Diaphragmatic hernia: formation mechanisms, clinical picture, treatment tactics

Abstract

The article presents current data on etiology, pathogenesis of diaphragmatic hernia. Types of diaphragmatic hernia are described in detail, namely: axial, paraesophageal, mixed; transient and fixed. Pathogenesis of the formation of hiatal hernia includes: failure of the connective tissue structures involved in the formation of the esophago-gastric junction; significant increase in intra-abdominal pressure; increase in motor activity of the esophagus (hypermotor dyskinesia). Clinical manifestations and peculiarities of pain, including pseudo-coronary pain, differential diagnosis, are described. Recommendations for non-drug treatment, including lifestyle and nutritional changes, are presented. Particular attention is paid to pantoprazole as a means of choice for therapy of patients. Advantages of pantoprazole as compared with other proton pump inhibitors are presented: selectivity of action depending on pH, absence of “decussation” with the metabolism of other drugs, efficacy, duration of acid suppressive action, safety, favorable pharmacoeconomic characteristics.