Gastroesophageal reflux disease: Difference between revisions

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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


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{{CMG}}; {{AE}} {{AEL}}  


{{SK}} GERD, GORD, gastroesophageal reflux, oesophageal reflux, peptic esophagitis, esophageal reflux
{{SK}} GERD, GORD, gastroesophageal reflux, oesophageal reflux, peptic esophagitis, esophageal reflux.


==Treatment==
==[[Gastroesophageal reflux disease overview|Overview]]==


==[[Gastroesophageal reflux disease historical perspective|Historical Perspective]]==


===Surgical treatment===
==[[Gastroesophageal reflux disease classification|Classification]]==
The standard surgical treatment, sometimes preferred over longtime use of medication, is the ''[[Nissen fundoplication]]''. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done [[Laparoscopic surgery|laparoscopically]].<ref name=Abbas_2004>{{cite journal |author=Abbas A, Deschamps C, Cassivi SD, et al. |title=The role of laparoscopic fundoplication in Barrett’s esophagus |journal=Annals of Thoracic Surgery |volume=77 |issue=2 |pages=393-396 |year=2004 |pmid=14759403}}</ref>


An obsolete treatment is [[vagotomy]] ("highly selective vagotomy"), the surgical removal of [[vagus nerve]] branches that innervate the stomach lining. This treatment has been largely replaced by medication.
==[[Gastroesophageal reflux disease pathophysiology|Pathophysiology]]==


===Endoluminal fundoplication===
==[[Gastroesophageal reflux disease causes|Causes]]==
In June 2006 EndoGastric Solutions introduced [http://www.egseurope.eu EsophyX ELF] in the Europe Union as an alternative to surgical and pharmaceutical approaches for GERD treatment. EsophyX ELF is intended to deliver similar benefits as the time-proven laparoscopic fundoplication procedures, by reducing hiatal hernia, recreating the Angle of His, and creating a GastroEsophageal Valve (GEV). The key differences are that EsophyX ELF is an endoscopic non-invasive procedure that is performed transorally (through the mouth), does not require incisions, and does not dissect any part of the natural anatomy.


Previous endoluminal treatments focused predominantly on the LES. However, failure to effectively treat reflux long-term with endoluminal therapies that focused only on the Lower Esophageal Sphincter (LES) combined with the fact that surgical approaches like Nissen fundoplication recreate the GEV and have excellent long-term efficacy, has led to an awareness that the GEV is probably the most powerful component of the Anti-Reflux Barrier. The device has been designed to deploy multiple tissue fasteners to create a robust and durable valve and is intended to restore the geometry of the GastroEsophageal Junction and recreate the natural, unidirectional valve mechanism necessary to prevent GERD. [http://www.endogastricsolutions.com/index.php?src=news&submenu=News&refno=19 EsophyX ELF has recently been cleared by the US FDA] and is now available in the U.S.
==[[Gastroesophageal reflux disease differential diagnosis|Differentiating Gastroesophageal Reflux Disease from other Diseases]]==


===Other treatments===
==[[Gastroesophageal reflux disease epidemiology and demographics|Epidemiology and Demographics]]==
In 2000 , the U.S. [[Food and Drug Administration]] (FDA) approved two [[endoscopy|endoscopic]] devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the [[stretta procedure|Stretta Procedure]], uses electrodes to apply radio frequency energy to the LES. The long term outcomes of both procedures compared to a Nissen fundoplication are still being determined.


Subsequently the NDO Surgical Plicator was FDA cleared for the endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The Plicator is currently marketed by NDO Surgical, Inc. [http://www.ndosurgical.com].
==[[Gastroesophageal reflux disease risk factors|Risk Factors]]==


Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.
==[[Gastroesophageal reflux disease screening|Screening]]==


==Barrett's esophagus==
==[[Gastroesophageal reflux disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
[[Barrett's esophagus]], a type of [[dysplasia]], is a precursor high-grade dysplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0.1% to 0.5% of cases, and has probably been exaggerated in the past. Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.


==References==
==[[Gastroesophageal reflux disease diagnosis|Diagnosis]]==
{{Reflist|2}}
[[Gastroesophageal reflux disease history and symptoms|History and Symptoms]] | [[Gastroesophageal reflux disease physical examination|Physical Examination]] | [[Gastroesophageal reflux disease laboratory findings|Laboratory Findings]] | [[Gastroesophageal reflux disease electrocardiogram|Electrocardiogram]] | [[Gastroesophageal reflux disease chest x ray|Chest X Ray]] | [[Gastroesophageal reflux disease CT|CT]] | [[Gastroesophageal reflux disease echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Gastroesophageal reflux disease other imaging findings|Other Imaging Findings]] | [[Gastroesophageal reflux disease other diagnostic studies|Other Diagnostic Studies]]
 
==Treatment==
[[Gastroesophageal reflux disease medical therapy|Medical Therapy]] | [[Gastroesophageal reflux disease surgery|Surgery]] | [[Gastroesophageal reflux disease primary prevention|Primary Prevention]] | [[Gastroesophageal reflux disease secondary prevention|Secondary Prevention]] | [[Gastroesophageal reflux disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gastroesophageal reflux disease future or investigational therapies|Future or Investigational Therapies]]
==Case Studies==
:[[Gastroesophageal reflux disease case study one|Case #1]]


==External links==
==External links==
*[http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/ GERD patient information page] at [[NIH]]
*[http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/ GERD patient information page] at [[NIH]]
*[http://kidshealth.org/teen/diseases_conditions/digestive/gerd.html KidsHealth GERD Information for Kids]
 
*[http://www.mayoclinic.org/gerd/ Mayo Clinic review of diagnosis and treatment options]
*[http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/acidpeptic/acidpeptic.htm Overview] at [[Cleveland Clinic]]


{{Gastroenterology}}
{{Gastroenterology}}
[[Category:Digestive diseases]]
[[Category:General practice]]
[[Category:Conditions diagnosed by stool test]]
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[[zh:胃食管反流病]]
[[zh:胃食管反流病]]
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[[Category:Gastroenterology]]

Latest revision as of 21:50, 29 July 2020

Gastroesophageal reflux disease
ICD-10 K21
ICD-9 530.81
OMIM 109350
DiseasesDB 23596
MeSH D005764

Gastroesophageal reflux disease Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Gastroesophageal Reflux Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

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Treatment

Medical Therapy

Surgery

Primary Prevention

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Synonyms and keywords: GERD, GORD, gastroesophageal reflux, oesophageal reflux, peptic esophagitis, esophageal reflux.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Gastroesophageal Reflux Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

External links


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