GASTROESOPHAGEAL REFLUX DISEASE (GERD): CLINICAL CHARACTERISTICS, MANAGEMENT AND LONG-TERM OUTCOMES

106 Pages·2016·1.946 MB·English

by  LARRY P. CORNETT

DIGESTIVE DISEASES - RESEARCH AND CLINICAL DEVELOPMENTS

G R
ASTROESOPHAGEAL EFLUX
D (GERD)
ISEASE

C C ,
LINICAL HARACTERISTICS
M
ANAGEMENT AND
L -T O
ONG ERM UTCOMES

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D D - R
IGESTIVE ISEASES ESEARCH AND
CLINICAL DEVELOPMENTS

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DIGESTIVE DISEASES - RESEARCH AND CLINICAL DEVELOPMENTS

G R
ASTROESOPHAGEAL EFLUX
D (GERD)
ISEASE

C C ,
LINICAL HARACTERISTICS
M
ANAGEMENT AND
L -T O
ONG ERM UTCOMES

LARRY P. CORNETT
EDITOR

New York
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Published by Nova Science Publishers, Inc. † New York
CONTENTS

Preface vii
Chapter 1 Patho-Physiology of Gastro Esophageal
Reflux Disease 1
Vikas Singhal
Chapter 2 Clinical Practice for Extra-Esophageal Reflux
and the Outcome 9
Zhi-Wei Hu, Ji-Min Wu and Zhong-Gao Wang
Chapter 3 Extraesophageal Reflux and Sleep Microarchitecture
Disturbance and Excessive Daytime Sleepiness 29
Wilfried Böhning and Else Briese
Chapter 4 Osteopathic Manipulative Therapy in
Gastroesophageal Reflux Disease 45
Leonardo Rios Diniz
and Wagner Rodrigues Martins
Chapter 5 Gastroesophageal Reflux Disease (GERD):
Update in the Surgical Approach
and Long-Term Outcome 53
Jaime Ruiz-Tovar and Carolina Llavero
Chapter 6 Bibliography 63
Index 87

PREFACE

Gastroesophageal reflux disease (GERD) is a common disorder affecting
approximately more than 10% of the population. GERD is highly
heterogeneous in terms of varied manifestations, test findings and treatment
responsiveness. The invasive treatment options for GERD have now greatly
expanded from just the Nissen Fundoplication to various other options such as
other minimally invasive options like the Lower Esophageal augmentation
with a magnetic device, and multiple endoscopic options like Radiofrequency
ablation, Trans-oral incisionless fundoplication (TIF) etc. Treatment options
require an understanding of the patho-physiology of GERD, which is
discussed in chapter one of this book. Chapter two studies the clinical
practices for extra-esophageal reflux and explores the outcomes. Chapter three
reviews extraesophageal reflux and sleep microarchitecture disturbance and
excessive daytime sleepiness. Chapter four discusses osteopathic manipulative
therapy. The final chapter provides updated research on the surgical treatment
options for GERD and their long-term outcomes.
Chapter 1 - Gastro Esophageal Reflux Disease (GERD) has a complex
patho-physiology. The invasive treatment options for GERD have now greatly
expanded from just the Nissen Fundoplication to various other options such as
other minimally invasive options like the Lower Esophageal augmentation
with a magnetic device, and multiple endoscopic options like Radiofrequency
ablation, Trans-oral incisionless fundoplication (TIF) etc. These treatment
options have their specific role and should be individualized to patients, which
requires understanding of the patho-physiology of GERD.
There are a lot of proposed theories and concepts regarding the patho-
physiology of GERD. Stein and coworkers gave us the concept of the
plumbing circuit where the esophagus functions as antegrade pump, the Lower
viii Larry P. Cornett
esophageal sphincter (LES) as a valve, and stomach as a reservoir. Problems
with any component of the circuit (either poor esophageal motility or a
dysfunctional LES or delayed gastric emptying) can lead to GERD.
Another cause of reflux is a hypotensive Lower esophageal sphincter
(LES). Transient inappropriate LES relaxations (TLESR) (relaxation in the
absence of swallowing) are also a relatively newer concept in the causation of
reflux. Prolonged or more frequent TLESRs have been investigated as a cause
of reflux. Apart from the LES itself the diaphragmatic crura, and the phreno-
esophageal ligament, which help form the angle of His also have a role in
preventing reflux. A hiatal hernia also contributes to reflux as proximal
migration of the LES may result in loss of its abdominal high-pressure zone
(HPZ). Herein the authors will discuss some of these mechanisms in the patho-
physiology of GERD.
Chapter 2 - Gastroesophageal reflux disease (GERD) is a common
disorder affecting more than 10% of the population. GERD is highly
heterogeneous in terms of varied manifestations, test findings and treatment
responsiveness. Acid regurgitation and heartburn are known as typical
symptoms of GERD. However, GERD can often represented as atypical
symptom of chest pain, as well as extraesophageal symptoms such as chough
and asthma. Extraesophageal reflux requires sufficient awareness,
understanding and evaluation. Multidisciplinary integrated treatment from
medical to surgical strategy should be followed in the management of
extraesophageal symptoms, according to the severity, reflux character, therapy
responsiveness of individual extraesophageal symptoms.
Chapter 3 - Gastroesophageal Reflux (GER) has a high prevalence. It
should be differentiated between the symptomatic reflux and the so called
“silent” Extraesophageal Reflux (EER) with dominant ENT-symptoms.
Additionally, it should be noticed that there is a high coincidence with
Obstructive Sleep Apnea (OSA).
A pilot study shows that the core symptom of OSA Excessive Daytime
Sleepiness (EDS) is also similarly common in EER. The background for this is
the sleep microstructure particularly in view of the Cyclic Alternating Pattern
(CAP) with the different subtypes. Reflux episodes are not linked to
respiratory events.
Reflux events are associated with high arousal activity and simultaneously
with increased variability of Heart Frequency (HF) and Pulse-Transit-Time
(PTT) – similar to respiratory induced arousals. The usual classification of
sleep structure is not useful with regard to the EDS.