Esophagitis Associated with Esophageal Hiatal Hernias: An Experimental Evaluation of the Effect of Acid-Peptic Inhibition

THIS ESSAY is premised on the hypothesis that present, commonly accepted techniques for surgical correction of esophageal hiatal hernias too often are inadequate. Generally speaking, the structural design of the esophagus is ideal for the ordinary physiological conduit demands. However, transmission of extremes of chemical composition which result in a radically altered pH is very poorly tolerated. Everyone is keenly aware of the disability which follows ingestion of strong acids or alkalis, but naturally-occuring, altered anatomical and physiological states probably claim an even greater number of victims than these self-inflicted hand-to-mouth lesions. While the nature of the prevention of the autodigestion of the stomach itself is still far from solved, it can be readily demonstrated that both inlet and outlet of the stomach have been designed to prevent repeated chemical insults from the digestive reservoir. Continuous pH recordings over a 24-hr period reveal that under normal conditions there are very