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Severe Reflux-Induced Esophagitis

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Gastrointestinal Surgery

Abstract

Severe reflux-induced esophagitis is a condition characterized by esophageal inflammation caused by acid and biliary reflux. The process leads to different degrees of esophageal damage with respective clinical presentations, which range from acute pain and severe debilitating dysphagia to life-threatening adenocarcinoma. Early intervention is essential in order to avoid irreversible damage, and since symptoms alone are not always reliable to identify progression of disease, it is important to monitor patients with predisposing risk factors. Depending on the severity of the disease, several options for treatment are available, ranging from medication to endoscopic and surgical therapy.

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References

  1. Kauer WK, Stein HJ. Emerging concepts of bile reflux in the constellation of gastroesophageal reflux disease. J Gastrointest Surg. 2010;14(Suppl 1):S9–16. doi:10.1007/s11605-009-1014-4.

    Article  PubMed  Google Scholar 

  2. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–87.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bredenoord AJ1, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet. 2013;381(9881):1933–42. doi:10.1016/S0140-6736(12)62171-0.

    Article  PubMed  Google Scholar 

  5. Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Surgical treatment of reflux esophagitis. J Gastrointest Surg. 2007;11(9):1207–9.

    Article  Google Scholar 

  6. Liu JJ, Saltzman JR. Management of gastroesophageal reflux disease. South Med J. 2006;99(7):735–41; quiz 742, 752.

    Article  PubMed  Google Scholar 

  7. Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: akalixanda study report. Scand J Gastroentero. 2005;40(3):275–85.

    Article  Google Scholar 

  8. Carlsson R, Dent J, Watts R, et al. Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. International GORD study group. Eur J Gastroenterol Hepatol. 1998;10:119–24.

    Article  CAS  PubMed  Google Scholar 

  9. Venables TL, Newland RD, Patel AC, et al. Omeprazole 10 milligrams once daily, 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol. 1997;32:965–73.

    Article  CAS  PubMed  Google Scholar 

  10. Souza RF. The role of acid and bile reflux in oesophagitis and Barrett’s metaplasia. Biochem Soc Trans. 2010;38(2):348–52. doi:10.1042/BST0380348.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Desai KM, Frisella MM, Soper NJ. Clinical outcomes after laparoscopic antireflux surgery in patients with and without preoperative endoscopic esophagitis. J Gastrointest Surg. 2003;7(1):44–51.Discussion 51–2.

    Article  PubMed  Google Scholar 

  12. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Genta RM, Spechler SJ, Kielhorn AF. The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. Dis Esophagus. 2011;24(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  14. Westhoff B, Brotze S, Weston A, McElhinney C, Cherian R, Mayo MS, etal. The frequency of Barrett’s esophagus in high-risk patients with chronic GORD. Gastrointest Endosc. 2005;61(2):226–31.

    Article  PubMed  Google Scholar 

  15. Labenz J, Nocon M, Lind T, Leodolter A, Jaspersen D, Meyer-Sabellek W, etal. Prospective follow-up data from the ProGORD study suggest that GORD is not a categorical disease. Am J Gastroenterol. 2006;101(11):2457–62.

    Article  PubMed  Google Scholar 

  16. Orr WC. Review article: sleep-related gastro-oesophageal reflux as a distinct clinical entity. Aliment Pharmacol Ther. 2010;31:47–56.

    Article  CAS  PubMed  Google Scholar 

  17. Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–31.

    Article  CAS  PubMed  Google Scholar 

  18. Armstrong D, Marshall JK, Chiba N, et al. Canadian consensus conference on the management of gastroesophageal reflux dis-ease in adults—update 2004. Can J Gastroenterol. 2005;19:15–35.

    PubMed  Google Scholar 

  19. Vakil N, Moayyedi P, Fennerty MB, et al. Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology. 2006;131:390–401.

    Article  PubMed  Google Scholar 

  20. Rantanen TK, Sihvo EI, Rasanen JV, et al. Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment. Am J Gastroenterol. 2007;102:246–53.

    Article  PubMed  Google Scholar 

  21. GralnekI M, Dulai GS, Fennerty MB, et al. Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol. 2006;4:1452–8.

    Article  Google Scholar 

  22. Vela MF, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.

    Article  CAS  PubMed  Google Scholar 

  23. Stein HJ, Kauer WKH, Feussner H, et al. Bile acids as components of the duodenogastric refluxate: detection, relationship to bilirubin, mechanism of injury and clinical relevance. Hepato.Gastroenterol. 1999;46:66–7.

    CAS  Google Scholar 

  24. Kauer WKH, Burdiles P, Ireland A, et al. Does duodenal juice reflux into the esophagus of patients with complicated GERD. Am J Surg. 1995;169:98–104.

    Article  CAS  PubMed  Google Scholar 

  25. Stein HJ, Kauer WKH, Feussner H, et al. Bile reflux in benign and malignant Barrett’s esophagus. Effect of medical acid suppression and fundoplication. J Gastrointest Surg. 1998;2:233–41.

    Article  Google Scholar 

  26. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71

    Article  PubMed  Google Scholar 

  27. Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1392–413.

    Article  PubMed  Google Scholar 

  28. Tytgat GNJ. Review article: management of mild and severe gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2003; 17(Suppl 2):52–6.

    Article  PubMed  Google Scholar 

  29. Chubineh S1, Birk J. Proton pump inhibitors: the good, the bad, and the unwanted. South Med J. 2012;105(11):613–8. doi:10.1097/SMJ.0b013e31826efbea.

    Article  PubMed  Google Scholar 

  30. Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American gastroenterological association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140(3):1084–91.

    Article  PubMed  Google Scholar 

  31. Vela MF, Camacho-Lobato L, Srinivasan R, et al. Intraesophageal impedance and pH measurement of acid and non-acid reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.

    Article  CAS  PubMed  Google Scholar 

  32. Ghatak S, Reveiller M, Toia L, Ivanov A, Godfrey TE, Peters JH. Bile acid at low pH reduces squamous differentiation and activates EGFR signaling in esophageal squamous cells in 3-D culture. J Gastrointest Surg. 2013;17(10):1723–31. doi:10.1007/s11605-013-2287-1.

    Article  PubMed  Google Scholar 

  33. Kahrilas PJ1, Shaheen NJ, Vaezi MF. American gastroenterological association institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1392–1413, 1413.e1–5. doi:10.1053/j.gastro.2008.08.044.

    Article  PubMed  Google Scholar 

  34. Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther. 2011;34:1269–81.

    Article  CAS  PubMed  Google Scholar 

  35. Laheij RJ, Sturkenboom MC, Hassing JR, et al. Risk of community- acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292:1955–60.

    Article  CAS  PubMed  Google Scholar 

  36. Campos GM1, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 1999;3(3):292–300.

    Article  CAS  PubMed  Google Scholar 

  37. Parasa S, Sharma P. Complications of gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol. 2013;27(3):433–42. doi:10.1016/j.bpg.2013.07.002.

    Article  CAS  PubMed  Google Scholar 

  38. Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the lotus randomized clinical trial. JAMA. 2011;305:1969–77.

    Article  CAS  PubMed  Google Scholar 

  39. Parrilla P, Martinezde Haro LF, Ortiz A, et al. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg. 2003;237:291–8.

    PubMed Central  PubMed  Google Scholar 

  40. Gurski RR, Peters JH, Hagen JA, et al. Barrett’s esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. J Am Coll Surg. 2003;196:706–12.

    Article  PubMed  Google Scholar 

  41. Zaninotto G, Parente P, Salvador R, et al. Long-term follow-up of Barrett’s epithelium: medical versus antireflux surgical therapy. J Gastrointest Surg. 2012;16:7–14.

    Article  PubMed  Google Scholar 

  42. Horvath KD, Jobe BA, Herron Dm, Swanstrom LL. Laparoscopic toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg. 1999;3:583–91.

    Article  CAS  PubMed  Google Scholar 

  43. Patti MG, Robinson T, Galvani C, Gorodner MV, Fisichella PM, Way LW. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg. 2004;198:863–70.

    Article  PubMed  Google Scholar 

  44. Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Management of Barrett’s esophagus. J Gastrointest Surg. 2007;11(9):1213–5.

    Article  Google Scholar 

  45. Broeders JA1, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg. 2010;97(6):845–52. doi:10.1002/bjs.7023.

    Article  CAS  PubMed  Google Scholar 

  46. Braghetto I1, Csendes A, Burdiles P, Botero F, Korn O. Results of surgical treatment for recurrent postoperative gastroesophageal reflux. Dis Esophagus. 2002;15(4):315–22.

    Article  CAS  PubMed  Google Scholar 

  47. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, et al. Evidence-based appraisal of antireflux fundoplication. Ann Surg. 2004;239:325–37.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Grant AM, Cotton SC, Boachie C, Ramsay CR, Krukowski ZH, Heading RC, Campbell MK. Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX). BMJ. 2013;346:f1908. doi:10.1136/bmj.f1908.

    Google Scholar 

  49. Faria R, Bojke L, Epstein D, Corbacho B, Sculpher M.REFLUX trial group. Cost-effectiveness of laparoscopic fundoplication versus continued medical management for the treatment of gastro-oesophageal reflux disease based on long-term follow-up of the REFLUX trial. Br J Surg. 2013;100(9):1205–13.

    Article  Google Scholar 

  50. Rossi M1, Barreca M, deBortoli N, Renzi C, Santi S, Gennai A, Bellini M, Costa F, Conio M, Marchi S. Efficacy of Nissen fundoplication versus medical therapy in the regression of low grade dysplasia in patients with Barrett esophagus: a prospective study. Ann Surg. 2006;243(1):58–63.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Lipham JC, Demeester TR, Ganz RA, et al. â£e LINX(®) reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc. 2012;26:2944–9.

    Article  PubMed  Google Scholar 

  52. Locke GR, Horwhat J, Mashimo H, Savarino E, Zentilin P, Savarino V, Zerbib F, Armbruster SP, Wong RK, Moawad F. Endotherapy for and tailored approaches to treating GERD, and refractory GERD. Ann N Y Acad Sci. 2013;1300:166–86. doi:10.1111/nyas.12240.

    Article  CAS  PubMed  Google Scholar 

  53. Pisegna J, Holtmann G, Howden CW, Katelaris PH, Sharma P, Spechler S, Triadafilopoulos G, Tytgat G. Review article: oesophageal complications and consequences of persistent gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004; 20(Suppl 9):47–56.

    Article  PubMed  Google Scholar 

  54. Awad ZT1, Filipi CJ, Mittal SK, Roth TA, Marsh RE, Shiino Y, Tomonaga T. Left side thoracoscopically assisted gastroplasty: a new technique for managing the shortened esophagus. Surg Endosc. 2000;14(5):508–12.

    Article  CAS  PubMed  Google Scholar 

  55. Urbach DR, Khajanchee YS, Glasgow RE, Hansen PD, Swan-strom LL. Preoperative determinations of an esophageal-length-ening procedure in laparoscopic antireflux surgery. Surg Endosc.

    Google Scholar 

  56. Pregun I, Hritz I, Tulassay Z, Herszényi L. Peptic esophageal stricture: medical treatment. Dig Dis. 2009;27(1):31–7. doi:10.1159/000210101. Epub 2009 May 8. Review.

    Article  PubMed  Google Scholar 

  57. Spechler SJ. Clinical manifestations and esophageal complications of GORD. Am J Med Sci. 2003;326(5):279–84.

    Article  PubMed  Google Scholar 

  58. Braghetto I, Csendes A, Burdiles P, Korn O, Compan A, Guerra JF. Barrett’s esophagus complicated with stricture: correlation be-tween classification and the results of the different therapeutic options. World J Surg. 2002;26:1228–33.

    Article  PubMed  Google Scholar 

  59. Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus. 2005;18(6):359–64.

    Article  CAS  PubMed  Google Scholar 

  60. Dakkak M, Hoare RC, Maslin SC, et al. Oesophagitis is as important as oesophageal stricture diameter in determining dysphagia. Gut.1993;34:152–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Watson A. Reflux stricture of the oesophagus. Br J Surg. 1987;74:443–8.

    Article  CAS  PubMed  Google Scholar 

  62. Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc. 1999;49(4 Pt 1):509–13.

    Article  CAS  PubMed  Google Scholar 

  63. Bender EM, Walbaum PR. Esophagogastrectomy for benign esophageal stricture. Fate of the esophagogastric anastomosis. Ann Surg. 1987;205:385–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Buttar NS, Falk GW. Pathogenesis of gastroesophageal reflux and Barrett esophagus. Mayo Clin Proc. 2001;76:226–34.

    Article  CAS  PubMed  Google Scholar 

  65. Lieberman DA, Oehlke M, Helfand M. Risk factors for Barrett’s esophagus in community-based practice. Gorge consortium. Gastroenterology outcomes research group in endoscopy. Am J Gastroenterol. 1997;92:1293–7.

    CAS  PubMed  Google Scholar 

  66. Modiano N, Gerson LB. Risk factors for the detection of Barrett’s esophagus in patients with erosive esophagitis. Gastrointest Endosc. 2009;69(6):1014–20. doi:10.1016/j.gie.2008.07.024.

    Article  PubMed  Google Scholar 

  67. Inadomi JM, Sampliner R, Lagergren J, et al. Screening and surveillance for Barrett esophagus in high risk groups: a cost-utility analysis. Ann Intern Med. 2003;138:176–86.

    Article  PubMed  Google Scholar 

  68. Prasad GA, Bansal A, Sharma P, Wang KK. Predictors of progression in Barrett’s esophagus: current knowledge and future directions. Am J Gastroentero. 2010;105(7):1490–502.

    Article  Google Scholar 

  69. Leodolter A, Nocon M, Vieth M, Lind T, Jaspersen D, Richter K, et al. Progression of specialized intestinal metaplasia at the cardia to macroscopically evident Barrett’s esophagus: an entity of concern in the Progord study. Scand J Gastroentero. 2012;47(12):1429–35.

    Article  Google Scholar 

  70. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.

    Article  CAS  PubMed  Google Scholar 

  71. Shaheen NJ, Crosby MA, Bozymski EM, et al. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus?.Gastroenterology. 2000;119:333–8.

    Article  CAS  PubMed  Google Scholar 

  72. Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67:394–8.

    Article  PubMed  Google Scholar 

  73. Falk GW, Jacobson BC, Riddell RH, Rubenstein JH, El-Zimaity H, Drewes AM, et al. Barrett’s esophagus: prevalence- incidence and etiology-origins. Ann N Y Acad Sci. 2011;1232:1–17.

    Article  CAS  PubMed  Google Scholar 

  74. Mori H1, Kobara H, Fujihara S, Nishiyama N, Nomura T, Kobayashi M, Hagiike M, Izuishi K, Suzuki Y, Masaki T. Simultaneous resection of Barrett’s esophageal cancer and severe stenosis caused by reflux esophagitis. Gastrointest Endosc. 2012;76(3):689–90. doi:10.1016/j.gie.2011.08.035.

    Article  PubMed  Google Scholar 

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Correspondence to Stephen C. Yang MD .

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Barbon, C., Mungo, B., Molena, D., Yang, S. (2015). Severe Reflux-Induced Esophagitis. In: Pawlik, T., Maithel, S., Merchant, N. (eds) Gastrointestinal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2223-9_7

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