Wolf B S
JAMA. 1976 Mar 22;235(12):1244-7. doi: 10.1001/jama.235.12.1244.
There is currently controversy as to the importance of the radiologic demonstration of a hiatal hernia, reflux, or both as the explanation of heartburn. It is clear, however, that clinical-radiologic correlation requires additional observations such as the straightness of the potential path for reflux, the presence of a contractile esophagogastric region, the degree of extrinsic compression of the cuff of the stomach within the hiatus, the size of the hernia, and the peristaltic activity of the body of the esophagus. Vigorous or water-swallowing maneuvers to demonstrate reflux are unreliable in individual cases. Of importance is the concept that the so-called patulous cardia, or effaced abdominal esophagus or widened or absent "submerged segment," is a variety of sliding hiatal hernia that is often neglected radiologically but may be of considerable clinical significance.
目前，关于通过放射学检查证实食管裂孔疝、反流或两者兼而有之作为胃灼热的解释的重要性存在争议。然而，很明显，临床与放射学的相关性需要额外的观察，如反流潜在路径的笔直程度、食管胃收缩区域的存在、食管裂孔内胃袖口的外在压迫程度、疝的大小以及食管体部的蠕动活动。在个别病例中，通过强力吞咽或吞水动作来证实反流并不可靠。重要的是，所谓的贲门松弛、腹部食管消失、“淹没段”增宽或缺失，是一种滑动性食管裂孔疝，在放射学上常常被忽视，但可能具有相当重要的临床意义。
