Sir.—Dr Herbst and co-workers, in the November 1976 issue of the Journal (130:1256, 1976), reported on three children with gastroesophageal reflux (GER), protein-losing enteropathy, and finger clubbing. This valuable documentation again shows the severe consequences of chronic GER in the pediatric-aged patient.
I would like to ask the authors the following questions about their article:
Did the history or physical examination suggest the presence of pulmonary disease? What studies besides chest roentgenograms were done to exclude GER-associated pulmonary disease?
2. Did you demonstrate sufficient intake of food or was caloric deprivation a contributing cause to the hypoalbuminemia? Did 51Cr studies postoperatively demonstrate a cessation in stool loss in association with a rise in serum albumin level?
3. Was there a fall-off in height and weight growth prior to surgery and a resumption of normal growth postoperatively?
4. At what point in the gastrointestinal tract did protein loss occur