Additionally, in the presence of a hiatal hernia, concurrent hiatal hernia repair should be performed along with the LNF. Laparoscopic Nissen fundoplication (LNF) has been established as the gold standard treatment procedure for GERD. In patients not responding to standard treatment, surgical therapy is often proposed. Additionally, reflux in typical treatment is not halted, because PPIs do not fundamentally address the pathophysiology of the disease and the function of the antireflux mechanism.
However, 10%-40% of patients do not respond well in standard treatment. The treatment approach usually starts with lifestyle modifications and antireflux medical therapy with proton-pump inhibitors (PPIs). The initial diagnostic approach includes some combination of symptom presentation, objective testing with endoscopy, ambulatory reflux monitoring (24 h PH-Metry), and response to antisecretory therapy. GERD can also cause Barrett’s esophagus (BE), a precancerous state for esophageal adenocarcinoma. Erosive esophagitis, peptic stricture, aspiration pneumonia, exacerbations of chronic obstructive lung disease and lung fibrosis have been associated with reflux of gastric contents into the esophagus and the airways.
#RELUX 2005 SERIES#
Should GERD stay undertreated, a series of severe complications may occur. However, the Montreal definition and classification of GERD describes a wide range of clinical presentation, from typical esophageal symptoms to atypical cardiac, laryngeal, and pulmonary ones. GERD typically presents with regurgitation and heartburn, which constitute hallmark clinical signs.
This mechanism consists of six anatomic elements the lower esophageal sphincter (LES), the diaphragmatic crura, the abdominal part of the esophagus, the acute angle of His and the Gubaroff valves.
The main underlying causal mechanism of GERD constitutes a failure in the valvular mechanism of the esophagogastric junction, which normally prevents reflux of stomach contents. According to the Montreal definition of GERD, it is defined as “a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications”. Gastroesophageal reflux disease (GERD) represents the most common gastrointestinal disorder of the esophagus, with an estimated prevalence of 10%-30% in the western world.
0 kommentar(er)
