The relationship between hiatal hernia and reflux esophagitis was compared in 93 patients who underwent both radiographic and endoscopic examination of the esophagus. In 46 patients with a normal esophagus shown endoscopically, hiatal hernia was present in 59%, while 94% of 47 patients with reflux esophagitis had hiatal hernia. The positive and negative predictive values for hiatal hernia in diagnosing or excluding esophagitis were 62% and 86%, respectively. Extrapolation of these data and review of the literature suggest that much of the confusion concerning the relationship between hiatal hernia and reflux esophagitis is based on reports of populations with considerable variation in the prevalence of esophagitis and in which the radiographic criteria for diagnosing hiatal hernia have not been uniformly applied.

Cowden's disease, or multiple hamartoma syndrome, is an uncommon condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. We describe a 51-year-old man with hyperplastic polyposis of the entire alimentary tract as the most prominent feature of this disease. We also present a review of 85 cases of this entity as reported in the English medical literature, and summarize the pertinent findings.

Three hundred multiphasic examinations of the lower esophagus and esophagogastric region were assessed to determine the individual sensitivities of the full-column, mucosal relief, and double-contrast techniques in the detection of common structural abnormalities, such as hiatal hernia, lower esophageal rings, and peptic strictures. In 159 patients, there were 211 structural abnormalities including 153 hiatal hernias, 35 mucosal rings, 20 peptic strictures, and 3 esophageal diverticula. The overall sensitivity of the full-column technique in detecting these abnormalities was 100% compared to 52% and 34% for the mucosal relief and double-contrast techniques, respectively. We conclude that the prone full-column technique must be incorporated into any examination of the esophagogastric region if these common abnormalities are to be demonstrated reliably.

No abstract

Forty-one (98%) of 42 patients with achalasia of the esophagus had pneumatic dilatation performed successfully using the Brown-McHardy dilator. One to four dilatations (mean, 1.9) were done on each patient with inflation pressures of 8-15 psi (mean, 11.1 psi). Immediately after the procedure, all patients were examined radiographically by injection of contrast material into the lower esophagus through a nasoesophageal tube. Two immediate and two delayed perforations occurred. Six intramural hematomas were noted, five of which resolved spontaneously. The luminal diameter at the esophagogastric junction increased from a mean of 4.2 mm before dilatation to 7.5 mm following treatment. Four patients with previous Heller myotomy were dilated without complications. Perforation was more common in patients with a minimal change in the esophagogastric diameter. Thirty-five patients (85%) improved symptomatically within several days following pneumatic dilatation. Excluding patients with perforation, the postdilatation appearance of the lower esophagus poorly correlated with clinical response.

We compared the clinical, radiographic, and manometric findings in 10 patients with atypical achalasia showing complete lower esophageal sphincter (LES) relaxation to 39 patients with classic achalasia (i.e., incomplete LES relaxation). Those with atypical achalasia were younger (46.1 vs 60.6 years), had dysphagia of shorter duration (18.7 vs 45.7 mos), had lost less weight (8.2 vs 21.5 lbs), and had less esophageal dilatation (2.8 vs 3.9 cm). However, the mean LES pressures (34.5 vs 37.7 mmHg) and the esophagogastric junction calibers (4.5 vs 4.8 mm) were similar. Radionuclide esophageal emptying studies were done in 15 patients (6 with atypical achalasia; 9 with classic achalasia) and were abnormal in all. Most patients in both groups (90 and 92%) responded well to pneumatic dilatation. We conclude that achalasia with apparent LES relaxation may represent an early form of this motor disorder and that the radiographic findings remain characteristic except for less dilatation of the esophagus.

No abstract

The efficacy of the barium enema examination and abdominal computed tomography (CT) was investigated in 81 patients who had undergone operation for colorectal carcinoma. Recurrent disease was found in 52 patients and was divided into local (anastomotic and perianastomotic) and remote (distant and hepatic metastases) types. In 32 patients with locally recurrent carcinoma, the sensitivity of the barium enema examination was 88%; for CT it was 69%. Conversely, the barium enema examination was not useful for detecting remote metastases shown on CT, which disclosed disease at one or more sites in 47 (90%) of the 52 patients. CT best evaluated recurrences remote from the anastomosis, pelvic recurrences in patients with colostomies, and hepatic metastases. Barium enema examination and CT were therefore found to be complementary modalities.