How it manifests itself
- Heartburn, worse lying down, bending over and after eating
- Belching air and sour, regurgitation
- Substernal pain, sometimes radiating to the back or jaw
- Feeling of a lump in the throat, hoarseness in the morning
- Night cough, asthma attacks, exacerbation of bronchial asthma
- Destruction of tooth enamel due to constant acid reflux
- Difficulty swallowing with large hernias
Внепищеводные проявления — хронический кашель, ларингит, ночные приступы удушья — нередко долго лечат у ЛОР-врача или пульмонолога, пока не выясняется, что причина в рефлюксе.
Why does it occur
- Age-related weakening of the ligamentous apparatus of the diaphragm
- Increased intra-abdominal pressure: obesity, pregnancy, constipation
- Chronic cough
- Heavy physical labor and heavy lifting
- Congenital features of connective tissue
- Previous operations in this area
Survey
- Гастроскопия — main метод: показывает саму грыжу, признаки рефлюкс-эзофагита, эрозии и, что важно, наличие пищевода Барретта.
- Рентгенография или МСКТ пищевода с контрастированием — уточняет размер и тип грыжи.
- При необходимости — суточная рН-метрия и манометрия пищевода.
- ЭКГ и консультация терапевта при загрудинной боли для исключения сердечной причины.
Treatment without surgery
For most patients, symptoms can be controlled without surgery, and this is where they begin.
- Raising the head of the bed by 15 cm is much more effective than a higher pillow
- Last meal 3 hours before bedtime
- Fractional meals in small portions
- Weight loss if you are overweight
- Limiting coffee, chocolate, fatty, spicy, carbonated drinks, citrus fruits
- Quitting smoking and alcohol
- Do not wear tight belts or bend over immediately after eating
- Proton pump inhibitors and other drugs - as prescribed by a doctor, in a course
When surgery is discussed
- Symptoms persist despite full therapy
- Complicated course: severe esophagitis, esophageal stricture, bleeding, anemia
- Barrett's esophagus - a precancerous change in the mucosa
- Large hernias with displacement of a significant part of the stomach into the chest
- Intolerance or unwillingness to take medications for a long time
Surgical treatment consists of returning the stomach to the abdominal cavity, suturing the enlarged opening of the diaphragm and forming an anti-reflux mechanism. The decision is made jointly by the gastroenterologist and the surgeon after a complete examination.
