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. 1986 Nov 15;135(10):1101–1109.

Gastroesophageal reflux: clinical presentations, diagnosis and management.

W E Waterfall, M A Craven, C J Allen
PMCID: PMC1491785  PMID: 2876769

Abstract

Symptomatic gastroesophageal reflux occurs daily in an estimated 7% of adults and weekly or monthly in 29%. Untreated it can lead to esophageal erosions, ulceration and stricture formation. The pathogenesis is often multifactorial: defects in the function of the lower esophageal sphincter, esophageal clearance mechanisms and gastric emptying combine to produce frequent lengthy periods during which the lower esophagus is bathed in regurgitated acid. In most patients reflux disease is easily recognized as recurrent heartburn, regurgitation or dysphagia, or a combination. When acute chest pain or respiratory illness is the primary presenting complaint the patient needs particularly careful investigation to determine whether the symptoms are due to a primary cardiac or respiratory condition, are secondary to gastroesophageal reflux alone or represent a combination of disorders. Endoscopy with biopsy and long-term pH monitoring are the most reliable ways of determining whether reflux disease is present. Additional investigations, such as exercise testing, cardiac catheterization or inhalation challenge, may be needed in patients with cardiac or respiratory symptoms. Treatment should follow a stepped-care approach and in most patients should begin with changes in lifestyle, including dietary manipulation, reducing alcohol and cigarette consumption, and raising the head of the bed, together with appropriate use of antacids or alginate-antacid combinations. H2-receptor antagonists and agents to improve both gastric emptying and the tone of the lower esophageal sphincter may be added in sequence. Most patients will respond well to this regimen. Surgery should be considered only for those with intractable symptoms or with complications (e.g., stricture formation, bleeding, development of dysplastic epithelium in those with Barrett's esophagus, or secondary pulmonary disease that does not respond to medical management). It is successful in 85% of well-selected patients and has few complications.

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Selected References

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  1. BERNSTEIN L. M., BAKER L. A. A clinical test for esophagitis. Gastroenterology. 1958 May;34(5):760–781. [PubMed] [Google Scholar]
  2. BERNSTEIN L. M., FRUIN R. D., PACINI R. Differentiation of esophageal pain from angina pectoris: role of the esophageal acid perfusion test. Medicine (Baltimore) 1962 May;41:143–162. doi: 10.1097/00005792-196205000-00002. [DOI] [PubMed] [Google Scholar]
  3. Babka J. C., Castell D. O. On the genesis of heartburn. The effects of specific foods on the lower esophageal sphincter. Am J Dig Dis. 1973 May;18(5):391–397. doi: 10.1007/BF01071988. [DOI] [PubMed] [Google Scholar]
  4. Bateman D. N., Rawlins M. D., Simpson J. M. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed) 1985 Oct 5;291(6500):930–932. doi: 10.1136/bmj.291.6500.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Behar J., Brand D. L., Brown F. C., Castell D. O., Cohen S., Crossley R. J., Pope C. E., 2nd, Winans C. S. Cimetidine in the treatment of symptomatic gastroesophageal reflux: a double blind controlled trial. Gastroenterology. 1978 Feb;74(2 Pt 2):441–448. [PubMed] [Google Scholar]
  6. Bennett J. R., Atkinson M. Oesophageal acid-perfusion in the diagnosis of precordial pain. Lancet. 1966 Nov 26;2(7474):1150–1152. doi: 10.1016/s0140-6736(66)90472-7. [DOI] [PubMed] [Google Scholar]
  7. Bennett J. R., Buckton G., Martin H. D. Cimetidine in gastro-oesophageal reflux. Digestion. 1983;26(3):166–172. doi: 10.1159/000198884. [DOI] [PubMed] [Google Scholar]
  8. Berquist W. E., Rachelefsky G. S., Kadden M., Siegel S. C., Katz R. M., Fonkalsrud E. W., Ament M. E. Gastroesophageal reflux-associated recurrent pneumonia and chronic asthma in children. Pediatrics. 1981 Jul;68(1):29–35. [PubMed] [Google Scholar]
  9. Boesby S. Gastro-oesophageal sphincter pressure, motility and acid clearing. A study of hiatus hernia patients and normal subjects and of the effect of a modified belsey MK IV repair on the results of the manometric and acid-clearing tests. Scand J Gastroenterol. 1977;12(4):407–416. doi: 10.3109/00365527709181681. [DOI] [PubMed] [Google Scholar]
  10. Booth D. J., Kemmerer W. T., Skinner D. B. Acid clearing from the distal esophagus. Arch Surg. 1968 May;96(5):731–734. doi: 10.1001/archsurg.1968.01330230039006. [DOI] [PubMed] [Google Scholar]
  11. Brand D. L., Eastwood I. R., Martin D., Carter W. B., Pope C. E., 2nd Esophageal symptoms, manometry, and histology before and after antireflux surgery: a long-term follow-up study. Gastroenterology. 1979 Jun;76(6):1393–1401. [PubMed] [Google Scholar]
  12. Bright-Asare P., El-Bassoussi M. Cimetidine, metoclopramide, or placebo in the treatment of symptomatic gastroesophageal reflux. J Clin Gastroenterol. 1980 Jun;2(2):149–156. doi: 10.1097/00004836-198006000-00008. [DOI] [PubMed] [Google Scholar]
  13. Champion M. C., Hartnett M., Yen M. Domperidone, a new dopamine antagonist. CMAJ. 1986 Sep 1;135(5):457–461. [PMC free article] [PubMed] [Google Scholar]
  14. Chevrel B. A comparative crossover study on the treatment of heartburn and epigastric pain: Liquid Gaviscon and a magnesium--aluminium antacid gel. J Int Med Res. 1980;8(4):300–302. doi: 10.1177/030006058000800411. [DOI] [PubMed] [Google Scholar]
  15. Christensen J. Effects of drugs on esophageal motility. Arch Intern Med. 1976 May;136(5):532–537. [PubMed] [Google Scholar]
  16. Cockcroft D. W., Killian D. N., Mellon J. J., Hargreave F. E. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977 May;7(3):235–243. doi: 10.1111/j.1365-2222.1977.tb01448.x. [DOI] [PubMed] [Google Scholar]
  17. Cohen S., Harris L. D. Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med. 1971 May 13;284(19):1053–1056. doi: 10.1056/NEJM197105132841902. [DOI] [PubMed] [Google Scholar]
  18. Cotton P. B., Shorvon P. J. Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease. Clin Gastroenterol. 1984 May;13(2):383–403. [PubMed] [Google Scholar]
  19. Dart A. M., Davies H. A., Dalal J., Ruttley M., Henderson A. H. Diagnosis and prognosis of chest pain with normal coronary arteriograms. Acta Med Scand Suppl. 1981;644:74–76. doi: 10.1111/j.0954-6820.1981.tb03127.x. [DOI] [PubMed] [Google Scholar]
  20. Dart A. M., Davies H. A., Lowndes R. H., Dalal J., Ruttley M., Henderson A. H. Oesophageal spasm and angina: diagnostic value of ergometrine (ergonovine) provocation. Eur Heart J. 1980 Apr;1(2):91–95. doi: 10.1093/oxfordjournals.eurheartj.a061111. [DOI] [PubMed] [Google Scholar]
  21. David P., Denis P., Nouvet G., Pasquis P., Lefrançois R., Morère P. Fonction respiratoire et reflux gastro-oesophagien au cours de la bronchite chronique. Bull Eur Physiopathol Respir. 1982 Jan-Feb;18(1):81–86. [PubMed] [Google Scholar]
  22. Davies H. A., Rhodes J. How often does the gut cause anginal pain? Acta Med Scand Suppl. 1981;644:62–65. doi: 10.1111/j.0954-6820.1981.tb03123.x. [DOI] [PubMed] [Google Scholar]
  23. DeMeester T. R., O'Sullivan G. C., Bermudez G., Midell A. I., Cimochowski G. E., O'Drobinak J. Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg. 1982 Oct;196(4):488–498. doi: 10.1097/00000658-198210000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Demeester T. R., Johnson L. F., Joseph G. J., Toscano M. S., Hall A. W., Skinner D. B. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976 Oct;184(4):459–470. doi: 10.1097/00000658-197610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Dennish G. W., Castell D. O. Inhibitory effect of smoking on the lower esophageal sphincter. N Engl J Med. 1971 May 20;284(20):1136–1137. doi: 10.1056/NEJM197105202842007. [DOI] [PubMed] [Google Scholar]
  26. Dent J., Dodds W. J., Friedman R. H., Sekiguchi T., Hogan W. J., Arndorfer R. C., Petrie D. J. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980 Feb;65(2):256–267. doi: 10.1172/JCI109667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Dodds W. J., Dent J., Hogan W. J., Helm J. F., Hauser R., Patel G. K., Egide M. S. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982 Dec 16;307(25):1547–1552. doi: 10.1056/NEJM198212163072503. [DOI] [PubMed] [Google Scholar]
  28. Dodds W. J., Dent J., Hogan W. J. Pregnancy and the lower esophageal sphincter. Gastroenterology. 1978 Jun;74(6):1334–1336. [PubMed] [Google Scholar]
  29. Dodds W. J., Hogan W. J., Arndorfer R. C., Dent J. Efficient manometric technic for accurate regional measurement of esophageal body motor activity. Am J Gastroenterol. 1978 Jul;70(1):21–24. [PubMed] [Google Scholar]
  30. Dodds W. J., Hogan W. J., Helm J. F., Dent J. Pathogenesis of reflux esophagitis. Gastroenterology. 1981 Aug;81(2):376–394. [PubMed] [Google Scholar]
  31. Dyer N. H., Pridie R. B. Incidence of hiatus hernia in asymptomatic subjects. Gut. 1968 Dec;9(6):696–699. doi: 10.1136/gut.9.6.696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Ellis F. H., Jr Esophageal hiatal hernia. N Engl J Med. 1972 Sep 28;287(13):646–649. doi: 10.1056/NEJM197209282871307. [DOI] [PubMed] [Google Scholar]
  33. Ferguson R., Dronfield M. W., Atkinson M. Cimetidine in treatment of reflux oesophagitis with peptic stricture. Br Med J. 1979 Aug 25;2(6188):472–474. doi: 10.1136/bmj.2.6188.472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ferguson S. C., Hodges K., Hersh T., Jinich H. Esophageal Manometry in Patients with Chest Pain and Normal Coronary Arteriogram. Am J Gastroenterol. 1981 Feb;75(2):124–127. [PubMed] [Google Scholar]
  35. Fiasse R., Hanin C., Lepot A., Descamps C., Lamy F., Dive C. Controlled trial of cimetidine in reflux esophagitis. Dig Dis Sci. 1980 Oct;25(10):750–755. doi: 10.1007/BF01345293. [DOI] [PubMed] [Google Scholar]
  36. Goodall R. J., Earis J. E., Cooper D. N., Bernstein A., Temple J. G. Relationship between asthma and gastro-oesophageal reflux. Thorax. 1981 Feb;36(2):116–121. doi: 10.1136/thx.36.2.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Graham D. Y., Patterson D. J. Double-blind comparison of liquid antacid and placebo in the treatment of symptomatic reflux esophagitis. Dig Dis Sci. 1983 Jun;28(6):559–563. doi: 10.1007/BF01308159. [DOI] [PubMed] [Google Scholar]
  38. Guslandi M., Testoni P. A., Passaretti S., Masci E., Ballarin E., Comin U., Marchi R., Ronchi G., Tittobello A. Ranitidine vs metoclopramide in the medical treatment of reflux esophagitis. Hepatogastroenterology. 1983 Jun;30(3):96–98. [PubMed] [Google Scholar]
  39. Habibulla K. S., Ammann J. F., Collis J. L. Effects of posture in hiatus hernia as studied by oesophageal pH measurement. Thorax. 1971 Nov;26(6):689–695. doi: 10.1136/thx.26.6.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Hasan S. S. Treatment of moderate to severe gastro-oesophageal reflux with an alginate/antacid combination. Curr Med Res Opin. 1980;6(10):645–648. doi: 10.1185/03007998009110074. [DOI] [PubMed] [Google Scholar]
  41. Helm J. F., Dodds W. J., Pelc L. R., Palmer D. W., Hogan W. J., Teeter B. C. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med. 1984 Feb 2;310(5):284–288. doi: 10.1056/NEJM198402023100503. [DOI] [PubMed] [Google Scholar]
  42. Henderson R. D., Wigle E. D., Sample K., Marryatt G. Atypical chest pain of cardiac and esophageal origin. Chest. 1978 Jan;73(1):24–27. doi: 10.1378/chest.73.1.24. [DOI] [PubMed] [Google Scholar]
  43. Higgs R. H., Smyth R. D., Castell D. O. Gastric alkalinization. Effect on lower-esophageal-sphincter pressure and serum gastrin. N Engl J Med. 1974 Sep 5;291(10):486–490. doi: 10.1056/NEJM197409052911002. [DOI] [PubMed] [Google Scholar]
  44. Hogan W. J., Viegas de Andrade S. R., Winship D. H. Ethanol-induced acute esophageal motor dysfunction. J Appl Physiol. 1972 Jun;32(6):755–760. doi: 10.1152/jappl.1972.32.6.755. [DOI] [PubMed] [Google Scholar]
  45. Huxley E. J., Viroslav J., Gray W. R., Pierce A. K. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978 Apr;64(4):564–568. doi: 10.1016/0002-9343(78)90574-0. [DOI] [PubMed] [Google Scholar]
  46. Irwin R. S., Corrao W. M., Pratter M. R. Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis. 1981 Apr;123(4 Pt 1):413–417. doi: 10.1164/arrd.1981.123.4.413. [DOI] [PubMed] [Google Scholar]
  47. Ismail-Beigi F., Horton P. F., Pope C. E., 2nd Histological consequences of gastroesophageal reflux in man. Gastroenterology. 1970 Feb;58(2):163–174. [PubMed] [Google Scholar]
  48. Ismail-Beigi F., Pope C. E., 2nd Distribution of the histological changes of gastroesophageal reflux in the distal esophagus of man. Gastroenterology. 1974 Jun;66(6):1109–1113. [PubMed] [Google Scholar]
  49. Johnson L. F., DeMeester T. R. Evaluation of elevation of the head of the bed, bethanechol, and antacid form tablets on gastroesophageal reflux. Dig Dis Sci. 1981 Aug;26(8):673–680. doi: 10.1007/BF01316854. [DOI] [PubMed] [Google Scholar]
  50. Johnson L. F., Demeester T. R. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974 Oct;62(4):325–332. [PubMed] [Google Scholar]
  51. Kjellén G., Tibbling L., Wranne B. Bronchial obstruction after oesophageal acid perfusion in asthmatics. Clin Physiol. 1981 Jun;1(3):285–292. doi: 10.1111/j.1475-097x.1981.tb00897.x. [DOI] [PubMed] [Google Scholar]
  52. Kjellén G., Tibbling L., Wranne B. Effect of conservative treatment of oesophageal dysfunction on bronchial asthma. Eur J Respir Dis. 1981 Jun;62(3):190–197. [PubMed] [Google Scholar]
  53. Knoblich R. Pulmonary granulomatosis caused by vegetable particles. So-called lentil pulse pneumonia. Am Rev Respir Dis. 1969 Mar;99(3):380–389. [PubMed] [Google Scholar]
  54. Laitinen S., Ståhlberg M., Kairaluoma M. I., Kiviniemi H., Päkkönen M., Lahtinen J., Poikolainen E., Aukee S. Sucralfate and alginate/antacid in reflux esophagitis. Scand J Gastroenterol. 1985 Mar;20(2):229–232. doi: 10.3109/00365528509089662. [DOI] [PubMed] [Google Scholar]
  55. Langman M. J. Antisecretory drugs and gastric cancer. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1850–1852. doi: 10.1136/bmj.290.6485.1850. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Lind J. F., Warrian W. G., Wankling W. J. Responses of the gastroesophageal junctional zone to increases in abdominal pressure. Can J Surg. 1966 Jan;9(1):32–38. [PubMed] [Google Scholar]
  57. Mansfield L. E., Hameister H. H., Spaulding H. S., Smith N. J., Glab N. The role of the vague nerve in airway narrowing caused by intraesophageal hydrochloric acid provocation and esophageal distention. Ann Allergy. 1981 Dec;47(6):431–434. [PubMed] [Google Scholar]
  58. Mansfield L. E., Stein M. R. Gastroesophageal reflux and asthma: a possible reflex mechanism. Ann Allergy. 1978 Oct;41(4):224–226. [PubMed] [Google Scholar]
  59. Martin F., Farley A., Gagnon M., Bensemana D. Comparison of the healing capacities of sucralfate and cimetidine in the short-term treatment of duodenal ulcer: a double-blind randomized trial. Gastroenterology. 1982 Mar;82(3):401–405. [PubMed] [Google Scholar]
  60. Mays E. E., Dubois J. J., Hamilton G. B. Pulmonary fibrosis associated with tracheobronchial aspiration. A study of the frequency of hiatal hernia and gastroesophageal reflux in interstitial pulmonary fibrosis of obscure etiology. Chest. 1976 Apr;69(4):512–515. doi: 10.1378/chest.69.4.512. [DOI] [PubMed] [Google Scholar]
  61. McCallum R. W., Berkowitz D. M., Lerner E. Gastric emptying in patients with gastroesophageal reflux. Gastroenterology. 1981 Feb;80(2):285–291. [PubMed] [Google Scholar]
  62. McHardy G. A multicentric, randomized clinical trial of Gaviscon in reflux esophagitis. South Med J. 1978 Jan;71 (Suppl 1):16–21. doi: 10.1097/00007611-197801001-00004. [DOI] [PubMed] [Google Scholar]
  63. Miller W. N., Ganeshappa K. P., Dodds W. J., Hogan W. J., Barreras R. F., Arndorfer R. C. Effect of bethanechol on gastroesophageal reflux. Am J Dig Dis. 1977 Mar;22(3):230–234. doi: 10.1007/BF01072281. [DOI] [PubMed] [Google Scholar]
  64. Moossa A. R., Skinner D. B. Gastro-oesophageal reflux and hiatal hernia. A re-evaluation of current data and dogma. Ann R Coll Surg Engl. 1976 Mar;58(2):126–132. [PMC free article] [PubMed] [Google Scholar]
  65. Nebel O. T., Castell D. O. Inhibition of the lower oesophageal sphincter by fat--a mechanism for fatty food intolerance. Gut. 1973 Apr;14(4):270–274. doi: 10.1136/gut.14.4.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Nebel O. T., Castell D. O. Lower esophageal sphincter pressure changes after food ingestion. Gastroenterology. 1972 Nov;63(5):778–783. [PubMed] [Google Scholar]
  67. Nebel O. T., Fornes M. F., Castell D. O. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov;21(11):953–956. doi: 10.1007/BF01071906. [DOI] [PubMed] [Google Scholar]
  68. Ockene I. S., Shay M. J., Alpert J. S., Weiner B. H., Dalen J. E. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med. 1980 Nov 27;303(22):1249–1252. doi: 10.1056/NEJM198011273032201. [DOI] [PubMed] [Google Scholar]
  69. Orr W. C., Johnson L. F., Robinson M. G. Effect of sleep on swallowing, esophageal peristalsis, and acid clearance. Gastroenterology. 1984 May;86(5 Pt 1):814–819. [PubMed] [Google Scholar]
  70. Ott D. J., Wu W. C., Gelfand D. W. Reflux esophagitis revisited: prospective analysis of radiologic accuracy. Gastrointest Radiol. 1981 Jan 15;6(1):1–7. doi: 10.1007/BF01890213. [DOI] [PubMed] [Google Scholar]
  71. Perpiñ M., Pellicer C., Marco V., Maldonado J., Ponce J. The significance of the reflex bronchoconstriction provoked by gastroesophageal reflux in bronchial asthma. Eur J Respir Dis. 1985 Feb;66(2):91–97. [PubMed] [Google Scholar]
  72. Perrin-Fayolle M., Bel A., Braillon G., Lombard-Platet R., Kofman J., Harf R., Montagnon B., Pacheco Y., Perpoint B. Asthme et reflux gastro-oesophagien. Résultats de la cure chirurgicale chez 50 malades. Poumon Coeur. 1980;36(4):231–237. [PubMed] [Google Scholar]
  73. Perrin-Fayolle M., Bel A., Kofman J., Harf R., Montagnon B., Pacheco Y., Daudet J., Nesmoz J., Perpoint B. Asthme et reflux gastro-oesophagien. Résultats d'une enquête portant sur 150 cas. Poumon Coeur. 1980;36(4):225–230. [PubMed] [Google Scholar]
  74. Pope C. E., 2nd Pathophysiology and diagnosis of reflux esophagitis. Gastroenterology. 1976 Mar;70(3):445–454. [PubMed] [Google Scholar]
  75. Powell-Jackson P., Barkley H., Northfield T. C. Effect of cimetidine in symptomatic gastro-oesophageal reflux. Lancet. 1978 Nov 18;2(8099):1068–1069. doi: 10.1016/s0140-6736(78)91802-0. [DOI] [PubMed] [Google Scholar]
  76. Richardson C. T. Sucralfate. Ann Intern Med. 1982 Aug;97(2):269–272. doi: 10.7326/0003-4819-97-2-269. [DOI] [PubMed] [Google Scholar]
  77. Richter J. E., Castell D. O. Gastroesophageal reflux. Pathogenesis, diagnosis, and therapy. Ann Intern Med. 1982 Jul;97(1):93–103. doi: 10.7326/0003-4819-97-1-93. [DOI] [PubMed] [Google Scholar]
  78. Roberts R., Henderson R. D., Wigle E. D. Esophageal disease as a cause of severe retrosternal chest pain. Chest. 1975 May;67(5):523–526. doi: 10.1378/chest.67.5.523. [DOI] [PubMed] [Google Scholar]
  79. Saco L. S., Orlando R. C., Levinson S. L., Bozymski E. M., Jones J. D., Frakes J. T. Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive esophagitis. Gastroenterology. 1982 Jun;82(6):1369–1373. [PubMed] [Google Scholar]
  80. Schweitzer E. J., Bass B. L., Johnson L. F., Harmon J. W. Sucralfate prevents experimental peptic esophagitis in rabbits. Gastroenterology. 1985 Mar;88(3):611–619. doi: 10.1016/0016-5085(85)90128-3. [DOI] [PubMed] [Google Scholar]
  81. Sedman A. J. Cimetidine-drug interactions. Am J Med. 1984 Jan;76(1):109–114. doi: 10.1016/0002-9343(84)90758-7. [DOI] [PubMed] [Google Scholar]
  82. Stanciu C., Bennett J. R. Oesophageal acid clearing: one factor in the production of reflux oesophagitis. Gut. 1974 Nov;15(11):852–857. doi: 10.1136/gut.15.11.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  83. Stanciu C., Bennett J. R. Smoking and gastro-oesophageal reflux. Br Med J. 1972 Sep 30;3(5830):793–795. doi: 10.1136/bmj.3.5830.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  84. Ström M. Antacid side-effects on bowel habits. Scand J Gastroenterol Suppl. 1982;75:54–55. [PubMed] [Google Scholar]
  85. THOMPSON J. R. Identification of foreign material in the lungs. Am Rev Respir Dis. 1962 Feb;85:281–281. doi: 10.1164/arrd.1962.85.2.281. [DOI] [PubMed] [Google Scholar]
  86. Thanik K. D., Chey W. Y., Shah A. N., Gutierrez J. G. Reflux esophagitis: effect of oral bethanechol on symptoms and endoscopic findings. Ann Intern Med. 1980 Dec;93(6):805–808. doi: 10.7326/0003-4819-93-6-805. [DOI] [PubMed] [Google Scholar]
  87. Thanik K., Chey W. Y., Shak A., Hamilton D., Nadelson N. Bethanechol or cimetidine in the treatment of symptomatic reflux esophagitis: a double-blind control study. Arch Intern Med. 1982 Aug;142(8):1479–1481. [PubMed] [Google Scholar]
  88. Thomas F. B., Steinbaugh J. T., Fromkes J. J., Mekhjian H. S., Caldwell J. H. Inhibitory effect of coffee on lower esophageal sphincter pressure. Gastroenterology. 1980 Dec;79(6):1262–1266. [PubMed] [Google Scholar]
  89. Vantrappen G., Janssens J., Hellemans J., Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology. 1979 Mar;76(3):450–457. [PubMed] [Google Scholar]
  90. Venables C. W., Bell D., Eccleston D. A double-blind study of metoclopramide in symptomatic peptic oesophagitis. Postgrad Med J. 1973 Jul;49 (Suppl 4):suppl 4–4:77. [PubMed] [Google Scholar]
  91. Wesdorp E., Bartelsman J., Pape K., Dekker W., Tytgat G. N. Oral cimetidine in reflux esophagitis: a double blind controlled trial. Gastroenterology. 1978 May;74(5 Pt 1):821–824. [PubMed] [Google Scholar]
  92. Wesdorp I. C., Dekker W., Klinkenberg-Knol E. C. Treatment of reflux oesophagitis with ranitidine. Gut. 1983 Oct;24(10):921–924. doi: 10.1136/gut.24.10.921. [DOI] [PMC free article] [PubMed] [Google Scholar]
  93. Wynne J. W., Ramphal R., Hood C. I. Tracheal mucosal damage after aspiration. A scanning electron Microscope study. Am Rev Respir Dis. 1981 Dec;124(6):728–732. doi: 10.1164/arrd.1981.124.6.728. [DOI] [PubMed] [Google Scholar]

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