BASIC CONSIDERATIONS IN GASTROESOPHAGEAL REFLUX DISEASE - 11/09/11
Résumé |
Reflux of gastric content into the esophagus occurs in many circumstances in patients of all ages and can be categorized in many ways (Table 1). The symptoms of gastroesophageal reflux (GER) are variable and are broadly separated into “typical” or “atypical,” as shown in Table 2. The typical symptoms are readily associated with reflux of gastric contents, whereas the atypical symptoms are not so readily associated with gastroesophageal reflux disease (GERD).18, 20 As the clinician begins to analyze foregut symptoms, therefore, a reflux problem must be considered in the differential diagnosis.
If GER occurs in the absence of other abnormalities, as it commonly does, the usual treatments have a high probability of success. When GER occurs secondary to problems such as pyloric stenosis, gastric atony, or other foregut abnormalities, treatment cannot be successful unless that problem is addressed. GER can also occur in conjunction with developmental abnormalities of the central nervous system, accounting for the majority of GER observed in pediatric patient populations.
In evaluating an individual patient, the anatomic, physiologic, and constitutional factors that might play a role should be evaluated in a systematic fashion. Although most GER patients do not have identifiable co-morbid conditions, failure to recognize the notable exceptions usually compromises the success of treatment. In addition, some conditions mimic GER's symptomatology (Table 2) but require totally different treatment; such patients do not respond to treatment directed against GER.10
This overview of “basic considerations” is relevant to physicians, surgeons, and administrators, all of whom face challenges in the evaluation and treatment of GER. Perhaps the greatest potential benefit will come to those in general practice or primary care, who are challenged as never before to be cost-effective, focused, and accurate in the diagnosis and staging of all foregut diseases, especially GER, which is the most common of these disorders. All physicians and health care systems should ideally have diagnostic and treatment algorithms for these problems, basing their choice of “required” tests on realistic expectations of success. Failure to properly evaluate patients ultimately, in my view, proves more costly and dangerous than the alternative presented here. It seems inherently obvious (but impossible to prove) that the most cost-effective approach is to properly evaluate patients before any protracted course of conservative treatment, or prior to surgical intervention.10, 11
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| Address reprint request to Philip E. Donahue, MD, General Surgery—Room 6429, Cook County Hospital, 1835 W. Harrison St., Chicago, IL 60612 |
Vol 77 - N° 5
P. 1017-1040 - octobre 1997 Retour au numéro
Article précédent
- SURGICAL MANAGEMENT OF ACHALASIA
- John G. Hunter, William S. Richardson
- MEDICAL THERAPY OF GASTROESOPHAGEAL REFLUX AND MANAGEMENT OF ESOPHAGEAL STRICTURES
- John M. Wo, J. Patrick Waring
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