Lesions of the Cardiac Orifice of the Stomach Produced by Vomiting

In a previous communication we1called attention to a clinical syndrome associated with characteristic lesions at the junction of the esophagus and the cardiac opening of the stomach. The chief clinical manifestations of these lesions were persistent vomiting and retching, frequently precipitated by alcoholic debauches and associated with massive hematemesis. The history of some of the patients revealed similar previous attacks. In four of the patients the hemorrhage was so severe that shock and death followed. Autopsy revealed from two to four fissure-like lesions of the mucosa, characteristically arranged around the circumference of the cardiac opening, along the longitudinal axis of the esophagus. The lesions extended up into the esophagus or down into the cardiac opening of the stomach. On microscopic examination the fresh lesions were found to be ulcerations of the mucosa, extending as deep as the muscular layer. The floor of the ulcers was composed of fresh