Antireflux Surgery

The role of fundoplication in patients with BE has shifted over the decades. The rapid introduction and success of laparoscopic fundoplication has increased the application of this procedure. Antireflux surgery is appropriate in patients with volume reflux (ie, ongoing regurgitation even when their heartburn is controlled) and in patients who prefer a surgical approach to taking daily medications. Theoretically, the mechanical correction provided by antireflux surgery would most effectively prevent the reflux of gastric contents into the esophagus and, therefore, have maximum beneficial effect. There are no large randomized studies of medical versus surgical therapy to document an impact on the incidence of AC of the esophagus. A large meta-analysis from the published literature on therapy of BE by Corey and colleagues (2003), suggests that the incidence of cancer is similar whether the therapy has been medical or surgical (Corey et al, 2003). Surprisingly, one of the experienced surgical groups in the country has a five-year series with antireflux surgery in patients with BE that demonstrates a 20% failure rate in relation to symptoms, recurrence of hiatal hernia, and abnormal 24-hour pH (Hofstetter et al, 2001). Most patients with BE have hiatal hernias, and patients with longer segments of BE tend to have longer hiatal hernias. Antireflux surgery in patients with large hiatal hernias can be more of a technical challenge. There is a separate chapter on antireflux surgery (see Chapter 11, "Management of Extraesophageal Presentations of GERD").

^Editor's Note: A flaw in this concept is the observations that patients who develop BE become less symptomatic with acid reflux.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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