Topic: HeartburnEsophageal acid clearance
Once acid and pepsin get into the esophagus, as occurs under normal circumstances in all of us,
it is cleared promptly by salivary secretions and swallowing. Of importance is that patients
with hiatal hernia have a very prolonged acid clearance time. In other words, the presence of
the hernia results in delayed clearance of acid and pepsin from the esophagus that can then
go on to result in esophagitis, ulcers, strictures, etc.
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Atypical symptoms
It has been recognized over the past decade that a number of patients with GERD present with cough, hoarseness,
asthma, or bronchitis.
In other words, they fail to develop heartburn symptoms or direct intraesophageal
complications, but their symptoms are secondary to, in large part, pulmonary aspiration. Of interest,
the success rate with surgery in those patients with atypical symptoms (ie, cough, hoarseness, asthma,
bronchitis) was substantially less than in those with conventional GERD.
Typically, only approximately
55% of those with cough or hoarseness responded to fundoplication with relief of their symptoms,
while well over 90% with conventional heartburn respond to fundoplication.
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