Reflux disease and Barrett's esophagus

被引:25
作者
Falk, GW [1 ]
机构
[1] Cleveland Clin Fdn, Dept Gastroenterol, Ctr Swallowing & Esophageal Disorders, Cleveland, OH 44195 USA
关键词
D O I
10.1055/s-1999-13643
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Gastroesophageal reflux disease (GERD) is a common clinical problem. New information suggests that infection with Helicobacter pylori may protect patients from developing GERD and its complications. Endoscopy may be used by clinicians to tailor GERD therapy, but an empirical trial of a proton-pump inhibitor may be an alternative diagnostic approach. Studies continue to show that laparoscopic antireflux surgery is a cost-effective treatment option for patients requiring maintenance therapy with proton-pump inhibitors. However, the minimally invasive nature of the operation should not alter the indications for antireflex surgery, especially for patients with atypical symptoms. It remains unclear why some patients with GERD develop Barrett's esophagus, whereas others do not. Recent guidelines suggest that patients with long-standing GERD symptoms, especially white men over 50 years of age, should undergo endoscopy at least once to screen for Barrett's esophagus, Debate concerning short-segment Barrett's esophagus continues. Intestinal metaplasia at a normal-appearing gastroesophageal junction may be associated with intestinal metaplasia of the stomach and infection with H, pylori, whereas short tongues of intestinal metaplasia in the esophagus are associated with GERD, Cancer surveillance is indicated in short-segment Barrett's esophagus, as dysplasia may develop in these patients. Barrett's esophagus is the only known risk factor for the development of esophageal adenocarcinoma, but the incidence of adenocarcinoma may be lower than previously reported. New clinical guidelines for endoscopic surveillance suggest that the surveillance interval should be lengthened to every two years in patients without dysplasia, Newer treatment options, such as thermal ablation and photodynamic therapy, continue to show promise, but are not yet ready for routine clinical use.
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页码:9 / 16
页数:8
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共 45 条
  • [11] Increased esophageal chemoreceptor sensitivity to acid in patients after successful reversal of Barrett's esophagus
    Fass, R
    Yalam, JM
    Camargo, L
    Johnson, C
    Garewal, HS
    Sampliner, RE
    [J]. DIGESTIVE DISEASES AND SCIENCES, 1997, 42 (09) : 1853 - 1858
  • [12] Incidence of Barrett's adenocarcinoma in an Italian population: an endoscopic surveillance programme
    Ferraris, R
    Bonelli, L
    Conio, M
    Fracchia, M
    Lapertosa, G
    Aste, H
    Iaquinto, G
    DOnofrio, V
    Ravelli, P
    Missale, G
    Cestari, R
    Macri, G
    Salvadori, G
    Fulcheri, E
    Munizzi, F
    Sciallero, S
    Bruzzi, P
    Briglia, R
    Podesta, O
    Marchi, S
    Costa, F
    Maltinti, G
    Benedetti, G
    Sablich, R
    Lacchin, T
    Lombardo, L
    Pera, A
    [J]. EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 1997, 9 (09) : 881 - 885
  • [13] Inflammation and intestinal metaplasia of the gastric cardia:: The role of gastroesophageal reflux and H-pylori infection
    Goldblum, JR
    Vicari, JJ
    Falk, GW
    Rice, TW
    Peek, RM
    Easley, K
    Richter, JE
    [J]. GASTROENTEROLOGY, 1998, 114 (04) : 633 - 639
  • [14] Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid
    Gossner, L
    Stolte, M
    Sroka, R
    Rick, K
    May, A
    Hahn, EG
    Ell, C
    [J]. GASTROENTEROLOGY, 1998, 114 (03) : 448 - 455
  • [15] Grade A, 1997, AM J GASTROENTEROL, V92, P2040
  • [16] Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy
    Guelrud, M
    Herrera, I
    [J]. GASTROINTESTINAL ENDOSCOPY, 1998, 47 (06) : 512 - 515
  • [17] Intestinal metaplasia at the gastro-oesophageal junction:: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?
    Hackelsberger, A
    Günther, T
    Schultze, V
    Manes, G
    Dominguez-Muñoz, JE
    Roessner, A
    Malfertheiner, P
    [J]. GUT, 1998, 43 (01) : 17 - 21
  • [18] Hardwick R H, 1997, Dis Esophagus, V10, P233
  • [19] Harris RA, 1997, AM J GASTROENTEROL, V92, P2179
  • [20] Early adenocarcinoma in Barrett's oesophagus
    Holscher, AH
    Bollschweiler, E
    Schneider, PM
    Siewert, JR
    [J]. BRITISH JOURNAL OF SURGERY, 1997, 84 (10) : 1470 - 1473