The Treatment of Regurgitant Esophagitis by Reconstruction of the Cardiac Sphincter Mechanism in Patients with No Demonstrable Hiatal Hernia

摘要

IntroductionnSince esophagitis was first described in 1879 by Quinke,’ a number ofnpapers based on clinical and laboratory observations have been publishednassociating esophagitis with the regurgitation of acid-peptic juice fromnthe stomach.’-’ Although Jackson’ described peptic ulcers of the esoph-nagus in 1927, Winklestein7 is usually given the credit for first describingnpeptic esophagitis as a new clinical entity in 1935. He stated that thenmechanism of its production was not entirely clear. In 1957, he8 discussednpeptic esophagitis associated with duodenal ulcer, and suggested it asnpart of the ulcer diathesis as is the duodenitis and antral gastritis seennin association with a peptic ulcer. Since many patients with severe ulcerndiathesis have no associated esophagitis, and since other patients with anknown gastric hypoacidity may develop severe esophagitis, this is not thenonly explanation for the production of such esophageal changes. Whethernan ulcer diathesis exists or not, the transcardial reflux of gastric juiceninto the lower esophagus is the sine qua non in the development of thenesophagitis. In the absence of such abetting factors as prolonged severenvomiting, the presence of a nasogastric tube, or surgery on the esophago-ngastric junction, regurgitant esophagitis is most likely due to an in-ncompetent cardiac sphincter mechanism associated with a hiatal hernia.