Failed Anti-Reflux Therapy

This multi-authored text provides information on the pathophysiology of Gastroesophageal Reflux Disease (GERD), appropriate medical management, and proper indications for and performance of surgical and endoscopic procedures.

The Editors look at the current understanding of this disease, and present new information regarding tissue susceptibility, the role of bile and digestive enzymes, and cyclic changes in LES tone. Chapters are devoted to standard therapeutic options for GERD, including lifestyle changes, pharmacologic therapy, and surgery. In addition, newer endoscopic treatments including Stretta, Endocinch, injection of bulking agents, as well as others, are described.

Failed Anti-Reflux Therapy: Analysis of Causes and Principles of Treatment is essential to any physician who manages patients with GERD, including internists, gastroenterologists, general surgeons, and thoracic surgeons.

Auteur
Dr. P. Marco Fisichella is an expert in Minimally Invasive Gastrointestinal, Esophageal, and Bariatric Surgery. Executive Director with over 12 years experience in patient care, clinical research, and higher education. Strong leadership and project management skills coupled with demonstrated ability to achieve profitable growth. Have directed:
• The Surgical Services at Jamaica Plains, Boston VA Healthcare System, with a volume of 63,000 clinic visits per year.
• A $4.5M Simulation Center at Loyola University Stritch School of Medicine
• The Surgical Subspecialty Clinics at Hines Jr. VA Medical Center with a volume of 85,000 clinic visits per year
• The Swallowing Center at Loyola University Medical Center.

Résumé
th Although GERD was initially described in the early 19 century,it is essentially a c- sequence of our modern day largesse. Dietary factors and associated obesity have c- bined with as yet other unknown factors (e. g. a decrease in the prevalence of H. pylori?) to make GERD one of the most common diseases affecting western society. It is es- mated that up to 20 million adults in the United States suffer from GERD,and treatment of these individuals consumes approximately $10 billion annually,the majority of it for prescription drugs used to manage the disease and its symptoms. Fortunately, despite challenges presented by co-factors resulting in GERD (diet, obesity, etc. ), therapy of GERD is largely successful. However, even a low failure rate for a therapy used in the management of GERD still results in large numbers of affected patients because of the high prevalence of this disease. Use of a conservative estimate of a failure rate of 5% translates to 1 million ineffectively treated and unhappy patients. How to manage these patients is the subject of this book. Why is publication of this book important now? Several factors prompted us to work on this project. Mature results for proton pump inhibitor use are available,making this an appropriate time to review outcomes of PPI therapy of GERD. Similarly,mature results are now available for minimally invasive surgical therapy for GERD.

Contenu
The Epidemiology and Pathophysiology of Gastroesophageal Reflux Disease.- History of Medical and Surgical Anti-Reflux Therapy.- Medical Management of GERD: Algorithms and Outcomes.- Complications of GERD: Esophagitis, Stricture, Barrett's, and Cancer.- Principles of Successful Surgical Anti-Reflux Procedures.- Acute Complications of Anti-Reflux Surgery.- Persistent Symptoms after Anti-Reflux Surgery and their Management.- Technical Surgical Failures: Presentation, Etiology, and Evaluation.- Symptoms after Anti-Reflux Surgery: Everything is not Always Caused by Surgery.- The Medical and Endoscopic Management of Failed Surgical Anti-Reflux Procedures.- Reoperation for Failed Anti-Reflux Surgery.- Management of Alkaline Reflux.- Management of the Short Esophagus.- Esophagectomy: Indications, Techniques, and Outcomes.- Vagal Sparing Esophagectomy.- Future Directions of Therapy for GERD.