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The interesting comment of Heading (Gut 2002;50:592–3) on the work by Fibbe et al needs to be completed by considering the anatomical factor in the study of gastro-oesophageal reflux disease (GORD) before advocating any non-medical appropriate treatment (fundoplicator, Stratten procedure, Gastropexie, etc).
The multiple controversies arising from all non-medical proposed treatments, with contradictory results, are due to the complete neglect of delimitating the cardio-oesophageal junction (CEJ) and the shape of the angle of HIS, and the role of the anatomical factor in selecting the correct candidate for successful non-medical treatment.
The new generation of gastrointestinal specialists, who come after the endoscopy era, are not aware of the radiology of the gastrointestinal tract, particularly when we need to have the anatomical configuration of the CEJ.
Gastric physiology and junction motility are the next step in evaluating any case of GORD. Ignoring the anatomical shape of the CEJ is behind the various conflicting results that we are hearing at medical meetings devoted to GORD.
Imposing the study of the anatomical feature of the junction, which is very variable from person to person, is the first step in evaluating any proposed treatment of GORD, medically or surgically.
Applying the devices (Plicator, Stratten procedure, etc) without studying the anatomy of the junction is behind any side effects of these proposed procedures.