Diagnosis and Treatment of Gastroesophageal Reflux Disease Michael F. Vaezi Editor Diagnosis and Treatment of Gastroesophageal Reflux Disease 1 3 Editor Michael F. Vaezi, MD, PhD, MSc Department of Gastroenterology Vanderbilt University School of Medicine Nashville Tennessee USA ISBN 978-3-319-19523-0 ISBN 978-3-319-19524-7 (eBook) DOI 10.1007/978-3-319-19524-7 Library of Congress Control Number: 2015944713 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) To my wife, Holly, who is not only my kids’ hero but also mine. Preface Gastroesophageal reflux disease is a common clinical entity encountered by all spe- cialties in medicine. Over the past few years, there has been increasing understand- ing of the pathophysiology of this disease, and treatment options are vast. Improved and novel diagnostic tests are providing an easier way for clinicians to establish the diagnosis and offer patients the latest treatment options. This book is a constella- tion of information from the world’s experts in the field of esophagology and reflux disease. The chapters are organized so that the reader systematically learns about the disease definition, recognizes the current challenges in diagnosis, and then is provided with the latest information about medical, endoscopic, and surgical op- tions for patients with reflux disease. We are grateful to the contributors and hope that the book provides useful insight into this commonly encountered disease and can pave the way for optimal patient care. Michael F. Vaezi, MD, PhD, MSc vii Contents 1 Definitions of Gastroesophageal Reflux Disease (GERD) ...................... 1 Amit Patel and C. Prakash Gyawali 2 Complications of Gastroesophageal Reflux Disease ............................... 19 Patrick Yachimski 3 Diagnostic Approaches to GERD ............................................................. 37 Dejan Micic and Robert Kavitt 4 Lifestyle Modifications in GERD ............................................................. 59 Ali Akbar and Colin W. Howden 5 Role of H2RA and Proton Pump Inhibitor Therapy in Treating Reflux Disease ............................................................................. 71 John W. Jacobs, Jr. and Joel E. Richter 6 Novel Upcoming Therapies ....................................................................... 93 Carla Maradey-Romero and Ronnie Fass 7 Minimally Invasive GERD Therapies ...................................................... 117 Dan E. Azagury and George Triadafilopoulos 8 Role of LES Augmentation for Early Progressive Disease in GERD and Fundoplication for End-Stage Disease in GERD ................ 145 Stephanie G. Worrell and Tom R. DeMeester Index .................................................................................................................. 161 ix Contributors Ali Akbar Divison of Gastroentrology, University of Tennessee Health Science Center, Memphis, TN, USA Dan E. Azagury Department of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, CA, USA Tom R. DeMeester Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA Ronnie Fass Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA C. Prakash Gyawali Department of Medicine, Division of Gastroenterology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO, USA Colin W. Howden Divison of Gastroentrology, University of Tennessee Health Science Center, Memphis, TN, USA John W. Jacobs Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Swallowing Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA Robert Kavitt Section of Gastroenterology, Hepatology and Nutrition, Center for Esophageal Diseases, University of Chicago, Chicago, IL, USA Carla Maradey-Romero Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA Dejan Micic Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medical Center, Chicago, IL, USA Amit Patel Department of Medicine, Division of Gastroenterology, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, MO, USA xi xii Contributors Joel E. Richter Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Swallowing Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA George Triadafilopoulos Department of Medicine, Stanford University, Stanford, CA, USA Stephanie G. Worrell Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA Patrick Yachimski Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA Chapter 1 Definitions of Gastroesophageal Reflux Disease (GERD) Amit Patel and C. Prakash Gyawali Gastroesophageal reflux disease (GERD) is one of the most common gastrointesti- nal outpatient diagnoses and carries a significant clinical impact and disease burden worldwide [1]. A systematic review of population-based studies suggested that the prevalence of GERD is 10–20 % in the Western world and 5 % in Asia [2]. Preva- lence rates are higher than incidence rates worldwide, implying that the condition is chronic [2]. Estimates of the annual direct cost burden of GERD on the USA health- care system alone top US$ 9 billion [3]. GERD is well documented to adversely affect quality of life, and patients with persistent GERD symptoms suffer from re- duced physical as well as mental health-related quality of life (HRQOL) [4]. This is mainly from symptomatic presentations, hence the importance of symptom-based definitions of GERD [1]. As the population ages, the severity of reflux esophagitis and the prevalence of Barrett’s esophagus (BE) increase while symptoms become less prevalent, highlighting the importance of diagnostic definitions of GERD on investigative studies [5]. In this chapter, we explore different approaches to defining GERD—symptomatic definitions, endoscopic definitions, parameters on ambula- tory reflux testing (acid and impedance monitoring) defining GERD, diagnostic implications of structural and anatomic abnormalities, and the impact of newer di- agnostic modalities on the definition of GERD. Spectrum of GERD Gastroesophageal reflux (GER), or the retrograde flow of gastric content across the esophagogastric junction (EGJ) and the lower esophageal sphincter (LES), can be physiologic, especially in the postprandial setting. Inherent mechanisms are in C. P. Gyawali () · A. Patel Department of Medicine, Division of Gastroenterology, Barnes-Jewish Hospital/Washington University School of Medicine, Campus Box 8124, 660 S. Euclid Avenue, St. Louis, MO 63110, USA e-mail: [email protected] © Springer International Publishing Switzerland 2016 1 M. F. Vaezi (ed.), Diagnosis and Treatment of Gastroesophageal Reflux Disease, DOI 10.1007/978-3-319-19524-7_1 2 A. Patel and C. P. Gyawali place for the LES to relax transiently in response to distension of the fundus of the stomach, resulting in venting of air (belching) [6]. The resting LES tone, inspiratory diaphragmatic crural pinch at the same level as the LES, and the angle between the long axes of the esophagus and the stomach prevent significant retrograde move- ment of gastric content across the EGJ and LES in the physiologic setting. However, transient LES relaxations (TLESRs) can result in small amounts of gastric content refluxing into the esophagus; in health, esophageal secondary peristalsis is efficient in stripping any refluxed material back into the stomach [7]. GER becomes pathologic (GERD) when associated with symptoms (typically heartburn or regurgitation) or mucosal injury (typically esophagitis or BE) [8, 9]. Symptoms and mucosal injury are not mutually exclusive, and each can occur in the absence of the other. Therefore, subjective symptom analysis, and, indeed, en- doscopic inspection of the esophageal mucosa, may not always be indicative of GERD. Symptoms related to GERD can be atypical (noncardiac chest