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January 1974

Gastroesophageal Reflux: A Panel by Correspondence

Arch Surg. 1974;108(1):16-23. doi:10.1001/archsurg.1974.01350250010004

This is another Panel by Correspondence in a series being published by the Archives. Three recognized experts on gastroesophageal reflux were asked to participate, and with their help ten questions were composed; each expert was then asked to answer them independently. Since it is not possible to have direct discussion of any differences of opinion that may be expressed in this type of panel among the panelists themselves, an editorial comment appears at the end which attempts to summarize the major points. The Archives is grateful to the distinguished surgeons who have agreed to participate in this panel on "Gastroesophageal Reflux."

Question 1: What, in your opinion, are the normal mechanisms that maintain competence of the cardia and prevent esophageal reflux? When reflux occurs, is a hiatal hernia always present?

Dr. Hill: The most important mechanism in the prevention of reflux is the lower esophageal sphincter. This has been well