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A 41‐year‐old man was diagnosed with gastro‐oesophageal reflux disease (GORD) in 1993 when he took part in a clinical study. He was on H2 receptor antagonists and then proton‐pump inhibitors until he was referred to the surgical clinic in 2001 for worsening reflux symptoms.
An upper gastrointestinal endoscopy was performed, which showed a large sliding hiatus hernia, a Barrett's mucosa 3 cm in length, and distal gastritis. Oesophageal pH studies and manometry showed marked reflux disease and impaired motility in the distal oesophagus. A preoperative barium swallow showed a sliding hiatus hernia, considerable oesophageal reflux and erosions in the stomach.
The patient underwent trans‐abdominal Lind fundoplication in 2003. He was discharged from the clinic after a full recovery. Eleven months after his surgery, he presented with recurrent severe reflux symptoms. He had a gastroendoscopy and a barium meal (figure 11).
What is the diagnosis?
See page 1231 for answer
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