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• W2786288045 abstract "The present definition of gastroesophageal reflux disease (GERD) is based on the presence of troublesome symptoms and/or complications. A patient satisfying these criteria of GERD often has significant reflux into the thoracic esophagus (a 24-h pH test that shows a pH <4 for >4.5% of the time) and a defective lower esophageal sphincter (abdominal LES <10 mm). The definition therefore commits limitation of the diagnosis of GERD to patients with severe LES damage where the abdominal LES has shortened from its normal 35 to 10 mm (i.e., a 70% loss of abdominal LES). GERD patients with this severity of LES damage are difficult to manage; they progress in significant numbers to failure of proton pump inhibitor (PPI) therapy to control symptoms, Barrett esophagus, and, in a significant but increasing minority, to adenocarcinoma. PPI therapy does not prevent this progression. The present management algorithm makes no attempt at prevention of progression to treatment failure and adenocarcinoma; it is simply allowed to happen. I will propose new definitions of GERD that are based on the presence of cardiac metaplasia of squamous epithelium and severity of abdominal LES damage. This will allow recognition of that part of the disease process before the occurrence of reflux and troublesome symptoms that presently define GERD. Accurate measurement of abdominal LES damage by histology will allow for recognition of abdominal LES damage from 0 to 25 mm. It will also allow for predicting future LES damage, identifying those people destined to progress to 25 mm of abdominal LES damage. This will allow methods of intervention at an early stage of the disease to prevent progression to severe GERD defined as 25 mm of abdominal LES damage. Such an intervention has the new objective of preventing Barrett esophagus and adenocarcinoma, rather than letting these happen and reacting to them." @default.
• W2786288045 created "2018-02-23" @default.
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• W2786288045 date "2018-01-01" @default.
• W2786288045 modified "2023-09-25" @default.
• W2786288045 title "Definition of Gastroesophageal Reflux Disease" @default.
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• W2786288045 doi "https://doi.org/10.1016/b978-0-12-809855-4.00001-4" @default.
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