A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. The mucous plug prevents further reflux of the acid contents of the stomach into the esophagus and mouth. After the appearance of mucosal prolapse, the symptoms and signs of esophagitis disappear. The most characteristic complaint of the patients is retrosternal pain on lying and bending down. Endoscopy with provocative tests reveals the mucosal prolapse. Tooth erosions due to previous acid reflux into the mouth are diagnostic. The symptoms of this new subtype of sliding hiatus hernia were cured by the Nissen fundoplication.
12 patients with Crohn's disease (CD) and 9 with ulcerative colitis (UC) affecting the colon were studied by scanning electron microscopy (SEM). The macroscopically unaffected mucosa was distorted in both diseases by irregularities in the normal polygonal units. The individual absorptive cells were disorganized, having lost their pentagonal-hexagonal cell borders. In 7 cases of CD an increase of goblet cells was seen. In 4 cases of UC their number was decreased. One case of UC showed an increased number of goblet cells, the case possibly belonging to the sub-category of indeterminate colitis. The microvilli were normal in CD but affected in many cells from cases of UC. Re-epithelization was followed during conservative treatment in 2 UC patients. It is suggested that with simplified SEM techniques the instrument can be a useful aid in the differential diagnosis of inflammatory colonic diseases.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.