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Gastroesophageal Reflux Disease - Essay Example

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The esophagus is a collapsible muscular tube consisting of nonkeratinized stratified squamous epithelium, lamina propria (areolar connective tissue), and a muscularis mucosae in the mucosa. The submucosa contains areolar connective tissue, blood vessels, and mucus glands…
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Gastroesophageal Reflux Disease
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Download file to see previous pages The superficial layer of the esophagus is known as adventitia. The adventitia attaches the esophagus to surrounding structures. The esophagus secretes mucus and transports food into the stomach but it does not produce digestive enzymes. The stomach contents can reflux (back up) into the inferior portion of the esophagus when the lower esophageal sphincter fails to close adequately after food has entered the stomach; the condition which is known as gastroesophageal reflux disease (GERD). In GERD, the basal layer of of the epithelium is is thickened, and the papillae of the lamina propria are elongated and extend toward the surface. Abnormalities of the lower esophageal sphincter, Hiatus hernia, Delayed esophageal clearance, Gastric contents, Defective gastric emptying, Increased intra-abdominal pressure, and Dietary and environmental factors may be the factors involved in GERD. Clinically, GERD may be diagnosed by radiographic examinations using dyes, endoscopy, and esophageal pH-metry. PPI trial is also an accepted method of first line diagnostic test. Treatment involves both non-pharmacological treatment measures as well as pharmacotherapy. Non-pharmacological treatment include avoidance of foods and medications that exacerbate GERD, smoking secession, weight reduction, taking a small meal at a time, avoidance of alcohol and elevation of the head of the bed. Drugs for treating GERD include H2 receptor antagonists like cimetidine, ranitidine, famotidine or nizatidine. Proton pump inhibitors such as omeprazole, pantoprazole, lansoprazole and rebeprazole are found to be very effective to reduce acid reflux and hence inflammation. H2 blockers were found to heal ulcers and erosions but the typical reflux changes of the squamous epithelium of the esophageal mucosa are not recovered. Studies confirmed that PPIs not only heal ulcers and erosions but also cures basal cell hyperplasia and elongation of the papillae. The percentage of normal epithelium were also reported to increase significantly after PPI administration in patients with GERD. Two commonly employed treatment alternatives for GERD are antirefluctive surgery and Endoscopic Treatments. Surgery is preferred only when the patient fails to respond to pharmacological treatment, when the patient prefers surgery, in those patients who have complications of GERD like barrett's esophagitis, or if the patient has atypical symptoms and reflux documented on 24-hour ambulatory pH monitoring. Several randomized controlled trials have confirmed that open fundoplication and medical treatment have similar long-term effects for GERD. Laparoscopic antireflux surgery is also reported to have similar outcomes to the open procedures. Endoscopic Treatments for GERD include plicating gastric folds methods (Endoscopic Gastroplication, ELGP method, thermal tissue remodeling /neurolysis method, and bulking injection method. These endoluminal treatments augment the reflux barrier.



Section I: Organ system structure and Function. Explain the accepted normal healthy structure of parts and function of organ system; How it works
The esophagus is a collapsible muscular tube, about 25 cm (10 in.) long that lies posterior to the trachea. The esophagus begins at the inferior end of the laryngopharynx and passes through the mediastinum anterior to vertebral column. Then it pierces the diaphragm through an opening called the ...Download file to see next pagesRead More
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