OBJECTIVES: Medications that may increase gastroesophageal reflux could be risk factors for esophageal adenocarcinoma; however, epidemiologic studies present conflicting results. We evaluated patients with a high-risk condition, Barrett’s esophagus, to identify risk factors that may act early in the carcinogenic process. METHODS: We conducted a nested case-control study within a large integrated health-services organization. Electronic… Read more »
Endoluminal fundoplication (ELF): evolution of EsophyX, a new surgical device for transoral surgery
A novel endoluminal fundoplication (ELF) technique using a trans-oral and fastener-deploying device (EsophyX, EndoGastric Solutions) was developed and evaluated for feasibility, safety and the treatment of gastroesophageal reflux disease (GERD) in a series of bench, animal, human (phase 1, phase 2, commercial registry) studies. The studies verified biological compatibility, durability and non-toxicity of the polypropylene… Read more »
Concepts in the prevention of adenocarcinoma of the distal esophagus and proximal stomach
Abstract For decades, the incidence rates for squamous cell carcinoma of the esophagus and adenocarcinoma of the distal stomach have been declining while the rates for adenocarcinomas of the esophagus and gastric cardia have increased profoundly. Recent studies have shown that the gastroesophageal junction (GEJ) is regularly exposed to concentrated gastric acid and to a… Read more »
Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease
Guidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD) were published in 1995 and updated in 1999. These and other guidelines undergo periodic review. Advances continue to be made in the area of GERD, leading us to review and revise previous guideline statements. GERD is defined as symptoms or mucosal damage produced by… Read more »
Endoscopic appraisal of the gastroesophageal valve after antireflux surgery
OBJECTIVES: Little consensus exists regarding the endoscopic assessment of the esophagogastric junction after antireflux surgery. The purpose of this report is to characterize the gastroesophageal valve appearance unique to each type of antireflux procedure and to introduce an endoscopic lexicon by which to describe this anatomic region. METHODS: Endoscopic images were obtained from patients who… Read more »
Management of gastroesophageal reflux disease in primary care: results of a survey in 2 areas in Germany
BACKGROUND: The incidence of gastroesophageal reflux disease (GERD) is increasing. Although guidelines have been issued on the diagnosis and treatment of GERD, the way in which these should be applied in everyday practice is unclear. The aim of the present survey was to interview private-practice physicians on their personal opinions concerning the management of GERD.… Read more »
Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview
The aim of this paper is to present a systematic overview of the efficacy of the proton pump inhibitors (PPI), omeprazole and the newer lansoprazole, in the healing and maintenance of erosive or worse (grade II to IV) esophagitis. At the time of the 1996 gastroesophageal reflux disease (GERD) consensus meeting, a third PPI, pantoprazole,… Read more »
Gastroesophageal sphincter: a model
Abstract There is substantial experimental and anatomic evidence suggesting that the human lower esophageal sphincter is not a muscular ring but has its correlate in the arrangement of the so-called muscular clasps and oblique sling fibers at the gastroesophageal junction. We assessed the mode of action of these distinct muscle units in a mechanical model.… Read more »
Mechanisms of action of antireflux surgery: theory and fact
Abstract Despite the absence of definitive explanations regarding either the physiologic or surgical factors which curtail gastro-esophageal reflux, effective antireflux operations exist. This article explores the theoretical factors relevant to the surgical control of reflux. These theoretical features include: (1) the pressure, length, and location of the manometrically defined lower esophageal sphincter (LES); (2) the… Read more »
The medical management of reflux esophagitis. Role of antacids and acid inhibition
Of the more than 60 million adult Americans who have heartburn at least once a month, 60% choose over-the-counter medication rather than consulting their physician. Those individuals who do seek medical advice for reflux symptoms will probably receive a prescription for an H2-receptor antagonist, although in many instances simple life-style changes and occasional use of… Read more »