Etiology
1.Congenital factors of esophageal hypoplasia.
2, structure of esophageal cleft site, such as muscles with atrophy or weakened muscle tone.
3, Acquired factors of long-term increased abdominal pressure, such as pregnancy, pneumoperitoneum, chronic cough, habitual constipation, etc. can cause the body of the stomach to herniate above the diaphragm and form an esophageal hiatal hernia.
4. Post-surgical hiatal hernia, such as surgery on the upper part of the stomach or the cardia, which destroys the normal structure can also cause hernia.
5. Traumatic hiatal hernia.
Clinical manifestations
1. Gastroesophageal reflux symptoms
The symptoms include burning sensation behind the sternum or under the glabella, retrograde sensation of gastric contents, epigastric fullness, belching and pain. The nature of the pain is mostly burning or pins-and-needles pain, which can be radiated to the back, shoulders, neck, etc. The symptoms may be triggered and aggravated by lying down, eating sweet and acidic foods. This symptom is especially common in sliding hiatal hernia.
2. Complications
(1) Bleeding hiatal hernia can sometimes bleed, mainly due to esophagitis and hernia bursitis, and is mostly chronic with a small amount of oozing blood, which can lead to anemia. Ulceration of the herniated stomach and intestine may lead to vomiting of blood and black stool.
(2) Reflux esophageal strictures In patients with reflux symptoms, organic strictures occur in a few cases, resulting in dysphagia, painful swallowing, and vomiting after eating.
(3) Hernia sac impaction is usually seen in paraesophageal hernia. A patient with a hiatal hernia who has sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage suggests acute intussusception.
3. Compression symptoms of hernia sac
When the hernia sac is large and compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitation, cough and cyanosis. When the esophagus is compressed, food stagnation or difficulty in swallowing can be felt behind the sternum.
Examination
1.X-ray examination
It is still the main method to diagnose esophageal hiatal hernia. For reversible hiatal hernia (especially for mild cases), a negative examination cannot exclude the disease, and those who are highly suspicious clinically should repeat the examination and take special positions, such as supine head-low-foot-high position, whose barium meal imaging can show direct signs and indirect signs.
2.Endoscopy
The diagnostic rate of endoscopy for esophageal hiatal hernia is higher than before, and it can be supplemented with X-ray examination to assist the diagnosis.
3.Esophageal manometry
In the case of esophageal hiatal hernia, esophageal manometry can have abnormal patterns, which can assist in the diagnosis.
4.Diagnosis
Since this disease is relatively rare and there are no specific symptoms and signs, it is difficult to diagnose. It should be taken seriously in suspected patients with GERD symptoms, older age, obesity, and obvious correlation between symptoms and body position, and some instrumentation is needed to confirm the diagnosis.
5.Treatment
1.Medical treatment
It is suitable for small slip hernia and those with mild reflux symptoms. The main principles of treatment are to eliminate the factors of hernia formation, control gastroesophageal reflux, promote esophageal emptying and moderate or reduce gastric acid secretion.
(1) Lifestyle changes
Avoid coffee, chocolate, alcohol, etc. Avoid lying down after meals and eating before sleep.
(2) Take a head-high, foot-low position during sleep and elevate the head of the bed when lying down.
③Avoid bending, wearing tight clothes, vomiting and other factors that increase intra-abdominal pressure.
④Obese people should try to reduce their weight, and those with chronic cough and long-term constipation should try to treat them. For asymptomatic esophageal hiatal hernia and small hiatal hernia, the above treatment can be given appropriately.
(2) Drug treatment
For those who already have GERD symptoms such as chest pain, retrosternal burning, acid reflux or postprandial regurgitation, in addition to the above preventive measures, anti-reflux and esophageal mucosa-protective drugs and motivational drugs should be given.
2.Surgical treatment
(1) Indications for surgery
①Esophageal hiatal hernia combined with reflux esophagitis, the effect of medical treatment is not good.
(2) Esophageal hiatal hernia with pyloric obstruction and duodenal stasis.
③Para-esophageal hiatal hernia and giant hiatal hernia.
④Esophageal hiatal hernia with suspected cancer.
(2) Surgical principles
①Reset the contents of the hernia.
②Repair the loose and weak esophageal hiatus.
(3) Prevention and control of gastroesophageal reflux.
④Keep the gastric outflow tract unobstructed.
⑤Treat coexisting complications.
(3) Surgical methods
There are many surgical methods to treat esophageal hiatal hernia, mainly hernia repair and anti-reflux surgery.
6.Prevention
Prevention of factors that increase the abdominal pressure for a long time, such as pneumoperitoneum, chronic cough and habitual constipation, can reduce the occurrence of esophageal hiatal hernia.