Brazil World Cup final, Germany and Afghanistan battle 120 minutes. Argentina’s Ballon d’Or winner Lionel Messi was again photographed vomiting. Argentina “Ole” newspaper: “classic vomit” to describe Messi’s vomiting. Messi walked with his head down for a few steps, feeling uncomfortable and vomiting under nausea. Messi vomited as he walked. Finally stopped and vomited, bent his body and vomited again, before continuing to put into the game. This is not the first time Messi has vomited in this World Cup. As early as the second match against Iran in the group stage, Messi felt uncomfortable shortly after the start of the match and vomited with his head down. Messi’s vomiting was due to a variety of reasons, so Dr. Zhang Cheng of the Xinjiang Autonomous Region People’s Hospital ventured to speculate that Messi might be suffering from GERD caused by a hiatal hernia, which might be the real reason for Messi’s mysterious vomiting. Messi was advised to undergo a barium meal examination of the upper gastrointestinal tract, esophageal manometry and 24-hour acid monitoring tests to clarify the cause of the 20th Golden Globe winner. The esophagus enters the abdominal cavity from the posterior mediastinum through an orifice in the posterior part of the diaphragm, which is called the esophageal foramen ovale. The gastric cardia and the ventral segment of the esophagus or the abdominal viscera enter the thoracic cavity through this foramen and its parietal protrusion, called the esophageal foramen (hiatal
hernias). The etiology of the formation of hiatal hernias is controversial, with few patients having congenital factors; others suggest that acquired factors are the main ones, related to obesity and chronic intra-abdominal pressure elevation. Messi Ballon d’Or has elevated intra-abdominal pressure during exercise and running and forcefulness, resulting in an esophageal hiatal hernia attack with reflux of gastric contents and vomiting. Such patients come to the clinic with complaints of typical symptoms such as heartburn and acid reflux, or atypical symptoms such as foreign body sensation in the larynx, hoarseness, hysterical globus pallidus, acid vomiting, chest pain, and paroxysmal cough. The diagnosis of reflux esophagitis should be considered for asthma and aspiration pneumonia and other non-ulcer dyspeptic symptoms. To confirm the diagnosis, esophagoscopy and 24h pH monitoring should be performed. X-ray examination Endoscopy is the main method to diagnose hiatal hernia of the esophagus. Barium meal examination is the most commonly used, but requires the help of manipulation to show the hernia. Esophageal manometry Esophageal intraluminal pressure provides esophageal motility parameters when measured simultaneously in different planes. In recent years, ultrasound examination of the esophagogastric cardia and measurement of the length of the ventral segment of the esophagus has been more effective than barium meal x-ray in diagnosing smaller hiatal hernias. Examination of a paraesophageal hernia with magnetic resonance provides a clearer determination of the nature of the hernia content. Treatment Most sliding esophageal hiatal hernias have minimal symptoms, and mild to moderate esophagitis is common in the country, and these patients should be treated internally first. These patients should first be treated medically. Measures such as taking acid suppressants, regulating diet, avoiding activities with elevated abdominal pressure, and sleeping in a high pillow position and left lateral position can be taken. If reflux esophagitis has progressed to grade III, surgery should be considered to avoid esophageal stricture. Paraesophageal hernia should be treated with surgery early regardless of symptoms; mixed hiatal hernia should also be treated with surgery to avoid complications of gastric obstruction and striae narrowing. Regarding the medical treatment of reflux esophagitis, such as antacids, alginate or antacid combination drugs can relieve the symptoms and reduce the inflammation, but most of them use H2 receptor blockers, which have more certain efficacy. In severe cases, omeprazole (Loxacol) is superior to regular doses of ranitidine. All antacids, despite their recent efficacy, do not alter the natural course of the disease and have a high recurrence rate after discontinuation. Therefore, surgical treatment with hernia repair and antacids is eventually required.