Gastroesophageal Reflux (Differential Diagnosis RDS)

Upper gastrointestinal contrast study in a 1-month-old child with severe vomiting. Left picture: The contrast within the stomach has retrogradely filled up the esophagus; immediately above the diaphragm there is a localized dilatation. During a period of 1.9 years the vomiting persists, and in addition, regurgitation and dysphagia occur. Center picture: After 2 months, part of the gastric fundus has entered the thoracic cavity partially next to the distal esophagus. Right picture: After 16 months the larger part of the stomach lies reversed above the diaphragm. It is a progressive and severe form of gastroesophageal reflux caused by an abnormal fixation of the abdominal esophagus. In the left picture part of the fundus is permanently above the diaphragm = fixed epiphrenic pouch. In the center picture another part of the stomach has herniated into the thoracic cavity next to the epiphrenic pouch in a paraesophageal position = mixed type of hiatal hernia. In the figure on the right, nearly the whole stomach lies reversed above the diaphragm = upsidedown stomach. This development explains why in addition to the vomiting, regurgitation and dysphagia have occurred as an effect of compression of the distal esophagus by the paraesophageally herniated, differently filled part of the fundus.