[Clinical picture and differential diagnosis of esophageal reflux and hiatal hernia complex]

In the years from 1948 to 1977, 359 patients with simple or complicated reflux disease of the oesophagus (RDOe) and/or the hiatushernia complex were operated on at the 1st Clinic of Surgery of the Medical Faculty, Palacký University in Olomouc. The authors found the following frequency of occurrence of the fundamental symptoms: (1) In simple RDOe, pyrosis in 82%, pain in 82% (epigastrium 42%, thorax 30%, throat 7%), a postural impairment in 50%, regurgitation in 30%, vomiting in 15%, ructus and dysphagia in 11%. The median time of the anamnesis was 5.6 years. --(2) In the complicated RDOe, the most frequent symptoms were dysphagia in 78%, pyrosis in 62%, pain in 39%, loss of weight in 33%, and regurgitation in 28%. The median time of the anamnesis was 2.5 years. Only in 20% of the patients, a longer anamnesis of the subjective complaints was recorded. --(3) In cases of paraoesophageal hernias, the fundamental symptom was pain--in the epigastrium in 62% and retrosternally in 38%. There followed vomiting in 38%. Quite asymptomatical was the course of the disease in 12% of the patients. The median time of the anamnesis was 2 years. --(4) In the mixed form of hiatus hernias, the gastro-eosophageal reflux was preoperatively present in 46%; this was consistent with the symptomatology. Coincidence of the RDOe with cholelithiasis was found in 20% and in combination with a duodenal ulcus in 11% of the cases. These two forms of the disease are now mostly treated with the antireflux operation. In cases of an ulcus duodeni, superselective vagotomy and fundoplicatio according to Nissen-Rossetti are the methods of choice. --In 5% of the patients, the development of the reflux symptomatology had been preceded by a stomach resection. In 4 patients with reflux stenosis, the interval between the operation and the stenosis was very short (1 to 12 weeks).