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May 1964

Symptomatic Esophageal Hiatus HerniasStudy of 105 Patients

Arch Intern Med. 1964;113(5):737-743. doi:10.1001/archinte.1964.00280110117022

The present study was undertaken to ascertain the effects of long periods of medical management in a group of patients with noncongenital, nontraumatic, symptomatic hiatus hernias.

Clinical investigation suggests that most symptoms of hiatus hernias are produced by esophageal reflux.1-4 Manometric studies 5,6 indicate that the lower esophageal physiologic sphincter (or vestibule) is a zone higher in pressure than the gastric pressures and normally prevents reflux from the stomach (Figure). In the presence of a hiatus hernia, however, this zone of high pressure as well as normal esophageal contractions becomes disturbed, and reflux ensues. In addition, pressure effects of the hernia in the thorax and other mechanical disturbances may produce symptoms.

Selection of Cases  The records of the first 600 patients with hiatus hernias seen at the Lahey Clinic since 1935 were reviewed. Of this group, 105 patients were considered to have symptomatic hernias (Table 1). Cases in which

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