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Ann Thorac Surg 1976;22:120-130
© 1976 The Society of Thoracic Surgeons
From the Department of Surgery, Section of Thoracic Surgery, and the Department of Internal Medicine, Simpson Memorial Institute, University of Michigan, Ann Arbor, MI.
* Address reprint requests to Dr. Orringer, C-7175 University Hospital, Ann Arbor, MI 48109.
Fifty-three patients with scleroderma were evaluated by history, barium swallow, and esophageal function tests. The most common esophageal symptoms were heartburn and dysphagia. Abnormal motility was seen radiologically in 43 patients, gastroesophageal reflux in only 9. Esophageal function tests demonstrated: (1) abnormal motility in 51 patients and lack of a distal esophageal high-pressure zone in 18; (2) moderate to severe gastroesophageal reflux in 38; and (3) abnormal acid-clearing ability in 50.
Eleven patients, including 8 with peptic stricture, underwent the combined Collis-Belsey operation. Symptomatically, reflux was abolished in all and dysphagia in 10. Roentgenograms showed that regression of strictures was complete in 5 and partial in 3. Postoperative esophageal function tests in 9 patients demonstrated a competent distal esophageal valvular mechanism in 7.
Gastroesophageal reflux, not impaired motility, is the major cause of esophageal symptoms in scleroderma. Its effective operative control is not contraindicated by systemic disease in these patients.
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