The most common diseases of the gastrointestinal tract remain gastritis, peptic ulcer, cholecystitis, pancreatitis, however, in the last decade, scientists have begun to devote considerable attention to a disease with a more cumbersome name. Hiatal hernia manifested at the beginning only heartburn. True, everyone is familiar with heartburn, only a certain number of people are familiar with hernia. The difference is that the latter, against the background of heartburn, gradually develop serious problems in the work of geographically close to the esophagus of the lungs and heart. This patient was once and unsuccessfully treated for arrhythmias or respiratory disorders. If it was possible to make a correct diagnosis, other difficulties arose. Therapeutic treatment could be infinite and with varying success: therapy stopped – unpleasant symptoms returned. Surgical treatment was carried out through a large traumatic incision. Moreover, even through this incision, it was difficult to get to the site of the intervention. Therefore, such operations were isolated. In recent years, the situation with the diagnosis and treatment of hernia of the esophageal opening of the diaphragm has changed, as told by the head of the surgical department of the Minsk City Clinical Hospital No. 6, MD Sivets Nikolay Fedorovich.
– Just three years ago, thanks to the introduction of new technologies, the use low traumatic endoscopic method of operation it became possible to help patients whose quality of life seriously undermines hiatal hernia. Only in our department, more than 40 patients underwent surgery for hernia of the esophagus. On average, we are talking about 2-3 operations per month. Quite often, patients undergo intervention simultaneously on the muscles of the diaphragm, and because of gallstone disease. Such operations are longer, but less than a week later, patients are discharged home. High-tech and low-traumatic interventions on the diaphragm and esophagus are performed, in addition to our clinic, in a rather limited number of medical institutions.
– And how should a small trauma be understood?
– The surgeon does not cut, but several punctures, through which special tubes, a video camera and the working tool are entered. In the mediastinum we secrete the esophagus, the upper section of the stomach and suture the muscles of the diaphragm, narrowing the hernial ring to its normal state. After that, still performed plastic – a special coupling is formed, which will, firstly, perform the function of a valve mechanism between the esophagus and the stomach, and secondly, will counteract the repeated entry of the stomach from the abdominal cavity into the mediastinum, above the diaphragm, where the lungs and heart are located.
– How does a hernia appear? Why do the diaphragm muscles begin to weaken?
– There is no single reason. Anatomical features may be important – laying the muscular system during the formation of the organism. On the other hand is important Lifestyle. What matters is, for example, hard physical work, especially lifting weights against the background of the anatomical weakness of the muscular apparatus of the diaphragm. A sudden increase in intra-abdominal pressure will contribute to esophageal hernia. Muscle relaxation, an increase in the hernial ring and the movement of the upper third of the stomach into the mediastinum, in turn, impede the normal functioning of the heart and lungs.
In fact, a hernia of the esophagus is formed as a result of a defect in the diaphragm, the opening of which increases beyond the norm and thus the upper part of the stomach passes into the abdominal cavity. This situation is accompanied by the main clinical symptom – heartburn, which may occur including lying down. The acidic contents of the stomach are thrown into the alkaline environment of the esophagus, which means that esophagitis gradually develops – inflammation of the esophageal mucosa.
– Alcohol and tobacco can relax the muscles of the diaphragm?
– Directly, neither positive nor negative impact is not. However, a person who abuses alcohol may be prone to overeating, because, being under a degree, people lose control over the amount of food they eat. On the other hand, and just one who eats, should understand that you can not infinitely throw products into themselves. The body is designed so that it needs time to process a certain portion, transfer it to the intestine. When overeating the stomach is full, the food does not have time to be processed. In this form, it enters the small intestine, where, again, the microflora is not prepared for this volume, and the brain receives a signal to slow down this movement. Thus, the food is longer in the stomach, which, in turn, exerts unnecessary pressure on the muscles of the diaphragm.
– These troubles manifest themselves only with one symptom – heartburn. However, heartburn is the main symptom of gastroesophageal reflux disease. Does this mean that they come in pairs?
– Indeed, it turns out an interesting thing. Some scientists are convinced that gastroesophageal reflux disease leads to a hernia of the esophagus, and others that the appearance of a hernia provokes the development of a reflux disease. Generally, inflammation of the esophageal mucosa is a manifestation of gastroesophageal reflux disease.
– How often does this disease occur?
– Hernias of the esophageal opening of the diaphragm are found, according to statistics, in 3-30 percent of cases of diseases of the gastrointestinal tract. They are noted in 50 percent of gastroenterological patients over the age of 60 years and are expressed in 2 percent of patients who have undergone x-ray examination for diseases of the gastrointestinal tract.
– How is the diagnosis of hiatal hernia exposed?
– In any diagnosis, the most important is the clinical manifestations of the disease. Every doctor has a certain set of knowledge, clinical thinking. Next step – fibroesophagogastroduodenoscopy and X-ray examination of the esophagus and stomach. Then you can use special research methods – for example, esophagomanometry, which allows you to measure the pressure of the esophageal pulp.
– What complications can meet a patient with a hernia of the esophagus?
– If the mucous membrane of the esophagus is constantly irritated with acid, then local manifestations develop: first, inflammation of the mucous membrane, then erosion, which can later turn into Barrett’s esophagus, – and this is a precancer, which goes into cancer.
Our esophagus, as well as the stomach, is a moving organ. Therefore, even in a healthy person, when water and food moves along the esophagus, the stomach is physiologically tightened. If the diaphragm has an opening exceeding the normal one, then the stomach is tightened more than necessary. And thus prevents the normal operation of the lungs and heart. Breathing is disturbed – the patient simply suffocates, appears unreasonable arrhythmia, shortness of breath. In such situations, therapists sometimes treat what is a consequence of the underlying disease. But in fact, at a certain point, when the patient’s quality of life deteriorates due to a disease, it is time for surgical treatment.
– Without surgery can not do?
– In medicine, you can not be categorical. Therapy may be effective, but not in all cases. If the patient does not receive any treatment at all, the discomfort may progress more rapidly. However, with the therapeutic treatment the patient will feel better, but the situation will gradually worsen because drug therapy aims to relieve symptoms, and not to eliminate their causes. While the patient will take pills, heartburn will not bother. Proton pump blockers – modern drugs that reduce acidity, prevent the formation of esophagitis, are very good, but the cause of the problem remains. A person can not drink medicine all his life, if only because it is very expensive.
– In what cases the patient is recommended surgery?
– It is shown to all who have been diagnosed with a hernia of the esophageal opening of the diaphragm. However, appointed when the patient himself decided to do it. You can return to the usual life after such an operation in 2-3 months. The very next day you can drink water, then eat liquid food. The body must adapt to the fact that everything now works a little differently. Gradually, the threads are replaced with scar tissue, everything becomes more elastic, and the patient returns to normal.
The body will take its
“I adhere to this point of view: people invent themselves what they can use and what cannot,” says Nikolai Sivets. – Meanwhile, the body is prone to self-regulation. He knows how much he needs proteins, fats and carbohydrates. If a person thinks that you can live on one curd or fruit, then you are mistaken. One day the body will avenge such monotony, because it needs various substances to restore and create new cells, the work of internal organs. And all the substances necessary for this purpose cannot be contained in a narrow circle of products. A person should eat a variety of and monitor the quality of food consumed.
For the same, in order to prevent the development of such common pathologies as gastritis and ulcer, it is first necessary to eat regularly. Your body does not care that you decided today to sit on a diet or refuse to eat at all. When we feel a burning sensation under the spoon, this means that the hydrochloric acid has developed. We can not tell her do not work out. If the food does not arrive on time, the acid irritates the gastric mucosa and there are grounds for the development of erosion and the same peptic ulcer. If we are hungry at all, the body adapts. So, for someone who regularly eats, 60-70 percent goes to the needs of the body, and 30 percent is recycled. One who is starving begins to digest 80-90 percent.