GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH COLUMNAR-LINED ESOPHAGUS
Section snippets
ASSOCIATION BETWEEN GASTROESOPHAGEAL REFLUX DISEASE AND BARRETT'S ESOPHAGUS
Early investigators suggested that the columnar-lined esophagus was a congenital abnormality secondary to arrested regression of the glandular epithelium normally lining the fetal esophagus.4, 41 In 1953, Allison and Johnston2 suggested that reflux symptoms, esophagitis, and hiatal hernia might be associated with BE, thus starting a controversy. This confusing situation was clarified in 1970 by Bremner and colleagues,8 who used an experimental model in dogs. They showed evidence of columnar
CAUSE AND PATHOGENESIS
To understand the association between BE and GERD, one must understand the cause and pathogenesis of GERD, which are multifactorial.16, 26, 72 Esophagitis develops when noxious substances in the refluxate (the aggressive factors) come in contact with the esophageal mucosa for a sufficient time to overcome the intrinsic structural and functional defenses. The defense mechanisms of the esophagus can be broadly categorized into three factors: (1) the antireflux barrier, (2) efficient clearing of
AGGRESSIVE FACTORS
The offensive factors in GERD reside in the refluxate. Animal models have shown that esophageal mucosal injury depends on the pH.28, 93 The lower the pH of the refluxate, the longer the time required for intraesophageal pH to return to noninjurious levels and the higher the risk for severe manifestation of GERD. The severity of GERD is thus related to the concentration of acid in the refluxate and the frequency and duration of esophageal acid exposure.5
With prolonged exposure, regurgitated
GASTROESOPHAGEAL REFLUX DISEASE AND BARRETT'S ESOPHAGUS
There is now strong evidence that supports the association of GERD with BE, including studies that show higher frequencies of BE in patients undergoing endoscopy for symptoms of gastroesophageal reflux than in patients having endoscopy for other symptoms.12, 62, 91 In one study, the prevalence of BE was 12% in patients who underwent endoscopy for symptoms of chronic gastroesophageal reflux.91 This value may be an underestimation, and BE may actually occur more frequently because some patients
TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN BARRETT'S ESOPHAGUS
There is now overwhelming evidence supporting the association of columnar-lined esophagus with GERD. An attractive hypothesis would propose that if gastroesophageal reflux could be abolished, the metaplastic epithelium might regress and be replaced by normal squamous epithelium. Treatment of GERD could be approached in two ways: (1) medical treatment with lifestyle changes and with antisecretory drugs, thus reducing acid reflux into the esophagus, and (2) antireflux surgery. To date, neither of
CONCLUSION
There is no doubt that BE is associated with GERD. Both animal and human studies have confirmed that not only acid, but also possibly DGER acting in synergy cause the most esophageal damage. BE predisposes the patient to adenocarcinoma of the esophagus. With the dramatic increase in adenocarcinoma in the population, it has become more important to recognize BE. Current recommendations concerning screening for BE remain controversial. Controlled clinical trials have demonstrated that patients
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Benign Esophageal Disease
2010, Medical Management of the Thoracic Surgery PatientBenign Esophageal Disease
2009, Medical Management of the Thoracic Surgery PatientLifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic Twins
2007, GastroenterologyCitation Excerpt :Finally, the GERD diagnosis, based on symptoms only, might have been misclassified. However, several studies have indicated that the assessment of GERD through structured questionnaires might be the best tool available for defining true GERD.39–42 Our GERD definition was based on weekly symptoms, and the prevalence, approximately 15%, coincided with that from other studies, 10%–20%.11
Barrett's Esophagus
2006, Therapy of Digestive DisordersThe real value of lower esophageal sphincter measurement for predicting acid gastroesophageal reflux or Barrett's esophagus
2005, Journal of Gastrointestinal SurgeryCitation Excerpt :In the subjects with Barrett's, it seems that PR is affected before TL and AL, that is to say, there may be primary involvement of pressure (functional change) not secondary to the structural defect of the LES smooth musculature (lower TL) and to the lesser influence of abdominal pressure (less AL) (anatomic change). Given that we know the importance of biliary reflux in the physiopathology of Barrett's esophagus,13,14,16,17 this functional alteration of the LES may be accompanied by an alteration, also functional, in the pressure of the pylorus, this all favoring duodenogastric and gastroesophageal reflux. Lower PR of the LES, with normal TL and AL, or only diminished, could reflect diminished pressure of the pylorus.
Barrett's esophagus
2005, Therapy of Digestive Disorders, Second Edition
Address reprint requests to Donald O. Castell, MD, Department of Medicine, The Graduate Hospital, 1800 Lombard Street, Suite 501 Pepper Pavilion, Philadelphia, PA 19146