By Lee L. Swanstrom, Christy M. Dunst
This quantity presents a finished, state of the art review of the key concerns particular to the sphere of antireflux surgical procedure. It presents unheard of tutorial aspect concerning functionality of antireflux surgical procedure from prime esophageal surgeons worldwide. This quantity represents the one source of its type devoted in particular to the problems targeted to antireflux surgical procedure. it really is wealthy intimately and invaluable illustrations that show surgeons in right process in addition to proposing the reasoning at the back of a variety of innovations. Written via specialists within the box, Antireflux surgical procedure is of significant worth to practising surgeons who practice gastrointestinal surgical procedure, clinical scholars, surgical citizens, and fellows.
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Extra resources for Antireflux Surgery
An inverse relation between cagA + strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res. 1998;58: 588–90. 32. Blonski W, Vela MF, Castell DO. Comparison of reflux frequency during prolonged multichannel intraluminal impedance and pH monitoring on and off acid suppression therapy. J Clin Gastroenterol. 2009;43:816–20. 33. Tamhankar AP, Peters JH, Portale G, Hsieh C-C, Hagen JA, Bremner CG, DeMeester TR. Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology.
It does not have goblet cells. Like the cardiac metaplasia of squamous epithelium resulted from a genetic switch, oxyntocardiac mucosa is generated in cardiac mucosa by activation of a different differentiating genetic signal—possibly a combination of BMP-4 and the Sonic Hedgehog gene . Sonic hedgehog gene is the usual genetic signal in the gastric oxyntic mucosa and is required for development of parietal cells in gastrointestinal columnar epithelia . ” The second type of change in cardiac epithelium occurs as a result of development of goblet cells which can appear in the surface, foveolar region, or in the glands.
The length of the squamo-oxyntic gap at first presentation is an exquisitely accurate measure of the severity of reflux. Oberg et al.  from our unit showed that the presence of cardiac and/or oxyntocardiac mucosa in biopsies of endoscopically normal patients compared with their absence correlated significantly with a greater likelihood of an abnormal 24-h pH test and lower esophageal sphincter abnormalities. In a study of pediatric patients at Harvard, Glickman et al.  showed that children who had greater than 1 mm of measured cardiac mucosa between the squamous epithelium and the first observed parietal cell had significantly greater evidence of reflux than those with less than 1 mm of cardiac mucosa.