Introduction

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)

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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