Esophagus gerd grade my essay

Let's talking about esophagus gerd grade my essay.

Heartburn or burning sensation is the most common symptom of gastroesophageal reflux. 2 The sensation of burning or pain at the level of the sternum is the most common symptom of gastroesophageal reflux, but there are many others that we tell you. PHmetry is the best method to establish the existence of reflux. 3 The diagnosis of gastroesophageal reflux is based on the patient's symptoms, but there is evidence to confirm the disease or its consequences. When there is reflux, the epithelium of the esophagus changes and becomes the epithelium of the stomach to better support the acidity. 4 Complications of gastroesophageal reflux range from esophagitis, Barrett's esophagus, stenosis due to esophagitis, esophageal ulcer or digestive hemorrhage. One of the 'weapons' against reflux are the inhibitory drugs of the proton pump. 5 These are the treatment options of gastroesophageal reflux to relieve symptoms, cure esophagitis and prevent the appearance of complications.

The progress made in understanding the pathogenesis of this disease, largely determined by the introduction of functional examinations such as esophageal manometry and 24-hour pH-metry, has provided information of great physiopathological interest. The typical and atypical or extraesophageal clinical manifestations are described, as well as an update of the diagnostic methodology. Finally, the present moment of the treatment is reviewed in its pharmacological, endoscopic and surgical aspects. Finally, we review the present state of treatment in its pharmacological, endoscopic and surgical facets. Accepted for publication on April 30, 2003. It is currently one of the most prevalent nosological entities of the digestive system in the western population. Reflux esophagitis, whose frequency in the general population has been estimated at 2%, 5 defines a group of patients with histopathological lesions secondary to reflux. Under normal conditions the anti-reflux barrier limits this step and its dysfunction makes it easier. The contact of refluxed material from the stomach with the esophageal mucosa causes the symptoms and histopathological lesions characteristic of this disease. These pressure values ​​show variations throughout the day and are modifiable depending on specific increases in intra-abdominal pressure, the intake of certain foods and the intake of drugs, mainly. There is a certain overlap of the pressive values ​​between patients and healthy. These relaxations are the physiological reflex response to gastric distension by gas or food and are related to belching. It has been observed that a variable percentage of these relaxations are followed by episodes of reflux and determine the majority of reflux episodes in healthy individuals. In this analysis, the reflux intensity correlated with the axial extension of the hernia, that is, with its size10. However, the absence of a gold standard for the diagnosis of the disease, as has been mentioned previously, does not allow us to know with certainty the predictive capacity of this symptom14. Heartburn appears about 30-60 minutes after ingestion and is usually relieved by taking antacids, even if only transiently. When it is very intense, the patient may perceive it as pain in the epigastrium or at the retrosternal level. It is known that there is no good correlation between the intensity of heartburn and the severity of esophageal lesions15. It consists of the passage of material contained in the stomach to the mouth, either spontaneously or triggered by certain postures that increase the intra-abdominal pressure. It is typical to appear when leaning forward or in right lateral decubitus. When episodes of nocturnal regurgitation occur, they may manifest in the patient in the form of dyspnea or irritative cough crisis. Dysphagia The sensation that the food stops in its passage from the mouth to the stomach is considered dysphagia. In the first case, the patient usually presents a paradoxical dysphagia while when there are esophageal lesions, the dysphagia is progressive, initially for solids and later for liquids. In some patients dysphagia may be related to the presence of a Schatzki ring whose origin has been related to reflux. Usually, odynophagia is manifested by pain of mild intensity, although in certain circumstances, it can be intense, even making it difficult for the patient to feed. Its presence usually indicates either the existence of a esophagitis, usually severe, or the appearance of synchronous or tertiary contractions and is an indication of an endoscopy. Third, although it is true that gastroesophageal reflux is associated with a higher frequency than expected with these diseases, this does not ensure that it is the cause, and may even be its consequence. Finally, extraesophageal manifestations can be caused by other multiple factors, which makes it more difficult to interpret the response to antisecretory treatment, be it favorable or not. Among the extraesophageal manifestations, the most widely studied have been chronic cough, bronchial asthma and posterior laryngitis. In these three cases, an initial evaluation by the otolaryngologist or pulmonologist is advised and, if specific pathology is ruled out, a digestive study including endoscopy and functional tests is recommended. The normality of these tests does not rule out the existence of pathological reflux, although it makes it less likely. Subsequently, antisecretory treatment with omeprazole should be initiated at a dose of 40 mg daily for 3-6 months and assess the clinical response. If the disappearance of the symptoms or the healing of the lesion is achieved, the treatment should be suspended, since we know that many patients will not present recurrence or will do so after some time. In case of clinical recurrence, maintenance treatment will be indicated. Within extraesophageal manifestations, chest pain deserves special consideration, since it is sometimes an entity difficult to manage clinically. It is a symptom, generally alarming, that can be caused by a wide spectrum of processes ranging from serious cardiovascular diseases to banal processes of musculoskeletal origin. Once the cardiovascular origin of the pain has been properly ruled out, a digestive study with endoscopy and functional explorations can be considered. In addition, the prevalence of Barrett's esophagus is higher in males and its incidence increases with age. Numerous publications have shown that Barrett's esophagus is associated with an increased risk of adenocarcinoma of the esophagus estimated at between 0.5 and 1% per year19. Barrett's long esophagus is considered when the involvement is greater than 3 cm and Barrett's esophagus is short when it is less than 3 cm. Both entities share a common pathophysiology, but although the studies are not absolutely conclusive, it seems that the risk of neoplastic degeneration in the short type may be lower20. Currently, the most widely accepted strategy is to perform an initial endoscopy with biopsies taken from the four quadrants, every two centimeters along the entire path of metaplastic mucosa. If the anatomopathological study shows the existence of inflammation that interferes with the assessment of dysplasia, a powerful antisecretory treatment should be performed for 8-12 weeks and then repeat the biopsies. In patients with Barrett's esophagus in whom no dysplasia is detected, it would be convenient to continue with controls every three or five years21. In those with low grade dysplasia, it is advisable to perform two endoscopies with biopsies, consecutive, separated by the 6-month interval and then continue with annual endoscopies22. Finally, the attitude towards the finding of a focus of high-grade dysplasia is controversial. Some authors consider that after confirmation of the diagnosis of high-grade dysplasia by a second expert pathologist, given the high prevalence of adenocarcinoma in these patients, esophagectomy would be the most recommended option. Other authors defend, on the contrary, that with a meticulous program of biopsies, they can differentiate high-grade dysplasia foci from those of carcinoma and propose only esophagectomy when carcinoma is detected in said follow-up. According to these authors, the high morbidity of esophagectomy, as well as the variable natural history of high-grade dysplasia, would justify this conservative strategy. In patients with high-grade dysplasia with elevated surgical risk, endoscopic ablative therapies can be considered. It has been shown that among the factors that predispose to the appearance of stenosis are advanced age, prolonged history of reflux and the coexistence of an associated severe esophageal motor disorder23. It may be a macroscopic hemorrhage or chronic microscopic bleeding, manifested by the appearance of iron deficiency anemia. It is estimated that when heartburn and acid regurgitation are the predominant symptoms, the probability that the patient presents a pathological reflux is approximately 70%. It is known that up to 25% of patients with esophagitis documented by endoscopy can have a normal pH-metric record30,31. Other indications accepted by different authors and scientific societies are:?? Patients with normal endoscopy who are going to be considered for antireflux surgery. Hence the efforts aimed at the development of clinical management strategies and the development of algorithms that serve as a guide in daily clinical practice, homogenizing the guidelines for action with these patients. These objectives must be achieved by trying to minimize the necessary costs and the possible adverse effects, while maximizing the available resources. Although several drugs have been tested such as baclofen, loxiglumide and others34 that have shown their ability to reduce the number of transient relaxations and therefore the number of episodes of reflux, their efficacy in controlling symptoms has not been demonstrated. Therefore, the current therapeutic approach is preferably aimed at recovering the balance between aggressive and defensive factors at the level of the esophageal mucosa, modifying the composition of the refluxed material from the stomach and reducing the exposure of the esophagus to acid. The drugs currently used in the treatment of reflux are framed in three therapeutic groups: antacids, prokinetics and antisecretores. The relative clinical efficacy of each of these groups has been compared in multiple controlled studies that have allowed to establish a hierarchy from higher to lower therapeutic power. Other measures related to lifestyle, such as weight loss, smoking cessation and elevation of the head of the bed, are very dubious useful and there is no evidence to support their routine recommendation36. However, although no scientific evidence is available, clinical observation has led some authors to recommend prokinetics in patients in whom regurgitation dominates as a symptom of reflux23. The cardiovascular adverse effects described with cisapride have further restricted, if possible, the use of this prokinetic40. Continuation of initial treatment Those patients with severe esophagitis would be candidates for this strategy given the high probability of recurrence as previously indicated4. Treatment in descending pattern It is about reducing the intensity of treatment following order descending the hierarchical scale of effectiveness, until finding the minimum effective dose. It can be considered as short cycles of treatment or as a day-to-day treatment, depending on the presence of symptoms. Omeprazole has been shown to be superior to ranitidine when this strategy is used39. There is some evidence in favor of an effective anti-reflux therapy, which reduces exposure to acid, can reduce the risk of malignant transformation44. No differences were observed in the rates of malignization between medical and surgical treatment45. Once this is done, patients should receive maintenance treatment with double dose antisecretory drugs to avoid restenosis47. In these cases the objective of the treatment will not be the relief of typical symptoms of reflux but that of those extradigestive manifestations with which the reflux disease can occur. Some uncontrolled studies report good results of fundoplication50. Bronchial asthma The efficacy of medical treatment is very limited in this group of patients, with most of them not having apparent benefits in their respiratory symptoms, with the exception of some group of difficult identification51. Surgical treatment Surgical treatment is aimed at reconstructing the anti-reflux barrier that is altered in patients affected by this disease. From the pathogenic point of view, treatment with anti-reflux surgery is more logical than medical treatment, since it is in the barrier dysfunction that the main pathogenic mechanism of the disease underlies. The universally accepted surgical technique is fundoplication, with its different variants. This technique requires a learning curve defined by what the experience of the surgeon is a determining factor in the results obtained in the short and long term58. The data currently available are not conclusive, although they suggest that the results of laparoscopic surgery are similar to those of the traditional approach in terms of symptomatic relief59. Surgical treatment obtains results similar to medical treatment in patients with esophagitis, although surgery can surpass medium and long term medical treatment in the available cost-effectiveness studies60, 61. They are indications of surgical treatment:?? Early relapse in a young patient who responds to medical treatment and discards lifelong pharmacological treatment. The patient must be informed of the advantages and disadvantages of surgical treatment as well as the results of the hospital in which it is going to be operated, given that these may vary significantly from one center to another, especially when it comes to laparoscopic surgery64. These are techniques that, like surgical fundoplication, aim to restore the anti-reflux barrier function, acting at the level of the esophagogastric junction. Nowadays, they should be considered as experimental techniques, to be developed in reference centers. Scand J Gastroenterol 1991; 26: 73-81. Gastroenterology 1997: 112: 1448-56. Scand J Gastroenterol 1999; 231: 20-28. An evidence-based appraisal of reflux disease management. Anatomy and phisiology of the gastroesophageal junction. Gastroesophageal reflux disease and its complications. The antireflux barrier and mechanisms of gastro-oesophageal reflux. The importance oh hiatal hernia in reflux esophagitis compared with lover esophageal sphincter pressure or smoking. J Clin Gastroenterol 1991; 13: 628-643. Am J Roentgenol 1995; 165: 557-559. Barret's esophagus: prevalence and size of hiatus hernia. Gastroenterology 1998; 114: G0338. Symptoms in gastro-oesophageal reflux disease. Scand J Gastroenterol 1987; 22: 714-718. Prevalence of endoscopic and histologic findings in subjects with and without dyspepsia. Gastroenterol Hepatol 2001; 24: 21-29. Is there publication order descending the hierarchical scale of effectiveness, until finding the minimum effective dose. It can be considered as short cycles of treatment or as a day-to-day treatment, depending on the presence of symptoms. Omeprazole has been shown to be superior to ranitidine when this strategy is used39. There is some evidence in favor of an effective anti-reflux therapy, which reduces exposure to acid, can reduce the risk of malignant transformation44. No differences were observed in the rates of malignization between medical and surgical treatment45. Once this is done, patients should receive maintenance treatment with double dose antisecretory drugs to avoid restenosis47. In these cases the objective of the treatment will not be the relief of typical symptoms of reflux but that of those extradigestive manifestations with which the reflux disease can occur. Some uncontrolled studies report good results of fundoplication50. Bronchial asthma The efficacy of medical treatment is very limited in this group of patients, with most of them not having apparent benefits in their respiratory symptoms, with the exception of some group of difficult identification51. Surgical treatment Surgical treatment is aimed at reconstructing the anti-reflux barrier that is altered in patients affected by this disease. From the pathogenic point of view, treatment with anti-reflux surgery is more logical than medical treatment, since it is in the barrier dysfunction that the main pathogenic mechanism of the disease underlies. The universally accepted surgical technique is fundoplication, with its different variants. This technique requires a learning curve defined by what the experience of the surgeon is a determining factor in the results obtained in the short and long term58. The data currently available are not conclusive, although they suggest that the results of laparoscopic surgery are similar to those of the traditional approach in terms of symptomatic relief59. Surgical treatment obtains results similar to medical treatment in patients with esophagitis, although surgery can surpass medium and long term medical treatment in the available cost-effectiveness studies60, 61. They are indications of surgical treatment:?? Early relapse in a young patient who responds to medical treatment and discards lifelong pharmacological treatment. The patient must be informed of the advantages and disadvantages of surgical treatment as well as the results of the hospital in which it is going to be operated, given that these may vary significantly from one center to another, especially when it comes to laparoscopic surgery64. These are techniques that, like surgical fundoplication, aim to restore the anti-reflux barrier function, acting at the level of the esophagogastric junction. Nowadays, they should be considered as experimental techniques, to be developed in reference centers. Scand J Gastroenterol 1991; 26: 73-81. Gastroenterology 1997: 112: 1448-56. Scand J Gastroenterol 1999; 231: 20-28. An evidence-based appraisal of reflux disease management. Anatomy and phisiology of the gastroesophageal junction. Gastroesophageal reflux disease and its complications. The antireflux barrier and mechanisms of gastro-oesophageal reflux. The importance oh hiatal hernia in reflux esophagitis compared with lover esophageal sphincter pressure or smoking. J Clin Gastroenterol 1991; 13: 628-643. Am J Roentgenol 1995; 165: 557-559. Barret's esophagus: prevalence and size of hiatus hernia. Gastroenterology 1998; 114: G0338. Symptoms in gastro-oesophageal reflux disease. Scand J Gastroenterol 1987; 22: 714-718. Prevalence of endoscopic and histologic findings in subjects with and without dyspepsia. Gastroenterol Hepatol 2001; 24: 21-29. Is there publication contact with you The Telephone field is required. Please check the phone number. In the case of international numbers, please enter 00 followed by the corresponding international prefix and your telephone number. Wait a few moments while we process your request. We will contact you shortly. The Telephone field is required. Please check the phone number. In the case of international numbers, please enter 00 followed by the corresponding international prefix and your telephone number. Wait a few moments while we process your request. Close Send The initial diagnosis of gastroesophageal reflux is based on the symptoms. Existence or not of complications derived from reflux. Discard other lesions that clinically resemble reflux and have a different treatment and prognosis. In gastroesophageal reflux, diagnosis and treatment are related, since the response to antisecretory therapy is considered a diagnostic criterion. In all cases, hygienic-dietetic measures aimed at reducing intra-abdominal pressure should be adopted. Then treatment will be indicated with drugs that are very effective in most patients. If all these measures fail, you can perform surgical treatment to solve the problem permanently. Our Endoscopy Unit has been performing endoscopic techniques for the treatment of gastroesophageal reflux in mild cases for a few years without having to resort to surgery. Request an appointment Diagnostic methods What treatments do we perform? The doctor can study the reflux by different diagnostic tests: Gastroscopy: it allows to know if esophageal inflammation has occurred and its severity. It also allows samples to be taken for biopsy in the case of finding lesions and ruling out other diseases that can simulate reflux. Esophageal manometry: a probe studies how the esophagus moves when the patient swallows liquids. Contrast radiographs: a liquid is administered orally, which is opaque and can be seen by X-rays, and the passage from esophagus to stomach and the existence or not of reflux into the esophagus is studied. 24-hour pH measurement: it consists of introducing a probe through the nose with a system at the tip that detects the existing pH in the esophagus and in the stomach. It lets you know when reflux episodes occur, how long they last, whether or not they are related to symptoms, etc. The pharmacological treatment will depend on the symptoms of the patient, especially its frequency and severity. Sometimes it is enough to take antacids, although in some cases it is necessary to block the acid secretion of the stomach. If there are symptoms of regurgitation, prokinetic drugs that increase esophageal motility can be indicated. Surgery will be indicated in those cases in which there are serious complications arising from reflux or there is a need for high doses of drugs to control symptoms. In general, mild and uncomplicated cases only require controlling the symptoms and the duration of treatment depends only on the discomfort referred by the patient. Severe or complicated cases require maintenance treatment even if there are no symptoms. The term "gastroesophageal reflux" describes the passage of stomach contents into the esophagus. Under normal conditions, the gastric or intestinal content does not pass into the esophagus, since there is a lower esophageal sphincter that acts as a valve and prevents the passage of food. When this muscle barrier is altered or inappropriately relaxed, the gastric content passes into the esophagus, irritating the mucosa and producing different symptoms and / or complications. Dietary and postural measures There are dietary factors or life forms that can contribute to gastroesophageal reflux. Tobacco also produces sphincter relaxation. The existence of a hiatus hernia favors gastroesophageal reflux, although it is not the only cause. All those situations that suppose an increase of the intra-abdominal pressure also favor the reflux. It is possible that it is associated with the passage of acidic or bitter foods from the stomach to the mouth. It usually worsens after meals, especially with foods that favor sphincter relaxation or with excess diets. In many cases, it also gets worse during the night's rest or when the trunk is flexed. In some cases the predominant symptoms are respiratory: aphonia or hoarseness or even asthma or respiratory distress. There are several complications derived from reflux, although these do not occur in most cases. They depend on the severity of the reflux in each subject. The most frequent is esophagitis, which is the inflammation of the esophageal mucosa that is exposed to acid. Severe esophagitis can: ulcerate and bleed; Heal irregularly, reducing the diameter of the esophageal lumen and hindering the passage of food. In some cases a change of the normal esophageal mucosa can occur, which is replaced by a mucosa more similar to the stomach or the small intestine, more resistant to acid. This situation is known as "Barrett's esophagus" and its main importance is that it is considered a risk factor for developing esophageal cancer. Losing weight in case of obesity. Raise the head of the bed about 10 cm. It is important NOT to place pillows, which only flex the neck. The aim is to achieve an inclination of the whole trunk, that is why articulated beds are recommended or wooden blocks placed on the front legs of the bed. Avoid lying down before having spent 2 or 3 hours of intake. Dietary and postural measures should be maintained despite following a pharmacological treatment, since it is shown that they significantly help the good clinical control of the disease. Our patients tell their experience. Stories of hope, struggle and overcoming.


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