Full text of "Ten thousand words often mispronounced;"

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Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal problems worldwide. The aim of this study was to evaluate the clinical spectrum, prevalence, and some of the variables that are supposed to be the risk factors of this chronic disorder. Some patients have persistence of symptoms that were part of their GERD presentation, raising the concern that they are suffering from an ineffective or failing fundoplication. Unexpected postoperative heartburn, regurgitation or chest pain may result in continuation of acid-suppressive medications, or even dose escalation, without documentation. In some cases, wrap failure is implicated.

What is acid reflux?

Gastroesophageal reflux disease (GERD) is the main etiologic factor of erosive esophagitis (“reflux esophagitis”). The prevalence of esophagitis is less than 10% in the general population, and approximately 30% in patients with gastroesophageal reflux symptoms.

Symptoms of erosive esophagitis are not different from symptomatic gastroesophageal reflux, i.e., mainly heartburn, acid regurgitation, and chest pain. Dysphagia may be present whatever the severity of endoscopic lesions, and even in the absence of esophageal stricture. Proton pump inhibitors are the mainstay of medical therapy of reflux esophagitis, providing high healing rates (90%) and symptom relief (70-80%).

Heartburn happens when acid from the stomach comes back up into the food pipe. It is common during pregnancy because of hormonal changes, and because the growing baby is pushing up against the stomach.

The relationship between reflux index (RI) and bolus exposure parameters in multichannel intraluminal impedance (MII) has not been examined sufficiently among children. The significance of acid and bolus exposure in evaluating pediatric reflux disease (RD) was explored by focusing on mucosal lesions. The aim of this Editorial is to describe the growing possibility of a link between gastro-esophageal reflux disease (GERD) and metabolic syndrome on the light of recent epidemiological and pathophysiological evidence.

The state of the art of GERD is described, based on recent definitions, pathophysiological evidence, epidemiology in developed countries, clinical subtypes together with a diagnostic approach specifically focussed on the appropriateness of endoscopy. Metabolic syndrome is accurately defined and the pivotal role of insulin resistance is emphasized. The strong relationship between GERD and metabolic syndrome has been pathophysiologically analyzed, taking into account the role of obesity, mechanical factors and metabolic changes. Data collected by our group regarding eating habits and GERD are briefly summarized at the end of a pathophysiological analysis. The literature on the subject strongly supports the possibility that lifestyle and eating habits may be involved in both GERD and metabolic syndrome in developed countries.

Patients may too often be directed to increasing medical therapies or even redo antireflux procedures rather than revisiting the differential diagnosis from a broader perspective. Efficacy (healing, symptom relief) and cost-effectiveness are the principal reasons for the rapidly increasing use of proton pump inhibitors (PPIs) for the management of gastro-oesophageal reflux disease. The charts of 19 patients with a ringed esophagus were reviewed. A single pathologist interpreted all available esophageal biopsy specimens and graded them for the presence of GERD-related abnormalities. Phone interviews were conducted to assess response to therapy and confirm historical features obtained from medical records.

New studies have also made clear, for the first time, that endoscopy-negative acid reflux disease has a measurable and substantial impact on the patients’ general well-being and quality of life. Patients with endoscopy-negative disease have quality-of-life scores that are similar to those found in patients with oesophagitis.

1 Castell in 1985 described GERD and pressed it as an “iceberg”, 2 thereafter the apparent part of the “iceberg” has been growing con- tinually. Extra-esophageal symptoms may be a consequence of GERD but there is substantial overlap with other etiologies. Patients with documented GERD and prominent symptoms such as chest pain, cough, hoarseness or wheezing do not always realize any benefits in these extra-esophageal symptoms after antireflux surgery.

We see patients with laryngopharyngeal reflux all the time. The train started back in the early ’90s in Winston-Salem when Don Castell and Joe Richter were working with James Koufman, and they put together some very interesting work on the relationship between gastroesophageal reflux and extraesophageal disease. Lo and behold, the larynx was part of this focus, and Dr. Koufman really took off on this and started to educate laryngologists that this can occur. Visit our Acid Reflux / GERD category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Acid Reflux / GERD. The main treatment options for people who repeatedly experience acid reflux in GERD are either PPIs or H2 blockers, both of which are medications.

The key is to keep these patients away from a surgeon. Heaven help these patients if they have a little bit of reflux disease — the success of those patients getting better is very unpredictable. We don’t send patients to surgery just to see if they will get better. We know that antireflux surgery has considerable risk, and it is not done very often anymore. The non-PPI responder is the worst patient to send to an antireflux surgeon.

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