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Gastroesophageal reflux disease and heartburn

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of GERD.

Alternative Names

Heartburn; GERD

Highlights

New Research

• Obesity and GERD . Research presented at the 2004 annual meeting of the American College of Gastroenterology suggests that the prevalence of GERD symptoms among obese patients has been underreported. A second study reported that increased body mass index (BMI) is associated with increased risk for cancer of the esophagus (esophageal adenocarcinoma).
• Surgery and Children . A recent study published in an American Gastroenterological Association journal reported that more than 60 percent of children who received surgical fundoplication had recurrent GERD symptoms in the months following surgery. The research suggests that fundoplication may not be the most effective long-term treatment for pediatric GERD.
• Eosinophilic Esophagitis. This condition causes difficult or painful swallowing. The esophageal lining develops furrows and rings when eosinophilic cells enter the lining of the esophagus. A 2006 study published in Gastrointestinal Endoscopy evaluated treatment with swallowed fluticasone propionate in 19 patients. The researchers reported significant improvement in all patents and a significant decrease in esophageal eosinophil counts. This condition is being recognized more frequently and is a distinct disorder, yet can coexist with GERD.
• Laparoscopic Fundoplication Surgery in Children. New research published in the journal Surgical Endoscopy reviewed the medical records of 238 children from 5 months to 16 years of age who underwent laparoscopic surgery for management of GERD in 3 European medical centers. Researchers used three laparoscopic procedures: Thal, Nissen, and Toupet. After a minimum follow-up period of 5 years, all patients were symptom free, except 9 (3.7%), who still required occasional medication. The investigators concluded that all 3 laparoscopic procedures are very effective at treating GERD symptoms in children.
• Prevalence of Esophageal Cancer is Rising. The American Cancer Society estimates that 14,550 new cases of this disease were diagnosed in 2006. The 5-year survival rate for esophageal cancer is approximately 15%. Barrett’s esophagus is a precancerous condition characterized by cellular changes in the esophagus that may warn of development of esophageal cancer.

New Approval

• Capsule Endoscopy. A newer version of PillCam has been developed and approved for use. PillCam is a small capsule with tiny video cameras that the patient swallows. This new version takes color photographs of the patient’s esophagus at a rate of 14 frames per second, as opposed to the earlier PillCam, which photographed 4 frames per second. The photographic procedure takes about 20 minutes, and the capsule passes from the digestive system naturally after about 24 hours. The new PillCam provides the doctor with better views of the entire esophagus and is superior in identifying GERD.

Withdrawn From Clinical Use

• Enteryx Implant. The Food and Drug Administration cleared Enteryx for use in 2003. Although studies showed that the implant was effective, the manufacturer voluntarily withdrew this product in September 2005 because of severe complications associated with the implant injection technique.

• Review Date: 6/20/2006
• Reviewed By: Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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