Hiatal Hernia and Back Pain – How are they related?

Lifestyle today makes us do so much that we do not want to spend time on ourselves. We tend to ignore minor pain, body pain, or headaches which can trigger other bigger problems. One of them is hernia – back pain. Back pain can be due to several reasons and is difficult to diagnose. One of the reasons for back pain can be hiatal hernia. 

How hiatal hernia can cause back pain?

Back pain and hiatal hernia may go together due to the location of hernia. Hiatal hernia is located at the junction of the stomach and esophagus and happens when the stomach shifts a little upward and is unable to fit in properly. Now, when the stomach changes its position, the acid formed in the stomach for digestion can also move upward. This causes heartburn and can make people very uncomfortable. 

The symptoms of hiatal hernia are: 

• Heartburn
• Regurgitation of food or liquids into the mouth
• Backflow of stomach acid into the esophagus (acid reflux or GERD)
• Difficulty swallowing
• Chest or abdominal pain
• Shortness of breath
• Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding.

Also read: Difference between GERD and Heartburn

There can be a pain in the chest and even go up to back depending upon the condition of each and every person. Therefore, if you notice these symptoms along with back pain for a long time, consult a doctor. Do not leave either of them untreated.

What factors cause back pain along with hiatal hernia?

Hernia must be treated when you notice the symptoms because it might grow and worse with time. Back pain, which includes pain in the middle of the back, is not particularly a symptom of hiatal hernia. It can be due to health conditions such as herniated disk or osteoarthritis. 

Also, in hiatal hernia, the pain may not just be in a particular area, it can radiate to hip, back, legs, or even genitals. This can hinder your day to day life affecting your daily activities. (Also read: Everything you need to know about hiatal hernia)

Pain in the middle of the back is less common than lower back pain. It could be dull or sharp. Depending on the underlying cause and how severe it is, it may come up with some of the following symptoms: 

• Muscle stiffness or tightness.
• Numbness or tingling in the belly, chest, legs, or arms.
• Chest pain.
• Poor for controlling bladder or bowel.

Back pain can be due to: 

• Obesity: Obesity is the primary factor of hernia, including hiatal hernia. Being overweight can definitely lead to back pain along with hiatal hernia.
• Abdominal pain: Abdominal pain and chest pain can also affect your back as for some people the pain receptors work quickly. (Also read: Difference between Groin Pain and Hernia Pain)
• Heartburn or heartburn: Although heartburn pain is typically felt behind the breastbone, it could be painful enough to radiate elsewhere in the body such as the neck, throat, or even the back.

Also read: Signs of hernia that warrant doctors visit

What helps in treating back pain and hiatal hernia?

Consult a doctor for diagnosis especially if the symptoms are getting worse and home remedies are not helping. You can try some lifestyle changes and home remedies if your doctor suggests. These changes include:

1. Take a rest, especially when the pain flares up. But it’s also important to avoid strenuous activities and excessive bed rest. Keep active but do not put a strain on your muscles. 
2. Avoid prolonged activities that aggravate the pain (e.g. sitting for long hours during the workday). Instead, practice good posture to prevent such body and muscle pain. Make sure to sit or stand properly so your back will not get hurt later. 
3. Maintain healthy body weight. Keeping your body healthy and fit is equally important to prevent the hernia from getting worse and preventing back pain. 
4. Do exercises that help strengthen the core and structures of your back! Moreover, exercise is a good way to control weight. 
5. Avoid food that might cause heartburn or aggravate your hiatal hernia symptoms. 
6. Stop smoking! It can hurt your esophagus. 
7. Stop taking stress. In fact, emotional stress can affect you physically, making the pain worse, and inhibiting your recovery!

Also read: Difference between hiatal hernia and GERD

What can be the treatment options?

Consult a doctor to understand the treatment options for hiatal hernia. You can book online consultation to talk to our experts and get answers and solutions to hiatal hernia problems immediately. You can also write to us below and our medical coordinator will get back to you as soon as possible. 

Also read: Alchalasia Disorder – Causes and Symptoms

Also read: Common Lifestyle Mistakes Leading to Gastrointestinal Problem

Is it Related to Back Pain?

Hiatal hernia is a hernia of the stomach. It normally affects people over the age of 50. 90% of people with Hiatal hernia will face mild or no symptoms. It can normally be treated with lifestyle adjustments and also by medication to alleviate the symptoms.

Many people with Hiatal hernias may experience some problematic symptoms. These symptoms can include Hiatal hernia pain radiating to the back, acid reflux, heartburn, etc.

Author Tips: How to Erase Acid Reflux & Improve Your Digestion✅

This can make it difficult to live with a hiatal hernia without any form of intervention. In some cases, surgery may be required to correct the problem.

In this article, we’ll take a look at how Hiatal hernias occur and what you can do to manage them.

How Do We Define Hiatal Hernia?

Hiatal hernia is the hernia of the stomach. It occurs when a part of the stomach protrudes from the abdominal cavity into the thorax.

The stomach is separated from the chest cavity by a sheet of muscle called the diaphragm. The diaphragm has several openings. These are there to allow some important structures through from the upper half of the body to the lower half.

These are the esophagus leading to the stomach, the inferior vena cava reaching the heart, and the descending aorta reaching the lower parts of the body.

A hiatal hernia occurs when the esophageal opening of the diaphragm is weakened and enlarged. This causes a part of the stomach to squeeze through to the chest cavity. This causes problems related to digestion and chest pain.

The exact cause of Hiatal hernia is still not known. Hiatal Hernia in children is not as common. But they are most likely caused by birth defects, congenital anomalies, or hereditary factors.

Most of the time hiatal hernias don’t show any symptoms and are not considered to be life-threatening. Large hernias however may lead to severe complications and can only be treated by surgery.

What Are The Signs of a Hiatal Hernia?

Most of the time hiatal hernia shows no signs or symptoms. They are discovered by accident by some other unrelated investigation or checkup.

The majority of the signs of Hiatal hernia are very similar to GERD or Gastroesophageal Reflux Disease. So there may be a chance of it being misdiagnosed.

The signs of Hiatal hernia are:

• Burning sensation in the chest or heartburn. It is commonly felt in the front of the chest, just behind the breastbone. It is most prominent right after eating.
• Regurgitation or having small bits of bitter-tasting digested food or fluid coming back up to the mouth. This phenomenon is called acid reflux.
• It causes difficulty or pain in swallowing food
• Hiatal hernias cause burping and belching after taking food
• It causes persistent bad breath and doesn’t go away
• It can make you feel bloated, tired, or sick after a meal
• Chronic indigestion
• Nausea and vomiting

Hiatal hernia causes the stomach to push up against the esophagus. Thus upsetting the digestive tract and the lower esophageal sphincter. This causes the backflow of acidic food materials from the stomach.

So these symptoms can be exaggerated by movement like bending over or lying down. If you find that the symptoms of Hiatal hernia are getting worse, contact your doctor immediately.

Does Hiatal Hernia Cause Back Pain?

A hiatal hernia can cause pain to spread from the chest to other parts of the body. This is called referred pain.

People often complain of Hiatal hernia pain between the shoulder blades. It can also spread to the chest, jaw, and rarely, to the back. Back pain is not a common symptom of a hiatal hernia.

If you are experiencing back pain and hiatal hernia at the same time, the back pain is most likely being caused by some other factor. It might not be related to the hiatal hernia.

In any case, if you are experiencing back pain while suffering from a hiatal hernia, consult a doctor at once. The back pain may be the sign of something more serious that warrants immediate medical attention.

Heartburn, chronic abdominal pain or kidney diseases can show symptoms similar to a Hiatal hernia. It can also cause back pain. So be sure to go to a hospital and get yourself checked.

Treatment of Hiatal Hernia

As most Hiatal hernias tend to be harmless, treatments are designed mainly to reduce the symptoms rather than to correct the problem. Adopting a healthier lifestyle and taking some medication can be enough to bring a hiatal hernia completely under control.

But in more severe cases like strangulated or incarcerated hiatal hernia, surgery is recommended to prevent any life-threatening complications.

The three levels of Hiatal hernia treatment are as follows:

Lifestyle Changes

Lifestyle changes for Hiatal hernia mean adjusting everyday life to mitigate the factors leading to hiatal hernia or to minimize its effects.

For that, it’s important to know what kind of behaviors or activities worsen the Hiatal hernia or exaggerate its symptoms.

The target group most likely to develop a Hiatal hernia or GERD is above the age of 50. So people of this age group need to know what factors affect Hiatal hernia and what kind of lifestyle adjustments are necessary to combat them.

Author Tips: The MORNING CURE for smelly poops & fiery heartburn☑️

Obesity is the number one factor responsible for hernia and back pain. So, it’s necessary to keep your weight under control.

Eat a balanced diet. Eat less and control the number of calories you take. Avoid fatty junk food, desserts, and sugary foods.

Hiatal hernia diet should consist of healthy meals with lots of vegetables rich in fiber. Taking green tea helps keep weight under control. 

There are also many alternative supplements you can add to your diet to help reduce fat build-up and weight gain. Check out Tox Flush, one of our favorites.

Try to get some exercise every day. Simple exercises like walking, cycling, yoga, etc. are great for keeping weight under control. But don’t take any undue stress on your body.

👉Author Tips: Try This 5 second ritual sheds unwanted body fat✅

Overextending yourself may lead to injury or even cause severe problems. Avoid lifting heavy weights and strenuous exercises as they can cause your hernia to get worse.

Talk to your doctor before starting any intense work-out regimen and discuss what Hiatal hernia exercises are safe for you.

The next step is to simply adjust your lifestyle in a way that accommodates for Hiatal hernia:

• Don’t take foods that cause your symptoms to worsen.
• Avoiding stooping down or bending over.
• Don’t lie down immediately after eating.
• Keep your head raised from the rest of your body while sleeping so the acid reflux does not travel back up your throat.
• Avoid coughing violently as it may cause your hernia to weaken or rupture.
• Avoid tight-fitting clothes.
• Quit smoking. Tobacco is known to cause gastrointestinal irritation and may worsen your symptoms.

Over-the-counter Medication

Many kinds of drugs are available to help mitigate the symptoms of hiatal hernia and gastroesophageal reflux. These medications can be obtained by both prescription and over-the-counter.

These drugs are mainly advised to help minimize the symptoms of reflux like acidity and heartburn but only provide short-term relief. It should also be mentioned that for any long-term medication. You should always consult a doctor.

Three kinds of drugs are mainly prescribed: antacids, histamine blockers, and proton pump inhibitors.

Antacids counteract the acid produced in the stomach, neutralizing them. This provides relief from pain and diminishes symptoms like belching and heartburn.

Some popular antacids are

• Aluminum hydroxide
• Magnesium hydroxide
• Calcium carbonate

Histamine blockers or H-2 blockers reduce the amount of acid secreted by the stomach. This reduces all other symptoms related to GERD and is a great choice to treat Hiatal hernia.

There are many kinds of histamine blockers available:

• Ranitidine
• Nizatidine
• Cimetidine
• Famotidine

Proton pump inhibitors block the production of acid in the stomach. So these meds are very effective and also help tissues damaged by stomach acid to heal. They are the medications of choice which are prescribed to patients suffering from acid reflux.

These proton pump inhibitors include:

• Pantoprazole
• Omeprazole
• Lansoprazole

Surgery

Surgery is never the first choice for the treatment of a Hiatal hernia. It is most often regarded as a last resort. Surgery is recommended by the doctor only when the hernia is large or complicated.

Or if the symptoms of the hernia are not responding to any other form of treatment.

Hiatal hernia surgery can be conducted with minimal invasion by using techniques like laparoscopic surgery or ‘keyhole’ surgery. They can also be done openly if the condition of the hernia is too severe or complicated.

The surgery to correct Hiatal hernia may consist of the following procedures:

• Pulling down the stomach to a level below the diaphragm, relieving the hernia.
• Strengthening the esophageal opening of the diaphragm.
• Strengthening the area of the diaphragm near where the stomach lies.
• Fixing the stomach to a position below the diaphragm, to prevent recurring hernias.

After laparoscopic surgery, the patient generally doesn’t feel much pain, but there might be some discomfort while swallowing. The patient can walk the day after the surgery and may be allowed to go home when they recover from anesthesia.

The patient is also advised to follow some precautions in the following weeks after the surgery. They should avoid lifting heavy loads and drinking through a straw.

Patients should only take soft foods for a few days, take medications properly, and get adequate rest.

If all goes well, they should be completely free from any symptoms of Hiatal hernia.

Conclusion

You can manage Hiatal hernia quite easily. For that make the necessary lifestyle changes, take proper medication, and keep a positive mentality.

We hope this article helped answer your questions about hiatal hernia pain radiating to the back. You’ve also found the causes of hiatal hernia, and Hiatal hernia pain relief.

Let us know by commenting if our methods helped relieve your pain!

The

FAQs About Hiatal Hernia Pain Radiating to Back

Q. What causes a Hiatal hernia to flare up?

Fatty foods, strenuous exercise, smoking, etc. are responsible for making Hiatal hernia symptoms worse.

Q. Can a hernia make your back hurt?

A hernia can cause chest pain, which can radiate to the shoulder, neck, or sometimes to the back. But back pain due to hernia is rare.

Q. How good is pantoprazole for Hiatal hernia?

Pantoprazole is a proton pump inhibitor. It stops the production of acid in the stomach and alleviates symptoms like irritation and heartburn, It is one of the best medications available for Hiatal hernia.

Symptoms, Causes, Diagnosis, and Treatment

What Is a Hiatal Hernia?

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

There are two main types of hiatal hernias: sliding and paraesophageal.

Ordinarily, your esophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. Most people with hiatal hernias have this type.

A paraesophageal hernia is more dangerous. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.

Hiatal Hernia Symptoms

Many people with hiatal hernia don’t notice any symptoms. Others may have:

• Heartburn from gastroesophageal reflux disease (GERD)
• Chest pain
• Bloating
• Burping
• Trouble swallowing
• Bad taste in your mouth
• Upset stomach and vomiting
• Backflow of food or liquid from your stomach into your mouth
• Shortness of breath

Get medical care right away if you have a hiatal hernia and:

• Severe pain in your chest or belly
• Upset stomach
• Vomiting
• Can’t poop or pass gas

These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.

Hiatal Hernia Causes

Doctors don’t know why most hiatal hernias happen. Causes might include:

• Being born with a larger hiatal opening than usual
• Injury to the area
• Changes in your diaphragm as you age
• A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

Hiatal Hernia Risk Factors

Hiatal hernias happen more often in women, people who are overweight, and people older than 50.

Hiatal Hernia Diagnosis

To diagnose a hiatal hernia, your doctor may do tests including:

• Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your esophagus and stomach.
• Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows inside your esophagus and stomach.
• Esophageal manometry. A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.

Hiatal Hernia Treatment

If you don’t have any symptoms, you might not need treatment.

If you have acid reflux, your doctor may suggest medications to treat those symptoms, including:

• Antacids to weaken your stomach acid
• Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid
• Prokinetics to make your esophageal sphincter – the muscle that keeps stomach acid from backing up into your esophagus — stronger. They also help muscles in your esophagus work and help your stomach empty.

Your doctor might do surgery if you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus) so your stomach doesn’t become strangled.

Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few small (5 to 10 millimeter) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive” procedures have smaller cuts, less risk of infection, less pain and scarring, and faster recovery than traditional surgeries.

Hiatal Hernia Lifestyle Changes and Home Remedies

Some changes to your daily life can help with acid reflux symptoms. They include:

• Don’t exercise or lie down for 3 or 4 hours after you eat.
• Avoid acidic foods like orange juice, tomato sauce, and soda.
• A diet of mashed and soft foods  is recommended for up to 2-3 weeks post-surgery.
• Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
• Eat smaller meals.
• Lift the head of your bed about 6 inches.
• Don’t wear tight belts or clothes that put pressure on your belly.
• Lose extra pounds.
• Don’t smoke.

Back Pain and Hiatal Hernia: Avoid Extra Strains

Back pain can be caused by so many things that it can often be very difficult to diagnose. One of the things that can be easily diagnosed and that can cause back pain, though, is a hiatal hernia. Back pain and hiatal hernia go together because of the location of the hernia. It’s at the area where the stomach meets the esophagus, and occurs when the stomach rolls up a bit and doesn’t fit correctly. Because the ‘lay of the land’ has been changed, acid can back up there and make people very uncomfortable.

This pain, which is often in their chests, can often be mistaken for the pain that a person would go through if they were having a heart attack. That’s why it’s so important that a person with this kind of pain be seen by his or her doctor. When it comes to back pain and hiatal hernia problems, though, they’re more common than you might think. Anyone who has a hiatal hernia can experience pain that ends up in the back, not just the chest. Pain in the body is an odd thing, and sometimes it can hurt far away from the actual problem. This occurs because there are so many pain receptors, and they don’t always react the same way in every person.

In other words, don’t assume that the pain in your back is a pulled muscle. It could be something else. At the same time, panicking or becoming an alarmist isn’t what you really want to do, either. Instead, you want to balance safety and care with realistic understanding. When you do research into a hiatal hernia and find that it could be causing back pain, you may want to make an appointment with your doctor to see if that’s the source of the pain in your back. That’s especially true if the pain has been there for a long time, it’s getting worse, or it’s accompanied by other hiatal hernia symptoms.

Don’t underestimate the ability of your doctor and modern medical technology to find out what’s causing your back pain. If the pain is from a hiatal hernia, you can rest assured that it can be corrected, which is the best way to handle something like that. It’s not a good idea to just let the hernia sit, because it can cause other problem. Some hiatal hernias also grow and get worse, so you want to have them corrected before they get a chance to do that.

Hernias can be made larger when you strain to do something, so your doctor might advise you not to lift anything heavy and/or not to do certain types of exercises. If you lead a very active lifestyle and are suddenly sidelined by back pain and hiatal hernia problems, it makes sense that you would want to find a way to get better quickly. Your doctor is the one to help you, because he can quickly diagnose you and then find what works for your treatment.

Filed Under: Back Pain
Written By: Jesse Cannone, CFT, CPRS, MFT Updated: June 23,2011

Hiatal Hernia and Pain in the Middle of the Back

You can have hiatal hernia if the upper part of your stomach pushes upward through hiatus, an opening in the diaphragm where the esophagus goes down through to the stomach. It may bulge up into your chest, which could be large enough to cause a number of symptoms. Does it also cause pain in the middle of the back?

Hiatal hernia pain

Hiatal hernia usually has no symptom. Even some people don’t realize they have the condition until it’s incidentally discovered during X-ray or certain tests for another condition. Most often if the pain occurs, it’s caused by GERD (gastroesophageal reflux disease).

GERD is a condition when the stomach contents (including stomach acid) back up into the esophagus. It is common in people with hiatal hernia. This is quite reasonable because hiatal hernia will weaken the lower esophageal sphincter (LES), the flexible muscle ring that’s responsible to allow foods to flow into your stomach and prevent acidic stomach from moving upward into the esophagus.

Sometimes GERD could be quite painful. It is often described as a feeling of burning chest pain, typically felt behind the breastbone. Also, it may make you have a feeling of having foods coming back into your throat leaving a bitter-acid taste.

And it is usually mild and often relieves with a few lifestyle measures (won’t need treatment). However in a few cases, it becomes chronic and medications are required.

Furthermore, it’s important to ensure that your pain is not caused by something else. For instance, if exercise makes the pain worse, it may be caused by heart problems. Hiatal hernia pain associated with GERD is less likely aggravated with physical activity.

Hiatal hernia may also become large enough to cause other symptoms, such as: shortness of breath, dysphagia (difficulty swallowing), abdominal /chest pain, or gastrointestinal bleeding (passing of black-tarry stools /vomiting of blood). See also warning signs and symptoms of hiatal hernia getting worse!

Does hiatal hernia cause middle back pain?

Pain in the middle of the back (above the bottom of rib cage and below the neck) is less common than lower back pain. It could be dull or sharp. Depending on the underlying cause and how severe it is, it may come up with some of the following symptoms;

Hiatal Hernia

Overview

The esophagus sphincter muscle normally closes tightly. With a hiatal hernia, the sphincter’s new position may keep it from completely closing. The back flow of digestive juices may damage the esophagus.

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.

Who is at risk for developing a hiatal hernia?

A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:

• Lower part of the esophagus and stomach.
• Small intestine, colon and rectum.
• Liver.
• Gallbladder, pancreas and spleen.
• Kidneys.
• Bladder.

This pressure can build up from things like:

• Coughing.
• Vomiting.
• Straining during a bowel movement.
• Heavy lifting.
• Physical strain.

There are also other reasons a hiatal hernia could develop. You may experience a hiatal hernia during pregnancy, if you are obese, or if there’s extra fluid in your abdomen.

Increased pressure in the abdomen (arrows) causes part of the stomach to push through the diaphragm and into the chest cavity.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:

• Heartburn.
• Bitter or sour taste in the back of the throat.
• Bloating and belching.
• Discomfort or pain in the stomach or esophagus.

Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can be done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy procedure, esophageal manometric studies, a pH test and gastric emptying studies.

• A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
• An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
• An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
• A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
• Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.

Management and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do not cause problems and rarely need treatment. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:

• Losing weight if you’re overweight.
• Decreasing the portion sizes of meals.
• Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
• Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
• Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
• Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
• Quitting smoking.
• Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top hosiery and body shapers.
• Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid AC® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is another way to decrease the amount of stomach acid you have, which can help prevent reflux. When you take this medication, your body doesn’t make as much stomach acid as normal. This is similar to H-blocker medications.

Can over-the-counter medications help relieve my hiatal hernia symptoms?

In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might use for relief. However, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:

• Pantoprazole (Protonix®).
• Rabeprazole (Aciphex®).
• Esomeprazole (Nexium®).
• Omeprazole (Prilosec®).
• Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

• Pulling the hiatal hernia back into the abdomen.
• Improving the valve at the bottom of the esophagus.
• Closing the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.

Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:

• Smaller incisions.
• Less risk of infection.
• Less pain and scarring.
• A shorter recovery.

Outlook / Prognosis

How effective is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very effective in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications.

Hiatal Hernia | Cedars-Sinai

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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 belly (abdomen) 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 two 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?

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

You
may also have tests, including:

• Chest
  X-ray.
  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 while you are
  sedated. 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 inside of the esophagus, stomach, and
  intestines so that they can be seen on an X-ray. 
• Esophageal
  manometry.
  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 and during swallowing.

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.

In
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
  (strangulation)
• Is more
  difficult because of severe GERD (gastroesophageal reflux disease)
• Is more
  difficult because of redness and swelling (inflammation) of your esophagus
  (esophagitis)

Your
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

In
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
  diaphragm

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 one or both lungs
• Strangulation of the hernia, cutting off blood flow to your stomach (medical
  emergency)

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
• Elevating the head of your bed while you sleep

When should I call my healthcare provider?

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

Key points about hiatal
hernia

• A hiatal hernia is when part of your stomach pushes up into an opening (the hiatus)
  in your diaphragm.
• There
  are two 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
provider:

• 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.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Diaphragmatic hernia – symptoms, modern methods of diagnosis and treatment

A hernia of the esophageal opening of the diaphragm (diaphragmatic hernia) occurs if through the esophageal opening of the diaphragm – the opening through which the esophagus from the thoracic cavity enters the abdominal – the abdominal part of the esophagus, part of the stomach or the abdominal part of the esophagus, together with part of the stomach, is displaced into the chest cavity. Sometimes, through the esophageal opening of the diaphragm, other organs located in the abdominal cavity can be displaced into the chest cavity.

At the onset of the disease, the displacement of the abdominal cavity organs into the chest cavity occurs periodically, under the influence of physical exertion, coughing, vomiting, overeating, etc. Then such loss becomes more frequent or permanent. The most common hernia is axial or sliding. In this case, the abdominal part of the esophagus or the end of the esophagus with a part of the stomach falls into the esophageal opening of the diaphragm.

Causes of the disease

The cause of a diaphragmatic hernia is the increased elasticity of the tissues limiting the esophageal opening of the diaphragm.This elasticity can be innate. Sometimes there is a developmental anomaly – the so-called “short esophagus with a pectoral stomach”. But more often a hernia occurs during the patient’s life under the influence of conditions that contribute to an increase in intra-abdominal pressure: hard physical labor, obesity, ascites (accumulation of fluid in the abdominal cavity), endocrine diseases. Sometimes pregnancy leads to a hiatal hernia. The weakening and thinning of the ligaments and connective tissue with age matters.

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Symptoms of the disease

One of the most common complaints is heartburn (caused by reflux of gastric contents into the esophagus). With a hernia of the diaphragm, heartburn often occurs at night or after eating. Heartburn can also occur after exercise, and is often accompanied by pain.

Pain with a hiatal hernia occurs in 40-50% of patients. The pain is quite intense, it is felt retrosternal, has a burning character and, therefore, is often confused by patients with pain with angina pectoris. Pain with a hernia of the esophagus is most often associated with bending, physical exertion and is aggravated in the supine position. When the position of the body changes, the pain often subsides.

The next common symptom of a hiatal hernia is belching.Belching – involuntary sudden release of gas through the mouth from the stomach or esophagus, sometimes with an admixture of stomach contents, occurs in 30 – 73% of patients. Regurgitation occurs with gastric contents or air. Belching, as a rule, is preceded by a feeling of fullness in the epigastric region. This condition occurs after eating or during a conversation. Taking antispasmodics can be ineffective; only belching with a significant amount of food brings relief.

Difficulty passing food through the esophagus with a hiatal hernia is intermittent.Often provoked by the intake of very cold or, on the contrary, very hot food, as well as nervous overload. The constant nature of the difficulty in passing food through the esophagus should alert to complications.

Complications

A complication of a hiatal hernia is most often reflux esophagitis, but a peptic ulcer of the esophagus can develop, with a prolonged course of which, in turn, cicatricial stenosis (narrowing) of the esophagus can occur.There are acute and chronic bleeding from the esophagus, perforation of the esophagus or infringement of a hernia in the esophageal opening of the diaphragm.

Diagnostics

The diagnosis of a hiatal hernia is made by X-ray examination. Conventional fluoroscopy of the esophagus and stomach with barium contrast is often sufficient. To clarify the diagnosis, esophagogasroscopy is performed.

Treatment

A diet with fractional meals in small portions is prescribed, treatment of constipation.Physiotherapy is mandatory. Doing certain exercises can help prevent stomach displacement. Drugs are used to reduce gastric secretion and reduce acid aggressiveness of gastric contents, normalize dyskinesias of the gastrointestinal tract.

The occurrence of complications of a hiatal hernia is an indication for the appointment of surgical treatment.

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For each patient, without fail, even at the prehospital stage, an individual treatment regimen is developed, taking into account all the characteristics of the body: age, health status, medical history, etc.- this approach allows you to minimize risks both during the operation and in the postoperative period, and as a result, to ensure the fastest possible rehabilitation with a minimum period of hospitalization.

Multidisciplinary approach

The medical staff of the Hospital Center is a single team made up of doctors – experts of different specializations, which allows for a multidisciplinary approach.We treat a patient, seeing in front of us not a list of the diseases he has, but a person whose problems are interrelated and interdependent. The therapeutic measures taken are always aimed at improving the overall health, well-being and quality of life of the patient, and are not limited to eliminating the symptoms of a specific disease.

Surgical treatment of any level of complexity

The operating doctors of the Hospital Center possess advanced and high-tech methods of performing operations.The combination of highly qualified doctors and innovative equipment allows for surgical treatment of the highest level of complexity.

High-tech, minimally invasive treatment methods

The basis of the methodology of treatment carried out in the Hospital Center is the principles of minimizing risks for the patient and the fastest possible rehabilitation.

Implementation of such an approach is possible only with the use of the most high-tech techniques, modern equipment and the use of the latest achievements of medical science.

The qualification of doctors in combination with modern equipment allows us to successfully implement this approach to treatment.

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Fast-track is a comprehensive technique that allows you to minimize the patient’s stay in the hospital without compromising the quality of treatment.

The approach is based on minimizing surgical trauma, reducing the risk of postoperative complications and accelerating recovery from surgery, which ensures our patients have a minimum hospital stay.

Even such complex operations as, for example, cholecystectomy, thanks to this approach, require a hospital stay of no more than 3 days.

Personal medical supervision in the postoperative period

To completely exclude the development of possible complications, the early postoperative period, all patients, regardless of the complexity of the operation, are carried out in the intensive care unit under the individual supervision of an intensive care physician.

Transfer of the patient to the ward is carried out only in the complete absence of even the smallest possible risks.

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We are as open as possible and take care not only of the patient, but also of his loved ones. Patient health information is provided to relatives seven days a week, 24 hours a day.

Visiting patients is also possible at any convenient time.

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At the service of patients are spacious comfortable single and double rooms equipped with everything necessary for rest and recovery.

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According to the tax legislation of the Russian Federation, each patient has the right to compensation up to 13% of the amount spent by him on his treatment, as well as the treatment of close relatives.

Our specialists will prepare for you a package of documents for the tax office for a refund of 13% of the cost of treatment, as well as give recommendations on various ways of interacting with the tax office.

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Nearest metro station: Baumanskaya

Hernia of the esophageal opening of the diaphragm: causes, complaints, treatment

Hernia of the esophageal opening of the diaphragm (hiatal hernia, hernia of the esophagus, hernia of the stomach) is an expansion of the esophageal opening of the diaphragm through which the esophagus normally enters the abdominal cavity, and with a hernia, the abdominal organ, most often the stomach, enters the chest.Sometimes intestinal loops and rarely the spleen penetrate into the chest during HH. This disease is quite common, it is found on average in 40% of the world’s population. Fortunately, for the majority, it does not cause any problems, however, in 5 – 7% of all gastroenterological patients, complaints are caused by this particular ailment (Fig. 1).

Causes of hiatal hernia

Most often, it is not possible to find out the cause of the development of this disease in a particular patient.In general, HHH is a multifactorial disease and it can be difficult to isolate one single cause, unless there is a clear connection with trauma.

The following reasons for the development of a hernia of the esophagus are distinguished:

• Increased intra-abdominal pressure, for example due to overeating at night, or chronic constipation. Another reason for the increase in intra-abdominal pressure, and hence the development of HH, is hard physical labor.
• Congenital degenerative changes in the ligamentous apparatus and connective tissue.
• Age and associated degeneration of connective tissue. Therefore, these patients often have a combination with an inguinal or ventral hernia.
• Blunt trauma to the abdomen.
• The presence of chronic diseases that disrupt the normal motility of the gastrointestinal tract (peptic ulcer, reflux esophagitis, cholelithiasis, diseases of the large intestine).
• Overweight. In people who are overweight, intra-abdominal pressure increases, which leads to the “squeezing” of the stomach into the chest

Classification of hiatal hernia

In our country, unfortunately, there are many classifications of this disease, but the most common classification proposed by B.V. Petrovsky and N.N. Kanshin. Following it, the following variants of the GPOD are distinguished:

Axial:

• fixed
• unfixed

Without shortening of the esophagus

• cardiac
• cardiofundal
• subtotal
• total

With shortening of the esophagus

1st degree cardia fixed 4 cm above the diaphragm

2nd degree cardia is fixed more than 4 cm in the chest

Paraesophageal

1. fundal
2. antral
3. intestinal

Now let’s figure out which is which.So a hernia of the esophageal opening of the diaphragm is called axial if the esophageal-gastric junction is located above the diaphragm. It is called cardiac if only the cardia (the upper part of the stomach) is located above the diaphragm, the cardiofundal hiatal hernia is called if both the cardia and the fundus of the stomach leave the mediastinum, a subtotal hernia is called if 2⁄3 of the stomach leaves the mediastinum (above the esophageal opening of the diaphragm), and, accordingly, the total this is when the whole stomach is in the chest.

Paraesophageal hernia is a situation when the esophageal-gastric junction (cardiac stomach or simply cardia) is in the abdominal cavity, and any part of the stomach or other organ penetrates through the esophageal opening of the diaphragm into the mediastinum (Fig. 2).

Complaints with hernia of the esophagus

The most common complaint with HHH is heartburn . Read more about heartburn here. Heartburn often occurs at night or after eating while lying down, often it occurs after physical exertion, especially in an inclined position. Sometimes heartburn is accompanied by chest pain. Most often, this condition is relieved by taking antacids, such as reni, or drugs that reduce the production of hydrochloric acid in the stomach, such as omeprazole.

The next common symptom in this disease is pain . It is burning in nature, localized behind the sternum, gives to the right shoulder. The pain intensifies most often after eating or when lying down. Sometimes it is accompanied by an abnormal heart rhythm. Most often, the pain goes away after belching, or if the patient got up and walked. Sometimes pain in people with a hiatal hernia is confused with pain in the heart, especially since pain in HH is often accompanied by arrhythmia.They relieve pain most often by antispasmodics, but-shpa, etc.

Another complaint in patients is belching . Belching occurs both with food debris and air. Sometimes it is uncontrollable and occurs without reference to food intake. Often, this uncontrolled and unpredictable occurrence of the latter is the main reason for the surgical treatment of patients with HH.

Regurgitation – the throwing of food into the oral cavity in the supine position or when tilting.This complaint is relatively rare, occurs more often with large hernias.

Dysphagia – difficulty in the passage of food through the esophagus, develops at the stage of complications of the hiatal hernia. Dysphagia is caused either by an inflammatory process in the walls of the esophagus or by scarring (narrowing) of the esophagus. Dysphagia requires inpatient treatment

Also, extraesophageal manifestations of hernia of the esophageal opening of the diaphragm are distinguished. The most common of this group of complaints is cough .Often the cough accompanies the patient for years. It occurs more often in the supine position or when bending over, after eating. The cough is accompanied by persistent sore throat.

The second most frequent extraesophageal complaint is arrhythmia . Most often, arrhythmia occurs with a large hernia of the esophagus, when most of the stomach is in the chest. In this case, the arrhythmia is associated with eating or bending, or occurs when lying down. Usually, when examining such patients, cardiologists do not find cardiac pathology.Another manifestation of HHH is chronic diseases of the ENT organs, pharyngitis and laryngitis. It is possible to confirm or deny the connection of laryngitis or pharyngitis with hiatal hernia using daily pH metry of the esophagus.

In addition, the consequence of an esophageal hernia may be damage to the teeth, hoarseness, bronchitis, bronchial asthma.

The course of hernia of the esophageal opening of the diaphragm

HHOD is a very common disease. As I already wrote, up to 40% of the world’s population have this disease, but most of them do not even know about it.Problems begin when the sphincter between the esophagus and the stomach stops working and the contents of the latter enter the esophagus. Or if the hernia of the POD reaches a large size and causes complications associated with neighboring organs (arrhythmias, pneumonia, etc.). In most cases, with proper treatment, the course of the disease is favorable, and conservative therapy is sufficient. Therapy is aimed at reducing the reflux of gastric contents into the esophagus, relieving inflammation, and normalizing gastrointestinal motility.If conservative therapy is not effective, one has to resort to surgical intervention.

Complications of hiatal hernia

Erosions and ulcers of the esophagus occur in 7 – 9% of cases in patients with HH. This complication is associated with the aggressive action of gastric juice, which enters the esophageal mucosa. Usually, the presence of ulcers and erosions is accompanied by the most severe complaints of patients. The danger of an ulcer lies in the fact that, if not properly treated, a scar can form at the site of the ulcer, which in turn can lead to obstruction of the esophagus.In the presence of multiple erosions, chronic anemia may develop. The presence of an ulcer in the esophagus is an indication for surgery.

Bleeding and anemia with hiatal hernia occur in 11 – 20% of cases. Bleeding most often occurs against the background of vomiting, for example, after poisoning. Such bleeding is quite massive and requires emergency hospitalization in the clinic. Bleeding can be manifested by vomiting blood, or the so-called coffee grounds, dark coffee-colored contents.Sometimes bleeding may present with black, tarry stools. In the case of recurring bleeding episodes, surgical treatment is indicated.

Anemia occurs in two cases. The first is chronic insignificant blood loss against the background of the presence of multiple erosions of the esophageal mucosa. This bleeding occurs intermittently and goes unnoticed, and can last for months. The second reason is a violation of the absorption of iron against the background of inflammatory changes in the stomach. This anemia is called iron deficiency and develops when most of the stomach is in the chest.Anemia is manifested by severe weakness.

Cicatricial stricture of the esophagus. With a prolonged inflammatory process in the wall of the esophagus against the background of HH, scars are formed that narrow the lumen of the esophagus. A stricture is manifested, a violation of the passage of food through the esophagus. This complication is manifested not by the ability to eat, first solid food, but with the progression of the process, and liquid

Infringement of hernia of the esophageal opening of the diaphragm. A very rare complication, but extremely dangerous, which, in the absence of qualified medical care, leads to death.This complication is manifested by the sharp appearance of severe bursting chest pains, a feeling of bursting. Patients constantly try to induce belching, which is either impossible or does not bring relief. With this complication, emergency surgery is required.

Summing up, I want to repeat that with proper treatment, complications of HHH develop quite rarely.

Diagnosis of hiatal hernia

The main role in the diagnosis is played by X-ray examination with barium and gastroscopy.

X-rays are performed on an empty stomach using barium contrast solution. The doctor observes the passage of contrast through the esophagus and stomach on the screen of an X-ray apparatus. Thanks to X-ray examination, it is possible to reveal the size of the hernia, the presence or absence of the reflux of gastric contents into the esophagus, the presence or absence of violations of the passage of contrast through the esophagus and stomach.

Gastroscopy allows you to assess the condition of the esophageal mucosa, the presence or absence of inflammation, erosions, ulcers, the presence of narrowing.In the vast majority of cases, these two studies are sufficient to make a correct diagnosis. In some cases, computed tomography is performed to assess the presence or absence of a hernia of the esophagus and its size. In the presence of an unclear clinical picture outside the esophageal manifestations, daily pH metry is performed. A thin probe is inserted into the lumen of the esophagus for 24 hours, which registers the reflux of gastric contents into the esophagus, so that a connection between complaints and reflux of gastric contents can be identified.

Treatment of hernia of the esophagus

In the overwhelming majority of cases, conservative therapy is carried out, which in fact is symptomatic and aimed at improving the well-being of patients and preventing the development of complications. The main reason for the complaints of patients is the reflux of aggressive gastric contents into the esophagus. Therefore, proton pump inhibitors (esomeprazole, nexium, etc.) are prescribed. This is a group of drugs that reduce the acidity of gastric juice, thereby minimizing the damaging effect on the esophageal mucosa.Coating preparations in the form of suspensions are also used, such as Gaviscon, Maolox, Almagel. These drugs effectively reduce gastric acidity and protect the esophagus from reflux by enveloping the walls of the esophagus. And the third group of drugs is prokinetics (motilium, ganaton). These are drugs that improve and normalize the motility of the esophagus and stomach, thereby reducing the frequency of reflux.

This therapy leads to an improvement in well-being and quality of life. Unfortunately, up to 80% of patients experience a relapse of complaints immediately after stopping the drug intake and therefore have to drink them constantly.Complete disposal of a hiatal hernia is possible only by surgery. You can read about the surgical treatment of hiatal hernia here

Author: Ph.D. Siyukhov R.Sh.

Hernia of the esophageal opening of the diaphragm

Department of Thoracic Surgery No. 1

Hernias of the esophageal opening of the diaphragm occur quite often in gastroenterology. The likelihood of diaphragmatic hernia formation increases in proportion to age – from 9% in people under 40 years old to 69% in people over 70 years old.Most often, a hernia of the esophageal opening of the diaphragm is formed in women. Moreover, in half of the cases, the disease is asymptomatic and remains unrecognized. Sometimes patients are treated for a long time by a gastroenterologist for concomitant diseases that determine the leading clinical manifestations – chronic gastritis, cholecystitis, stomach ulcers.

About half of cases of hiatal hernia are asymptomatic or accompanied by mild clinical manifestations.Since a hiatal hernia naturally leads to the development of gastroesophageal reflux disease, a group of symptoms associated with indigestion arises. Patients with diaphragmatic hernia, as a rule, complain of belching of gastric contents or bile, a feeling of bitterness in the mouth, belching with air. Often there is regurgitation of recently taken food without previous nausea; regurgitation often develops in a horizontal position, at night. The pathognomonic manifestation of a hiatal hernia is dysphagia – a violation of the passage of a food lump through the esophagus.Dysphagia with a hernia of the esophageal opening of the diaphragm often accompanies the intake of semi-liquid or liquid food, too cold or hot water; develops with hasty eating or traumatic factors. Heartburn, hiccups, pain and burning sensation in the tongue, and hoarseness are also characteristic of a hernia of the esophageal opening of the diaphragm. If gastric contents enter the respiratory tract, tracheobronchitis, bronchial asthma, aspiration pneumonia can develop. In the clinical picture of a hiatal hernia, anemic syndrome is often noted, associated with latent bleeding from the lower esophagus and stomach due to reflux esophagitis, erosive gastritis, peptic ulcers of the esophagus.Also, one of the signs of a diaphragmatic hernia may be pain syndrome, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back. Sometimes the pain can be shingles, resembling pancreatitis.

Diagnostics:

Treatment:

• Endoscopic balloon dilation.
• Esophagofundoplication, including with the use of endovidiosurgical technologies.

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Worried about heartburn and chest pain: what to do | Saiko

This is a disease of the digestive system in which the contents of the stomach are thrown into the esophagus.About half of adults have experienced reflux symptoms at least once, but the suspicion of the disease is if a person has mild reflux about twice a week and more often, or severe reflux with food being thrown down the throat once a week.

This happens if the sphincter, the closing ring between the esophagus and the stomach, weakens. The sphincter weakens with increased pressure in the abdomen, so the main causes of gastroesophageal reflux disease include:

• Obesity and overeating;
• Pregnancy;
• Hernia of the esophageal opening of the diaphragm;
• Diseases of the connective tissue;
• Delayed gastric emptying.

In addition, there are additional factors that increase the acidity of stomach contents and increase the risk of reflux: smoking, alcohol, coffee, food before bed, especially fatty and fried foods. Also, some medicines can affect the acidity, such as aspirin.

The treatment is simple, if you consult a doctor in time and make the correct diagnosis.

How does it appear

The most common reflux symptoms are:

• Burning sensation in the chest (heartburn), usually after eating or at night;
• Chest pain;
• It can be difficult to swallow;
• Belching with acidic liquid or food;
• Sensation of a lump in the throat;
• Sore throat while eating.

Nocturnal reflux is manifested by persistent coughing, sleep disturbances, sore throat, and the development of asthma.

What will happen if you do not treat

Advanced gastroesophageal reflux disease can cause chronic inflammation of the esophagus and lead to scarring, ulceration and even precancerous changes due to the constant aggressive effects of gastric juice.

Also, the constant throwing of the contents of the stomach into the pharynx irritates the mucous membrane and causes chronic sore throat.And the most formidable complication is the ingress of the contents of the stomach into the respiratory tract, while a burn of the trachea and bronchi is possible, which is difficult to treat.

In advanced cases, such a disease is treated surgically, so it is so important to seek the help of a specialist in time.

How to detect

A physician or gastroenterologist can diagnose GERD. To do this, he will need a story about the symptoms, he may have to do an x-ray with contrast or an endoscopy of the gastrointestinal tract to understand how much the esophagus has suffered.

An ENT consultation is also needed to identify possible complications of the upper respiratory tract, throat and even nose.

How to treat

To treat reflux, you first need to change your lifestyle. To do this, you need to eat in small portions, do not overeat. You should not go to bed after eating, it is better to sit or walk for 20-30 minutes. It is also better to give up alcohol and nicotine, which increase the production of hydrochloric acid in the stomach and increase the risk of contents being thrown into the esophagus.

The doctor usually prescribes medications that neutralize the acid, reduce its amount and protect the walls of the esophagus from reflux. But if the treatment does not help, if the patient does not change his lifestyle. In this case, GERD is treated surgically. The main thing is to seek timely help not only from a therapist, but also to find an experienced otorhinolaryngologist who will help get rid of unpleasant manifestations in the throat and can improve your well-being.

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90,000 Treatment of pain in the left breast in Yekaterinburg

Chest pain is a serious symptom and a reason to see a doctor.

Localization of pain in the left half of the chest and in the left chest is often associated with pathology of the cardiovascular system, although it may be due to a number of other reasons.

Causes of pain in the left chest:

1. Diseases of the cardiovascular system:

• ischemic heart disease
• inflammatory heart diseases (myocarditis, pericarditis)
• Aortic dissecting aneurysm

2.Respiratory diseases:

• pneumonia
• pneumothorax

3. Diseases of the gastrointestinal tract:

• gastric ulcer
• gastroesophageal reflux disease (GERD)
• inflammation, trauma, tumors of the esophagus, stomach
• acute pancreatitis
• sliding hiatus hernia

4.Diseases of the musculoskeletal system:

• inflammatory diseases of the spine and ribs
• injuries of the spine and ribs
• degenerative diseases of the spine (osteochondrosis, spondylosis)

5. Infections of the soft tissues of the chest – herpes zoster

6. Diseases of the breast

CLINIC depends on the cause of the chest pain.

Ischemic heart disease can manifest itself as pain in the chest of a pressing, burning character, in the left half of the chest, which can radiate to the left arm and / or both arms, throat, lower jaw.Usually occurs during exercise and stops when it ends, or after taking nitroglycerin or administering analgesics. Such pain is accompanied by shortness of breath, weakness, sweating, fear of death.

In inflammatory heart diseases left chest pains occur after an acute respiratory viral infection, varied in nature (aching, stabbing, pressing, cutting). They are associated with body position and breathing, many hours, have nothing to do with physical activity and pass while taking anti-inflammatory drugs.

Dissecting aortic aneurysm is characterized by sudden, sharp, dagger pain of a diffuse nature in the chest, arising after a sharp rise in blood pressure, intense jerking load (lifting weights), accompanied by weakness, sweating, loss of consciousness, and a drop in blood pressure.

Inflammation of the lungs (pneumonia) is accompanied by cough, fever, stitching pains, cutting, aching associated with coughing and breathing.

Against the background of tuberculosis , chronic obstructive pulmonary disease, bronchiectasis, bullae – large bubbles can form in the lungs. With a sharp cough, trauma to the chest, they burst, the air from them goes into the chest and causes displacement of the internal organs located in it. This condition is “pneumothorax” and is manifested by sharp, high-intensity chest pain, shortness of breath, a drop in blood pressure and even loss of consciousness.

Any disease of the gastrointestinal tract may be accompanied by chest pain, especially in the left half.The fact is that all organs of the chest and abdominal cavity are closely interconnected through innervation. And very often with a gastroenterological disease there is a “reflected” pain. That is, the “epicenter” of the disease is in the abdominal cavity, and the pain is felt in the chest.

The pain syndrome itself in this case is diverse (stitching pains, aching, pressing, cutting, bursting, etc.), not associated with physical activity. But it is associated with eating or feeling hungry, usually for many hours.It often passes after eating or antispasmodics, may be accompanied by nausea, vomiting, weakness, urge to defecate.

With pathology of the musculoskeletal system (osteochondrosis, spondylosis), the pain on the left in the chest is often local (punctate), although it is often diffuse, mostly acute, piercing, sharp, associated with breathing, body position. It is not associated with physical activity and passes on its own, or when changing body position, when taking anti-inflammatory drugs (nise, diclofenac, ibuprofen).

Chest pain that occurred after injury may be associated with a post-traumatic inflammatory process or fracture. The characteristics of this pain syndrome are similar to those described for osteochondrosis and spondylosis.

With herpes zoster pain syndrome in the chest is burning, intense, sometimes unbearable, many hours, poorly relieved by analgesics. On the second – third day of pain syndrome, rashes appear on the chest.They resemble bubbles, cause unbearable itching and disappear after a while.

Diseases of the breast (mastopathy, mastitis, oncological pathology) can also be accompanied by pain in the left side of the chest and under it. The pain is also absolutely diverse, but more often local (small in area), acute, stabbing, often just discomfort in the mammary gland. At the same time, the mammary gland itself can become coarse (increase in volume), it is possible to determine focal compaction in it, often dense and painful.

Diagnostics

Diagnostics consists in taking anamnesis, studying the clinical picture, conducting general clinical analyzes, recording an ECG. And also in a specific examination (treadmill, ultrasound examination of the heart and abdominal organs, mammary glands, Holter ECG monitoring, fibrogastroscopy, chest x-ray and gastric fluoroscopy, etc.).

Prevention

Prevention of chest pain syndrome consists in the timely access to the doctor for the first symptoms of the disease, a healthy lifestyle and the implementation of all the recommendations of the attending physician.

PECULIARITIES OF THE COURSE OF PAIN SYNDROME IN THE BREAST in age groups in that the pain syndrome in the elderly is usually less pronounced. It can be masked by shortness of breath and weakness, dizziness, and its most common cause is coronary artery disease.

In younger patients, the list of main causes includes traumatic and inflammatory diseases of the chest, lungs, gastroenterological pathology.

There are no differences between persons of both sexes in the characteristics of chest pain.In pregnant women, the clinical picture of chest pain differs little from that of other individuals.

Our clinic of the Moscow Region “New Hospital” has all the necessary examinations and specialists to conduct a full examination of a patient with chest pain

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Diaphragmatic hernia – Diseases – Medical compass

Diaphragmatic hernia is a defect of the diaphragm at the place where the esophagus passes through it.This creates conditions for the protrusion of a part of the stomach into the chest cavity.

Symptoms of the disease

Symptoms of a diaphragmatic hernia are determined by developing esophagitis. It is associated with the throwing of acidic gastric contents into the esophagus, which causes irritation of its walls. However, other pathogenetic mechanisms also lead to the appearance of various symptoms, therefore, the clinical diagnosis of diaphragmatic hernia is extremely difficult.

The main clinical manifestations of this disease:

• Heartburn associated with eating or a sharp change in body position, and it also increases at night
• Pain of various localization, which can imitate not only diseases of the gastrointestinal tract (it can be sternum, in the epigastrium, etc.while its occurrence is provoked by the same factors as heartburn

• Swallowing disorder (dysphagia)
• Hiccups due to frequent irritation of the vagus nerve
• Thirst
• Refusal to eat, which provokes the appearance of certain unpleasant symptoms.

Diaphragmatic hernia can lead to pseudocoronary syndrome, that is, pain appears, as in heart disease. However, there are no characteristic changes in the electrocardiogram, and taking nitroglycerin does not lead to an improvement in well-being.In some cases, damage to the visceral nerves due to diaphragmatic hernia can lead to the development of reflex angina pectoris, which requires treatment according to the general principles of cardiology.

Causes of the disease

Based on the reasons for development, it is customary to distinguish two types of hernias:

• Congenital
• Acquired.

Congenital hernias develop as a result of the abnormal structure of the muscles and tendons that fix the cardiac stomach.The following are considered acquired causes:

• Reduced elasticity of the fixation apparatus of the stomach, which develops with age
• Diaphragm hypotension, especially in the esophageal opening
• Factors that lead to increased intra-abdominal pressure (bloating, Vienna).

Diagnostics

If a diaphragmatic hernia is suspected, the diagnostic search includes the following studies:

• X-ray (“gold” standard for diagnosing hiatal hernias) using contrast agents
• Fibrogastroduodenoscopy of the mucous membrane, which allows to assess the state of the esophagus stomach.

Other diagnostic methods are aimed at identifying complications of this disease.

Complications

Lack of timely treatment of a diaphragmatic hernia can lead to the following complications:

• Esophagitis with the formation of an ulcer of the esophagus and its cicatricial narrowing
• Bleeding from the veins of the esophagus
• Torsion of the esophagus

117 esophageal dilatation

117 esophageal dilatation

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• Angina pectoris, which is of a reflex nature.

Treatment of the disease

Treatment of diaphragmatic hernias can be:

• Conservative (they start with it)
• Operative, which is indicated when pharmacological correction is ineffective, as well as in the presence of life-threatening complications.

Conservative therapy is aimed at preventing the development of complications. It is carried out with the following drugs:

• Antispasmodics
• Antacids
• Proton pump blockers
• Laxatives with mild action.

symptoms, treatment and operations, prevention – Department of Vertebrology, Central Clinical Hospital of the Russian Academy of Sciences

Among all parts of the spine, the lumbar is most often subjected to hernia formation. This is due to increased stress on the lumbar region. About 70% of all patients who visit a doctor for spinal problems suffer from a lumbar spinal hernia.

How the lumbar disc works

The department is made up of five vertebrae, which are interconnected by intermediate discs.The elements perform very important functions – they absorb the load on the spinal column and distribute it evenly to reduce stress on the other parts. The disc is an annulus fibrosus with a nucleus composed of a jelly-like substance.

Mechanism of formation of intervertebral hernia

The spine is designed for stress. It supports and stabilizes the body in a standing position and provides full freedom of movement. When lifting weights, an uncomfortable body position, strong and stressful loads, he takes on the main effort.The load is especially pronounced when lifting heavy objects with outstretched arms. The heaviest load and, accordingly, wear, falls on the lumbar region. When age-related or pathological changes begin in the body, the tissues change their structure and can no longer perform the functions of depreciation fully. Under the influence of force, they can deform, crumble, which disrupts the functions of the spine and can disrupt the work of the whole organism.

How does a hernia appear

The bulge formation takes place in several stages:

• Protrusion.The beginning of pathological changes. The annulus fibrosus becomes less elastic, can shift and deform.
• Partial loss of a portion of the disc. This is the second stage in which tissue destruction can occur. This process is inevitably followed by displacement of the gel-like core of the disc.
• Prolapse. The nucleus leaves the disc ring and begins to act on the nerve endings located nearby.
• Sequestration. The process by which a semi-liquid substance from the nucleus enters the cavity of the spinal column.This is accompanied by allergic reactions, nerve connections and blood flow in tissues are disrupted. Due to the constant pressure in the area that is not designed for this, there is a loss of sensitivity and the threat of paralysis.

If help is sought on time, when the nerves and spinal cord are not involved in the process, conservative treatment is applied and the patient can be completely cured.

How does a hernia manifest

At the very beginning of the development of the pathological process, the patient does not feel serious pain, the symptoms are few.The more the tissues protrude, the more the patient feels it. There are three groups of symptoms for a herniated disc:

• The main symptom of a herniated disc is pain. At first, it is not sharp, it can be aching, it disappears when the position of the body changes. The more serious the stage of the process, the stronger the pain. Shooting appears, it hurts the patient to turn the body, the sensations intensify with physical exertion.
• Vertebral syndrome. Constant pain causes spasms of the muscles in the lower back.The patient cannot move fully, is forced to tilt the body in order to relieve some of the load and reduce pain.
• Damage and death of nerve roots due to constant compression. Compression, which occurs due to tissue protrusion, constantly affects the nerve fibers. This disrupts the blood flow, their functions, and later, dying off occurs altogether. The appearance of such a process is: weakness, decreased tone, loss of sensitivity, the appearance of body asymmetry, decreased sensitivity and skin tone.

If the bulge has occurred to the back, any physical work is likely to cause severe compression and paralysis.

Manifestations depending on the location of the hernia

The features of the hernia are determined by its location. In this zone, nerve roots are infringed and a characteristic clinical picture arises. The nerve pinched during the formation of the lumbar protrusion of the spine runs along the inner surface of the leg from the thigh to the ankle.The pain is not necessarily localized along the entire length, it can be reflected in the leg, foot, buttock, and the outer side of the thigh. The lower back may also hurt at one point. As the situation develops, the pain can move lower – to the lower leg, heel and toes. In terms of intensity, it can be constant aching pain or lumbago arising from movement.

Basically, the pain sensations become more intense with prolonged walking, standing, turning the body, bending. It also hurts to lift your leg, do a series of exercises, and ride on rough roads.

At the onset of hernia development, pain can be relieved by lying down by bending one leg at the chest. This will help relieve tension and pressure on the nerve endings. In a more difficult situation, this method will not help. The movements are constrained, their amplitude is greatly reduced, the leg gets tired.

Basically, the patient feels the compression of the spinal cord as tingling, burning, numbness. It dulls the pain. The main symptom that a specialist will pay attention to upon examination is muscle tension on the lateral side of the back, painful when pressed.

Making a diagnosis

The diagnosis is made after examination, examination of the patient. First of all, instrumental diagnostics are carried out to help determine whether tendon reflexes are normal. The patient is asked to raise the straightened leg. Tests for vibration sensitivity, the ability to feel temperature and pain are also performed. If there is a hernia, there will be certain manifestations:

• The doctor will determine the sensitivity disorder.
• The patient’s biomechanics of movements will be changed.
• Tendon reflexes will deviate from normal.

Also, to diagnose protrusion, CT or MRI diagnostics of the spine is performed. These studies will help not only visualize the hernia, but also determine the condition of the surrounding tissues, diagnose the narrowing of the spinal canal, if any. If indicated, contrast myelography may be prescribed. After the examination, you can determine the degree of pathological changes and prescribe adequate treatment.If the nerves are not affected, the patient only complains of pain, conservative therapy is used.

What is the danger of a hernia of the lumbar region

Any hernia brings not only pain, but also a serious risk of disruption of the body and paralysis. The vertebral protrusion in the lumbar region has a number of dangerous concomitant manifestations:

• Blood circulation in the small pelvis is impaired, due to which the organs do not receive proper nutrition. This provokes problems with the excretory system, disruption of the internal genital organs.
• The spine is curved due to muscle tone. This causes compression of internal organs and can provoke other pathologies that are not directly related to the spine.
• Sensitivity decreases, numbness is observed, limitation of body mobility.
• Shoots appear – severe sharp pain during exertion or movement.
• Knee reflexes may disappear, ankle and foot mobility may change.
• The worst consequence is paralysis.

Conservative treatment of hernia

It is used if the hernia does not compress the nerves and spinal cord. Key points:

• Taking anti-inflammatory drugs to relieve pain.
• Carrying out novocaine or hormonal blockades.
• Use of muscle relaxants, vitamins.
• Passing a massage course, visiting manual therapy sessions.
• Exercise therapy classes, stretching and muscle relaxation procedures.
• Exposure to physiotherapy.

Operation

Radical intervention is used when it is necessary to release the spinal cord and nerves from the pressure of the bulging tissues. The most popular methods are:

• Endoscopy is an operation through an incision in the spine using a probe. A camera and instruments are inserted through a small hole, the displaced tissues are removed.
• Endoprosthetics of the disc.The damaged items are removed. In their place, a prosthetic structure is installed.
• Percutaneous discectomy. Access is through a puncture, the deformed core is removed and replaced with a special compound.
• Laser reconstruction – a hernia is removed by evaporation of moisture from the tissue.

Preventive measures

Spinal hernia can be prevented. There are a few simple rules for this:

• Nutrition and weight control.Excess weight increases stress on the spine.
• Quitting bad habits.
• Regular physical activity – morning exercises, warm-up during sedentary work.
• Sleeping on a firm mattress, choosing the right pillow.
• Preventive examinations by a doctor, timely seeking medical help in the event of anxiety symptoms.

By contacting a neuropathologist at the Central Clinical Hospital of the Russian Academy of Sciences in time, you can avoid complications and return to a normal lifestyle as soon as possible.

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