GERD: A New Understanding of Pathology, Pathophysiology and Treatment

GERD: A New Understanding of Pathology, Pathophysiology and Treatment transforms the assessment of gastroesophageal reflux disease (GERD) from its present state, which is largely dependent on clinical definition and management, to a more objective scientific basis that depends on pathologic assessment. Sequential chapters in this single-author book describe the fetal development of the esophagus, the normal adult state and the way exposure to gastric juice causes epithelial and lower esophageal sphincter damage at a cellular level. It allows recognition of the pathologic manifestations of lower esophageal sphincter damage and develops new histopathologic criteria for quantitating such damage. This understanding provides new pathologic criteria for definition and diagnosis of GERD from its earliest cellular stage. Algorithms based on measurement of sphincter damage can identify, even before the onset of clinical GERD, persons who will never develop GERD during life, those who develop GERD but remain with mild and easily controlled disease and those who will progress to severe GERD with failure to control symptoms, Barrett esophagus and adenocarcinoma. Aggressive early intervention in the last group with the objective of preventing disease progression to its end points of uncontrolled symptoms and adenocarcinoma becomes feasible.

Key Features:

• Provides a new method of assessment of GERD that has never previously been presented, creating a pathway to control.
• Describes a new pathologic test based on standard histology that can define lower esophageal sphincter damage.
• Sequential chapters outline the way GERD progresses from the perspective of the amount of damage to the lower esophageal sphincter.
• Provides new avenues of clinical research and technologic innovations in pathology and treatment aimed at preventing esophageal adenocarcinoma.

Περιεχόμενα:

Introduction: Discovery: A Path to a New Solution for Gastroesophageal Reflux Disease
Chapter 1. Definition of Gastroesophageal Reflux Disease:
Past, Present and Future
Chapter 2: Present Diagnosis and Management of Gastroesophageal Reflux Disease: The Good, Bad and Ugly
Chapter 3. Fetal and Postnatal Development of the Esophagus and Proximal Stomach
Chapter 4. Histologic Definition and Diagnosis of Epithelia in the Esophagus and Proximal Stomach
Chapter 5: Definition of the Normal State – A Yet Unfinished Saga
Chapter 6. Definition of the Gastroesophageal Junction
Chapter 7. The Normal Lower Esophageal Sphincter
Chapter 8: The Pathogenesis of Early GERD
Chapter 9: Correlation of LES Damage and GERD
Chapter 10: The Effect of Damage to the Abdominal Segment of the LES: The Dilated Distal Esophagus
Chapter 11: Columnar-Lined Esophagus (Microscopic and Visible) and Barrett Esophagus
Chapter 12: Esophageal Adenocarcinoma
Chapter 13: Progression of GERD at the Clinical Level
Chapter 14: Progression  of GERD at a Pathological Level
Chapter 15: Molecular Evolution of Esophageal Epithelial Metaplasia
Chapter 16. Progression of GERD From the Perspective of LES Damage
Chapter 17. New Pathologic Test of LES Damage
Chapter 18: New Method of Functional Assessment of the LES
Chapter 19: Prediction of Future Progression of LES Damage
Chapter 20: Proof of Concept of the New Diagnostic Method
Chapter 21: Application of the New Method to Present and Future Management of GERD