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Invited Critique
July 2003

Gastric Surgery as a Long-term Risk Factor for Malignant Lesions of the Larynx—Invited Critique

Arch Surg. 2003;138(7):755. doi:10.1001/archsurg.138.7.755

Our understanding of GERD has evolved tremendously during the past decade. It is known today that GERD can cause respiratory and otolaryngological problems in addition to the more common esophageal symptoms and esophagitis. These extraesophageal manifestations can be due to a vagal reflux arc, to acid in the distal esophagus, or to the upward extent of the refluxate, with direct damage of the bronchial or laryngeal mucosa. Also, the role of duodenogastroesophageal reflux has been recognized as a pathological factor in addition to the traditional acid gastroesophageal reflux. In this study from the Catholic University in Rome, Italy, Cianci and colleagues suggest that long-term gastric surgery is a risk factor for the development of malignant lesions of the larynx due to upward reflux of duodenal contents, duodenogastroesophageal reflux, with direct damage to the larynx. Their conclusions were based on their observation of an increased number of benign and malignant lesions of the larynx in patients after gastric resection, as compared with a control group with dyspeptic symptoms who never had gastric surgery.

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