Surgical management of hiatal herniae and oesophageal strictures in systemic sclerosis.

Brain, R. H. F. (1973). Thorax, 28, 515-520. Surgical management of hiatal herniae and oesophageal strictures in systemic sclerosis. The clinical manifestations of 10 patients with systemic sclerosis whose oesophageal complications were managed by surgery are reported. Ninety per cent had a severe ulcerating type of oesophagitis and all had hiatal herniae demonstrable by contrast radiology. All but two had fibrous strictures. Their treatment by surgery is reviewed. Earlier diagnosis of reflux oesophagitis should be beneficial in leading to successful control by a simple hiatal hernia repair. The severity of the oesophagitis is explained. Stricture formation, when present, should be treated by excision with replacement by jejunum or colon before the cardiopulmonary manifestations of the disease preclude major surgical measures. The finding of an impaired vagal neurological supply to the oesophagus in the form of a deficiency in Auerbach's ganglion cells in two patients is of interest. Reflux oesophagitis is classified.