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March 22, 1976, Vol 235, No. 12 >
ARTICLE | March 22, 1976

Heartburn: Title and subTitle BreakThe Role of Radiology FREE

Bernard S. Wolf, MD
[+] Author Affiliations

Reprint requests to Department of Radiology, Mount Sinai School of Medicine, 5th Ave and 100th St, New York, NY 10029 (Dr Wolf).


JAMA. 1976;235(12):1244-1247. doi:10.1001/jama.1976.03260380038023
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References

There is currently controversy as to the importance of the radiologic demonstration of a hiatal hernia, reflux, or both as the explanation of heartburn. It is clear, however, that clinical-radiologic correlation requires additional observations such as the straightness of the potential path for reflux, the presence of a contractile esophagogastric region, the degree of extrinsic compression of the cuff of the stomach within the hiatus, the size of the hernia, and the peristaltic activity of the body of the esophagus. Vigorous or water-swallowing maneuvers to demonstrate reflux are unreliable in individual cases. Of importance is the concept that the so-called patulous cardia, or effaced abdominal esophagus or widened or absent "submerged segment," is a variety of sliding hiatal hernia that is often neglected radiologically but may be of considerable clinical significance.

(JAMA 235:1244-1247, 1976)

REFERENCES

1 +
Edwards DAW:  Symposium on gastroesophageal reflux and its complications: Definitions, the anti-reflux mechanism, and symptoms . Gut 14:233-237, 1973;.
2 +
Wolf BS:  Sliding hiatal hernia: The need for redefinition . Am J Roentgenol Radium Ther Nucl Med 117:231-247, 1973;.
3 +
Wolf BS, Guglielmo J:  A method for the roentgen demonstration of minimal hiatal herniation . J Mt Sinai Hosp 23:738-741, 1956;.
4 +
Stilson WL, Sanders I, Gardiner GA, et al:  Hiatal hernia and gastroesophageal reflux . Radiology 93:1323-1327, 1969;.
5 +
Hiebert CA, Belsey R:  Incompetency of the gastric cardia without radiologic evidence of hiatal hernia . J Thorac Cardiovasc Surg 42:352-359, 1961;.
6 +
Kramer P:  Does a sliding hiatus hernia constitute a distinct clinical entity? Gastroenterology 57:442-448, 1969;.
7 +
Wolf BS:  Roentgen features of the normal and herniated esophagogastric region: Clinical correlations , in Glass GBJ (ed): Progress in Gastroenterology. New York, Grune and Stratton Inc, 1970;, vol 2, pp 288-315.
8 +
Bennett JR:  Symposium on gastroesophageal reflux and its complications: The physician's problem . Gut 14:246-249, 1973;.
9 +
Edwards DAW:  The anti-reflux mechanism: Manometric and radiologic studies . Br J Radiol 34:474-487, 1961;.
10 +
Heitman P, Wolf BS, Sokol M, et al:  Simultaneous cineradiographic-manometric study of the distal esophagus: Small hernias and rings . Gastroenterology 50:737-753, 1966;.
11 +
Wolf BS, Heitman P, Cohen BR:  The inferior esophageal sphincter, the manometric high pressure zone, and hiatal incompetence . Am J Roentgenol Radium Ther Nucl Med 103:251-276, 1968;.
12 +
Clark MD, Rinaldo JA, Eyler WR:  Correlation of manometric and radiologic data from the esophagogastric area . Radiology 94:261-270, 1970;.
13 +
Longhi EH, Jordan PH:  Simultaneous cineradiographic and manometric analysis of incomplete emptying of the esophagus . Am J Surg 121:229-237, 1971;.
14 +
Habibulla KS:  The diaphragm as an anti-reflux barrier . Thorax 27:692-702, 1972;.
15 +
Hiebert CA:  Primary incompetence of the cardia . Am J Surg 119:365-371, 1970;.
16 +
Wolf BS:  The roentgen diagnosis of minimal herniation: Motor phenomena in the terminal esophageal segment ("vestibule") . J Mt Sinai Hosp 23:90-109, 1956;.
17 +
Stein GN, Finkelstein AK, Markowitz RI:  The x-ray diagnosis of hiatus and diaphragmatic hernia , in Bockus HL (ed): Gastroenterology , ed 3. Philadelphia, WB Saunders Co, 1974;, vol 1, pp 375-386.
18 +
Skinner DB, Belsey RHR:  Surgical management of esophageal reflux and hiatus hernia . J Thorac Cardiovasc Surg 53:33-50, 1967;.

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1 +
Edwards DAW:  Symposium on gastroesophageal reflux and its complications: Definitions, the anti-reflux mechanism, and symptoms . Gut 14:233-237, 1973;.
2 +
Wolf BS:  Sliding hiatal hernia: The need for redefinition . Am J Roentgenol Radium Ther Nucl Med 117:231-247, 1973;.
3 +
Wolf BS, Guglielmo J:  A method for the roentgen demonstration of minimal hiatal herniation . J Mt Sinai Hosp 23:738-741, 1956;.
4 +
Stilson WL, Sanders I, Gardiner GA, et al:  Hiatal hernia and gastroesophageal reflux . Radiology 93:1323-1327, 1969;.
5 +
Hiebert CA, Belsey R:  Incompetency of the gastric cardia without radiologic evidence of hiatal hernia . J Thorac Cardiovasc Surg 42:352-359, 1961;.
6 +
Kramer P:  Does a sliding hiatus hernia constitute a distinct clinical entity? Gastroenterology 57:442-448, 1969;.
7 +
Wolf BS:  Roentgen features of the normal and herniated esophagogastric region: Clinical correlations , in Glass GBJ (ed): Progress in Gastroenterology. New York, Grune and Stratton Inc, 1970;, vol 2, pp 288-315.
8 +
Bennett JR:  Symposium on gastroesophageal reflux and its complications: The physician's problem . Gut 14:246-249, 1973;.
9 +
Edwards DAW:  The anti-reflux mechanism: Manometric and radiologic studies . Br J Radiol 34:474-487, 1961;.
10 +
Heitman P, Wolf BS, Sokol M, et al:  Simultaneous cineradiographic-manometric study of the distal esophagus: Small hernias and rings . Gastroenterology 50:737-753, 1966;.
11 +
Wolf BS, Heitman P, Cohen BR:  The inferior esophageal sphincter, the manometric high pressure zone, and hiatal incompetence . Am J Roentgenol Radium Ther Nucl Med 103:251-276, 1968;.
12 +
Clark MD, Rinaldo JA, Eyler WR:  Correlation of manometric and radiologic data from the esophagogastric area . Radiology 94:261-270, 1970;.
13 +
Longhi EH, Jordan PH:  Simultaneous cineradiographic and manometric analysis of incomplete emptying of the esophagus . Am J Surg 121:229-237, 1971;.
14 +
Habibulla KS:  The diaphragm as an anti-reflux barrier . Thorax 27:692-702, 1972;.
15 +
Hiebert CA:  Primary incompetence of the cardia . Am J Surg 119:365-371, 1970;.
16 +
Wolf BS:  The roentgen diagnosis of minimal herniation: Motor phenomena in the terminal esophageal segment ("vestibule") . J Mt Sinai Hosp 23:90-109, 1956;.
17 +
Stein GN, Finkelstein AK, Markowitz RI:  The x-ray diagnosis of hiatus and diaphragmatic hernia , in Bockus HL (ed): Gastroenterology , ed 3. Philadelphia, WB Saunders Co, 1974;, vol 1, pp 375-386.
18 +
Skinner DB, Belsey RHR:  Surgical management of esophageal reflux and hiatus hernia . J Thorac Cardiovasc Surg 53:33-50, 1967;.

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