Oesophageal Reflux–Normal or Pathological?*

SUMMARYThe incidence of hiatus hernia with or without reflux appears to be very high. This condition is associated with upper gastro‐intestinal disorders which might be the symptom complex of imbalance in the autonomic nervous system. During the hypervagal state, the longitudinal fibres of the oesophagus contract and cause hiatal disorder or hiatus hernia and may upset the one‐way mechanism at the cardia. When the balance between the vagus and the sympathetic system is restored, the patient's symptoms disappear. There may be remissions and exacerbations. A series of normal subjects were able to demonstrate their ability to regurgitate at will and to produce a hiatus hernia at will. Cineradiological studies combined with oesophageal pressure studies have shown that any person can train himself or herself to do this. This raises a big question in the line of treatment, especially that of hiatal disorder.The question still remains to be answered whether a person who has a hiatus hernia and involuntary reflux can be trained to reduce the hernia and prevent the reflux, and whether voluntary inhibition of the vagus will also serve to reduce the gastric motility and secretion.