Diet for esophageal hernia

The role of nutrition in human life is difficult to overestimate. Healthy foods give us strength and energy, and poor-quality food and various nutritional disorders cause the development of many diseases, among which the first rows are pathologies of the digestive system. It is not surprising that the treatment of such diseases involves the correction of the diet and meal schedule, which makes it possible to optimize the work of the gastrointestinal tract. So, a diet for an esophageal hernia is aimed at unloading the stomach and intestines, normalizing the acidity of gastric juice, reducing the intensity of the gas formation process and intra-abdominal pressure, minimizing the frequency of reflux episodes.

Is all this possible with just dietary correction? It all depends on the stage of the disease. At the beginning of the disease, diet is the main method of treatment, and then it acts as an auxiliary one, helping to reduce the dosage of drugs taken and the frequency of their use.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Indications

Esophageal hernia is a disease of the digestive system in which some organs located in the abdominal region penetrate into the chest through the diaphragmatic opening. This may be the lower end of the esophagus, and with it the stomach, or just the stomach (sometimes with intestinal loops), while the esophagus remains in place. In the first case, we speak of an axial (sliding) hernia, which can change its location depending on the position of the body, in the second - of a paraesophageal (fixed) hernia.

A diet for esophageal hernia is prescribed regardless of the type and characteristics of the hernial sac, its location and existing symptoms, because in any case there is a digestive disorder. While the hernia is small, it does not cause inconvenience to a person, but once the pathological process, characterized by weakening of the diaphragmatic opening, has started, it will progress further, causing malfunctions in the gastrointestinal tract. Especially if we are talking about old age (according to statistics, most patients with esophageal hernia have crossed the fifty-year mark) or serious metabolic disorders that have affected the trophism of the diaphragm tissues and ligaments.

With a sliding hernia, the most painful symptom is the reflux of food from the stomach into the esophagus, which is associated with pain and burning in the epigastrium and along the esophageal tube. The displacement and compression of the stomach in the esophageal opening of the diaphragm negatively affects its work, causing inadequate contractions (in the opposite direction) and slow movement of the food bolus along the digestive tract. Stagnation, in turn, provokes a shift in the acid-base balance of the stomach towards acidification and the development of dyspeptic phenomena, such as heartburn, flatulence, bloating.

In paraphasogeal and mixed hernias, congestion is caused by the incorrect positioning of the stomach, which appears to be upside down to a greater or lesser extent. In addition to abdominal and chest pain, patients also experience symptoms of dysphagia (impaired swallowing), congestion in the stomach and intestines. Painful reflux and heartburn occur less frequently in such patients, but the risk of developing various complications in the form of peptic ulcers, esophageal perforation and hemorrhages, strangulated hernia, which is life-threatening for the patient, is significantly higher than with a sliding hernia.

Bloating caused by increased gas formation and difficult, irregular bowel movements becomes a risk factor for increased intra-abdominal pressure, which is consistently higher in patients with any type of esophageal hernia than in healthy people. If nothing is done, the stomach will be pushed further and further into the chest cavity under pressure, the hernial sac will grow and interfere with other organs located in the chest cavity.

How does sliding and paraesophageal hernia affect the heart? The heart is an organ located in the left chest of the vast majority of people. The stomach is located directly below it. The organs are separated by the diaphragmatic plate and in a normal state practically do not interfere with each other. But as soon as the stomach is overloaded, you begin to feel some heaviness under the heart, it becomes more difficult to breathe, and mild symptoms of hypoxia occur. And the reason for this is the pressure of the stomach on the diaphragm, which in turn slightly squeezes and displaces the heart, making it difficult for it to work.

It is not difficult to imagine what will happen if the stomach is steadily elevated or even goes into the chest cavity, where there is no room for it. It will press on the heart, and the larger the size of the hernia, the greater the impact it will have on the human motor. It is not surprising that a common reason for prescribing surgery for an esophageal hernia is heart problems (shortness of breath, irregular heartbeat and pressure).

In this case, we are not talking about the pain behind the breastbone with an esophageal hernia, which is so similar to the symptoms of angina, but about serious disturbances in cardiac activity, which over time can lead to the development of organ failure.

Diet for esophageal hernia is primarily an opportunity to stop the progress of the disease, so it is prescribed even for hernia of the 1st degree, when there are no symptoms of gastrointestinal pathology yet. In the initial stage of the pathology, nutritional correction is the main and often the only method of its treatment.

At 2 and 3 degrees of esophageal hernia, dietary nutrition is prescribed in combination with drug therapy, exercise therapy, and physiotherapy. It helps to treat the disease more effectively, restoring the normal natural process of digestion.

In severe cases of axial hernia and its paraesophageal variety, surgical intervention is often used. In this case, a diet is prescribed both at the stage of preparation for surgery and during the rehabilitation period, which helps the body to quickly recover and optimizes the work of the gastrointestinal tract, reducing the risk of postoperative complications.

General information esophageal hernia diets

Esophageal hernia is considered a progressive disease, which can only be completely dealt with by surgical intervention, which, however, also does not exclude relapses of the disease. In the treatment of hernia of the esophageal opening of the diaphragm, doctors use various methods of treatment: drug and manual therapy, physical impact, exercise therapy, surgical treatment, the use of traditional methods of combating pain and heartburn, which must be combined with a diet.

Thus, a diet for esophageal hernia is a key point that ensures the effectiveness of other therapeutic methods. For patients, dietary nutrition is indicated not only at the stage of relieving acute symptoms. It should become part of a changed lifestyle of the patient, which will help prevent exacerbations of the pathology and live a normal, full life.

In theory, a diet for a hernia of the esophageal orifice of the diaphragm is not something excruciatingly difficult, because it does not imply strict restrictions and a half-starved existence. The principles of a diet for a hernia of the esophagus are based on the requirements of a healthy, balanced diet.

When planning your diet, there are some important points to consider:

• The basis of the diet is fractional nutrition, indicated for any diseases of the gastrointestinal tract, since it reduces the load on the organs and promotes an easier and faster process of digestion. The frequency of food intake in this case increases to 5-6 times a day (we are talking about the main meals and do not include snacks, which are not prohibited).
• Increasing the number of meals with the same or reduced caloric content and total volume of products implies a reduction in the single portion. The portion size should be such that satiety occurs 15-20 minutes after eating, and not while at the table, which indicates overeating.
• The last meal should take place no later than 3 hours before going to bed.
• After eating, you should never take a horizontal position, especially with a sliding hernia of the esophagus, because this leads to displacement of the digestive organs and disruption of the digestion process.
• The diet should be as gentle as possible on the stomach and intestines, i.e. you need to exclude heavy fried and smoked dishes, limit the consumption of salt, which causes weight gain, remove hot spices and sauces from the diet - products that irritate the gastrointestinal mucosa.
• It is necessary to exclude from the diet all products that increase gas formation in the stomach and intestines and cause an increase in intra-abdominal pressure.
• Particular attention should be paid to the drinking regime. Limiting fluid intake slows down metabolic processes in the body and is a risk factor for constipation. Constipation is dangerous both due to the increase in the size of the intestines and due to straining during defecation. Both factors provoke an increase in intra-abdominal pressure.
• When choosing products, you need to focus on their nutritional value and chemical composition. The patient's body must receive sufficient amounts of vitamins, minerals, amino acids, etc., necessary for the normal functioning of various organs. Food should not only bring satiety, but also maximum health benefits.
• Before each main meal, half an hour before eating, it is a good idea to drink a glass of clean water, which will cleanse the stomach of excess acid and mucus and start the digestion process.

Regardless of the type of hernia and associated pathologies, the patient's food must undergo sufficient heat treatment. Raw food in this case is a risk factor for exacerbation of esophageal hernia, because raw vegetables and fruits are harder to digest in the gastrointestinal tract and can cause fermentation processes in it.

Features of the diet for concomitant diseases

Esophageal hernia is a pathology that rarely occurs out of nowhere. Usually, the disease develops against the background of existing disorders in the functioning of the digestive system. Therefore, it is often diagnosed completely by accident during examinations for other gastrointestinal diseases.

Esophageal hernia often accompanies such gastrointestinal diseases as gastritis, gastric ulcer, reflux disease, pancreatitis, cholecystitis, atony and inflammation of the intestinal walls, which are inflammatory in nature and are characterized by stagnation in the digestive system. Frequent symptoms of such pathologies are heartburn, dyspepsia and constipation, which increase pressure in the abdominal cavity and push the stomach and esophagus upward.

In addition, with various disruptions in the functioning of the gastrointestinal tract, the absorption of nutrients deteriorates, which causes disruptions in metabolic processes in the body, which negatively affect the condition of various tissues of the body, including the muscles and ligaments of the diaphragm.

A diet for esophageal hernia, developing against the background of other diseases, is at the same time a method of their treatment. But it has its own characteristics. A diet for gastritis and esophageal hernia implies the most gentle diet. The patient is allowed thermally processed food, which is recommended to be thoroughly chopped (grinded or chewed well). Food should in no case irritate the mucous membrane of the stomach and esophagus, be too sour, salty or spicy, hot or cold.

Meals should be consumed mainly warm, in small portions up to 6 times a day, in the acute period giving preference to liquid and semi-liquid foods.

It is especially important to follow a diet for a hiatal hernia with increased acidity of gastric juice. I associate it with the appearance of heartburn in patients. High acidity of the stomach in combination with reflux disease, i.e. throwing food back into the esophagus, is especially dangerous.

The higher the acidity of gastric juice, the more irritating the effect food will have on the walls of the stomach and esophagus. The latter are even more sensitive to acid, because they do not have a sufficient protective layer and are not designed for such an aggressive effect, so a hernia of the esophagus very quickly becomes complicated by reflux esophagitis (inflammation of the esophagus).

The diet for esophageal hernia and esophagitis is even stricter, because it must simultaneously regulate the acidity of the stomach and reduce the frequency of reflux. In case of cicatricial changes and narrowing of the esophagus caused by long-term inflammation of the organ walls and their weakening, preference is given to semi-liquid and liquid, well-chopped food.

With increased acidity of gastric juice, the patient's diet must necessarily include dishes with an enveloping effect, which will protect the walls of the stomach and esophagus from irritation by aggressive substances in food and gastric juice and thereby reduce the severity of the inflammatory process.

It is necessary to exclude both mechanical or chemical and thermal damage to the esophagus during meals. Warm food with low salt, sugar, and acid content is ideal. In case of esophageal and gastrointestinal bleeding, the patient's diet should include products that increase hemoglobin and prevent the development of iron deficiency anemia.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Benefits

Axial hernia of the esophagus due to regular displacement of the stomach in the diaphragmatic opening is characterized by frequent episodes of reflux, especially at stages 2 and 3 of development. And regular throwing of food with aggressive digestive enzymes from the stomach into the esophagus causes its irritation and chronic inflammation (reflux esophagitis), resulting in the formation of fibrous tissue, shortening and reduction of the lumen of the esophageal tube. Such complications, accompanied by pain, heartburn, belching, hiccups and difficulty swallowing, significantly worsen the quality of life of patients and can cause exhaustion of the body.

Paraphasogeaic hernia of the esophagus, although less prone to the development of reflux, as well as the accompanying painful and rather long attacks of heartburn, congestion in the gastrointestinal tract can provoke such an outcome. In addition, they cause an increase in pressure in the peritoneum, which in this case can cause strangulation of the hernia, accompanied by severe pain and dangerous to a person's life if he does not receive qualified assistance in time.

As we can see, in the absence of effective treatment, both axial and paraesophageal hernias pose a certain danger to the life and health of the patient. And since we are talking about the digestive system, the treatment of which is impossible without dietary nutrition, the benefits of a diet for esophageal hernia become undeniable.

Correction of the diet and eating regimen allows to reduce the load on the digestive organs, to facilitate their work, which will prevent stagnation and improve metabolism. Stabilization of metabolic processes along with the use of products rich in vitamins and minerals will help to improve the nutrition of the diaphragm tissues, which in turn will have a positive effect on the characteristics of muscle and connective tissue (their strength and elasticity, resistance to stretching).

Eliminating foods that cause increased gas formation from your diet will help reduce the likelihood of increased intra-abdominal pressure caused by food intake. Increased intra-abdominal pressure is the main factor that ensures the progression of a hiatal hernia.

The same goals are pursued by dividing the daily diet into small portions with a higher frequency of food intake than usual. And limiting the intake of dishes that stimulate increased production of gastric enzymes and increase the acidity of gastric juice will reduce its irritating effect on the walls of the esophagus during reflux.

If the patient's diet and nutrition regimen are properly coordinated, the frequency of unpleasant symptoms of the disease will be significantly reduced, which means that the number and dosage of medications taken in connection with the disease can be reduced. Normalization of metabolism and regular exercise therapy will help strengthen the diaphragm and stop the development of the disease, which is the goal of treatment procedures.

What can and what can not?

We can talk for a long time about the benefits of proper nutrition for a hernia of the esophageal opening of the diaphragm, but for a person who is not initiated into its basics, this will give absolutely nothing. After all, the basis of the patient's diet is permitted products prepared in the appropriate way: boiling, baking, stewing. But which products can be considered permitted, and which should be excluded from your diet?

Allowed in any diet are those products and dishes that can improve the patient's condition or at least do not harm his health. Let's consider what in this regard can be eaten with a sliding hernia of the esophagus, in the treatment of which diet plays a decisive role?

Products that are useful for esophageal hernia are:

• Bananas, which can be eaten raw and preferably before eating other foods, because these fruits are able to protect the inner lining of the stomach and esophagus due to the high content of mucous substances.
• Apples used in food in baked and mashed form (if you have high stomach acidity, you should avoid eating too sour or too sweet varieties, which equally promote the production of hydrochloric acid). It is recommended to peel the apples from the hard skin before eating.
• Soft varieties of pears and peaches.
• Any kind of porridge cooked in water with a small addition of salt (skim milk is allowed), except for those that contain coarse fiber, which can mechanically damage the esophagus and stomach. Preference is given to oatmeal, buckwheat, barley and millet porridge, which must be thoroughly boiled. However, millet is not recommended for gastritis with high acidity, so it is useful for a limited number of patients.
• Vegetable soups, which, when a hernia is exacerbated, are recommended to be rubbed through a sieve, which will facilitate their absorption, prevent injury to inflamed tissues by pieces of vegetables, and facilitate an easier process of digestion.
• Boiled, stewed or baked vegetables, except cabbage, which increases stomach acidity in any form and can cause increased gas formation. Carrots, boiled beets, and potatoes are considered especially useful. It is useful to prepare vegetable puree, which can be lightly seasoned with sour cream or cream.
• Lean meats and fish that can be boiled, baked, stewed, and even grilled, but the tough crust will need to be removed in this case.
• Light meat and vegetable broths are especially useful in the postoperative period and in cases of esophageal stenosis.
• Low-fat dairy and fermented milk products (their use is strictly individual and depends on the acidity of the gastric juice, the body's reaction, and the patient's age). With normal stomach acidity, kefir, sour milk, fermented baked milk, cottage cheese, and yogurts without artificial additives will be useful, but with increased acidity, their use will have to be minimized.
• Vegetable oil.
• Boiled eggs (especially whites) and steamed omelette.
• Vegetable oils that can be added to salads and consumed in small amounts in their pure form for more comfortable bowel movements.
• Rice flour-based baked goods, biscuits soaked in water or milk during acute periods of the disease with reflux esophagitis.
• Among drinks, preference should be given to green tea, purified water, sweet freshly prepared juices, which are recommended to be diluted, herbal decoctions and infusions. With increased stomach acidity, it is useful to regularly drink alkaline mineral water without gas. If milk does not cause bloating and diarrhea, it can also be included in the diet.
• Sweets are not prohibited for esophageal hernia, but this only applies to certain types of favorite desserts. Patients are allowed to eat marshmallows, jelly, gelatin-based products, and pastilles.

Now let's talk about what you can't eat with a hiatal hernia. Prohibited foods and dishes include:

• All types of citrus fruits, as well as dishes that include them.
• Fatty meats and fish in any form.
• Fried vegetables and meat products, as well as dishes to which they are added.
• Vegetables include cabbage, radish, red salad and hot peppers, onions and garlic. The latter, when heat-treated, can be added to dishes in minimal quantities to improve the flavor of food. With high stomach acidity, you should also be careful with tomatoes, adding them to dishes in small quantities or refusing to eat them at all. But green and yellow salad peppers are not prohibited, although it is better not to eat them fresh.
• Any hot spices and seasonings, mayonnaise, ketchup, which stimulate the production of hydrochloric acid and themselves can irritate the inflamed walls of the esophagus and stomach.
• Pickles and marinades.
• Mushrooms in any form.
• Fatty milk and fermented milk products, including butter.
• Fresh baked goods made from white flour. Yeast dough is considered especially dangerous, as it provokes fermentation processes in the intestines, as well as sweet baked goods made with margarine or butter, which are difficult to digest in the gastrointestinal tract.
• Any food that is too hard, hot or cold, ice cream that can be eaten in minimal quantities after melting.
• Grapes that cause fermentation processes.
• Legumes (beans, lentils, beans, peas) and corn. Only green beans and a little green peas are allowed. But you should definitely not abuse such products.
• Any kind of smoked meats.
• Chocolate and any dishes with added cocoa.
• Unsoaked crackers.
• Seeds, nuts, bran and any other food that contains coarse fiber.
• The prohibited drinks include sweet and unsweetened soda, kvass, pickles, coffee, cocoa, strong tea, and any type of alcohol.

The diet for esophageal hernia includes an impressive list of both permitted and prohibited products and dishes. But if you look closely, you will notice that it is difficult to call it strict. There are not so many absolute restrictions in food products. Fatty meat can be replaced with lean, butter with vegetable, sour cream with yogurt, etc.

The same applies to cooking methods. You will have to forget about fried meat, fish and vegetable dishes for the duration of treatment, or better yet forever, change your preferences in choosing baked goods in favor of yeast-free types of bread, and give preference to natural sweets in small quantities for dessert.

Some products can be called controversial in this diet. Such a product is, for example, cucumber, which is not recommended for patients with increased acidity of gastric juice due to the assertion that the stomach produces a large amount of hydrochloric acid to digest it. Another theory states that cucumber has an alkalizing ability and, on the contrary, is able to reduce inflammation of the stomach tissue, and its soft fiber cannot harm the inflamed organs.

With a hiatal hernia, cucumber is not on the list of prohibited foods. It can be included in salads or used to make sandwiches, after peeling off the rough skin. Just with acid reflux, you need to be more careful with such dishes, and if possible, do without cucumbers or limit their quantity as much as possible, sensitively reacting to the reactions of your body.

You should not eat freshly baked bread, get carried away with chewing gum, which promotes the introduction of air into the digestive system, drink carbonated and alcoholic beverages, including beer and "low alcohol", eat food in a hurry. The latter is very important in case of reflux disease and inflammation of the esophagus, because poorly chewed pieces of food can injure the inflamed tissues of the organ and cause pain. In addition, they slow down the process of digestion of food, which is undesirable in case of a hernia of the esophagus.

It is recommended to drink drinks between meals for this disease. Drinking with food leads to overstretching of the stomach. During the main meal, it is allowed to drink no more than half a cup of any drink or water, but this should be done after the meal. During snacks, you can drink a glass of liquid. The amount of water and drinks between meals is not limited.

It is not advisable to drink beverages through a straw if you have an esophageal hernia, because in this case, you will again swallow air, which will subsequently result in belching.

Contraindications

A diet for esophageal hernia is not just a way to get rid of the unpleasant symptoms of the disease. It is a complete treatment and preventive measure that helps restore the normal position of the digestive organs by normalizing intra-abdominal pressure and prevent hernia recurrence.

A low-calorie diet for a hernia has virtually no contraindications, since it includes products that help maintain a normal balance of fats, proteins and carbohydrates. Fractional nutrition is perceived by the body very well, because in this case the digestive process proceeds easily and without hitches, while rare meals can provoke stagnation and constipation.

Patients can eat almost all vegetables and non-acidic fruits (with rare exceptions), so they do not have to worry about a lack of vitamins and microelements. True, most products are recommended to be heat treated, which destroys some vitamins. But bananas, peaches and soft apples, which can be included in the menu even fresh, help solve the problem.

The risks associated with the diet are mainly limited to the patient's weight loss, after all, the diet is low in calories. But it is mainly the extra kilos that are at risk. Such a diet will not allow you to become exhausted, because the permitted dishes and products contain almost all the components that have high nutritional value and are necessary for the normal existence of the body.

The situation is somewhat different with therapeutic fasting. If a regular low-calorie diet and fractional meals are suitable for almost all patients, then abstaining from food intake even for just one day is not always possible. Even on the first day after surgery, patients with a hernia of the esophagus are prescribed food intake, although we are talking only about liquid products. Those who do not yet see the need for surgery can adhere to therapeutic fasting if concomitant diseases allow it. Otherwise, complications cannot be avoided.

The duration of such fasting, which would certainly help reduce inflammation of the esophagus walls, because the main irritant is food entering the esophagus from the outside or as a result of reflux from the stomach. In the absence of food, the problem is solved by itself. If there are no irritants, tissue regeneration processes are much more active and effective.

But, for example, in acute gastritis, when therapeutic fasting may be prescribed, the patient may refuse food for no more than a day. Further fasting may lead to the inflammation intensifying, and a hungry person will secrete gastric juice at the sight of food and corrode the mucous membrane. This is especially dangerous in gastritis with increased acidity of gastric juice.

Among the possible complications of a diet for esophageal hernia with a relatively low content of fiber, which stimulates the processing of the food bolus in the intestine and its exit, are constipation. But they mainly affect those who neglect the requirements of moderate physical activity. A good prevention of constipation is jogging, which is not prohibited for esophageal hernia. 10-15 minute evening jogs and a sufficient amount of water drunk during the day fully ensure comfortable bowel movements in the morning.

The diet for esophageal hernia involves limiting sugar, but does not involve a complete refusal to consume carbohydrates, which are sources of energy, so patients rarely complain of weakness and fatigue due to a change in diet and eating regimen (except in the first few days). But reducing salt intake will only be beneficial, especially for those who have heart and kidney problems, which are expressed by edema syndrome and increased pressure. It is only necessary to reduce the amount of salt consumed and one can expect stabilization of arterial and renal pressure, a decrease in edema syndrome, and an improvement in the general condition of patients.

A diet for esophageal hernia is considered therapeutic. Fractional nutrition in small portions, low calorie content of dishes and ease of their digestion are considered a plus in this case, because in this way the work of the gastrointestinal tract is facilitated, digestion is normalized, the frequency of reflux decreases and the inflammatory process in the esophagus decreases. In addition, the symptoms that contribute to an increase in intra-abdominal pressure and pushing the esophagus and stomach to the other side of the diaphragm go away.

But it is necessary to take into account the fact that low caloric content does not contribute to the energy support of the body. With bed rest, such a diet is ideal. With moderate physical activity, it is quite acceptable, although patients may complain of slight weakness and rapid fatigue. But for people engaged in heavy physical labor, this will be a half-starved existence, leading to fainting. Although, if you think about it, heavy physical labor is contraindicated for people with an esophageal hernia, and those who are worried about their health, first of all, will take care of changing activities.

[ 11 ], [ 12 ], [ 13 ], [ 14 ]