Pathophysiology, Incidence, and Clinical Presentation In normal esophageal anatomy the gastroesophageal junction (GEJ) is located below the hiatal orifice. It is held in place by both the phrenoesophageal ligaments and an aggregate of posterior attachments between the GEJ and cardia…
Paraesophageal hernias are the results of defects in the diaphragmatic hiatus. Widening of the hiatus between the left and right diaphragmatic crura provides the pathway for upward displacement of abdominal contents into the mediastinum. Paraesophageal hernias are an increasingly common…
Over the last three decades bariatric surgery moved from open to laparoscopic procedures, with all the benefits of minimally invasive surgery. All existing restrictive bariatric procedures may affect the esophagus over time, with the possibility of mild or sometimes severe…
Patients with recurrent, persistent, or new symptoms after antireflux surgery can be a challenging problem for the foregut surgeon. Determining who will benefit from reoperation and what operation to perform requires that the surgeon be able to interpret a host…
Gastroparesis is described as delayed gastric emptying (DGE) without evidence of mechanical outlet obstruction. Common symptoms of gastroparesis include chronic nausea, emesis, abdominal pain, early satiety, and bloating. Abdominal pain can be significant and is associated with narcotic dependence in…
Gastroesophageal reflux disease (GERD) is defined by the reflux of gastric fluid into the esophagus causing troublesome symptoms and/or complications, such as mucosal inflammation and metaplasia. Functional disturbances of the lower esophageal sphincter (LES), along with anatomic abnormalities of the…
The continuous search for the ideal antireflux procedure reflects a widely held perception among surgeons, gastroenterologists, and patients that therapy for gastroesophageal reflux disease (GERD) remains unsatisfactory. About 30% to 40% of patients are resistant or only partial responders to…
Gastroesophageal reflux disease (GERD) is the most common disorder of the esophagus and gastroesophageal junction. While transient reflux of stomach contents into the esophagus occurs physiologically, according to the Montreal Classification, the criteria for GERD are met when reflux causes…
Over the past 40 years, there has been a remarkable evolution in our understanding of the pathophysiology, clinical manifestations, and treatment strategies underlying gastroesophageal reflux disease (GERD). Initially synonymous with esophagitis and presence of hiatal hernias, we now understand that…
Gastroesophageal reflux (GER) refers to the reflux of stomach contents into the esophagus. GER can occur physiologically, particularly in the postprandial state. When reflux is of small volume for limited durations and limited to the distal esophagus, this retrograde flow…