ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Symptoms of gastroesophageal reflux disease (GERD) are among the most common encountered in primary practice. Reported symptoms certainly under-represent the true prevalence of this disease in the population, because many patients do not seek care for symptoms of GERD and many physicians do not specifically ask about such symptoms when performing the review of systems. We describe the epidemiology of GERD. We begin by considering the prevalence of GERD as a function of the disease definition used. We then discuss the epidemiology of nonerosive reflux disease. After that, we consider the population risk factors for GERD. Next, we briefly touch on the epidemiology of GERD complications, including erosive esophagitis, strictures, and Barrett esophagus. We will end with a brief discussion of population screening of those with GERD for Barrett esophagus.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The pathophysiology of reflux esophagitis involves contact of the esophageal epithelium with acid-pepsin in the refluxate. For this contact to occur with sufficient duration, there must either be a combination of defects in antireflux and luminal clearance mechanisms for acid-pepsin to overwhelm a previously healthy epithelium or primary defects within the epithelium develop that subsequently enable ‘normal’ acid contact times to become damaging to the epithelium. This report examines these 2 pathways to reflux esophagitis and questions the causative role attributed to some phenomena. In either case, the final common pathway for the clinical expression of reflux esophagitis is by damage to the esophageal epithelium that is responsible for the development of heartburn and/or esophageal necrosis and inflammation.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This report focuses on the manifestations of gastroesophageal reflux disease (GERD) that are caused directly by contact between refluxed gastric juice and the esophageal mucosa. These manifestations include heartburn, peptic esophageal erosion and ulceration, peptic esophageal stricture, and Barrett esophagus. Peptic esophageal erosions and ulcerations are excavated defects in the esophageal mucosa that result when epithelial cells succumb to the caustic effects of refluxed acid and pepsin. Uncommonly, esophageal ulcers are complicated by hemorrhage, perforation, and penetration into the airway. Esophageal ulcers can stimulate fibrous tissue production and collagen deposition that result in stricture formation, and the ulcers can heal through a metaplastic process in which an intestinal-type epithelium replaces the damaged squamous cells (Barrett esophagus). The management of these conditions is discussed below.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The association between gastroesophageal reflux disease (GERD) and extraesophageal disease is often referred to as extraesophageal reflux (EER). This article reviews EER, discussing epidemiology, pathogenesis, diagnosis, and treatment with a focus on the most studied and convincing EER disorders—asthma, cough, and laryngitis. Although EER comprises a heterogeneous group of disorders, some general characterizations can be made, as follows. First, although GERD’s association with extraesophageal diseases is well-established, definitive evidence of causation has been more elusive, rendering epidemiological data scarce. Secondly, regarding the pathogenesis of EER, 2 basic models have been proposed: direct injury to extraesophageal tissue by acid and pepsin exposure or injury mediated through an esophageal reflex mechanism. Third, because heartburn and regurgitation are often absent in patients with EER, GERD may not be suspected. Even when GERD is suspected, the diagnosis may be difficult to confirm. Although endoscopy and barium esophagram remain important tools for detecting esophageal complications, they may fail to establish the presence of GERD. Even when GERD is diagnosed by endoscopy or barium esophagram, causation between GERD and extraesophageal symptoms cannot be determined. Esophageal pH is the most sensitive tool for detecting GERD, and it plays an important role in EER. However, even pH testing cannot establish GERD’s causative relationship to extraesophageal symptoms. In this regard, effective treatment of GERD resulting in significant improvement or remission of the extraesophageal symptoms provides the best evidence for GERD’s pathogenic role. Finally, EER generally requires more prolonged and aggressive antisecretory therapy than typical GERD requires.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A range of tests is available to the physician pursuing the diagnosis of gastroesophageal reflux disease (GERD). Many times, these studies are unnecessary because the history is sufficiently revealing to identify the presence of troubling reflux disease.1However, this may not be the case and the clinician must decide which tests to choose to arrive at a diagnosis in a reliable, timely, and cost-effective manner (Table 1). Furthermore, the various esophageal tests need to be selected carefully depending upon the information desired. For example, identifying the presence of gastroesophageal reflux disease is different from proving that the patient’s symptoms are caused by reflux episodes. Additionally, defining that acid reflux exists may not be enough. To tailor appropriate medical or surgical therapy requires knowing whether complications of GERD are present as well as possible mechanisms by which abnormal GER occurs. A thorough and well-devised investigation strategy requires knowledge of testing procedures ranging from radiology and pathology to physiology and endoscopy. An informed background in these areas allows the clinician and investigator to address not only the presence of reflux and its correlation to patient symptoms but also the severity of esophageal injury and even the mechanisms by which the damage is done. By using the available tests judiciously, one can increase the opportunity of making a correct diagnosis of GERD and simultaneously limit the potential inconveniences or cost to the patient.Table 1.Commonly Used Tests for Assessing the Presence, Mechanism, and Consequences of GERDaaOrder of presentation represents the order of diagnostic usefulness

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID