When the lower esophagus is subjected to repeated or continuous exposure to gastric secretions regurgitating up from the stomach, esophagitis with ulceration is likely to develop. With recurring esophagitis and ulceration, healing with scar formation is likely to progress, and if this is extensive enough, it may actually produce stenosis of the esophageal lumen. As the esophageal disease continues and progresses, scarring of the lower esophagus may lead to enough distortion to result in its actual shortening. In some such cases there is also a diaphragmatic hernia—a physical condition which in itself predisposes to regurgitation. When this process occurs in a patient who has an underlying duodenal ulcer diathesis—ie, a basic peptic hypersecretion—the regurgitation is likely to be relentless, and the intensity of the insult may be serious. The dismal fate of patients caught in this vicious cycle is readily envisioned.
Early and intense attention to the hypersecretion must be