TY - JOUR
T1 - Treatment of GERD complications (Barrett's, peptic stricture) and extra-oesophageal syndromes
AU - Bansal, Ajay
AU - Kahrilas, Peter J.
N1 - Funding Information:
This work was supported by R01 DK56033 from the Public Health Service (PJK) and a Career Development Grant from the American College of Gastroenterology (AB) .
PY - 2010/12
Y1 - 2010/12
N2 - Apart from typical reflux symptoms and oesophagitis, the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett's oesophagus, oesophageal adenocarcinoma, Peptic structure) or by extra-oesophageal syndromes, most notably asthma, laryngitis, or chronic cough. Managing these entities is much less straightforward than with oesophagitis. With respect to adenocarcinoma, metaplasia and dysplasia are recognised precursors, but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment, medical or surgical. Consequently, management focuses on strategies to identify and eliminate high-grade dysplasia and intramucosal cancer, lesions that are potentially curable by endoscopic ablation or surgical resection. With respect to the extra-oesophageal GERD syndromes, these are increasingly recognised as multifactorial conditions with reflux as an exacerbating factor. Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment.
AB - Apart from typical reflux symptoms and oesophagitis, the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett's oesophagus, oesophageal adenocarcinoma, Peptic structure) or by extra-oesophageal syndromes, most notably asthma, laryngitis, or chronic cough. Managing these entities is much less straightforward than with oesophagitis. With respect to adenocarcinoma, metaplasia and dysplasia are recognised precursors, but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment, medical or surgical. Consequently, management focuses on strategies to identify and eliminate high-grade dysplasia and intramucosal cancer, lesions that are potentially curable by endoscopic ablation or surgical resection. With respect to the extra-oesophageal GERD syndromes, these are increasingly recognised as multifactorial conditions with reflux as an exacerbating factor. Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment.
KW - Barrett's oesophagus
KW - Extra-oesophageal GERD
KW - Oesophageal adenocarcinoma
KW - Peptic stricture
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U2 - 10.1016/j.bpg.2010.09.007
DO - 10.1016/j.bpg.2010.09.007
M3 - Article
C2 - 21126707
AN - SCOPUS:78649738774
SN - 1521-6918
VL - 24
SP - 961
EP - 968
JO - Bailliere's Best Practice and Research in Clinical Gastroenterology
JF - Bailliere's Best Practice and Research in Clinical Gastroenterology
IS - 6
ER -