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Diagnosis and initial management of gastroesophageal complications.

Abstract

Chronic esophageal exposure to reflux of gastroduodenal contents can result in complications of GERD including esophageal stricture, Barrett's oesophagus or extraesophageal symptoms such as laryngitis, chronic cough or asthma. Endoscopy is the main diagnostic tool for patients with chronic reflux presenting with dysphagia to visualise esophageal mucosa and identify the underlying pathology. Barrett's oesophagus should be suspected in those with chronic reflux disease. Patients with Barrett's oesophagus should undergo surveillance endoscopy in order to risk stratify to dysplasia or adenocarcinoma. New endoscopic ablative therapies in patients with Barrett's oesophagus and high grade dysplasia are promising new treatment modality for those who may not be candidates for definitive intervention. Given poor sensitivity of diagnostic tests in extraesophageal reflux, empiric therapy with proton pump patients is the initial recommended approach. Diagnostic testing with esophagogastroduodenoscopy and ambulatory pH and impedance monitoring is usually reserved for those unresponsive to acid suppressive therapy. Many uncertainties remain in this group of patients including which patient subgroups might benefit from acid suppressive therapy. Future outcome studies are needed to assess the role of impedance/pH monitoring in this group of patients and to determine who might symptomatically benefit from medical or surgical intervention.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Vanderbilt University Medical Center, Nashville, TN 37232, United States.

    Source

    MeSH

    Asthma
    Barrett Esophagus
    Catheterization
    Cough
    Endoscopy, Digestive System
    Esophageal Stenosis
    Esophageal pH Monitoring
    Gastroesophageal Reflux
    Humans
    Laryngitis
    Predictive Value of Tests
    Proton Pump Inhibitors
    Severity of Illness Index
    Stents
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    21126695

    Citation

    Kamal, Afrin, and Michael F. Vaezi. "Diagnosis and Initial Management of Gastroesophageal Complications." Best Practice & Research. Clinical Gastroenterology, vol. 24, no. 6, 2010, pp. 799-820.
    Kamal A, Vaezi MF. Diagnosis and initial management of gastroesophageal complications. Best Pract Res Clin Gastroenterol. 2010;24(6):799-820.
    Kamal, A., & Vaezi, M. F. (2010). Diagnosis and initial management of gastroesophageal complications. Best Practice & Research. Clinical Gastroenterology, 24(6), pp. 799-820. doi:10.1016/j.bpg.2010.09.008.
    Kamal A, Vaezi MF. Diagnosis and Initial Management of Gastroesophageal Complications. Best Pract Res Clin Gastroenterol. 2010;24(6):799-820. PubMed PMID: 21126695.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnosis and initial management of gastroesophageal complications. AU - Kamal,Afrin, AU - Vaezi,Michael F, PY - 2010/09/01/received PY - 2010/09/21/revised PY - 2010/09/23/accepted PY - 2010/12/4/entrez PY - 2010/12/4/pubmed PY - 2011/3/22/medline SP - 799 EP - 820 JF - Best practice & research. Clinical gastroenterology JO - Best Pract Res Clin Gastroenterol VL - 24 IS - 6 N2 - Chronic esophageal exposure to reflux of gastroduodenal contents can result in complications of GERD including esophageal stricture, Barrett's oesophagus or extraesophageal symptoms such as laryngitis, chronic cough or asthma. Endoscopy is the main diagnostic tool for patients with chronic reflux presenting with dysphagia to visualise esophageal mucosa and identify the underlying pathology. Barrett's oesophagus should be suspected in those with chronic reflux disease. Patients with Barrett's oesophagus should undergo surveillance endoscopy in order to risk stratify to dysplasia or adenocarcinoma. New endoscopic ablative therapies in patients with Barrett's oesophagus and high grade dysplasia are promising new treatment modality for those who may not be candidates for definitive intervention. Given poor sensitivity of diagnostic tests in extraesophageal reflux, empiric therapy with proton pump patients is the initial recommended approach. Diagnostic testing with esophagogastroduodenoscopy and ambulatory pH and impedance monitoring is usually reserved for those unresponsive to acid suppressive therapy. Many uncertainties remain in this group of patients including which patient subgroups might benefit from acid suppressive therapy. Future outcome studies are needed to assess the role of impedance/pH monitoring in this group of patients and to determine who might symptomatically benefit from medical or surgical intervention. SN - 1532-1916 UR - https://www.unboundmedicine.com/medline/citation/21126695/Diagnosis_and_initial_management_of_gastroesophageal_complications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-6918(10)00117-4 DB - PRIME DP - Unbound Medicine ER -