Esophagus

Gastroesophageal Reflux

 

The gastroesophageal reflux disease ( GERD) is defined as the condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms and / or complications . From a surgical point of view, the GERD is the dysfunction of the mechanism of the gastroesophageal sphincter , allowing abnormal reflux of gastric contents into the esophagus . This is a mechanical disturbance caused by a defective lower esophageal sphincter (LES ) , a gastric emptying disorder , or absence of esophageal peristalsis . As a result , patients feel " heartburn " to damage the lining of the esophagus with or without subsequent complications including malignancy or respiratory disease .

 

  While the exact nature of the deterrence mechanism regression

 

It is not completely understood , the current view is that the lower esophageal sphincter , the legs of the diaphragm and the phrenoesophageal  ligament  are key components of this deterrence mechanism .

 

 Erosion , ulcers or redness of the esophageal mucosa during endoscopy are typical of reflux oesophagitis .

 

Histological confirmation Barret esophagus ( precancerous condition ) is a serious complication of GERD . Other tests the pH meter , the manometry and examination of the esophagus with barium.

 

INDICATIONS FOR SURGICAL INTERVENTION

 

1.Failure of drug therapy or chronicity ( antacids , Prazoles )

 

2.Esophagus Barret, oesophageal ulcers .

 

3.Symptoms as asthma , snoring , severe coughing , chest pain , arrhythmias , aspiration .

 

Recent studies  about Barret 's esophagus regarding the dysplastic changes of Barrett while is reported an improvement with sufficient degree of esophagitis in correlation with patients receiving conservative treatment, to date there is no apparent preventing the development of  esophageal adenocarcinoma with surgical intervention.

 

DIAPHRAGMATIC HERNIAS

 

Another condition characterized by GERD is diaphragmatic hernia wherein represents the input of abdominal viscera in the thorax through the diaphragmatic defect.

 

95 % of sliding hiatal hernia or type I, and represent the insertion of  portion of the stomach to the chest.FIG 1.

 

The remaining 5% are paraesophageal  hiatal representing entrance dome of the stomach or other viscera inside the  thorax.FIG.2

 

Indications for surgery

 

1. Surgical repair of type I diaphragmatic hernia with no evidence of GERD  is not necessary

 

2 . All symptomatic paraesophageal diaphragmatic - hernias should be repaired surgically , especially those with acute symptoms of obstruction or accompanied by torsion of the stomach .

 

3.The procedures of  choice is Nissen fundoplication or when the lower esophageal sphincter introduced preoperative manometric pressure > 20cmH2O and partial fundoplication or transthoracic Belsey with accessed manometry < 20 cmH2O.

 

SAGES

 

Society of American Gastrointestinal and Endoscopic Surgeons

 

GUIDELINES

 

 


Fig. 1



Fig. 2