A hiatal hernia (HH) is a condition in which part of the stomach or other abdominal organs protrudes through a defect in the diaphragm, interfering with the normal functioning of the esophagus. This abnormality occurs as a result of weakening of the structures that hold the organs in the correct position and can lead to a variety of clinical manifestations, including heartburn, chest pain, and difficulty swallowing. The hernia may be latent or cause severe symptoms depending on its size and location. The condition is most often seen in older people, but in recent years there has been an increase in cases among younger patients.
History of the disease and interesting historical facts
Hernia of the esophageal opening of the diaphragm has been known to medicine since ancient times. The first mentions of this disease are found in the works of Hippocrates and Galen, who described various types of hernias, including diaphragmatic ones. In the Middle Ages, hernias were treated surgically, although operations were often carried out with a high risk for the patient. In the 19th century, a more detailed study of anatomy and physiology began, which contributed to the emergence of successful surgical techniques. Since the 20th century, the level of surgery has increased significantly, laparoscopic technologies have appeared, allowing to minimize the trauma of operations and accelerate the rehabilitation of patients.
Epidemiology
According to modern research, esophageal hernia of the diaphragm occurs in 10-30% of the adult population, and its prevalence increases with age. According to various statistical reports, among people over 60 years of age, the frequency of GERD reaches 60-70%. It is noteworthy that hernia is more often diagnosed in women, which may be due to the peculiarities of anatomy and hormonal background. At the same time, most cases may remain asymptomatic, which complicates statistical assessment of the true incidence.
Genetic predisposition to this disease
To date, some genetic factors have been identified that contribute to the development of hiatal hernia. There are mutations in genes responsible for the strength of connective tissues, such as COL1A1 and COL3A1. These genes synthesize collagen, which plays an important role in maintaining the structure of internal organs. Also, people with a family history of connective tissue diseases have an increased predisposition to hiatal hernia. However, most of the risk factors remain in the area of environmental influences and lifestyle.
Risk factors for the development of this disease
There are various risk factors that may contribute to the development of a hiatal hernia, including:
- Age: The risk increases with age.
- Obesity: Being overweight increases pressure in the abdominal cavity.
- Pregnancy: changes in hormonal levels and an increase in abdominal volume can provoke the development of a hernia.
- Chronic cough: often leads to increased intrathoracic pressure.
- Constipation: Retention of stool can lead to straining and pressure on the diaphragm.
- Hereditary predisposition: there must be a family history of GERD.
Diagnosis of this disease
When diagnosing a hiatal hernia, clinical symptoms such as:
- Heartburn and burning sensation behind the breastbone.
- Chest or abdominal pain that may mimic heart pain.
- Difficulty swallowing (dysphagia).
- Regurgitation of food or acid.
Laboratory tests include a complete blood count and biochemistry to rule out other conditions. Radiological tests such as barium enema and esophagogastroduodenoscopy are used to visualize the hernia and its size. Other diagnostic tests include esophageal manometry and 24-hour pH monitoring. It is also important to conduct a differential diagnosis to rule out other causes of symptoms, including coronary artery disease and gastritis.
Treatment
Treatment of a hiatal hernia depends on the severity of the condition and the severity of symptoms. In most cases, the manifestations of the disease can be controlled by conservative methods:
- General recommendations: lifestyle changes, diet, avoid overeating.
- Pharmacological treatment: use of antacids, proton pump inhibitors (PPIs) and prokinetics to relieve symptoms.
- Surgical treatment: in case of severe symptoms or complications such as stenosis or bleeding, fundoplication is indicated.
- Other methods: physical therapy and sessions with a nutritionist to correct your diet.
List of medications used to treat this disease
The following groups of drugs are used for drug treatment of esophageal hernia:
- Antacids: Almagel, Gaviscon.
- Proton pump inhibitors: omeprazole, esomeprazole.
- Prostaglandins: misoprostol.
- Prokinetics: metoclopramide.
Disease monitoring
Monitoring of the patient's condition with a hernia of the esophageal orifice of the diaphragm is carried out regularly. It is important to monitor symptoms and changes in health. The prognosis is usually positive, especially with timely treatment. However, complications such as esophageal ulcer, gastric bleeding, and the development of esophageal carcinoma are also possible.
Age-related features of the disease
Between the ages of 20 and 40, a hiatal hernia is often asymptomatic. People over 60 years of age experience more pronounced symptoms. In older people, the hernia may be complicated by concomitant diseases such as hypertension and diabetes, which require an individual approach to treatment. Women during pregnancy are also at increased risk due to changes in fluid balance and hormonal fluctuations.
Questions and Answers
- What causes a hiatal hernia? The main cause is recognized as weakening of the diaphragm muscles and increased pressure in the abdominal cavity.
- What are the symptoms of a hiatal hernia? Symptoms include heartburn, chest pain, difficulty swallowing, and regurgitation.
- How is this disease diagnosed? Diagnosis includes clinical examination, barium x-ray, esophagogastroduodenoscopy and other methods.
- What are the treatment options for hiatal hernia? The main treatments include lifestyle changes, drug therapy and, in some cases, surgery.
- Is surgery necessary for a hiatal hernia? Surgery is indicated for severe symptoms that do not respond to conservative therapy, or for complications.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov notes that it is important for patients with a hiatal hernia to follow a number of recommendations to reduce the risk of exacerbations:
- Eat in small portions: small portions of food will help avoid overloading the stomach.
- Avoid lying down after eating to prevent reflux.
- Avoid acidic and spicy foods that irritate the esophageal mucosa.
- Engage in physical activity regularly, but do not overexert your body.
Follow your doctor's advice and take an active role in your health.
