Introduction

The Acid Reflux Strategy

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Previously, gastroesophageal reflux disease (GERD) was defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the eso-phagus.1 In late 2008, the American College of Gastroenterology redefined GERD as troublesome symptoms and/or complications caused by refluxing the stomach contents into the esophagus. The key is that these troublesome symptoms adversely affect the well-being of the patient.2 Esophageal GERD syndromes can be divided into two distinct categories: (a) symptomatic (or "symptom-based") esophageal syndromes and (b) syndromes associated with esophageal tissue injury.2 Symptomatic esophageal syndrome is associated with severe reflux symptoms with normal endo-scopic findings. Erosive esophagitis, a syndrome associated with esophageal tissue injury, occurs when the esophagus is repeatedly exposed to refluxed material for prolonged periods (Fig. 17-1). The inflammation that occurs progresses to erosions of the squamous epithelium. Barrett's esophagus is a complication of GERD, characterized by replacement of the normal squamous epithelial lining of the esophagus by specialized columnar-type epithelium. Barrett's esophagus is more likely to occur in patients with a long history (years) of symptomatic reflux and may be a risk factor for developing adenocarcinoma of the esophagus.

FIGURE 17-1. Endoscopic images of the esophagus. Left: Image taken during an endoscopy of the esophagus revealing normal smooth squamous cell lining. Right: Narrowed esophageal lumen (stricture) due to chronic GERD with inflammation and scarring. The surrounding esophageal lining has ulcerations and erosions from chronic acid injury. (From Barrett's esophagus website: ht-tp://www. barrettsinfo.com)

FIGURE 17-1. Endoscopic images of the esophagus. Left: Image taken during an endoscopy of the esophagus revealing normal smooth squamous cell lining. Right: Narrowed esophageal lumen (stricture) due to chronic GERD with inflammation and scarring. The surrounding esophageal lining has ulcerations and erosions from chronic acid injury. (From Barrett's esophagus website: ht-tp://www. barrettsinfo.com)

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