried out for 1-2 degrees of the disease.
  • Grade 3 hernia is treated only with surgical or mixed methods.

How to treat a hernia without surgery

  1. In order to treat an ailment without surgery, you must follow a diet, regularly take medications, and exercise.
  2. Nutrition, diet and menu for hernia of the esophagus:
  • Complete rejection of acute. The list of products includes: onions, peppers, garlic, spices, sauce, mayonnaise, ketchup.
  • Avoid eating fried, salty, sour, smoked food.
  • Ban on alcohol, smoking, carbonated drinks, juices, coffee, energy drinks.
  • Restriction on fruits. Eliminate lemon, cranberries, pomegranate, kiwi, grapes, citrus fruits from the diet.
  • Vegetables and fruits are to be consumed in grated form.

Diet means fractional meals up to 6 times a day, portions should be small. Do not engage in physical activity for an hour after eating, sleep with a raised headboard. After eating, do not lie down.

Menu options

In case of pathology, the following products should be observed:

  • Dried fruits: dried apricots, prunes, raisins. They are best taken at afternoon tea or for dessert.
  • Low-fat fermented milk products. They can serve as breakfast and last meal.
  • Vegetable soups without frying for lunch as a first course.
  • Boiled fish, poultry meat. For a side dish or dinner. Prepare meatballs, steamed cutlets, soufflés.
  • Porridge on the water for breakfast.
  • Compote, tea and fruit salad for dessert.It is recommended to consume 1.5 liters of liquid per day.

Prescribed from medicinal products:

  • Proton pump inhibitors – Omez, Lansoprazole.
  • Antacids – Maalox, Almagel.
  • Prokinetics – Cerucal.
  • Antispasmodics – Duspatalin, Drotaverin.
  • Probiotics – Linex, Enterol.

Exercise and gymnastics

Doctors recommend breathing exercises and exercises to strengthen the muscles of the diaphragm.Everything is done on an empty stomach during the period of remission. During an exacerbation, exercise is contraindicated.

  • Position of the patient lying on the right side. Place a firm pillow under your head and shoulders so that they are raised at an angle of 45 degrees. While inhaling, we tighten the abdominal wall and gradually protrude the stomach. Exhale sharply. At this point, we relax the abdominal wall. Spend 10-15 minutes 2 times a day.
    The patient is on bent knees. The body is straight. We take a slow breath. At this time, tilting the body to the left as much as possible, then to the right.Exhale while straightening. Perform 1 time for 10 minutes.
    The position of the patient lying on the back. On inhalation, turn the body to one side. On exhalation – starting position. The next breath is a turn to the other side. And so do 10 alternations 2-3 times a day.

Surgery to remove hernia

During surgery, the hernial orifice is excised, the condition of the organ is examined, and it is returned to its place. The hernial sac and the collar are sutured. A retention mesh is applied to the vulnerable spots.

The following tactics are performed:

  • Nissen fundoplication – with the help of a special mesh, the translation is delimited from the stomach so that there is no displacement of organs.
  • Operation Belsi. The lower esophagus and ligamentous apparatus are sutured to the diaphragm. A hernia in this position will not be able to form again.

Diet after surgery

After surgery, the first day the principle operates: cold, hunger and rest. This means that 24 hours after the surgery, the patient only takes bed rest, it is forbidden to get up.

Apply cold ice or heating pads to the surgical site. You cannot eat, you can drink water in small sips.

After 24 hours, you can take a half-sitting position without standing up suddenly. Exclude all physical activity. Eat cold mushy and aquatic products: banana puree, oatmeal, jelly.

On the 3rd day, a sparing diet is prescribed. Everything is cooked and grated. After the patient’s condition improves, he returns to his normal diet.

Treatment with folk remedies

Grind the dried preparation. Pour 1 tablespoon with 250 ml of water, put on low heat to boil. Cook for 30 minutes without actively boiling.

Then cool, strain, can be diluted with chilled water.