"Silent" Gastroesophageal Reflux: An Important but Little Known Cause of Pulmonary Complications

¹ San Diego, California

A series of 25 patients with proved gastroesophageal reflux with or without roentgenographically-demonstrable hiatus hernia in whom the digestive abnormality came to light in the course of study for chronic pulmonary suppuration, has been presented. The pulmonary symptoms included bronchitis, often accompanied by hemoptysis, bronchiectasis, unresolved pneumonitis and in one, empyema. While the possibility that these are two relatively frequent coexisting disease states cannot be completely excluded, the fact that esophageal diseases producing dysphagia are known to produce pulmonary sequelae has made it reasonable to reach the same conclusion regarding chronic nocturnal aspiration of gastric contents in the patient with an incompetent cardioesophageal junction. Of 15 patients surgically treated, of whom nine had only repair of their hiatus hernia, both the pulmonary and gastrointestinal symptoms were relieved in all. This experience reaffirms that all patients with pulmonary infection or disease of obscure etiology should be investigated for occult gastroesophageal reflux.