Pub Date : 2019-04-03DOI: 10.5772/INTECHOPEN.82453
P. Quitadamo, A. Staiano
Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is a normal physiologic process occurring several times per day in healthy infants, children, and adults. The majority of GER episodes occur in the postprandial period, last in <3 min, and cause few or no symptoms. Conversely, when the reflux of gastric contents into the esophagus causes troublesome symptoms and/or complications, we talk about “gastroesophageal reflux disease (GERD).” Distinguishing physiologic GER from GERD may often be tricky for clinicians, especially in infants. The typical presentation of GERD includes the following symptoms: recurrent regurgitation, vomiting, weight loss or poor weight gain, excessive crying and irritability in infants, heartburn or chest pain, ruminative behavior, hematemesis, and dysphagia. Besides these esophageal symptoms, there is a set of extra-esophageal symptoms, mainly respiratory, which may occur along with typical symptoms or may represent the only clinical picture of GERD: odynophagia, wheezing, stridor, cough, hoarse-ness, dental erosions, and apnea/apparent life-threatening events (ALTEs). While infantile GER tends to resolve spontaneously and does not deserve pharmacological treatment, GERD management includes lifestyle changes, pharmacologic therapy, and surgery. Therefore, a proper diagnosis of these two conditions, besides other possible conditions mimicking reflux, is crucial in order to target the treatment, avoiding the overuse of antacid drugs that currently represents a major source of concern.
{"title":"Clinical Picture of Gastroesophageal Reflux Disease in Children","authors":"P. Quitadamo, A. Staiano","doi":"10.5772/INTECHOPEN.82453","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82453","url":null,"abstract":"Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is a normal physiologic process occurring several times per day in healthy infants, children, and adults. The majority of GER episodes occur in the postprandial period, last in <3 min, and cause few or no symptoms. Conversely, when the reflux of gastric contents into the esophagus causes troublesome symptoms and/or complications, we talk about “gastroesophageal reflux disease (GERD).” Distinguishing physiologic GER from GERD may often be tricky for clinicians, especially in infants. The typical presentation of GERD includes the following symptoms: recurrent regurgitation, vomiting, weight loss or poor weight gain, excessive crying and irritability in infants, heartburn or chest pain, ruminative behavior, hematemesis, and dysphagia. Besides these esophageal symptoms, there is a set of extra-esophageal symptoms, mainly respiratory, which may occur along with typical symptoms or may represent the only clinical picture of GERD: odynophagia, wheezing, stridor, cough, hoarse-ness, dental erosions, and apnea/apparent life-threatening events (ALTEs). While infantile GER tends to resolve spontaneously and does not deserve pharmacological treatment, GERD management includes lifestyle changes, pharmacologic therapy, and surgery. Therefore, a proper diagnosis of these two conditions, besides other possible conditions mimicking reflux, is crucial in order to target the treatment, avoiding the overuse of antacid drugs that currently represents a major source of concern.","PeriodicalId":344241,"journal":{"name":"Gastroesophageal Reflux Disease - Theory and Research","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114503509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-03DOI: 10.5772/INTECHOPEN.84879
A. Yahya
Gastroesophageal reflux disease (GERD) occurs frequently in developed countries. The number of cases, in fact, is increasing in the Middle East countries. In western countries, its occurrence ranges from 10 to 20% of the population who may present with typical or atypical symptoms or with complications. Although GERD was described by Asher Winkelstein, an American gastroenterologist, in 1935, it had appeared among patients earlier than that time. Nowadays, cases of GERD are common among obese individuals, patients with gallbladder disease, and those individuals under stress. It has also become a common clinical problem that commonly affects young adults, both male and female, of 40 years old.
{"title":"Introductory Chapter: Gastroesophageal Reflux Disease","authors":"A. Yahya","doi":"10.5772/INTECHOPEN.84879","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84879","url":null,"abstract":"Gastroesophageal reflux disease (GERD) occurs frequently in developed countries. The number of cases, in fact, is increasing in the Middle East countries. In western countries, its occurrence ranges from 10 to 20% of the population who may present with typical or atypical symptoms or with complications. Although GERD was described by Asher Winkelstein, an American gastroenterologist, in 1935, it had appeared among patients earlier than that time. Nowadays, cases of GERD are common among obese individuals, patients with gallbladder disease, and those individuals under stress. It has also become a common clinical problem that commonly affects young adults, both male and female, of 40 years old.","PeriodicalId":344241,"journal":{"name":"Gastroesophageal Reflux Disease - Theory and Research","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117244210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-03DOI: 10.5772/INTECHOPEN.81021
Mohamed-Amine Jabri, H. Sebai
Gastroesophageal reflux (GER) disease is a chronic disease characterized by the recurrent ascension of some of the gastric contents in the esophagus. Indeed, gastric acid secreted by parietal cells and the gastric pepsin activity, but not the intestinal alkaline content, are the most important pathogenic factors of GER. Several pathophysiological mechanisms are involved, the most important of which is the imbalance of the redox state of the esophageal tissue. Indeed, several studies have shown that reflux esophagitis is mediated by oxygen-derived free radicals. In this chapter, we describe the pathophysiology and important pathways, especially acid gastric contents and reactive oxygen species involved in pathology of GER.
{"title":"The Role of Increased Gastric Acid Secretion and Reactive Oxygen Species in the Pathophysiology of Reflux Esophagitis","authors":"Mohamed-Amine Jabri, H. Sebai","doi":"10.5772/INTECHOPEN.81021","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81021","url":null,"abstract":"Gastroesophageal reflux (GER) disease is a chronic disease characterized by the recurrent ascension of some of the gastric contents in the esophagus. Indeed, gastric acid secreted by parietal cells and the gastric pepsin activity, but not the intestinal alkaline content, are the most important pathogenic factors of GER. Several pathophysiological mechanisms are involved, the most important of which is the imbalance of the redox state of the esophageal tissue. Indeed, several studies have shown that reflux esophagitis is mediated by oxygen-derived free radicals. In this chapter, we describe the pathophysiology and important pathways, especially acid gastric contents and reactive oxygen species involved in pathology of GER.","PeriodicalId":344241,"journal":{"name":"Gastroesophageal Reflux Disease - Theory and Research","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123515199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.80792
Xia Chen, Fei Wang
Gastroesophageal reflux disease (GERD) is a chronic condition in which patients suffer troublesome symptoms and/or complications as the reflux of stomach contents occurs. GERD is a common disease worldwide with the range of estimated prevalence 18.1–27.8% in North America, 8.8–25.9% in Europe, 2.5–7.8% in East Asia, 8.7–33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. It causes significant morbidity, considerable decrease of quality of life and high costs of exams and treatment derived from repeated visit doctor. The patients with GERD suffer from typical symptoms such as heartburn and regurgitation, as well as other atypical symptoms including chest pain, cough, asthma, and hoarseness. With the usage of pump inhibitors (PPIs) in clinic, a dramatic improvement in symptom resolution and life quality, as well as in mucosal healing is expected. However, the treatment of GERD fails in a proportion of patients despite the high efficacy of PPIs. This situation is getting more and more common in clinical practices. In this chapter, we will discuss about this difficult situation, emphasizing diagnosis and treatment, combined with suggested management of these patients.
{"title":"Refractory Gastroesophageal Reflux Disease (GERD) Symptoms","authors":"Xia Chen, Fei Wang","doi":"10.5772/INTECHOPEN.80792","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80792","url":null,"abstract":"Gastroesophageal reflux disease (GERD) is a chronic condition in which patients suffer troublesome symptoms and/or complications as the reflux of stomach contents occurs. GERD is a common disease worldwide with the range of estimated prevalence 18.1–27.8% in North America, 8.8–25.9% in Europe, 2.5–7.8% in East Asia, 8.7–33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. It causes significant morbidity, considerable decrease of quality of life and high costs of exams and treatment derived from repeated visit doctor. The patients with GERD suffer from typical symptoms such as heartburn and regurgitation, as well as other atypical symptoms including chest pain, cough, asthma, and hoarseness. With the usage of pump inhibitors (PPIs) in clinic, a dramatic improvement in symptom resolution and life quality, as well as in mucosal healing is expected. However, the treatment of GERD fails in a proportion of patients despite the high efficacy of PPIs. This situation is getting more and more common in clinical practices. In this chapter, we will discuss about this difficult situation, emphasizing diagnosis and treatment, combined with suggested management of these patients.","PeriodicalId":344241,"journal":{"name":"Gastroesophageal Reflux Disease - Theory and Research","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134231028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.80793
S. Shimoyama
Gastroesophageal reflux disease (GERD) encompasses a spectrum of disorders caused by a reflux of gastric contents into the esophagus or complications of gastroesophageal reflux. Although depending on the definition, the prevalence of GERD is higher in the West than in the East, and the prevalence has been slightly increasing, so that the clinicians, even though they are not gastroenterologists, must encounter GERD patients and treat them. However, the clinicians do feel difficulty in treating GERD patients, since prescription of acid neutralizing agents, such as proton pump inhibitors (PPIs), sometimes fail to resolve their complaints. This may be partly explained by the discrepancies between clinical complaint and endoscopic findings; some patients present endoscopic esophagitis while some do not, and be partly explained by the potentially wide spectrum of pathophysiological etiologies than has been thought. This chapter describes current knowledge on heterogeneous mechanisms of GERD development. Clarifying the mechanisms of GERD on the individual basis may realize conceptual shift from uniform prescription of acid neutralizing agents to establishment of patient-oriented therapies.
{"title":"Challenges to Unravel Mechanisms of GERD","authors":"S. Shimoyama","doi":"10.5772/INTECHOPEN.80793","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80793","url":null,"abstract":"Gastroesophageal reflux disease (GERD) encompasses a spectrum of disorders caused by a reflux of gastric contents into the esophagus or complications of gastroesophageal reflux. Although depending on the definition, the prevalence of GERD is higher in the West than in the East, and the prevalence has been slightly increasing, so that the clinicians, even though they are not gastroenterologists, must encounter GERD patients and treat them. However, the clinicians do feel difficulty in treating GERD patients, since prescription of acid neutralizing agents, such as proton pump inhibitors (PPIs), sometimes fail to resolve their complaints. This may be partly explained by the discrepancies between clinical complaint and endoscopic findings; some patients present endoscopic esophagitis while some do not, and be partly explained by the potentially wide spectrum of pathophysiological etiologies than has been thought. This chapter describes current knowledge on heterogeneous mechanisms of GERD development. Clarifying the mechanisms of GERD on the individual basis may realize conceptual shift from uniform prescription of acid neutralizing agents to establishment of patient-oriented therapies.","PeriodicalId":344241,"journal":{"name":"Gastroesophageal Reflux Disease - Theory and Research","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131990661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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