Slipping hernia of the esophageal opening of the diaphragm: symptoms and treatment

Hernia of the esophageal opening of the diaphragm (photo pathology is presented below in the article) and reflux esophagitis are quite dangerous diseases. Against the background of these conditions there is a stretching of certain parts of the gastrointestinal tract. In particular, the changes occur in the ligaments that support the stomach and esophagus, a photo of which is also presented in the article. As a result of stretching, a displacement occurs. In particular, the upper gastric part emerges into the thoracic region. As a result, the functioning of the sphincter connecting the stomach and esophagus is broken (photo illustrates this site).

Probable risk

With a change in the angle of the Guiss and a violation of the activity of the esophageal (lower) sphincter, the acid contents of the stomach or bile are thrown into the esophagus from the duodenum. The process is accompanied by the development of inflammation, restructuring of the mucosa. This greatly increases the risk of cancer. Of particular importance in the development of pathology is the sliding hernia of the esophageal opening of the diaphragm. The operation is the only available method for eliminating this violation. However, the surgical intervention has its own nuances. Next, let us examine in more detail what the hernia of the esophageal aperture of the diaphragm represents. Degrees, types and manifestations will also be described in the article.

General information

Hernia in the esophagus usually develops in combination with gastroesophageal disease. GREB is accompanied by a complex of cardiological, pulmonological and dyspeptic disorders. They arise mainly because of a hernia and gastroesophageal reflux. According to the data of the American and European associations, if a person has GVLP, the probability of cancer occurrence after 5 to 12 years grows by 270% in 5-12 years, and by 350-490% in 12 years (depending on the age).

Prevalence of pathology

GAPD, according to several authors, is considered to be the same often diagnosed disease, as, for example, cholecystitis or ulcer of the esophagus. In their prevalence, these pathologies occupy leading positions among GI diseases. GVAP, like an esophagus ulcer, is considered quite a dangerous disease, requiring timely diagnosis and careful monitoring.

Classification

There are three main categories of HVAC. These include:

• Axial hernia of the esophageal opening of the diaphragm. This pathology has another name. The common name is a sliding hernia of the esophageal opening of the diaphragm. This type of pathology is detected in almost 90% of patients. The condition is characterized by the incidence of the cardia above the esophageal opening. In connection with this, a sharp violation of the closure function is noted.
• Paraesophageal hernia. This form is found in about 5% of patients. For the pathology of this type is characteristic of the invariability of the position of the cardia and the substantial curvature of the stomach.
• Short esophagus. As an independent, this pathology is rarely diagnosed. The disease is an anomaly in development. As a rule, this syndrome is accompanied by a sliding hernia of the esophageal opening of the diaphragm. It is also characterized by inflammatory and scarring processes.

Sliding hernia

This form of the disease is characterized by some features. In general, the sliding hernia is a protrusion, in which one of the walls is partially covered by the peritoneal organ. It may be, in addition to the site considered in the article, the bladder, the ascending and descending gut, and so on. In this hernial bag may not be. The protrusion in this case is formed by the parts of the organ not closed by the peritoneum.

The mechanism of occurrence

In accordance with this feature distinguish:

• Congenital hernia. In this case, the organs for some reason or other sections, not closed by the peritoneum, gradually descend to the site of the inner gate on the retroperitoneal tissue. At the same time they come out of the cavity. This process can begin as early as the embryonic period. As a result, the displaced parts become a component of protrusion without a hernial sac.
• Acquired violations. Hernias of this type are formed as a result of mechanical contraction of the intestine or segments of the bladder. They are devoid of serous cover and adhere to the peritoneum.

Inguinal sliding hernias in the large intestine, as a rule, are protrusions of large size with wide gates. Diagnosed, as a rule, in old age. It is detected by X-ray methods of examination of the large intestine. Slipping hernia in the bladder is manifested by dysuric disorders. In patients, there is a double urination. First emptying is carried out as usual, and then, with pressure on the protrusion, there is another urge, and the patient urinates again. When diagnosed, catheterization and cystography are performed. During these procedures, the shape and size of the hernia, the absence or presence of stones in the bladder are revealed.

Axial hernia of the esophageal opening of the diaphragm

This pathology is a displacement of the stomach or other abdominal organs into the chest cavity. The disease is detected in 5% of the adult population. At the same time, about half of patients do not notice any manifestations. This course of the pathology is due to the fact that the sliding hernia of the esophageal opening of the diaphragm has erased signs of a typical form, since bulging is located inside the body and it can not be detected during routine examination. The disease affects women more often than men. In children, pathology is mostly congenital in nature.

Forms of the disease

The sliding hernia of the esophageal opening of the diaphragm is divided into:

• Cardiofundal.
• Total gastric.
• Cardiac.
• Subtotal gastric.

The parasophageal hernia is classified into:

• Gastrointestinal.
• The stuffing box.
• Intestinal.
• Antral.
• Fundamental.

Stages of pathology

Slipping hernia of the esophageal opening of the diaphragm can be classified according to the volume of the stomach penetrating into the chest cavity:

• The first stage. In this case, the abdominal part of the esophagus is located in the thoracic cavity above the diaphragm. While the stomach is in a raised position. It is attached directly to the diaphragm. And at her level is cardia.
• The second stage. In the thoracic cavity is the abdominal part of the esophagus, the stomach is located directly in the area of the diaphragmatic opening.
• The third stage. Above the diaphragm are cardia, the gastric body and the bottom (sometimes the antral region), the abdominal esophagus.

Clinical picture

Symptoms of pathology are very similar to the manifestations of diseases of the digestive tract associated with impaired functioning. Against the background of worsening of the activity of the esophageal (lower) sphincter, catarrhal reflux is noted (reverse casting of gastric contents). After a while, because of the aggressive influence of the masses in the lower part of the esophagus, an inflammatory process develops. The patient begins to complain of heartburn after eating and is aggravated by physical overstrain or in a horizontal position. Often there is a sensation of a lump in the throat. After eating, pain may appear. They have different character. Soreness can extend to the scapula, to give in the neck, behind the sternum, into the heart or lower jaw. These manifestations are similar to those of angina with which a differential diagnosis is made. In some cases, soreness appears at a certain position of the body. Probable complaints of the patient on the swelling of the upper abdomen, the sense of presence of a foreign body.

Effects

More severe cases are characterized by a number of complications. One of them is bleeding from the esophageal vessels. As a rule, it proceeds in a latent form and manifests itself in the form of progressive anemia. Bleeding can be chronic and acute. In some cases, even pinchings of protrusions in the esophagus and perforation of the esophagus are revealed. The most frequent consequence of the pathology is reflux esophagitis. It can be transformed into a peptic ulcer in the esophagus. With prolonged therapy, this condition provokes an even more severe complication - cicatricial stenosis (constriction) of the organ.

Diagnostics

The detection of pathology is carried out using several methods. Among the main ones we should mention: esophagogastroduodenoscopy, x-ray of the stomach and esophagus, intrasophageal PH-metry. Ultrasound, computed tomography, and esophagometry are also used.

Treatment of pathology

Various measures are being taken to alleviate the manifestations that accompany the sliding hernia of the esophageal opening of the diaphragm: diet, medications. Conservative methods are aimed at eliminating the symptoms of pathology: the removal of pain, heartburn, nausea. At the same time, medications that reduce the acidity of gastric juice are prescribed. Such means, for example, include the drug "Kwamatel". One of the conditions for effective treatment of patients diagnosed with a hernia of the esophageal opening of the diaphragm is a diet. The diet restricts the presence of fatty, spicy, fried foods, alcohol, chocolate, coffee, products that promote the production of gastric juice. Take meals in small portions, often. To prevent reflux, the patient is recommended to sleep with an elevated upper trunk area, and avoid lifting weights.

Surgical intervention: general information

It should be noted that the above measures do not eliminate the cause of the sliding hernia of the esophageal opening of the diaphragm. Operation is the only way to restore the anatomical relationship between parts of the gastrointestinal tract. In the process of intervention, an antireflux mechanism is created that prevents the return of the contents of the stomach. During the operation, the hernial gate is eliminated by suturing the enlarged aperture to normal size.

Applied surgical techniques

Today, specialists use two methods of intervening:

• Open access. In this case can be carried out fundoplication according to Nissen or plastic according to Toupe. In the first case, there is a high risk of many complications. Therefore, plastic is preferred over Toupe.
• Laparoscopic access. This is the least traumatic method of intervention. After the operation in this way, the patient is more quickly and easily restored.

It should be said that laparoscopy with a hernia in the esophagus is often performed in conjunction with the operations of other organs in the abdominal cavity. For example, cholecystomy is performed with calculous cholecystitis in the chronic stage, proximal selective vagotomy - with ulcer in the duodenum.