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hernia, gerd, reflux

Emanuele Asti, Alberto Aiolfi, Veronica Lazzari, Andrea Sironi, Matteo Porta, Luigi Bonavina
Use of the magnetic sphincter augmentation (MSA) device for the laparoscopic treatment of gastroesophageal reflux disease is increasing since the first clinical implant performed a decade ago. The MSA procedure is a minimally invasive and highly standardized surgical option for patients who are partially responders to proton-pump inhibitors, which have troublesome regurgitation or develop progressive symptoms despite continuous medical therapy. The procedure has proven to be highly effective in improving typical reflux symptoms, reducing the use of proton-pump inhibitors, and decreasing esophageal acid exposure...
July 18, 2018: Updates in Surgery
James M Tatum, Evan Alicuben, Nikolai Bildzukewicz, Kamran Samakar, Caitlin C Houghton, John C Lipham
BACKGROUND: The magnetic sphincter augmentation (MSA) device was initially implanted with minimal hiatal dissection (MHD) at the diaphragmatic hiatus. Due to concern of possible MSA device dysfunction if herniated into an occult or small hiatal hernia, and increased understanding to the role of defective crura in reflux disease, the operative procedure was changed to planned obligatory dissection (OD) of the hiatus at the time of all implantations. METHODS: Between December 2012 and September 2016, 182 patients underwent MSA implant at a single medical center and have complete records available for review through September 2017...
July 13, 2018: Surgical Endoscopy
Antono C Valezi, Fernando A M Herbella, Francisco Schlottmann, Marco G Patti
Gastroesophageal reflux disease (GERD) and obesity coexist in many patients in the Western population. The association is not coincidental, since GERD pathophysiology is, in part, linked to obesity. Visceral adipose tissue secretes hormones, which increase the risk of GERD. Obesity increases esophageal motor disorders and higher number of transient lower esophageal sphincter relaxations. Central obesity increases abdominal-thoracic pressure gradient and disrupts the gastroesophageal junction by inducing hiatal hernia formation...
July 13, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Yves Borbély, Esther Schaffner, Lara Zimmermann, Michael Huguenin, Gabriel Plitzko, Philipp Nett, Dino Kröll
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric procedure to date. However, LSG is known to worsen pre-operative and result in de novo gastroesophageal reflux disease (GERD). Pre-operative evaluation reveals a high percentage of silent GERD of so far unknown influence on post-operative GERD. METHODS: Prospective data of patients undergoing primary LSG between 01/2012 and 12/2015 were evaluated. Pre-operative GERD-specific evaluation consisted of validated questionnaires, upper endoscopy, 24 h-pH-manometry, and esophagograms...
July 12, 2018: Surgical Endoscopy
Natalia Dowgiałło-Wnukiewicz, Agata Frask, Paweł Lech, Maciej Michalik
Introduction: Gastroesophageal reflux disease (GERD), demonstrated to impair quality of life (QoL), appears to show significant variation in its prevalence. Estimation of the prevalence is difficult. When defined as at least weekly heartburn and/or acid regurgitation, the prevalence reported in Asia is 2.5-27.6%, in Europe 23.7% and in the US 28.8%. Aim: The study evaluates the prevalence of GERD symptoms in the assessment of the GERD Impact Scale (GERD-IS) in two age groups of patients...
June 2018: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Tagore Sunkara, Emmanuel Ofori, Krishna Sowjanya Yarlagadda, Vinaya Gaduputi
Gastric mucosal prolapse (GMP) is a rare clinical syndrome that in patients with hiatal hernias and gastroesophageal reflux disease (GERD) may present with typical findings of abdominal pain and reflux symptoms but prove resistant to medical therapy. Physicians should therefore be aware and consider GMP as a differential in such patients in order to make an accurate diagnosis and provide timely treatment.
July 2018: Clinical Case Reports
Khus Raj Dewan, Bhanumati Saikia Patowary, Subash Bhattarai, Gaurav Shrestha
BACKGROUND: Barrett's esophagus a is metaplasia of normal squamous cells that line the lower part of the esophagus and carries a major risk for adenocarcinoma of esophagus. In Asian population, the prevalence of Barrett's esophagus and adenocarcinoma are less common than in Western countries but has been increasing. METHODS: This is a hospital based descriptive study comprising of 120 consecutive patients with symptoms of gastroesophagial reflux disease belonging to both sexes of any age group...
July 3, 2018: Journal of Nepal Health Research Council
Francisco Schlottmann, Ciro Andolfi, Fernando A Herbella, Fabrizio Rebecchi, Marco E Allaix, Marco G Patti
A hiatal hernia (HH) is a frequent finding in patients with gastroesophageal reflux disease (GERD). We examined a consecutive series of patients with GERD diagnosed by a 24-hour pH monitoring. Based on the presence and size of HH on barium swallow, patients were divided into the following groups: no HH, HH <3 cm, HH 3-5 cm and HH >5 cm. A total of 175 patients were included: 43 with no HH, 86 with HH <3 cm, 34 with HH 3-5 cm, and 12 with HH >5 cm. Patients with larger HH had more frequent episodes of coughing and wheezing associated with episodes of reflux...
June 1, 2018: American Surgeon
Al-Warith Al Hashmi, Guillaume Pineton de Chambrun, Regis Souche, Martin Bertrand, Vito De Blasi, Eric Jacques, Santiago Azagra, Jean Michel Fabre, Frédéric Borie, Michel Prudhomme, Nicolas Nagot, Francis Navarro, Fabrizio Panaro
BACKGROUND: Nearly 20% of patients who undergo hiatal hernia (HH) repair and anti-reflux surgery (ARS) report recurrent HH at long-term follow-up and may be candidates for redo surgery. Current literature on redo-ARS has limitations due to small sample sizes or single center experiences. This type of redo surgery is challenging due to rare but severe complications. Furthermore, the optimal technique for redo-ARS remains debatable. The purpose of the current multicenter study was to review the outcomes of redo-fundoplication and to identify the best ARS repair technique for recurrent HH and gastroesophageal reflux disease (GERD)...
June 25, 2018: Surgical Endoscopy
Stefano Siboni, Emanuele Asti, Pamela Milito, Gianluca Bonitta, Andrea Sironi, Alberto Aiolfi, Luigi Bonavina
BACKGROUND: Laparoscopic surgery has proven safe and effective in the treatment of large hiatus hernia. Differences may exist between objectively assessed surgical outcomes, symptomatic scores, and patient-reported outcomes. METHODS: An observational, single-arm cohort study was conducted in patients undergoing primary laparoscopic repair with crura mesh augmentation and Toupet fundoplication for large (> 50% of intrathoracic stomach) type III-IV hiatus hernia...
June 20, 2018: Digestive Surgery
Xiang-Xing Li, Jie Liu, You-Lian Chen, Guang-Jian Chen, Zhen-Yu Wang, Jun-Jun Zhu, Yun-Wei Guo, Xiu-Qing Wei
BACKGROUND Adrenal insufficiency is mainly due to insufficient adrenal corticosteroid hormones secretion by the adrenal cortex, which leads to clinical manifestations such as weakness, weight loss, hyperpigmentation, hypotension, and vomiting. However, the clinical manifestations of adrenocortical insufficiency may be atypical: anorexia, ascites, impaired liver function, and alacrima have been reported. Jaundice and anorexia presenting together in the same patient as the main symptoms are rare. CASE REPORT We present a rare case of a 65-year-old woman diagnosed as having adrenocortical insufficiency with chief complaints of anorexia and jaundice...
June 18, 2018: American Journal of Case Reports
Péter Varjú, Örs Péter Horváth, András Papp, Noémi Gede, József Czimmer
INTRODUCTION: Gastroesophageal reflux disease is one of the most common gastrointestinal diseases in developed countries. Besides the conservative modalities, surgery plays an increasing role in the treatment of the disease. AIM: Our aim was to investigate and compare the surgical and 6-month follow-up data of patients to the literature (quality control), who underwent Nissen fundoplication in the Medical Centre of Pécs between 2007 and 2014, and to assess the factors (especially psychiatric comorbidity and antidepressants) influencing the success...
June 2018: Orvosi Hetilap
Brett MacFarlane
Gastroesophageal reflux disease (GERD) is a common gastrointestinal diagnosis, a leading reason for endoscopy and cause of potentially serious complications, resulting in significant individual and system-wide health burden. Approximately one quarter of people living in western countries have experienced GERD, and the prevalence appears to be on the rise. Risk factors for GERD include hiatus hernia, obesity, high-fat diet, tobacco smoking, alcohol consumption, pregnancy, genetics, and some medications. The cardinal symptoms of GERD are troublesome heartburn and regurgitation...
2018: Integrated Pharmacy Research and Practice
Jutta Keller
International guidelines agree that high-resolution esophageal manometry (HRM) is an integral part of the diagnostic evaluation of patients with refractory reflux symptoms and should be performed before antireflux surgery. Its most important goal is to explore differential diagnoses, in particular major esophageal motility disturbances, that may be responsible for symptoms. HRM additionally provides insights into all relevant pathomechanisms of gastroesophageal reflux disease (GERD): It can reveal important information on the morphology and function of the esophagogastric junction (EGJ), the presence of a hiatus hernia, transient lower esophageal sphincter relaxations, and dysmotility of the esophageal body...
April 2018: Visceral Medicine
John Zografakis, Gregory Johnston, Jennifer Haas, Lindsay Berbiglia, Tyler Bedford, Justin Spear, Adrian Dan, Mark Pozsgay
Background and Objectives: Synthetic mesh reinforcement during laparoscopic hiatal hernia repair (LHHR) reduces recurrence. Biologically derived mesh is also associated with reduced recurrence. Urinary bladder matrix (UBM), a biologically derived extracellular matrix mesh, has shown clinical success. We wanted to determine the safety and efficacy of LHHR with porcine UBM reinforcement. Methods: This retrospective, single-surgeon study reviewed clinical data on patients who underwent LHHR from August 2009 through May 2014, with diaphragmatic reinforcement with porcine UBM mesh...
April 2018: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Katrin Schwameis, Milena Nikolic, Deivis G Morales Castellano, Ariane Steindl, Sarah Macheck, M Riegler, Ivan Kristo, Barbara Zörner, Sebastian F Schoppmann
Magnetic sphincter-augmentation (MSA) has been proven effective in the treatment of GERD. No consensus exists on whether crural closure should be performed. Our aim was to assess the impact of cruroplasty on reflux-control and quality of life. MSA-Patients treated between 03/2012-03/2017 were classified into those without hiatal hernia ("NHH"), those post-MSA (NHR) and those post-MSA/hiatal repair (HR). GERD-symptoms, PPI-intake, GERD-Health-related-Quality-of-Life (GERD-HRQL) and Alimentary Satisfaction were assessed...
May 9, 2018: Scientific Reports
Simon Erridge, Osama M Moussa, Paul Ziprin, Ara Darzi, Sanjay Purkayastha
BACKGROUND: Increasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study's aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett's esophagus (BE) and esophageal carcinoma. METHOD: A case-control population study was carried out, including patients from the CPRD...
May 1, 2018: Obesity Surgery
Daniel T Dempsey
Barium upper GI series performed by an interested and competent radiologist is still a very useful study to evaluate a variety of esophagogastric disorders. It usually provides information complementary to upper endoscopy and other foregut studies. Barium upper GI series is an important part of the diagnostic workup for gastroesophageal reflux disease, hiatal hernia, and esophageal motility disorders including achalasia. It is also an important part of the follow-up after operation for these common problems and after other operations such as resection or bariatric surgery...
June 2018: Abdominal Radiology
Rena Yadlapati, Michael F Vaezi, Marcelo F Vela, Stuart J Spechler, Nicholas J Shaheen, Joel Richter, Brian E Lacy, David Katzka, Philip O Katz, Peter J Kahrilas, C Prakash Gyawali, Lauren Gerson, Ronnie Fass, Donald O Castell, Jenna Craft, Luke Hillman, John E Pandolfino
BACKGROUND: The aim of this study was to assess expert gastroenterologists' opinion on treatment for distinct gastroesophageal reflux disease (GERD) profiles characterized by proton pump inhibitor (PPI) unresponsive symptoms. METHODS: Fourteen esophagologists applied the RAND/UCLA Appropriateness Method to hypothetical scenarios with previously demonstrated GERD (positive pH-metry or endoscopy) and persistent symptoms despite double-dose PPI therapy undergoing pH-impedance monitoring on therapy...
July 2018: American Journal of Gastroenterology
Mizelle D'Silva, Aparna Govil Bhasker, Nimisha S Kantharia, Muffazal Lakdawala
ᅟ: Obesity is a global epidemic and will soon become the number one priority in healthcare management. Bariatric surgery causes a significant improvement in obesity and its related complications. Pre-operative esophago-gastro-duodenoscopy (EGD) is done by several bariatric surgical teams across the world but is still not mandatory. AIM: To study the percentage of symptomatic and asymptomatic pathological EGD findings in obese patients undergoing bariatric surgery and to analyze whether these findings influence the eventual choice of bariatric surgery...
April 21, 2018: Obesity Surgery
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