Surgery>>>>>The Esophagus and Diaphragmatic Hernia
Question 8#

Maximal esophageal mucosal damage is caused by exposure to:

A. Acidic fluid alone
B. Acidic fluid, food contents, and pepsin
C. Acidic fluid, trypsin, and food contents
D. Acidic fluid, pepsin, and bile salts
E. Neutral fluid, pepsin, and trypsin

Correct Answer is D

Comment:

The potential injurious components that reflux into the esophagus include gastric secretions such as acid and pepsin, as well as biliary and pancreatic secretions that regurgitate from the duodenum into the stomach. There is a considerable body of experimental evidence to indicate that maximal epithelial injury occurs during exposure to bile salts combined with acid and pepsin. These studies have shown that acid alone does minimal damage to the esophageal mucosa, but the combination of acid and pepsin is highly deleterious. Similarly, the reflux of duodenal juice alone does little damage to the mucosa, although the combination of duodenal juice and gastric acid is particularly noxious.