Chalasia, Peptic Esophagitis, and Hiatal Hernia

A Common Syndrome in Patients with Central Nervous System Disease

¹ Assistant Clinical Professor, Department of Surgery, University of California, San Francisco Medical Center

Spastic neuromuscular diseases often produce an esophageal motor dysfunction characterized by relaxation (chalasia) of the cardiac sphincter mechanism. Reflux of gastric fluids, often high in acid concentration, results in esophagitis with bleeding and frequent stricture formation. An associated hiatal hernia is present in most affected patients, possibly as a subsequent development. Autonomic imbalance with parasympathetic predominance is suspected as mediator of esophageal relaxation and hyperacidity. Diminished vagal activity, and gastric hypoacidity have been documented in achalasia, by other authors. Treatment is surgical. Best results have been obtained by vagotomy, pyloroplasty, and restoration of the angle of Hiss by gastropexy. Significant hemorrhage has not recurred following vagotomy. Associated hiatal hernias are repaired by a simple transabdominal technique, to the left of the esophagus. Most strictures have remained functionally patent following control of reflux. One hundred three patients have been operated upon.