Gastroesophageal Reflux Disease PDF

Preface

Common and complex, gastroesophageal reflux disease (GERD) has seen an explosion in interest from both lay and scientific communities. As a result, information has been pouring in. And no wonder—symptoms and signs of GERD seem to be everywhere, affecting millions of people on every continent and in a variety of ways. On one hand, they masquerade innocently enough as heartburn, yet, on the other, they represent an insidious disorder that can lead to esophageal epithelial destruction, Barrett's esophagus, and esophageal adenocarcinoma—a deadly cancer whose frequency has increased dramatically in the past half-century. GERD, however, is not confined to the esophagus; it represents one of the known causes for such commonplace diseases of the oropharynx and airways as laryngitis, pharyngitis, pneumonia, and asthma. Not surprisingly, then, given the breadth of pathology, physicians and other healthcare providers are confronted with a wide range of important questions about its cause, natural history, and risks, in addition to the appropriate application of diagnostic tests and therapeutic medical and surgical approaches. Indeed, the therapeutic landscape for GERD and its complications has changed materially—with antacids, the old standard bearer, giving way to increasingly more powerful acid-suppressant and prokinetic medications, and surgically with traditional open fundoplication competing effectively with laparoscopic fundoplication. Moreover, endoscopic laser-based photodynamic therapy has emerged as a novel method of ablating dysplastic and superficial neoplastic tissue in Barrett's esophagus, and endoscopic treatment of esophageal strictures has improved as a result of refinements in stent technology.

Given the explosion of interest, information, and technology in GERD, this represents an ideal time to take stock and assess where we are and what gaps remain to be filled. Toward this end, we have assembled an international group of recognized experts to produce this state-of-the-art volume covering all aspects of GERD: epidemiology (Chap. 3), risk factors (Chap. 2), pathophysiology (Chaps. 5 and 6), clinical course and manifestations (Chap. 1), diagnostic testing (Chap. 4), medical treatment (Chap. 10), surgical treatment (Chap. 11), esopha geal complications such as stricture and Barrett's esophagus (Chaps. 7 and 8), and extraesophageal complications such as laryngitis and asthma (Chap. 9). In addition, Chapter 12 provides in-depth coverage of GERD in infants and children. Readers of this book should also take note that there are two chapters on the pathophysiology of GERD: Chapter 5 covers the esophageal antireflux and acid clearance mechanisms and Chapter 6 covers the noxious elements in the gastric refluxate and factors comprising tissue resistance. This division was not arbitrary but a means to explore two divergent views on the pathophysiology of GERD. Chapter 5 reflects the current view that GERD is a motor disorder and Chapter 6 reflects a contrary view, that GERD is in part, if not completely, an epithelial disorder (shades of H. pylori and peptic ulcer disease). In summary, based on the effort expended by the authors in creation of this work on GERD, we expect readers in the field of healthcare to come away with a better appreciation of our current knowledge about this intriguing disorder.