Basics

Interesting facts about reflux

Achalasia

Achalasia is a functional disorder of the esophagus with impaired relaxation of the lower esophageal sphincter and aperistalsis (=absence of motility) of the esophageal body. As a consequence the transport of food is incomplete or absent. In addition the lower esophageal sphincter (LES) fails to open for emptying the food into the Stomach (greek achalasein = fails to relax). A functional outflow obstruction occurs. Due to the inability to eat and swallow the patients loose weight. Achalasia is a rare condition and occurs in 0.5-1.0 cases per 100.000 persons a year.

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Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease ( GERD ) affects 20% to 30% of the population in Europe and North America. In addition similar trends are reported for Asia (China, Japan, Taiwan) and South America (Chile, Brasil). GERD affects men and women at similar frequency.

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Eosinophilic esophagitis

The eosinophilic Esophagitis is an allergic esophageal inflammation: the asthma of the esophagus. It is named after the observation that a special type of inflammatory cell, the eosinophil granulocyte (eosinophil), enriches within the esophagus.

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Magnetic ring (Linx, Torax®)

Reflux and Heartburn occur as a consequence of the failed function of the Anti reflux mechanism in the lower portion of the esophagus (the lower esophageal sphincter; LES). The laparoscopic Magnetic ring operation restores the function of the lower esophageal sphincter.

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Colonoscopy (anorectocolonoscopy)

Colonoscopy (anorectocolonoscopy) describes the endoscopic examination of the inner layer ( Mucosa ) of the anus, rectum and colon (large bowel). We perform painless colonoscopy under sedation. Usually colonoscopy lasts 15-20 min. During the Endoscopy our anesthesiologist monitors your blood pressure, heart rate and breathing.

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Gastroscopy (esophagogastroduodenoscopy)

Gastroscopy is the endoscopic examination of the upper part of the gastrointestinal tract: the esophagus (gullet), the Stomach and the Duodenum . We perform painless Gastroscopy under sedation. Usually Gastroscopy lasts 15-20 min. During the Endoscopy our anesthesiologist monitors your blood pressure, heart rate and breathing.

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Esophageal manometry (high resolution impedance manometry; HRIM)

Esophageal manometry is an important ambulatory diagnostic test for Gastroesophageal reflux disease ( GERD ). In our lab we combine investigation of pressure topography (high resolution manometry) with the assessment of esophageal transport function ( Impedance technology). Impedance changes along a catheter indicate the direction (influx, Reflux ) and quality of transport (complete, incomplete).

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Columnar lined esophagus (CLE)

Normally the Squamous epithelium covers the innermost layer ( Mucosa ) of the esophagus (gullet). Reflux inflames the esophagus. As a consequence the normal Mucosa is replaced by a Mucosa , which is lined by a columnar Epithelium . This condition is termed columnar lined esophagus (CLE).

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Squamo oxyntic gap (SOG)

The squamo oxyntic gap (SOG) is the morphological consequence of the Reflux . It develops at the cost of the normal tissue of the esophagus. Normally the squamous lined Mucosa covers the esophagus. The Oxyntic mucosa lines the upper portion of the Stomach . Reflux alters the innermost layer ( Mucosa ) of the esophagus. A columnar type Mucosa replaces the normal squamous Mucosa . This is the columnar lined esophagus (CLE).

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Barrett's esophagus

Barrett’s esophagus results from Reflux ( Gastroesophageal reflux disease ; GERD ). Barrett’s esophagus is an abnormal, premalignant tissue within the inner layer of the esophagus (i.e. the Mucosa ). Barrett’s esophagus affects 20% to 30% of individuals with symptoms of Gastroesophageal reflux disease ( GERD ) including Heartburn , acid regurgitation, coughing, wheezing and asthma. Barrett’s esophagus equally affects males and females with a maximal frequency at 40-50 years of age. Via a sequence involving low- and high- grade Dysplasia Barrett’s esophagus may progress to esophageal cancer: 0.5% annual risk. Thus the risk of Barrett’s esophagus to progress to cancer compares to the risk of a colonic polyp to progress to colon cancer.

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Dialeted distal esophagus

The dilated distal esophagus (the Cardia ) is the Reflux damaged dilated lower portion of the esophagus. It is covered by a columnar lined Mucosa (innermost layer of the esophagus), which resembles gastric and intestinal Mucosa . The Cardia interposes between the normal esophagus (lined by Squamous epithelium ) and the upper portion of the Stomach (lined by Oxyntic mucosa ).

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Fundoplicatio

Reflux occurs because of the impaired function of the Anti reflux mechanism in the lower part of the esophagus, the lower esophageal sphincter. Medical therapy lowers the acidity of the Reflux but it does not eliminate the Reflux per se. Surgery wraps the proximal Stomach ( Fundus ) around the lower portion of the esophagus and thus creates a functioning Anti reflux mechanism . Thus Fundoplication restores the lost function of the lower esophageal sphincter.

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Radiofrequency ablation (RFA; HALO®)

Radiofrequency ablation (RF ablation; RFA; HALO®; GI Solution, Covidien, USA) is a novel technology for the effective and durable minimal invasive endoscopic elimination of Barrett’s esophagus (± Dysplasia and early stage cancer). Barrett’s esophagus is a premalignant tissue of the innermost layer ( Mucosa ) of the esophagus (gullet). Barrett’s esophagus develops as a consequence of the Reflux . Reflux in turn causes inflammation and genetic changes, which format the tissue for progression to cancer.

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Reflux

Reflux indicates the back flow of gastric content (lat. refluare = flow back). Acid reflux is the major cause for Heartburn . Symptomatic Acid reflux with Heartburn , coughing and vomiting affects 20% to 30% of the population (male and females with similar frequency).

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Reflux without Heartburn

Reflux without Heartburn occurs, of the Reflux damages the nerves. As a consequence, the Reflux is not perceived. 10%-15% of persons without Heartburn have premalignant Barrett’s esophagus

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Reflux monitoring (intraluminal impedance pH monitoring)

Reflux monitoring works by the assessment of the flow of fluid along a catheter positioned in the lumen of the esophagus. Impedance technology allows us to assess the direction of a flow of fluid: influx vs. Reflux . Correlation of flows of fluid (influx vs Reflux ) with symptoms ( Heartburn etc.) enables us to say, if influx/ Reflux causes the symptoms. In addition the combination of Impedance and pH monitoring allows us to discriminate between acid and non acid refluxes. This is the rational background for our Reflux monitoring .

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Reflux Surgery

Reflux surgery describes the surgical therapy of Gastroesophageal reflux disease ( GERD ). GERD results from the eating behavior (too much, too often, too sweet) and affects 20%-30% of the population. Due to the symptoms ( Heartburn , acid regurgitation, wheezing, asthma) GERD impairs the life quality. Over-eating induced gastric distentions stretch and weaken the antireflux mechanism (lower esophageal sphincter) within the lower end of the esophagus (gullet). As a consequence Reflux and Heartburn occur.

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Heartburn

Heartburn describes the leading symptom of Reflux ( Gastroesophageal reflux disease ; GERD ). Heartburn is the burning sensation, which starts in the upper abdomen and extends behind the breastbone (sternum) through the chest into the neck, mouth and ears. Typically Heartburn occurs 30 min to 60 min after a meal. Heartburn affects 20% to 30% of the population in Europe, North America (Canada, USA) and Asian countries (China, Taiwan, Japan). Males and females are equally affected by Heartburn (age: 30-40 years).

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Hiatal hernia

On its course from the neck into the Stomach the esophagus (gullet) traverses through a small hole in the diaphragm (the hiatus). Small and large hernia is defined by a diameter of < 3cm and > 3 cm, respectively.

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