In Reply.—In none of our patients was there any evidence from a carefully obtained history, physical examination, and chest roentgenogram of pulmonary disease. The dietary history and observation in the hospital indicated that caloric intake was adequate, and loss of calories by vomiting was not sufficient to suggest that a caloric deficiency contributed to the hypoproteinemia. Postoperative 51Cr studies were not performed to demonstrate a cessation of the protein-losing enteropathy. The return of serum albumin levels to normal within one week of surgery in the face of the protein catabolic state associated with surgery is strong evidence that the excessive protein loss was reversed and that the patients were not protein depleted.
Since we could not detect other causes of protein-losing enteropathy, it was assumed but not proved that the excessive protein loss was from the severely inflamed esophagus in each case. In case 2 an attempt was
HERBST JJ. Gastroesophageal Reflux-Reply. Am J Dis Child. 1977;131(9):1035. doi:10.1001/archpedi.1977.02120220101021