Anatomic Variation And Evaluation

Heartburn and Acid Reflux Cure Program

Home Remedies for Gastro Esophageal Reflux Disease

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Esophageal reflux strictures tend to be one of three general varieties. Most reflux strictures are only 1 to 2 cm in

Figure 13-1 Barium esophagograms demonstrating the most frequent type of esophageal reflux stricture: a short, less than 2-cm stenosis (arrow) occurring at the esophagogastric junction just proximal to a sliding hiatal hernia. (From Orringer, M.B.: Short esophagus and peptic stricture. In Sabiston, D.C., Jr., and Spencer, F.C. [eds.]: Surgery of the Chest, 6th ed. Philadelphia, W.B. Saunders, 1995, p. 1059, with

Figure 13-2 Barium esophagogram demonstrating an 8-cm-long esophageal reflux stricture that occurred after protracted vomiting. There is an associated sliding hiatal hernia. (From Orringer, M.B.: Short esophagus and peptic stricture. In Sabiston, D.C., Jr., and Spencer, F.C. [eds.]: Surgery of the Chest, 6th ed. Philadelphia, W.B. Saunders, 1995, p. 1060, with permission.)

Anus Squamocolumnar Junction

Figure 13-3 Posteroanterior (left) and lateral (right) views from an esophagogram demonstrating a short midesophageal stricture (arrows) in a patient with chronic reflux symptoms and dysphagia. This "high" stricture suggested a Barrett's esophagus. At endoscopy, there was normal squamous epithelium down to the squamocolumnar epithelial junction, which was located at the site of the stricture. The esophagus distal to the stenosis was lined by columnar epithelium. A small sliding hiatal hernia is present.

Figure 13-4 A, Esophagogram demonstrating a cervicothoracic esophageal stricture (arrow) in a patient with a sliding hiatal hernia and chronic reflux symptoms. B, Detail of the stricture (the clavicle is highlighted), which was initially believed to be due to carcinoma. All esophageal biopsies at 5-cm intervals distal to the stenosis showed columnar epithelium. The squamocolumnar junction was located at the level of the stricture in this Barrett's esophagus. (From Orringer, M.B.: Short esophagus and peptic stricture. In Sabiston, D.C., Jr., and Spencer, F.C. feds. J: Surgery of the Chest, 6th ed. Philadelphia, W.B. Saunders, 1995, p. 1062, with permission.)

Figure 13-4 A, Esophagogram demonstrating a cervicothoracic esophageal stricture (arrow) in a patient with a sliding hiatal hernia and chronic reflux symptoms. B, Detail of the stricture (the clavicle is highlighted), which was initially believed to be due to carcinoma. All esophageal biopsies at 5-cm intervals distal to the stenosis showed columnar epithelium. The squamocolumnar junction was located at the level of the stricture in this Barrett's esophagus. (From Orringer, M.B.: Short esophagus and peptic stricture. In Sabiston, D.C., Jr., and Spencer, F.C. feds. J: Surgery of the Chest, 6th ed. Philadelphia, W.B. Saunders, 1995, p. 1062, with permission.)

Grade II: Mucosal erythema with superficial ulceration, typically linear and vertical and with an overlying fibrinous membranous exudate that is easily wiped away, leaving a bleeding surface (which is often misinterpreted as "scope trauma" by the inexperienced endoscopist). Grade III: Mucosal erythema with superficial ulceration and associated mural fibrosis—a dilatable "early" stricture. Grade IV: Extensive ulceration and fibrous luminal stenosis, which may represent irreversible panmural fibrosis.

In the Savary-Monnier clarification,1 ' there are five grades of reflux esophagitis:

Grade 1: Single or multiple erosions (may be erythematous or covered by exudate) on a single mucosal fold. Grade 2: Multiple erosions covering several mucosal folds (may be confluent, but not circumferential). Grade 3: Multiple circumferential erosions. Grade 4: Ulcer, stenosis, or esophageal shortening.

Grade 5: Barrett's epithelium: columnar mucosa reepithelialization in the form of an island, strip, or circumferential.

Regardless of which endoscopic grading system is used, such objectivity in describing the pathologic changes seen endoscopically is preferable to the traditional distinctions of "mild," "moderate," or "severe" esophagitis, which have inherent wide variation and observer variability. It is important to emphasize, particularly to physicians who do not frequently treat patients with reflux esophagitis, that the radiologic report of a mild esophageal reflux stricture does not imply that the process has been diagnosed at a sufficiently early stage that conservative therapy is likely to be successful. A mild radiographic stricture is an advanced stage of esophagitis, and institution of appropriate therapy is long overdue.

In addition to the endoscopic grading of esophagitis, there is a need to classify reflux strictures according to the degree of resistance encountered during attempts at dilation. The "hardness" of a reflux stricture—that is, the degree of fibrosis present—has direct implications on the likelihood of successful treatment with conservative measures. The severity of a stricture can be classified on the basis of the degree of resistance encountered during dilation. A mild stricture is defined as one in which minimal resistance is encountered as progressively larger dilators are passed through the stenosis. Moderate strictures require some, but not excessive, forceful dilation. Severe strictures require forceful dilation and are associated inevitably with marked periesophageal inflammation and mural thickening of the esophagus. The determination of the severity of a reflux stricture may not be possible until at operation the anesthetist passes progressively larger esophageal dilators by mouth with the mobilized esophagus supported by the surgeon's hand.

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Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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