Gastroesophageal Reflux Secondary to Blunt Injury-Reply

Farhad Navab, MD; E. Clinton Texter Jr, MD
Arch Intern Med. 1985;145(11):2133-2134. doi:10.1001/archinte.1985.00360110209057.
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—It is difficult to ascribe a cause-and-effect relationship between blunt trauma and symptomatic gastroesophageal reflux because of numerous problems associated with major trauma. Blunt injury due to motor vehicle accidents can cause traumatic rupture of the diaphragm, usually on the left side, and due to high pleuroperitoneal pressure gradient.1 Rupture of the right side of the diaphragm may occur after blunt trauma,2 but injuries to the central part of the diaphragm have not been reported, presumably due to stabilization by central structures.

Premedications used before anesthesia may reduce the lower esophageal sphincter pressure (LESP). In one study, LESP values were 12.89 ±1.45, 11.16 ±1.30, and 11.81 ±1.22 mm Hg before injections of morphine sulfate, 7 to 10 mg, meperidine (Pethidine) hydrochloride, 40 to 50 mg, and diazepam, 2.5 to 10 mg, respectively.3 In addition, reflux score measured by the standard acid reflux test increased after injection of


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