eMedicine Specialties > Gastroenterology > Esophagus

Gastroesophageal Reflux Disease: Follow-up

Author: Piero Marco Fisichella, MD, Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center
Coauthor(s): Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Contributor Information and Disclosures

Updated: Apr 28, 2009

Follow-up

Complications

  • Esophagitis (esophageal mucosal damage) occurs in approximately 50% of patients with gastroesophageal reflux disease (GERD).
  • Barrett esophagus is one of the most serious complications of gastroesophageal reflux disease (GERD), because it may progress to cancer (see Images 1 and 7 or below).
    Peptic esophagitis. A rapid urease test (RUT) is ...

    Peptic esophagitis. A rapid urease test (RUT) is performed on the esophageal biopsy sample. The result is positive for esophagitis.

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    Peptic esophagitis. A rapid urease test (RUT) is ...

    Peptic esophagitis. A rapid urease test (RUT) is performed on the esophageal biopsy sample. The result is positive for esophagitis.


    Endoscopy demonstrating intraluminal esophageal c...

    Endoscopy demonstrating intraluminal esophageal cancer.

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    Endoscopy demonstrating intraluminal esophageal c...

    Endoscopy demonstrating intraluminal esophageal cancer.


    {{mediacaption:1674255_7}} Even though a prospective randomized trial has never been performed to compare PPIs to laparoscopic fundoplication, the authors believe fundoplication is preferable for the following reasons: 
    • PPIs, although effective in controlling the acid component of the refluxate, do not eliminate the reflux of bile, which some believe to be a major contributor to the pathogenesis of Barrett epithelium.
    • Patients with Barrett esophagus tend to have lower LES pressure and worse esophageal peristalsis than patients without Barrett esophagus. Patients with Barrett esophagus are also exposed to a larger amount of reflux.
    • A fundoplication offers the only possibility of stopping any kind of reflux by creating a competent LES. However, until the definitive answer is known, the authors recommend that patients with Barrett esophagus continue to undergo periodic endoscopic surveillance even after laparoscopic fundoplication.
  • Respiratory complications include pneumonia, asthma, and interstitial lung fibrosis.

Prognosis

  • Most patients with gastroesophageal reflux disease (GERD) do well with medications, although a relapse after cessation of medical therapy is common and indicates the need for long-term maintenance therapy.
  • Identifying the subgroup of patients who may develop the most serious complications of gastroesophageal reflux disease (GERD) and treating them aggressively is important. Surgery at an early stage is most likely indicated in these patients.
  • After a laparoscopic Nissen fundoplication, symptoms resolve in approximately 92% of patients.

Miscellaneous

Medicolegal Pitfalls

  • Esophageal manometry and pH monitoring are considered essential before performing an antireflux operation. Endoscopy reveals that 50% of patients do not have esophagitis. The only way to determine if abnormal reflux is present and if symptoms are actually caused by gastroesophageal reflux is through pH monitoring.
  • Achalasia can present with heartburn. Only esophageal manometry and pH monitoring can be used to distinguish achalasia from gastroesophageal reflux disease (GERD). Therapy is completely different for the 2 conditions.
 


More on Gastroesophageal Reflux Disease

Overview: Gastroesophageal Reflux Disease
Differential Diagnoses & Workup: Gastroesophageal Reflux Disease
Treatment & Medication: Gastroesophageal Reflux Disease
Follow-up: Gastroesophageal Reflux Disease
Multimedia: Gastroesophageal Reflux Disease
References
Further Reading
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Further Reading

Additional resources on asthma are available at Medscape’s Gastroesophageal Reflux Disease Resource Center.

Related eMedicine Topics

Clinical Trials

National Guidelines Clearinghouse

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Keywords

gastroesophageal reflux disease, GERD, reflux, heartburn, esophagitis, gastritis, peptic ulcer disease, PUD, lower esophageal sphincter, LES, hiatal hernia, obesity, regurgitation, dysphagia, Barrett esophagus, adenocarcinoma, laryngitis, proton pump inhibitor, PPI, esophagogastroduodenoscopy, EGD, laparoscopic fundoplication, Nissen fundoplication

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Contributor Information and Disclosures

Author

Piero Marco Fisichella, MD, Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center
Piero Marco Fisichella, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

John Gunn Lee, MD, Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine
John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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