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May 1973

Bilious Vomiting

Arch Surg. 1973;106(5):627. doi:10.1001/archsurg.1973.01350170001001

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Reflux esophagitis is a common occurrence. It can occur with or without the presence of a hiatus hernia, and can be due to reflux of bile and pancreatic secretion as well as to acid reflux. Turner, in an article elsewhere in this issue (see p 685) has reported his experiences with an interesting group of 15 patients who developed postoperative "bilious" regurgitation following subtotal gastrectomy. Proof of reflux was substantiated in these cases by x-ray study and cineradiography. Manometric and pH studies of the lower end of the esophagus were not carried out.

Physiologically, the tone of the lower esophageal sphincter is controlled, at least in part, by gastrin, but also, to a certain extent, by the vagus nerves, by the competency of the phrenoesophageal ligament, by the snugness of the two limbs of the right crus of the diaphragm, and by the position of the gastroesophageal junction relative to

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