What is a hiatal hernia. How does it affect your digestive system. What are the common symptoms of hiatal hernias. Who is at risk for developing a hiatal hernia. How are hiatal hernias diagnosed. What treatment options are available for hiatal hernias.

Understanding Hiatal Hernias: Types and Mechanisms

A hiatal hernia occurs when the upper part of the stomach protrudes through the diaphragm, the muscular wall separating the chest cavity from the abdomen. This protrusion happens through a small opening called the hiatus, which normally allows the esophagus to pass through.

There are several types of hiatal hernias:

• Type I (Sliding Hiatal Hernia): The most common type, where the stomach slides up into the chest through the hiatus.
• Types II, III, and IV (Paraesophageal Hernias): Less common but potentially more dangerous, where part of the stomach becomes trapped in the chest cavity adjacent to the esophagus.

How does a hiatal hernia affect the digestive system? When a hiatal hernia occurs, it can disrupt the normal functioning of the lower esophageal sphincter (LES), a ring of muscle that acts as a valve between the esophagus and stomach. This disruption can lead to acid reflux and other digestive issues.

Recognizing the Symptoms of Hiatal Hernias

While many people with hiatal hernias may not experience any symptoms, others can develop a range of digestive discomforts. What are the common symptoms of hiatal hernias?

• Heartburn
• Regurgitation of food or liquids into the mouth
• Difficulty swallowing
• Chest or abdominal pain
• Shortness of breath after eating
• Feeling full quickly during meals

In some cases, particularly with paraesophageal hernias, more severe symptoms may occur, such as:

• Severe chest pain
• Difficulty breathing
• Vomiting
• Signs of gastrointestinal bleeding (blood in stool or vomit)

Risk Factors and Causes of Hiatal Hernias

Who is at risk for developing a hiatal hernia? Several factors can increase an individual’s likelihood of developing this condition:

• Age: People over 50 are at higher risk
• Obesity: Excess weight can put pressure on the diaphragm
• Pregnancy: Hormonal changes and increased abdominal pressure can contribute
• Smoking: Can weaken supportive tissues
• Genetic factors: Some people may be born with a larger hiatal opening

What causes hiatal hernias to develop? While the exact cause isn’t always clear, several factors can contribute:

• Increased abdominal pressure from chronic coughing, vomiting, or straining during bowel movements
• Lifting heavy objects
• Trauma to the abdominal area
• Congenital defects in the diaphragm

Diagnosing Hiatal Hernias: Medical Tests and Procedures

How are hiatal hernias diagnosed? Doctors use a combination of medical history, physical examination, and diagnostic tests to identify and assess hiatal hernias. Common diagnostic procedures include:

1. Barium Swallow (Upper GI Series): Patients swallow a contrast material that coats the digestive tract, making it visible on X-rays.
2. Chest X-ray: Can sometimes reveal a large hiatal hernia.
3. CT Scan: Provides detailed cross-sectional images of the chest and abdomen.
4. Upper Endoscopy (EGD): A flexible tube with a camera is inserted through the mouth to examine the esophagus and stomach directly.
5. Esophageal Manometry: Measures the strength and coordination of esophageal muscles.
6. pH Monitoring: Assesses the level of acid reflux over a 24-hour period.

Treatment Options for Hiatal Hernias

What treatment options are available for hiatal hernias? The approach to treatment depends on the severity of symptoms and the type of hernia. Options include:

Conservative Management

For mild cases or asymptomatic hernias, lifestyle modifications and medications may be sufficient:

• Dietary changes (avoiding trigger foods, eating smaller meals)
• Weight loss
• Avoiding lying down after meals
• Quitting smoking
• Antacids or acid-reducing medications (H2 blockers, proton pump inhibitors)

Surgical Intervention

When should surgery be considered for a hiatal hernia? Surgery may be recommended in cases of:

• Severe, persistent symptoms unresponsive to conservative treatment
• Large paraesophageal hernias
• Complications such as obstruction or strangulation
• Chronic anemia due to gastrointestinal bleeding

Surgical options include:

1. Laparoscopic Nissen Fundoplication: A minimally invasive procedure to repair the hernia and reinforce the lower esophageal sphincter.
2. Robotic-Assisted Surgery: Offers enhanced precision and visualization during the repair.
3. Open Surgery: May be necessary for complex cases or if complications arise during laparoscopic surgery.

Living with a Hiatal Hernia: Lifestyle Adjustments and Management

How can individuals manage their hiatal hernia symptoms in daily life? Several lifestyle adjustments can help alleviate discomfort and prevent complications:

• Elevating the head of the bed to reduce nighttime reflux
• Practicing good posture to reduce pressure on the stomach
• Avoiding tight clothing around the waist
• Managing stress through relaxation techniques
• Staying hydrated but avoiding large volumes of liquid with meals
• Chewing food thoroughly and eating slowly

What dietary changes can help manage hiatal hernia symptoms? Consider the following recommendations:

• Avoiding foods that trigger acid reflux (e.g., spicy, fatty, or acidic foods)
• Eating smaller, more frequent meals
• Limiting alcohol and caffeine intake
• Incorporating fiber-rich foods to prevent constipation
• Avoiding carbonated beverages

Complications and Long-term Outlook for Hiatal Hernias

While many hiatal hernias remain asymptomatic or manageable with conservative treatment, some may lead to complications if left untreated. What are potential complications of untreated hiatal hernias?

• Chronic Gastroesophageal Reflux Disease (GERD)
• Esophagitis (inflammation of the esophagus)
• Barrett’s Esophagus (precancerous changes in esophageal tissue)
• Esophageal Stricture (narrowing of the esophagus)
• Strangulation (blood supply to the herniated portion of the stomach is cut off)
• Gastric Volvulus (twisting of the stomach)

What is the long-term outlook for individuals with hiatal hernias? With proper management and treatment, most people with hiatal hernias can lead normal, symptom-free lives. Regular follow-ups with healthcare providers and adherence to treatment plans are essential for optimal outcomes.

Innovative Approaches and Future Directions in Hiatal Hernia Management

As medical research advances, new approaches to treating hiatal hernias are emerging. What innovative techniques are being developed for hiatal hernia management?

• Magnetic Sphincter Augmentation: A device implanted around the lower esophageal sphincter to prevent reflux.
• Endoscopic Plication: A minimally invasive technique to tighten the gastroesophageal junction without external incisions.
• Bioengineered Tissue Reinforcement: Using biological scaffolds to strengthen the repaired diaphragm.
• Personalized Medicine: Tailoring treatments based on genetic and physiological factors.

How might future research impact hiatal hernia treatment? Ongoing studies are focusing on:

• Improved diagnostic tools for early detection
• Novel pharmaceutical approaches to manage symptoms
• Advanced surgical techniques with faster recovery times
• Understanding the genetic basis of hiatal hernias for targeted therapies

As our understanding of hiatal hernias grows, so does our ability to provide effective, personalized care. Patients and healthcare providers alike can look forward to more refined treatment options and improved quality of life for those affected by this common condition.

Psychological Impact and Support for Hiatal Hernia Patients

Living with a chronic condition like a hiatal hernia can have psychological effects on patients. How does a hiatal hernia impact mental health and well-being?

• Anxiety about potential complications or worsening symptoms
• Depression related to chronic discomfort or dietary restrictions
• Social isolation due to fear of symptoms occurring in public
• Stress from managing the condition and its treatments

What support systems are available for individuals with hiatal hernias?

1. Support Groups: Both online and in-person groups can provide emotional support and practical advice.
2. Psychological Counseling: Therapists can help patients develop coping strategies and manage stress.
3. Nutritional Counseling: Dietitians can assist in creating meal plans that minimize symptoms while ensuring proper nutrition.
4. Patient Education Programs: Many hospitals offer classes to help patients better understand and manage their condition.

How can family members and caregivers support someone with a hiatal hernia?

• Learning about the condition to better understand the challenges faced
• Assisting with meal planning and preparation
• Encouraging adherence to treatment plans and lifestyle modifications
• Providing emotional support and understanding during flare-ups
• Accompanying the patient to medical appointments for additional support

By addressing both the physical and emotional aspects of living with a hiatal hernia, patients can achieve a better quality of life and more effective management of their condition.

Hiatal Hernias | Michigan Medicine

A hernia occurs when an organ protrudes through the wall of muscle that encircles it. A hiatal hernia means that the upper part of your stomach has protruded up into your chest, pushing through the little opening (or hiatus) in your diaphragm (which separates your abdomen from your chest).

Most of the time, hiatal hernias are so small they might not be felt at all. But if the hernia is a bit larger, it could force the opening in your diaphragm to become larger, too. At that point, the entire stomach and other organs are in danger of sliding up into your chest.

A hiatal hernia can also put undue pressure on your stomach, by squeezing or twisting it. This pressure can make your stomach retain acid, which can then flow up into your esophagus. You could develop chest pain, gastroesophageal reflux disease, and/or heartburn, and have trouble swallowing or even breathing.  The acid may also cause ulcers within the stomach that can bleed and lead to acute or chronic anemia (low blood counts).

There are a few different kinds of hiatal hernias. Type I hernias, or sliding hiatal hernias, are the smallest and most common variety. These hernias cause your stomach to slide through a small opening in the diaphragm, and up into your chest. These often do not require an operation or treatment.

Much less common than these are Types II, III, and IV hernias, or paraesophageal hernias. These occur when a part of the stomach protrude into the chest adjacent to the esophagus. That part of the stomach is “trapped” above the diaphragm and can’t slide back down again. While these hernias are far less common, they can be more dangerous, since they cause more serious symptoms, and because the blood flow to your stomach can be compromised.

Risk Factors

Those over the age of 50, pregnant women, and the obese are at higher risk. A hiatal hernia can also be triggered by insistent pressure on the hiatus muscles. That pressure can be caused by coughing, vomiting, immoderate straining during bowel movements, lifting heavy objects, and/or excessive physical exertion.

Symptoms

Hiatal hernias, especially Type I hernias, do not usually cause symptoms. They may, however, be associated with the following: burping, heartburn, nausea, vomiting, and/or regurgitation into the esophagus.

A paraesophageal hernia, or Type II, III, or IV hernia, may cause more severe symptoms. These can include:

• Abdominal/chest pain
• Abdominal bleeding (which can be indicated by blood in vomit, red or black stool, anemia, blood test indicating loss of blood)
• Change in voice
• Early satiety (or becoming full after only eating a small amount of food)
• Occasional trouble swallowing (especially solid food)
• Shortness of breath or trouble breathing after eating
• Acid reflux
• Regurgitation or a sensation of food “sticking”

Diagnosis

Along with a complete exam and detailed medical history, your surgeon may use one or more diagnostic tests to determine the best course of treatment.

Barium Swallow / Upper GI study requires that you swallow a small amount of contrast material, or liquid barium, which coats the lining of your esophagus so that X-ray images may be obtained. If you have experienced trouble swallowing, this procedure can help to locate any areas in your esophagus that may have narrowed. These areas are called strictures.

Chest X-rays: Electromagnetic energy produces images of internal tissues, bones and organs.

CT-Scans: These scans make up a series of images of the inside of your body, all taken from different angles, to reveal a high level of detail. To ensure that your veins and organs show up clearly in these scans, you may need to swallow a dye used for that purpose, or have it injected into your vein.

Upper Endoscopy (EGD): A procedure in which an endoscope is threaded through your mouth and then into your esophagus. This procedure allows your surgeon to actually see your upper digestive tract, which includes your esophagus, stomach, and duodenum, or the first part of your small intestine. Your surgeon can then remove a tissue sample as well.

Treatments

Hiatal hernias don’t always require treatment beyond regular monitoring and medications. Under certain conditions, however, treatment will be necessary. Those conditions include: chronic anemia; chronic pain; complications by gastroesophageal reflux disease; complications by esophagitis; danger of strangulation; inability to vomit; recurrent pneumonia or other infections. The following treatments are available for those with hiatal hernias.

Minimally Invasive Hernia Repair

Minimally invasive surgery can effectively diminish the size of a hernia, as well as reduce the opening in the diaphragm, thereby preventing strangulation. During this procedure, surgeons will insert a tiny video camera into your abdomen. They’ll be able to view images projected onto a monitor, which will allow them to complete the procedure with greater control and finesse. The purpose of this surgery is to restore the stomach into your abdomen and close down the hole in the diaphragm. Minimally invasive surgery is associated with a quicker recovery and faster return to function than traditional open repair. Your doctor will determine if you are a candidate for this approach. (Video)

Fundoplication

Your surgeons may also perform a fundoplication, which will help to prevent acid from rising through the stomach.

Make an Appointment

To discuss a potential hernia treatment or surgery, contact the Surgery Call Center at (734) 936-5738.

Hiatal Hernia | Cedars-Sinai

ABOUT

CAUSES
DIAGNOSIS

TREATMENT

NEXT STEPS

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

© 2000-2022 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.

Hernia, symptoms, diagnosis and treatment | Alpha

Esophageal hernia: symptoms and treatment

A hiatal hernia (hiatal hernia) is a condition in which the upper portions of the stomach and part of the esophagus enter the chest area through an opening in the diaphragm. Diaphragmatic hernia of the esophagus causes significant discomfort and interferes with a person in everyday life. Over time, the disease can provoke dangerous complications, therefore, it requires serious treatment.

Causes of disease

In childhood, a hernia of the diaphragm of the esophagus occurs due to anatomical pathologies of the formation of the fetus. The child has a displacement of the cardial part of the stomach into the chest cavity.

Possible causes of hernia of the esophagus in adults:

• weakness of the ligamentous apparatus of the digestive system;
• inflammatory diseases of the stomach: ulcer, chronic gastroduodenitis, pancreatitis, etc.;
• pathology of the esophagus: burns of the mucosa, esophagitis, varicose veins, etc.;
• injuries of the gastrointestinal tract;
• damage caused by a prolonged increase in pressure in the abdominal cavity, for example, during heavy physical exertion;
• obesity, constipation, flatulence;
• tumors.

Diaphragmatic hernia classification

• Sliding (axial) . The fundus of the stomach and part of the esophagus slide freely into the chest cavity. Axial hernias are the most commonly diagnosed. The risk of infringement is minimal.
• Perioesophageal (paraesophageal) . Less common is a pathology in which the esophagus remains in place, and the fundus of the stomach and other abdominal organs protrude through the opening of the diaphragm. Paraesophageal hernias are often infringed, therefore, as a rule, they require surgical treatment.
• Mixed . Hernia of the esophagus of the stomach has signs of both types described above.
• Acquired short esophagus . Pathology occurs as a result of trauma and inflammatory diseases. The stomach is drawn into the mediastinum through the diaphragmatic opening.

Esophageal hernia stages

• I – the abdominal esophagus is displaced into the mediastinum, the fundus of the stomach is located close to the diaphragm.
• II – the bottom and cardia of the stomach are located in the esophagus.
• III – the stomach and part of the esophagus are displaced into the mediastinum.

Hernia symptoms

The disease can proceed for many years without severe symptoms. Most often, pathology is diagnosed during a routine examination or medical examination.

There are several non-specific symptoms of a hernia of the esophagus, in the event of which it is necessary to consult a gastroenterologist:

• Heartburn, which is aggravated by physical exertion, bending over.
• Pain behind the sternum, the cause of which is the compression of displaced organs.
• Belching with a sour or bitter taste.
• Dysphagia after swallowing food quickly or eating fried food.
• Hiccups, which may increase to vomiting.

Signs of a hernia of the esophagus are often confused with cardiac symptoms. The patient may experience persistent cough, shortness of breath, tachycardia, blanching of the skin after eating. Pain with a hernia of the esophagus can be localized in the region of the heart.

Disease diagnosis

The most informative are instrumental diagnostic methods:

• Barium X-ray . Pictures are taken in several projections. Radiography allows you to detect the protrusion of organs in the esophageal opening of the diaphragm and assess the severity of the disease.
• Computed tomography . According to the pictures, the doctor determines the size, localization of the defect. The CT image clearly shows the blood vessels and contents of the hernia.
• Fibroesogastroscopy . A thin tube with a video camera is pushed into the esophagus. The doctor on the screen sees the mucous membrane of the internal organs, can detect inflamed areas, ulcers, scars and other defects.
• ultrasound . The examination determines the degree of displacement of the boundaries of the mediastinum, heart, measure the defect of the diaphragm.
• Esophageal manometry . An examination is prescribed to assess the performance of the esophageal sphincters. Esophageal manometry helps not only in diagnosis, but also in evaluating the effectiveness of prescribed therapy.

Treatment

At stages 1 and 2, conservative treatment of esophageal hernia is indicated. To reduce heartburn, drugs are prescribed that reduce the level of acidity in the stomach, antacids. It is possible to take medications that stimulate the peristalsis of the stomach.

Proper nutrition plays an important role in treatment. The patient should divide the daily norm into 5-6 small portions, have dinner no later than 2 hours before bedtime. Fried, spicy, fatty foods, alcoholic and carbonated drinks are excluded from the diet. The menu is based on vegetable soups, boiled fish, meat, kissels, cereals, fruits. Normalization of nutrition with a hernia of the esophagus allows you to almost completely get rid of unpleasant symptoms.

In severe clinical cases, surgery is indicated. The task of the surgeon is to eliminate reflux and reduce the esophageal opening in the diaphragm. Rehabilitation after surgery takes several days. To prevent relapse, patients are advised to follow a diet, give up bad habits and avoid physical activity.

What is dangerous hernia of the esophagus without treatment:

• infringement of internal organs;
• increased reflux to vomiting;
• development of ulcers, erosion in the digestive tract;
• occurrence of internal bleeding.

Diagnosis and treatment of esophageal hernia in Nizhny Novgorod

The clinic “Alfa Health Center” invites you to undergo a comprehensive examination of the gastrointestinal tract. Our specialists will make a diagnosis, prescribe competent treatment, and help get rid of the uncomfortable manifestations of the disease. The phone number for registration is listed on the website.

Dysphagia

Go to article »

Hyperprolactinemia – increased level of prolactin

A condition characterized by an increased content of the hormone prolactin in the blood, manifested in women by menstrual dysfunction, colostrum secretion when pressing on the nipples, in men – impaired reproductive function, impotence, infertility.

Go to article »

Irritable bowel syndrome: symptoms and treatment

Irritable bowel syndrome is a pathological condition that is accompanied by bloating, soreness, and problems with emptying. Pathology can manifest itself unexpectedly or go into a chronic form. In any case, the disease is accompanied by tangible discomfort.

Go to article »

Hernia of the esophageal opening of the diaphragm – treatment and operation of the hernia of the esophagus in the clinic of Dr. Paramonov.

To date, hiatal hernia (HH) is considered one of the most common diseases of the gastrointestinal tract, in terms of its frequency (among gastroenterological pathology) it occupies 2–3 place, competing with peptic ulcer and cholecystitis.

A hernia of the esophagus is a pathology of a chronic nature that affects the organs of the digestive system, during which there is a displacement of those internal organs that are normally located under the diaphragm. These organs include the abdominal part of the esophagus and the cardial part of the stomach.

The percentage of frequency of diagnosing HH increases depending on the age category of the patient. The disease occurs in every twentieth adult, and over the age of 50 years – in every second.

What are the causes of pathology?

The immediate cause of the formation of a hernia is the expansion of the esophageal opening of the diaphragm. Most often this is due to age-related weakening of the muscles surrounding this opening.

Another factor provoking the development of a hernia 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 coughing.

Dyskinesia (pathological movement) of the digestive tract, which is often observed against the background of such chronic inflammatory diseases as gastric ulcer and duodenal ulcer, gastroduodenitis, pancreatitis, cholecystitis, can also lead to the development of a hernia.

Sometimes the cause of the disease can be malformations of embryonic development (short esophagus, chest stomach).

Symptoms of esophageal hernia

The most common symptoms are:

• heartburn, stubborn, painful, occurring both after eating and on an empty stomach, especially when bending over and lying down;

• eructation of sour or bitter air;

• spitting up food.

Another characteristic symptom of a hernia of the esophageal opening of the diaphragm is pain, usually of a burning nature, which occurs in the epigastric region, behind the sternum, in the left hypochondrium, increases with physical exertion, with bending over.

Often there is a sensation of a lump in the throat and the appearance of pain when swallowing food. In this situation, a person feels discomfort behind the sternum, up to severe arching pain that spreads to the left shoulder and shoulder blade (as with angina pectoris), burning, a feeling of lack of air or dissatisfaction with inhalation.

In some patients, there is a sudden, for no apparent reason, an increase in blood pressure. At night, there is increased salivation, attacks of coughing and suffocation, in the morning there is a hoarseness of voice.

The above symptoms are not specific to HH and GERD (gastroesophageal reflux disease), and may be manifestations of other diseases, and HH by itself is not a reason to see a surgeon unless it is a paraesophageal hernia.

There are two types of hiatal hernia: axial hernia and paraesophageal hernia.

Paraesophageal hernia , as noted above, is an absolute indication for surgical treatment and this is not subject to any doubt, since paraesophageal hernia is prone to infringement, which entails traumatic and crippling operations, which in turn leads to disability of patients.

There are 4 types of axial hernia: Types I and II are not an indication for surgery if there are no complications and manifestations of GER. It is especially worth paying attention to the “atypical symptoms” of the manifestation of GER.

Complications of esophageal hernia

Hiatus hernia can actually 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 serious cardiovascular complications up to myocardial infarction.

Belching of gastric contents or air can also lead to negative consequences. 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, but occurs by contraction of the esophagus.

Treatment and prevention

Conservative treatment of hiatal hernia is mainly aimed at preventing gastroesophageal reflux (GER) and relieving symptoms of reflux esophagitis.

To prevent GER, frequent, fractional meals are recommended, limiting the amount of food and certain products (animal fats, chocolate, coffee, coarse fiber, carbonated drinks, spicy and spicy foods, fresh bread, flour products, etc. ). Do not lie down for 3 hours after eating. Dinner is light, no later than 2-3 hours before bedtime. You should completely stop smoking and exclude situations that cause an increase in intra-abdominal pressure.

For the prevention and treatment of reflux esophagitis, agents are used that correct the motility of the esophagus and stomach and the secretory activity of the stomach.

More and more in the diagnostic program of HH and GERD, high-resolution esophageal manometry and daily pH-impedancemetry of the esophagus are used, which allows making the correct diagnosis and choosing the right antireflux operation.

Surgical removal of a hernia of the esophagus is prescribed mainly when conservative therapy is ineffective, when the use of proton pump inhibitors is effective, but the patient does not want to take them all his life, in the presence of serious complications (peptic ulcer, esophageal bleeding, Barrett’s esophagus, etc. ), as well as when analyzing the results of studies of high-resolution esophageal manometry and pH-impedancemetry.

Rehabilitation

The main task during the rehabilitation period is a quick recovery and return to normal life, while it is important to avoid the possibility of relapse. As a rule, after surgery, the patient is sent to the ward, where he spends the night. During this period, our doctors will be able to establish how the surgical treatment of the esophagus and removal of the hernia was transferred. If there are no complications, the patient can be released the next day.

Doctor Paramonov’s Clinic employs experienced surgeons and gastroenterologists who are ready to help you even in the most difficult cases. You can sign up for a consultation on the treatment and removal of a hernia of the esophagus by calling 8 (8452) 66-03-03.

Our specialists

• Mikhnevich

  Vadim Vladimirovich

  Head physician of the clinic

  surgeon, oncologist

• Davydov

  Nikolai Yakovlevich

  Chief Physician of the Central Polyclinic

  surgeon

Prices

Laparoscopic fundoplication (diaphragmatic hernia repair and repair)

Go to price list

The total cost of the operation is calculated based on the preoperative examination, anesthesia, the volume of surgery and the number of days of stay in the clinic.