Post by michele on Jun 15, 2009 17:18:14 GMT -5
I received this from the Sclero Found. group leader in Atlanta. A bit technical, but very interesting. Gonna check it with the MUSC when I go for the procedure in a couple of weeks.
Research News from The University of Chicago
Connective Tissue Disorders and Gastroesophageal Reflux Disease. Pathophysiology and Implications for Treatment.
Connective tissue disorders (CTD) are systemic diseases that can affect several organs. They share the common features of cutaneous and gastrointestinal tract involvement, most commonly esophageal dysmotility and gastroesophageal reflux disease (GERD). Up to 40% to 60% of these patients can develop complications of GERD such as an esophageal stricture or Barrett’s esophagus. In addition, the lungs are often involved by the disease process, and 60% of patients eventually progress to end-stage lung disease (ESLD) which causes severe morbidity and mortality. When GERD is present, patients are usually managed with acid-suppressing medications on the assumption that because esophageal function is routinely deteriorated, antireflux surgery would create or worsen dysphagia.
We recently evaluated by esophageal manometry and ambulatory pH monitoring 48 patients with CTD, 20 of them already on the lung transplant list**. We found that esophageal peristalsis was preserved in all patients with CTD and GERD. In contrast, peristalsis was absent in about half of patients when ESLD was also present. Ten patients underwent a laparoscopic fundoplication tailored to the esophageal function of the individual patients. This tailored surgical approach resulted in control of reflux symptoms in all patients.
The clinical implications of this study are very important. It is reasonable to suggest that severe esophageal involvement can cause or contribute to the development of pulmonary complications in patients with CTD through repeated episodes of microaspiration. An operation is the only way to stop the reflux to occur, as it creates a new valve between the stomach and the esophagus. However, patients with GERD and CTD are usually treated with acid reducing medications based on the unproven fear that a laparoscopic fundoplication would result in severe dysphagia. Data from many recent studies show that treatment with acid reducing medications only affects acid production and raises the pH of the gastric refluxate but reflux still occurs as the frequency and duration of reflux episodes is not affected. This observation explains the persistence of symptoms and mucosal injury while on proton pump therapy, and it suggests the need for an antireflux operation to restore the competence of the gastroesophageal junction and stop any type of reflux, independent from its pH. In addition our results show that the operation is safe and effective.
In summary, we feel that patients with CTD should be screened early in the course of their disease by esophageal function tests. If GERD is present, a fundoplication should be offered early to prevent esophageal (esophagitis) and extra-esophageal complications (lung problems).
** Patti MG et al. Journal of Gastrointestinal Surgery 2008;12:1900-1906.
Research News from The University of Chicago
Connective Tissue Disorders and Gastroesophageal Reflux Disease. Pathophysiology and Implications for Treatment.
Connective tissue disorders (CTD) are systemic diseases that can affect several organs. They share the common features of cutaneous and gastrointestinal tract involvement, most commonly esophageal dysmotility and gastroesophageal reflux disease (GERD). Up to 40% to 60% of these patients can develop complications of GERD such as an esophageal stricture or Barrett’s esophagus. In addition, the lungs are often involved by the disease process, and 60% of patients eventually progress to end-stage lung disease (ESLD) which causes severe morbidity and mortality. When GERD is present, patients are usually managed with acid-suppressing medications on the assumption that because esophageal function is routinely deteriorated, antireflux surgery would create or worsen dysphagia.
We recently evaluated by esophageal manometry and ambulatory pH monitoring 48 patients with CTD, 20 of them already on the lung transplant list**. We found that esophageal peristalsis was preserved in all patients with CTD and GERD. In contrast, peristalsis was absent in about half of patients when ESLD was also present. Ten patients underwent a laparoscopic fundoplication tailored to the esophageal function of the individual patients. This tailored surgical approach resulted in control of reflux symptoms in all patients.
The clinical implications of this study are very important. It is reasonable to suggest that severe esophageal involvement can cause or contribute to the development of pulmonary complications in patients with CTD through repeated episodes of microaspiration. An operation is the only way to stop the reflux to occur, as it creates a new valve between the stomach and the esophagus. However, patients with GERD and CTD are usually treated with acid reducing medications based on the unproven fear that a laparoscopic fundoplication would result in severe dysphagia. Data from many recent studies show that treatment with acid reducing medications only affects acid production and raises the pH of the gastric refluxate but reflux still occurs as the frequency and duration of reflux episodes is not affected. This observation explains the persistence of symptoms and mucosal injury while on proton pump therapy, and it suggests the need for an antireflux operation to restore the competence of the gastroesophageal junction and stop any type of reflux, independent from its pH. In addition our results show that the operation is safe and effective.
In summary, we feel that patients with CTD should be screened early in the course of their disease by esophageal function tests. If GERD is present, a fundoplication should be offered early to prevent esophageal (esophagitis) and extra-esophageal complications (lung problems).
** Patti MG et al. Journal of Gastrointestinal Surgery 2008;12:1900-1906.
