الفهرس 
Anatomy of the EsophagusOnly 14 pages are availabe for public view
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Abstract
GERD is defined as the presence of symptoms or lesions that can be attributed to the reflux of gastric juice or gastro duodenal contents into the esophagus. It is one of the most common disorders affecting the gastrointestinal tract. GERD can be defined as a pathologic condition of symptoms or histopathologic injury to the esophagus caused by percolation of the gastric juice or gastro duodenal contents into the esophagus.
Gastro esophageal reflux disease (GERD) is a common condition. It is a foregut disorder which accounts for approximately 75% of esophageal pathology. GERD is a life long condition, and of those who can be healed, over 80% relapse when treatment stopped, even if omeprazole is continued in therapeutic doses, 30% relapse by one year.
The pathophysiology of GERD includes alterations in the volume, composition, or distribution of gastric contents, anatomical and/or motor dysfunction of the antireflux barrier at the gastro esophageal junction, impaired clearance mechanism, and defective resistance to injury at the mucosal level. Acid suppressive therapy addresses one of the pathophysiological mechanisms, In spite of the efficacy of acid suppressive therapy; there have many attempts to target other aspects of GERD pathophysiology, such as basal lower esophageal sphincter (LES) pressure, esophageal body motility or gastric emptying.
The prerequisite for the development of acid reflux events is the occurrence of functional and/or anatomical failure of the antireflux at gastro esophageal junction. Tonic contraction of the lower esophageal sphincter is the principal factor preventing the reflux of gastric contents into the esophagus. Most patients with mild GERD resulting from transient relaxation of normal (LES), can be controlled effectively with lifestyle changes and appropriate pharmacological treatment. A minority have more severe disease, with ulceration, circumferential esophagitis, often associated with severe impairment of the LES and peristaltic function and a tendency to develop complications such as ulcer, stricture, bleeding, and Barrett’s columnar lined esophagus.
The diagnosis of GERD is clearly based on the patient’s history. Investigations are performed to exclude or confirm the diagnosis and separate symptoms of GERD from those of motility disorders and other causes of chest pain or heartburn like symptoms. Investigations include routine laboratory investigations, barium studies, upper GI endoscopy and esophageal manometry.
Treatment of GERD includes lifestyle changes, pharmacological options in the form of H2 receptor antagonists, prokinetics and PPIs and surgical therapy by antireflux repairs,it can be done surgically or laparoscopically.
Surgery indicated if there is, failed medical treatments, intractable esophagitis , peptic ulcer or stricture, reflux in children persisting beyond the age of two, histological changes, unresponsive pulmonary complications and esophageal chest pain, large sliding hiatal hernia and para-esophageal hernia, associated lesions such as gallstones and peptic ulcers or mixed reflux of gastric and duodenal juices.
Esophageal manomety must be done to every patient who will do fundoplication to run out esophageal spasm, achalasia and sclroderma as symptoms from these disorders may overlap or mimic those caused by reflux. The manometric characters of the LES including the mean resting LES pressure and the residual LES pressure after sphincter relaxation were measured. The postoperative LES characters are highly significant imported denoting the good surgical results.
With regard to laparoscopic fundoplication, it produces faster recovery period, minimal pain and discomfort, rapid return of bowel transit, early natural feeding, short hospital stay, more cosemotic, speedy convalescence and similar outcome as open fundoplication.