By Michael F. Vaezi
This quantity provides the newest advancements in analysis and therapy of sufferers with gastroesophageal reflux sickness (GERD) and those that remain refractory to standard GERD cures. The booklet delineates the position of newly built endoscopic treatments in GERD and descriptions the easiest applicants for surgical fundoplication. issues because the hazards linked to GERD, way of life amendment in GERD and the function of H2RA and proton pump inhibitor treatment in treating reflux ailment also are explored.
Written by means of specialists within the box, Diagnosis and remedy of Gastroesophageal Reflux illness is a concise but accomplished source that's worthwhile for basic care companies, gastroenterologists, pulmonologists, surgeons and ENT specialists.
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Extra resources for Diagnosis and Treatment of Gastroesophageal Reflux Disease
Sample text
Therefore, advanced imaging techniques may provide endoscopy with an improved sensitivity for the diagnosis of GERD. Esophageal Biopsy The addition of esophageal biopsies to endoscopy allows for histologic assessment in order to assess for microscopic mucosal injury, rule out alternative diagnoses such as eosinophlic esophagitis, and assess for disease complications such as the development of Barrett’s esophagus or neoplasia. Early histologic studies in asymptomatic patients and in whom no reflux was demonstrated by pH studies detailed the normal histologic appearance of the esophageal mucosa characterized by dermal papillae that extended less than halfway to the free luminal margin and a basal cell 3 Diagnostic Approaches to GERD 43 layer occupying less than 15 % of the total thickness of the epithelium.
The primary indications for ambulatory 24-h esophageal pH monitoring are (1) to document excessive acid reflux in patients with suspected GERD but without endoscopic esophagitis, (2) to assess reflux frequency, and (3) to assess symptom association. Standard ambulatory 24-h esophageal pH monitoring measures distal esophageal acid exposure by using a single pH electrode catheter that is passed through the nose and positioned 5 cm above the superior margin of the manometrically determined LES. Although other techniques for electrode placement exist, such as pH step-up (rise in pH from stomach to esophagus) and endoscopic and fluoroscopic placement, they are less accurate and not standardized [38, 39].
Whether such practice can be supported from a resource utilization standpoint may be sensitive to refined estimates of malignant progression, as well as the need for posttreatment endoscopic surveillance. Conclusion Patients with chronic GERD are at risk for development of esophageal pathology. While the prevalence of peptic esophageal stricture has become less common in the era of potent pharmacologic antisecretory therapy, attention is now instead focused upon premalignant and malignant esophageal pathology in the context of an increasing prevalence of EAC.