Sievering Surgical Clinic

Sieveringer St 9, A-1190 Vienna Tel: 328 8777

Gastroenterology Unit

Stool incontinence

Diagnosis & Treatment

Reflux

Patient information on digestive disorder

AKA:

Definition

Adenocarcinoma in the distal esophagus has in the past 20 years, the strongest increase in incidence of gastroenterological cancer. Because Barrett's mucosa is the only precursor for these cancers, this disease has gained wider recognition. At the same time the discussion on pathogenesis, diagnostic criteria and treatment options has begun.


The assessment of new therapies is difficult, as long as there is no consensus on diagnostic criteria, it is not clear what form of Barrett's oesophagus is at increased risk of cancer since we lack long-term results of fundoplication or radio-frequece ablation of Barrett mucosa. These restrictions also apply to the evaluation of the results



By definition, it is in Barrett's esophagus is a mucosal metaplasia which developed on the floor of the destroyed squamous epithelium through acid reflux.

New Classification

1st Zylinderepithelösophagus with specialized intestinal metaplasia
2nd Zylinderepithelösophagus without specialized intestinal metaplasia
3rd Specialized intestinal metaplasia at the transition ösophagokardialen

This new classification appears especially for the evaluation of endoscopic screening and new therapeutic concepts make sense.

The most important clinical marker screening, although far from being ideal, is the dysplasia. Their prevalence is typically from five to ten percent.
Causes

The most common cause is a long-standing chronic acid exposure of the esophagus
Very different symptoms, some patients have no symptoms.

Heartburn
Bloating.
Larity.
Belching.
chronic bronchitis, asthma.

Diagnosis

Such Barrett's metaplasia is medically and operationally and not be influenced is not returned even with conservative antireflux therapy or surgical reflux treatment. As developing a Barrett's esophagus, but only on the bottom of a chronic recurrent reflux disease, is a

complete reflux examination in the sense of endoscopy with biopsies,

of oesophageal manometry and

Long-term pH-metry

Chromoendoscopy required urgently.

Only after the presence of these investigations may be decided by which conservative or operative differential treatment for the patient the best individual therapy represents.

Treatment

The pharmacological treatment options should be exhausted, as would surgical alternative to laparoscopic or open fundoplication or Hemifundoplicatio in question.

The histologically proven high grade dysplasia (HGD) is classified as a clear precancerous lesion. It is therefore recommended as a treatment option for HGD or an esophagectomy, close endoscopic surveillance.


Surgical Risisiko increases in:

Ages over 75
Overweight.
Smoking.
Alcohol abuse.
Chronic lung disease.

Operational procedures

Fundoplication with or without vagotomy
Esophagectomy for high grade dysplasia

| 25.01.2011 | Read more | Print |

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