What is the significance of a defective LES? The finding of a permanently defective LES (pressure less than 6 mm Hg) has several implications. First, it is almost always associated with esophageal mucosal injury and predicts that symptoms will be difficult to control with medical therapy alone. A defective LES results in an increased GE junction diameter …
What factors play a role in altering the GE barrier? The two most important are hypotension of the LES and loss of the angle of His as a result of hiatal hernia. Either may contribute to loss of competency of the sphincter and thus abnormal reflux. Physiologic reflux or reflux in early disease results from …
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surgical management of patients with HGD HGD is defined as the detection in the Barrett’s epithelium of epithelial abnormalities that could equally be described as carcinoma in situ (markedly enlarged nuclei at the surface, pronounced pleomorphism and focal loss of nuclear polarity). Many large surgical series document that following esophageal resection, between 20% and 40% of patients …
Can Barretts esophagus regress after antireflux therapy? Recent publications have suggested that curtailing reflux may decrease the tendency of GERD patients without Barrett’s epithelium to develop Barrett’s esophagus. In addition, reflux control may diminish the tendency toward dysplastic or malignant degeneration of existing Barrett’s epithelium. That can be accomplished by either medical or surgical management, …
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Relationship of Barretts esophagus to esophageal cancer Barrett’s columnar-lined esophagus is an acquired condition of the distal esophagus occurring in 10% to 15% of individuals with chronic GE reflux and in 6.8% of the general population. The incidence of adenocarcinoma increases nearly fortyfold in patients with Barrett’s esophagus. It is estimated that 5% of patients with …
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Complications of Heller myotomy The most common complication of a surgical myotomy is esophageal perforation, which is reported in 0% to 4.6% of patients. Previous pneumatic dilatation and botulinum toxin injection increase the technical difficulty in performing a myotomy and may increase the rate of perforation. Mucosal injuries detected during surgery may be repaired primarily. …
What is the association between achalasia and esophageal cancer? Patients with achalasia are thought to be at increased risk for the development of squamous cell carcinoma, with risk as high as 140-fold reported . The risk is elevated because of food retention, chronic chemical irritation, and bacterial growth, as well as the associated esophagitis and Barrett’s formation, …
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