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A PROPOSITO DE UN CASO.
Although the pathogenesis of AEN is believed to be multifactorial with the precise cause still unknown, ischemia seems to play a central role. Factors favoring an ischemic etiology include the acute start of symptoms in the absence of other causes of acute esophagitis. The appearance of esophageal lesions after periods of hemodynamic instability either due to cardiac failure, sepsis, or hypovolemia from dehydration. The predominance of esophageal necrosis in the middle and distal third of esophagus, which are the least vascular portion of the esophagus. The presence of thrombi in the capillaries of the lamina propria on biopsy all favor ischemia in the pathogenesis of this condition.
Other investigators have suggested transient gastric outlet obstruction in the pathogenesis of AEN. It has been theorized that obstruction leads to accumulation of large volumes of acid build up in the stomach, resulting in large and prolonged amount of esophageal reflux. The exposure of the esophagus to large amount of acid is believed to overwhelm the physiological defense mechanism resulting in direct injury with necrosis. Factors favoring this theory include the predominance of this entity seen in the distal two third of esophagus and an association of gastric outlet obstruction and recent NG tube placement with this endoscopic finding.
Other investigators have suggested transient gastric outlet obstruction in the pathogenesis of AEN. It has been theorized that obstruction leads to accumulation of large volumes of acid build up in the stomach, resulting in large and prolonged amount of esophageal reflux. The exposure of the esophagus to large amount of acid is believed to overwhelm the physiological defense mechanism resulting in direct injury with necrosis. Factors favoring this theory include the predominance of this entity seen in the distal two third of esophagus and an association of gastric outlet obstruction and recent NG tube placement with this endoscopic finding.
http://www.mediafire.com/?sharekey=a0e4c6e99266f8c161d4646c62b381cb9eb53163892ba023b8eada0a1ae8665a
GERD is seen in up to 40% of the population.1 If avoidance
Technical Considerations in Laparoscopic Fundoplication
How I Do It
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of triggers such as coffee, carbonated beverages, alcohol or
fruit juice, and long-term medication with proton pump
inhibitors cannot provide satisfactory results, surgery is
indicated.2,3 Since 1991, laparoscopic fundoplication has
emerged as the best surgical option with superiority over
other treatments.4,5 During this experience, several lessons
have been learned. The primary goal is to restore adequate
LES function with an increase in resting LES pressure,
fewer transient LES relaxations, increased intraabdominal
esophageal length, accentuation of the angle of His,
creation of a mucosal rosette, and speeding of gastric
emptying.6 In essence, the fundoplication is carried out in
much the same way as for the open procedure with only
minor modifications required. The steps of the procedure
are described in detail, and suggestions are given how to
avoid and deal with operative pitfalls.
http://www.4shared.com/file/32172537/281d570a/Technical_Considerations_in_Laparoscopic_Fundoplication.html
http://www.4shared.com/file/32172537/281d570a/Technical_Considerations_in_Laparoscopic_Fundoplication.html
Management of Barrett's Esophagus.
The Society for Surgery of the Alimentary Tract.
Journal of Gastrointestinal Surgery 2007; 11: 1213-5
El esófago de Barrett se presenta en alrededor del 10 al 20 % de los pacientes que padecen reflujo gastroesofágico, con su conocido riesgo de desarrollar cáncer esofágico. Este documento revisa y actualiza los aspectos relacionados con el diagnóstico, tratamiento y seguimiento de esta patología. Sus recomendaciones se basan en las evidencias científicas disponibles en la literatura médica.
http://www.4shared.com/file/37518624/831df1dd/Management_of_Barretts_Esophagus.html
The Effect of Antireflux Surgery on Esophageal Carcinogenesis in Patients With Barrett Esophagus: A Systematic Review
Objective: To determine whether patients with Barrett esophagus who undergo antireflux surgery differ from medically treated patients in incidence of esophageal adenocarcinoma and probability of disease regression/progression.
Conclusions: Antireflux surgery is associated with regression of Barrett esophagus and/or dysplasia. However, evidence suggesting that surgery reduces the incidence of adenocarcinoma is largely driven by uncontrolled studies .
Tratamiento laparóscopico del reflujo gastroesofágico: funduplicatura de Nissen, Nissen-Rosseti y Toupet
http://www.4shared.com/file/31058373/a0585099/nissen_vlp.html