Peptic Esophagitis, Peptic Stricture, and Short Esophagus
- Peptic esophagitis occurs in 40% of patients with GERD
- Impaired esophageal acid clearance may play a pivotal role
- It may be associated with hiatal hernia
- Peptic esophagitis precedes stricture and short esophagus
- Proton pump inhibitor therapy resolves 90%
- Continuous medical therapy required unless surgically treated
- It occurs in 8% to 23% of patients with untreated esophagitis
- Peptic stricture is short (~1 cm)concentric, and immediately proximal to the squamocolumnar junction
- Associated with short esophagus
- Proton pump inhibitor therapy, dilation, and surgery are complimentary
- The diagnosis can only be confirmed intraoperatively: the intra-abdominal esophagus is less than 2.5-cm long.
- Associated with large hiatal hernia
- True, reducible short esophagus (requiring mobilization): up to 20% of surgically treated GERD patients
- True, non-reducible short esophagus (requiring gastroplasty): < 5% of surgically treated GERD patients
- Large (Giant) hiatal hernia repair with gastroplasty and fundoplication has a recurrence requiring reoperation in less than 10% in select, experienced centers.
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