Pathophysiology of Gastro-oesophageal Reflux Disease (GERD) with Respect to Reflux-Induced Carcinogenesis

Abstract

Summary: Background: Gastro‐oesophageal reflux disease has a complex pathophysiology. Therefore, therapeutic considerations should not only include the peptic component of the disease. Methods: A variety of studies in rats and in humans demonstrate the consequences of gastro‐oesophageal reflux and medical and surgical interventions in terms of inflammation, epithelial growth stimulation, apoptosis and oxidative stress in the epithelium of the oesophagus. Results: Gastro‐oesophageal reflux disease consists of a variety of pathophysiologically important factors. These include changes in the anatomy, gastro‐oesophageal motility, epithelial growth, inflammation, apoptosis and molecular structure and may lead to carcinogenesis. Surgery restores the antireflux barrier and improves oesophageal and gastric motility, thus preventing the consequences of the disease. Conclusions: Antireflux surgery provides a causative therapy of gastrointestinal reflux disease.

Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease

“…Between January 19 and May 31, 2006, 35 consecutive patients (20 males) presenting at the University Clinic of Surgery, Vienna, with clinical signs of GERD, i.e. heartburn and regurgitation [22,23], prospectively underwent video-esophagogastroduodenoscopy (EGD) and biopsy sampling of the esophagogastric junction (see below) [21]. Endoscopies were conducted by three investigators each of whom routinely performs 250 EGDs per year.…”

Histopathology of columnar-lined esophagus in patients with gastroesophageal reflux disease

“…In addition to symptom-induced impairment of quality of life [2,3], GERD is associated with a morphology termed "columnar-lined esophagus" (CLE) [4,5]. During esophagogastroduodenoscopy (EGD), the rise of the gastric folds indicates the end of the tubular esophagus [6].…”

Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?

“…Antireflux surgery is an effective treatment for gastroesophageal reflux disease (GERD), with its complex pathophysiology with good long-term results in the majority of patients, and is superior over medical therapy to control GERD [1][2][3][4][5][6][7]. Therefore, antireflux surgery should be considered in all patients with severe GERD and even in those patients with mild reflux oesophagitis in whom continuous medical treatment with proton pump inhibitors on a standard dose fails to achieve acceptable symptomatic and/or endoscopic results [8].…”