Biology of gastroesophageal reflux disease: pathophysiology relating to medical and surgical treatment.

Abstract:

:This chapter reviews the biology of gastroesophageal reflux disease, relating pathophysiology to medical and surgical therapy. Various definitions of the disease are presented and workable criteria are developed to identify patients with the disease. The central importance of the lower esophageal high-pressure zone as a barrier to reflux is emphasized, along with an analysis of its biomechanical alteration in disease. The composition of the refluxed gastric juice is characterized in regard to its potential for mucosal injury. Evidence is provided that cardiac-type mucosa is an acquired sequel to acid-induced squamous mucosal injury in the terminal esophagus. A hypothesis regarding the process of intestinalization of cardiac-type mucosa to form Barrett's esophagus is presented. An integrated concept of the pathophysiology of gastroesophageal reflux disease is constructed. Practical concepts regarding the treatment of gastroesophageal reflux disease are developed, based on a review of studies on the natural history of the disease and the long-term outcome of therapy.

journal_name

Annu Rev Med

authors

DeMeester TR,Peters JH,Bremner CG,Chandrasoma P

doi

10.1146/annurev.med.50.1.469

subject

Has Abstract

pub_date

1999-01-01 00:00:00

pages

469-506

eissn

0066-4219

issn

1545-326X

journal_volume

50

pub_type

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