Multilayered epithelium at the gastroesophageal junction is a marker of gastroesophageal reflux disease: data from a prospective Central European multicenter study (histoGERD trial)

Abstract Has a histologic transition from gastroesophageal reflux disease–damaged epithelium to columnar metaplasia ever been seen in humans? The answer to this question seems to be that it has but that we either do not readily recognize it or it is not readily recognizable with regular light microscopy. There are at least 3 possible mechanisms for the genesis of Barrett esophagus. The first is ulceration at the gastroesophageal junction with subsequent repair by an epithelium that differentiates into Barrett epithelium. The second is metaplasia through multilayered epithelium. The third is creeping columnar metaplasia at the Z-line proximally followed by intestinalization. These 3 hypotheses may not be mutually exclusive, and all may be operative, depending on the local circumstances, amount of inflammation, erosion, ulcers, healing, acid and alkaline reflux, and use of proton pump inhibitors. Any of the epithelial types involved could be stable and not progress. They might even be reversible, which may also in part explain the mosaic of epithelial types that typify Barrett esophagus, and may be modified by any of the molecular mechanisms that turn protein transcription on and off (eg, promoter methylation, mutations). These mechanisms ultimately may also be involved in the genesis of neoplastic transformation.

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Multilayered Epithelium in Mucosal Biopsy Specimens From the Gastroesophageal Junction Region is a Histologic Marker of Gastroesophageal Reflux Disease

The American Journal of Surgical Pathology ◽

10.1097/pas.0b013e3181984697 ◽

2009 ◽

Vol 33 (6) ◽

pp. 818-825 ◽

Cited By ~ 38

Author(s):

Jonathan N. Glickman ◽

Stuart J. Spechler ◽

Rhonda F. Souza ◽

Tisha Lunsford ◽

Edward Lee ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Gastroesophageal Junction ◽

Mucosal Biopsy ◽

Junction Region ◽

Biopsy Specimens ◽

Multilayered Epithelium

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Minimally Invasive Esophageal Procedures

10.2310/tywc.2051 ◽

2020 ◽

Author(s):

Jon O. Wee

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Minimally Invasive ◽

Reflux Disease ◽

Paraesophageal Hernia ◽

Nissen Fundoplication ◽

Gastroesophageal Junction ◽

Outcome Evaluation ◽

Barrett Esophagus ◽

Asymptomatic Patients

In most instances, laparoscopy has replaced open procedures as the standard of care. Nevertheless, equipoise remains in the literature regarding the benefits of surgery compared with alternative treatment strategies such as medications in the case of gastroesophageal reflux disease (GERD) or endoscopic procedures in the case of achalasia. According to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines published in 2010, indications for surgery include (1) failure of medical management, (2) patient preference, (3) complications of GERD (Barrett esophagus, peptic stricture), and (4) extraesophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration). This chapter is organized by surgical procedure, all of which are derivatives of the laparoscopic Nissen fundoplication. In this chapter, the authors focus on minimally invasive surgical approaches to the treatment of the following benign esophageal disorders: GERD, achalasia, and paraesophageal hernias. New in this chapter is the in-depth coverage of laparoscopic paraesophageal hernia repair. The majority of patients with paraesophageal hernias are asymptomatic, and their hernias are found incidentally with a retrocardiac gastric bubble on an upright chest x-ray or herniated gastroesophageal junction seen on a chest or abdominal computed tomographic scan. For patients who are symptomatic, surgical repair is indicated as there is no medical treatment for this mechanical problem. For asymptomatic patients, clinical judgment needs to be used. All surgical procedures are covered by preoperative evaluation, operative planning, and operative technique, with a troubleshooting note for every step. Procedure complications, postoperative care, and outcome evaluation follow each procedure, listing the most current reports and data. This review contains 10 figures, 9 tables and 49 references Keywords: Minimally invasive surgery, esophagectomy, myotomy, gastroesophageal reflux disease, Barrett esophagus, Nissen fundoplication, fundoplication, paraesophageal hernia

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A novel endoscopic assessment of the gastroesophageal junction for the prediction of gastroesophageal reflux disease: a pilot study

Endoscopy International Open ◽

10.1055/a-0990-9737 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1468-E1473 ◽

Cited By ~ 3

Author(s):

Haruhiro Inoue ◽

Yusuke Fujiyoshi ◽

Mary Raina Angeli Abad ◽

Enrique Rodriguez de Santiago ◽

Kazuya Sumi ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Gastroesophageal Junction ◽

Optimal Cutoff ◽

Esophageal Ph ◽

Impedance Monitoring ◽

Acid Exposure Time ◽

Sensitivity Specificity ◽

Endoscopic Assessment

Abstract Background and aim Hiatal hernia and lower esophageal sphincter (LES) dysfunction play major roles in gastroesophageal reflux disease (GERD) pathogenesis. We developed a novel endoscopic assessment to evaluate the gastroesophageal junction (GEJ). This study aims to evaluate the feasibility of this method for the diagnostic prediction of GERD. Methods A retrospective analysis of patients with GERD symptoms who underwent gastroscopy and esophageal pH-impedance monitoring was conducted. The novel assessment evaluated the following in retroflex view: 1) Cardiac Opening (CO): diameter of the opening of the cardia, 2) Sliding Hernia (SH): length from the diaphragmatic crus to the squamocolumnar junction, 3) Scope Holding Time% (SHT%): the percentage of time that the Scope Holding Sign (SHS) was observed out of 30 seconds. The SHS is defined as the lower esophagus holding the endoscope under excessive insufflation. The results of this assessment and that of pH-impedance monitoring were compared. Results In total, 61 patients (mean age ± SD, 54.1 ± 16.4 years, 32 males) were enrolled. CO and SH were significantly correlated with acid exposure time (AET) (ρ = 0.36, P = 0.005, and ρ = 0.36, P = 0.004). The optimal cutoff of CO for AET > 6 % was 3 cm (Sensitivity = 72.4 %, Specificity = 46.9 %, AUC = 0.64) and that of SH was 2 cm (Sensitivity = 55.2 %, Specificity = 75.0 %, AUC = 0.70). When the population was stratified according to this cutoff, patients with CO > 3 cm and those with SH > 2 cm presented higher AET (15.1 vs 4.1 %, P = 0.037, and 23.0 vs 3.6 %, P = 0.026). Optimal cutoff of SHT% for the number of all reflux episodes > 80 was 75 % (Sensitivity = 81.8 %, Specificity = 54.6%, AUC = 0.67). Patients with SHT% < 75 % presented a higher number of all reflux episodes (88 vs 65, P = 0.014). Sensitivity, specificity, and accuracy of SHT% < 75 % for all reflux episodes > 80 were 81.8 % (95 %CI: 67.7 – 91.8), 54.5% (95 %CI: 40.4 – 64.5), and 68.2 % (95 %CI: 54.0 – 78.1). Conclusion This novel endoscopic assessment of GEJ significantly predicted the presence of GERD and merits further testing in future studies.

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Magnetic Sphincter Augmentation with the LINX Device for Gastroesophageal Reflux Disease after U.S. Food and Drug Administration Approval

The American Surgeon ◽

10.1177/000313481408001027 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1034-1038 ◽

Cited By ~ 16

Author(s):

Jessica L. Reynolds ◽

Joerg Zehetner ◽

Nikolai Bildzukewicz ◽

Namir Katkhouda ◽

Giovanni Dandekar ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Drug Administration ◽

Reflux Disease ◽

Food And Drug Administration ◽

Intraoperative Complications ◽

Gastroesophageal Junction ◽

Balloon Dilation ◽

Magnetic Sphincter Augmentation ◽

Related Quality

Magnetic sphincter augmentation (MSA) of the gastroesophageal junction with the LINX Reflux Management System is an alternative to fundoplication for gastroesophageal reflux disease (GERD) that was approved by the U.S. Food and Drug Administration (FDA) in March 2012. This is a prospective observational study of all patients who underwent placement of the LINX at two institutions from April 2012 to December 2013 to evaluate our clinical experience with the LINX device after FDA approval. There were no intraoperative complications and only four mild postoperative morbidities: three urinary retentions and one readmission for dehydration. The mean operative time was 60 minutes (range, 31 to 159 minutes) and mean length of stay was 11 hours (range, 5 to 35 hours). GERD health-related quality-of-life scores were available for 83 per cent of patients with a median follow-up of five months (range, 3 to 14 months) and a median score of four (range, 0 to 26). A total of 76.9 per cent of patients were no longer taking proton pump inhibitors. The most common postoperative complaint was dysphagia, which resolved in 79.1 per cent of patients with a median time to resolution of eight weeks. There were eight patients with persistent dysphagia that required balloon dilation with improvement in symptoms. MSA with LINX is a safe and effective alternative to fundoplication for treatment of GERD. The most common postoperative complaint is mild to moderate dysphagia, which usually resolves within 12 weeks.

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