PAEA Surgery End Of Rotation (EOR) Practice Exam

Which of the following can contribute to esophageal reflux?

1. Increased esophageal motility

2. Lower esophageal sphincter (LES) tone

3. Hiatal hernia

4. None of the above

The correct answer is: Hiatal hernia

The correct answer highlights a key anatomical factor that can significantly contribute to esophageal reflux. A hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity, which can disrupt the normal mechanics of the lower esophageal sphincter (LES). This disruption can lead to decreased pressure in the LES, making it less effective at preventing the backflow of gastric contents into the esophagus. This backward flow of stomach acids can cause symptoms of gastroesophageal reflux disease (GERD). While increased esophageal motility is generally associated with propelling contents down the esophagus, it does not directly facilitate reflux as effectively as the structural issues arising from a hiatal hernia. Lower esophageal sphincter (LES) tone can indeed contribute to reflux, but this is more of a symptom or condition that might be present rather than a specific anatomical change like that seen in a hiatal hernia. Thus, out of the choices given, acknowledging the role of a hiatal hernia provides a clearer understanding of how such anatomical conditions can lead to the development of esophageal reflux.