![]() It has the ability to reach the protective mucus layer at the surface of gastric mucosa and to survive the extreme acid content of the stomach thanks to its 4-6 flagella, and by avoiding low pH areas using chemiotaxisit first colonizes the antrum, where there are no acid-producers cells. H.pylori is a gram-negative microaerophilic bacterium, that generally colonizes the stomach in early life ( 8). pylori has been established as a major cause of chronic gastritis and peptic ulcer, being in fact involved in the pathogenesis of gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Warren published on Lancet a paper in which they claimed the presence of “small curved and S shaped bacilli”, later classified as Helicobacter pylori ( 7). The mucosa of GERD patients produces significantly larger amounts of various cytokines ( 4) that activate immune cell recruitment and migration, and are involved in the pathophysiology of the illness. Other factors involved are a delay in gastric emptying, reduced oesophageal motility and an excessive stomach relaxation, but the variability of endoscopic findings depends on the different resistance and sensitivity of the individual patient’s esophagus. The pathophysiology of GERD is determined by a failure of the lower esophageal sphincter, that can be related to different factors such as hiatal hernia, obesity, pregnancy, drugs that act on the sphincter musculature, cigarette smoking. However, more than 70% of patients that experience heartburn do not have visible lesions at endoscopy ( 5) and they are termed as NERD ( 6) (Non Erosive Reflux Disease). Probably a defective anti-reflux barrier and luminal clearance mechanisms are responsible for macroscopically detectable injury to the esophageal squamous epithelium ( 4), which concretizes in erosive esophagitis and Barrett’s Esophagus. According to Montreal classification, GERD is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications ( 3). Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population ( 1), but an universally accepted definition is lacking since 2006 ( 2). May 1, 2022.Reflux disease and esophagitis, definition and pathophysiology Management of gastroesophageal reflux disease in children and adolescents. Medical management of gastroesophageal reflux in adults. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Gastroesophageal reflux disease and hiatal hernia. Gastroesophageal reflux disease (GERD) (adult). Clinical manifestations and diagnosis of gastroesophageal reflux in adults. National Institute of Diabetes and Digestive and Kidney Diseases. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Gastroesophageal reflux disease: A review. These changes are associated with an increased risk of esophageal cancer. Damage from acid can cause changes in the tissue lining the lower esophagus.
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