Managing Failed Anti-Reflux Therapy

Description:
Gastroesophageal reflux disease (GERD) affects millions of people in western society. Since the introduction of laparoscopic techniques in the 1990s, it is now one of the most common indications for surgery. This multi-authored provides information on the pathophysiology of GERD, appropriate medical management, and proper indications for and performance of surgical and endoscopic procedures for GERD. Thousands of patients will experience inadequate relief from medical therapy or will develop complications from their procedures or recurrent or new symptoms afterwards; this describes in detail the proper evaluation and management of such patients. Beginning with an overview of the current understanding of the pathophysiology of GERD, the book moves onto new information regarding tissue susceptibility, the role of bile and digestive enzymes, and cyclic changes in LES tone. The next chapters are devoted to standard therapeutic options for GERD, including lifestyle changes, pharmacologic therapy, and surgery. In addition, newer endoscopic treatments such as Stretta, Endocinch, injection of bulking agents, etc, are described. Subsequent chapters focus on the causes for failure of medical, endoscopic, and surgical therapies. The remainder of the is a detailed examination of medical, endoscopic, and surgical remedies for these treatment failures. This is essential to any physician who manages patients with GERD, including internists, gastroenterologists, general surgeons, and thoracic surgeons.
GERD is one of the most common affecting Western society. Up to 20 million adults in the United States suffer from GERD at considerable economic cost. Although medical and surgical GERD therapy is largely successful, because of the high prevalence of the disease, even a failure of 5% results in large numbers of ineffectively treated and unhappy patients. This book deals with the management of patients who have failed anti-reflux medical and surgical therapy. The objectives are to review current medical and surgical management of GERD, to define what constitutes failure of these therapies and to delineate approaches to the management of these treatment failures. This is both a common and important problem in every gastroenterologist’s practice and the book provides a superb approach to these often vexing clinical situations. This multi-authored book is aimed at physicians who manage patients with GERD, including internists, gastroenterologists, general and thoracic surgeons. The authors (all credible experts in their fields) are predominantly from the United States, but also include some from Canada and Europe. Features: The book provides information on the pathophysiology of GERD, appropriate medical management, and proper indications for and performance of surgical and endoscopic procedures for GERD. There is particular focus on those patients who fail to respond to medical therapy or who develop complications from their procedures or experience new or recurrent symptoms. Beginning with an overview of the current understanding of the pathophysiology of GERD, new information is presented regarding the role of bile and cyclic changes in lower esophageal sphincter tone. There are sections on standard therapeutic options for GERD such as lifestyle changes, medical therapy, and surgery. In an excellent chapter, newer anti-reflux endoscopic therapies, including Stretta, Endocinch and injection of bulking agents are described. The most informative and enjoyable chapters deal with the causes and the subsequent management of medical, surgical, and endoscopic treatment failures. Excellent color illustrations abound and many useful algorithms enhance the utility of this outstanding book.

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