The recognition and management of gastroesophageal reflux without hiatal hernia

Abstract Since 1969, 40 additional patients with gastroesophageal reflux without demonstrable hiatal hernia have been identified, treated, and followed. Diagnosis is established from the clinical history of posturally aggravated symptoms plus the identification of a relaxed and incompetent lower esophageal sphincter on esophagoscopy. Esophageal pH studies and manometry may provide supporting evidence when necessary. Twenty‐five of the 31 patients treated by the Mark IV Belsey procedure had a good to excellent result when scored on the basis of durable relief from preoperative reflux symptoms, as well as the ability to swallow easily, belch, and, when necessary, vomit.