Introduction

Abstract

Grouped into nine sections, the 31 articles in this supplement collectively offer a wide spectrum of information on the subject of gastroesophageal reflux disease (GERD). This supplement is based on the information presented at the Second Multi-Disciplinary International Symposium on Supraesophageal Complications of Reflux Disease on August 6–8, 1998, in Seattle, Washington. The discussion begins with four updates on mechanisms for protecting the airway against aspiration of gastric content. In the first update, the isolation of a mechanism that prevents herniation in swallow-related esophageal shortening and that, when dysfunctional, also may contribute to reflux esophagitis reopens the question of hiatus hernia and its relation to reflux esophagitis. The information in the second update is a functional classification of eight reflex-mediated airway-protective mechanisms identified in patients without GERD. Turning to lung response to aspiration and studies of patients with cystic fibrosis, the third update includes information about two more protective mechanisms: neutralization of acid and water transport, drawing specific attention to bicarbonate secretion impairment as a potential contributor to reflux injuries. The last update is an examination of secondary esophageal peristalsis in patients with GERD. As does the first update, this one postulates that a defect in esophageal sensation is responsible for low response to reflux.