The Esophagus

1 Cover

2 Title Page

3 Copyright Page

4 Dedication Page

5 Contributors

6 Preface

7 About the Companion Website

8 PART I: Esophageal Symptoms 1 Symptom Overview and Quality of Life Introduction Esophageal anatomy and production of symptoms Symptoms Healthcare utilization and quality of life Conclusion References 2 Diagnosis and Treatment of Esophageal Chest Pain Introduction Epidemiology Gastroesophageal reflux Esophageal hypersensitivity Dysmotility Available treatment options for esophageal chest pain Conclusion References 3 Disorders Causing Oropharyngeal Dysphagia Introduction Swallowing Presentation Evaluation Management Conclusions References 4 The Esophagus Introduction Definition, clinical presentation, and demographic characteristics Differential diagnosis Pathophysiology Diagnosis Treatment Conclusion References

9 PART II: Esophageal Physiology and Testing 5 Functional Anatomy and Physiology of Swallowing and Esophageal Motility Introduction Swallowing Upper esophageal sphincter Esophageal stage motor activity Lower esophageal sphincter References 6 Radiology of the Pharynx and Esophagus Introduction Pharynx Esophagus References 7 Special Endoscopic Imaging and Optical Techniques for Evaluating the Esophagus Chromoendoscopy Electronic chromoendoscopy Confocal laser endomicroscopy (CLE) Volumetric laser endomicroscopy (VLE) Summary References 8 High‐Resolution Manometry and Esophageal Pressure Topography Acknowledgments Introduction Indications for esophageal manometry Manometry study technique and protocol Interpretation of high‐resolution manometry and esophageal pressure topography HRM/EPT beyond the Chicago classification Conclusions References 9 Esophageal Testing Using Multichannel Intraluminal Impedance Introduction Basic principles High‐resolution impedance manometry Esophageal function testing using combined multichannel intraluminal impedance and manometry Multichannel intraluminal impedance for assessment of bolus transit in esophageal function tests Combined MII‐EM in belching and rumination Combined multichannel intraluminal impedance and pH for detection of acid and nonacid gastroesophageal reflux References 10 Ambulatory Monitoring for Reflux Introduction Esophageal pH monitoring Esophageal pH‐impedance monitoring Esophageal bilirubin monitoring Symptom association analysis References 11 New Diagnostic Tests for GERD Introduction Bile monitoring Novel impedance parameters Salivary pepsin Mucosal integrity Oropharyngeal pH monitoring Narrow‐band imaging The road ahead References 12 Role of Histology and Cytology in Esophageal Diseases Introduction Normal esophagus Esophagitis Esophageal Involvement in Systemic Disease Esophageal manifestations of dermatologic and collagen vascular diseases Gastroesophageal reflux esophagitis Barrett’s esophagus References

10 PART III: Motility Disorders 13 Achalasia Definition Epidemiology Pathophysiology Clinical manifestations Diagnosis Treatment What to do if symptoms reoccur following successful initial treatment Esophagectomy for end‐stage achalasia Prognosis To screen or not for esophageal cancer? Guidelines References 14 Non‐Achalasia Esophageal Motility Abnormalities Introduction Disorders with esophagogastric junction outflow obstruction other than achalasia Major disorders of peristalsis Minor disorders of peristalsis Conclusions and future directions References 15 Surgery for Esophageal Motor Disorders: Introduction Achalasia Esophagogastric junction outflow obstruction Distal esophageal spasm Jackhammer esophagus Conclusion References 16 Esophageal Webs and Rings Definitions Proximal esophageal webs Plummer‐Vinson syndrome Lower esophageal rings Schatzki’s ring References 17 Esophageal Diverticula Classification Epidemiology Anatomy Pathophysiology Complications Physical examination Diagnostic studies Surgical management Post‐operative management References 18 Esophageal Involvement in Systemic Diseases Introduction Connective tissue disorders Endocrine disorders Genetic syndromes Infiltrative disorders Inflammatory disorders Neuromuscular disorders Conclusion References

11 PART IV: Gastroesophageal Reflux Disease 19 Clinical Spectrum and Diagnosis of GERD Phenotypes Introduction The current paradigm of gastroesophageal reflux disease Clinical spectrum of GERD Further esophageal physiologic testing Conclusion References 20 Hiatus Hernia and Gastroesophageal Reflux Disease Introduction Anatomy of the diaphragm and the esophagogastric junction Physiology of the esophagogastric junction Hiatus hernia Congenital diaphragmatic hernias Sliding hiatus hernia and reflux disease Diagnosis Therapy Conclusions References 21 Pathophysiology of Gastroesophageal Reflux Disease: Motility Factors Introduction Sphincter mechanism at the esophagogastric junction (EGJ) Gastroesophageal junction pressure under various physiologic conditions Mechanisms of gastroesophageal reflux Hiatus hernia and reflux disease Compliance/opening function of LES and EGJ in GER disease Role of esophageal peristalsis in reflux disease Conclusions References 22 Pathophysiology of Gastroesophageal Reflux Disease: Epithelial Factors Introduction Acid, pepsin, and bile acids: the epithelial triple threat Development of the esophagus and its defensive players Esophageal tissue resistance: epithelial factors and beyond Assessing the epithelial barrier: measurements of resistance, permeability, and intercellular spaces Pathophysiology of GERD and reflux esophagitis: acid burn or cytokine sizzle? Conclusions and future directions References 23 Duodenogastroesophageal Reflux Introduction The role of acid and pepsin The role of duodenal contents Detection of DGER in humans Medical and surgical treatment Conclusion References 24 Helicobacter pylori and GERD Introduction Epidemiology of H. pylori and GERD Pathobiology of H. pylori and GERD Implication of eradication of H. pylori on de novo GERD Implication of H. pylori eradication on patients with known GERD H. pylori and Barrett’s esophagus H. pylori and esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma Professional guidelines, recommendations, and updates Conclusions References 25 Medical Management of Gastroesophageal Reflux Disease Introduction Lifestyle modifications Pharmacologic therapy Long‐term management References 26 Refractory Heartburn: Reflux Hypersensitivity and Functional Heartburn Introduction Functional heartburn Reflux hypersensitivity Overlap with GERD References 27 Endoscopic Therapies for GERD Introduction Understanding GEJ anatomy and physiology Radiofrequency energy treatment of GERD (Stretta) Trans‐oral incisionless fundoplication (TIF) Endoscopic suturing for GERD Conclusions References 28 Behavioral Treatment of Oropharyngeal and Esophageal Disorders Dysphagia Aerophagia Supragastric belching Rumination Extraesophageal reflux Disorders of laryngeal hyper‐responsiveness Summary References 29 Barrett’s Esophagus Introduction Definition and diagnostic criteria Epidemiology Pathogenesis and progression Clinical Presentation Management Treatment Challenges In Management References 30 Esophageal Strictures Classification of strictures Types of esophageal dilators Techniques of esophageal dilation Simple strictures Complex strictures Radiation‐induced strictures Steroid injections Incisional therapy Temporary stents Mitomycin C Self dilation Conclusions References 31 ENT Complaints in GERD Introduction Prevalence Pathophysiology Diagnosis Laryngoscopy Confirmatory testing for EER/LPR Endoscopy Management Surgical therapy Cost Conclusion References 32 Pulmonary Complications of Gastroesophageal Reflux Disease Introduction Pathophysiology Clinical presentations and evaluation Therapy Asthma and GERD Pulmonary fibrosis and GERD GERD and lung transplant Conclusions References 33 Pediatric Gastroesophageal Reflux Disease Gastroesophageal reflux Diagnostic evaluation Treatment Pharmacologic therapy Surgical Therapy Conclusion References 34 Challenges in the Understanding and Application of Antireflux Surgery for GERD Historical overview Fundoplications Longevity of antireflux surgery Antireflux surgery and Barrett’s esophagus Conclusions References 35 New Surgical Treatments for GERD Introduction Magnetic sphincter augmentation (MSA) of the lower esophageal sphincter Current approach to patient selection and perioperative management Lower esophageal sphincter (LES) electrical neuromodulation therapy (LES‐ENT) References 36 Obesity and Gastroesophageal Reflux Disease Introduction Obesity and GERD symptoms Obesity and GERD‐related complications Mechanical and non‐mechanical effects of obesity Weight loss as GERD treatment Conclusion References