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A retroflexed view of a hiatal hernia. (Esophagoscopy Clinic).

A 47-year-old male accountant came to the office with a 2-year history of heartburn and a dry, nonproductive, nocturnal cough. He also reported excessive throatclearing and a globus sensation. Transnasal esophagoscopy (TNE) revealed no evidence of esophagitis or a web, stricture, or neoplasm. However, retroflexed TNE of the lower esophageal sphincter (LES) detected a large, sliding hiatal hernia (figure, A).

Twenty-four-hour dual-probe pH testing revealed severe proximal and distal acid exposure (figure, B), which was probably the cause of the patient's heartburn and cough. The patient underwent a laparoscopic reduction of the hernia and a Nissen fundoplication.
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Article Details
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Author:Koufman, James A.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 1, 2003
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