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Chalasia, Peptic Esophagitis, and Hiatal Hernia

1971; Elsevier BV; Volume: 60; Issue: 5 Linguagem: Inglês

10.1378/chest.60.5.441

1931-3543

Thomas W. Holmes,

Congenital Diaphragmatic Hernia Studies

Abstract Spastic neuromuscular diseases often produce an esophageal motor dysfunction characterized by relaxation (chalasia) of the cardiac sphincter mechanism. Reflux of gastric fluids, often high in acid concentration, results in esophagitis with bleeding and frequent stricture formation. An associated hiatal hernia is present in most affected patients, possibly as a subsequent development. Autonomic imbalance with parasympathetic predominance is suspected as mediator of esophageal relaxation and hyperacidity. Diminished vagal activity, and gastric hypoacidity have been documented in achalasia, by other authors. Treatment is surgical. Best results have been obtained by vagotomy, pyloroplasty, and restoration of the angle of Hiss by gastropexy. Significant hemorrhage has not recurred following vagotomy. Associated hiatal hernias are repaired by a simple transabdominal technique, to the left of the esophagus. Most strictures have remained functionally patent following control of reflux. One hundred three patients have been operated upon.