Hiatal hernia treatment, conservative treatment is the most common

The most common symptom of hiatal hernia is pain, which becomes more obvious after eating. Sometimes it is accompanied by burning pain, belching or hiccups. Hiatal hernia can be treated with non-surgical treatment, which means paying attention to dietary adjustments to avoid excessive pressure on the abdomen.

1. Non-surgical treatment of infant hiatal hernia. Small hiatal hernia with mild symptoms can disappear or improve on its own during the development process, and conservative treatment is the first choice.

(1) Dietary adjustment: Infants and young children can choose viscous food, and pat their backs appropriately after meals to expel gas from the stomach; eat a low-fat, high-protein diet to increase the tension of the lower esophageal sphincter and reduce reflux; avoid irritating foods, and abstain from alcohol, tobacco and coffee; eat small meals frequently to make full use of the neutralizing effect of saliva on gastric acid; eat slowly and avoid full meals, especially before going to bed.

(2) Use gravity to prevent reflux: use a semi-sitting, sitting or upright position; do not lie down immediately after a meal, and develop a habit of taking a walk after a meal; raise the head of the bed by 15 to 20 cm when sleeping.

(3) Avoid factors that increase abdominal pressure, such as bending over, tight belts, constipation, vomiting, coughing, and obese people should lose weight.

(4) Use of gastrokinetic drugs: such as cisapride, domperidone (Motilium) and metoclopramide, which can reduce reflux and promote the healing of esophagitis by increasing the tension of the sphincter and promoting the peristalsis of the stomach and esophagus. Avoid the use of anticholesterol drugs to avoid reducing the pressure of the lower esophageal sphincter, delaying gastric emptying and promoting gastroesophageal reflux.

(5) Treatment of esophagitis: Mild and moderate esophagitis can be treated with H receptor antagonists or proton pump inhibitors (such as omeprazole, cimetidine and ranitidine) for 8 to 12 weeks with good efficacy. Omeprazole (Losec) is more effective than cimetidine and ranitidine, and can cure esophagitis or completely relieve symptoms in 80% to 85% of patients. However, the patient needs to continue taking the medication, otherwise the disease will relapse. However, it is ineffective for severe esophagitis, and antacids or drugs that neutralize gastric acid can be used appropriately.

(6) Monitoring: During non-surgical treatment, barium meal fluoroscopy, esophagoscopy and dynamic monitoring of 24-hour pH should be performed regularly. If the 24-hour pH value is <4 after non-surgical treatment, esophageal inflammation is severe, the pressure at the lower end of the esophagus (high-pressure zone) is significantly lower than the gastric pressure, and vomiting symptoms are obvious, surgery should be considered.

2. Surgical treatment

The purpose of the operation is to restore the lower esophagus and the gastroesophageal junction to their normal positions in the abdominal cavity and to strengthen the lower esophageal sphincter. The main problems that the operation solves are: restoring the abdominal segment of the esophagus to its normal position; fixing the esophagus and cardia; sharpening the blunt His angle; repairing and shrinking the enlarged esophageal hiatus; and preventing reflux.