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July 7, 1978

Esophageal Mythology

Author Affiliations

From the Internal Medicine Service, National Naval Medical Center, and Uniformed Services University of the Health Sciences, Bethesda, Md.

JAMA. 1978;240(1):44-46. doi:10.1001/jama.1978.03290010048022

RECENT trends in the diagnosis and management of esophageal disorders have led to an outpouring of articles concerned with clarifying the mechanisms behind these disorders. As new data became available, certain well-entrenched "truths" are found to be myths. This report reviews some of the commonly held beliefs pertaining to certain diseases affecting the esophagus and offers some new perspectives based on recently acquired knowledge.

Myth 1 

Hiatal Hernia is the Major Factor Responsible for Gastroesophageal Reflux.—  It is true that a high percentage of patients with reflux symptoms have a hiatal hernia, and for many years this association was believed to indicate a cause-and-effect relationship. It is important to put this observation into a more realistic perspective based on information that is currently available.A sliding hiatal hernia is a common phenomenon that can be demonstrated in up to 33% of young volunteers.1 In addition, a hernia of this