Poor Esophageal Motility: A Tailored Approach?
Fig. 20.1 Example of ineffective esophageal motility, Swallow (Sw) 1–10: Hypotensive contraction (Swallow 1, 4, 6, 7, 8, 9); Failed peristalsis (Swallow 2, 3, 5, 10); Weak peristalsis with small…
Effects of Reflux on the Esophageal Mucosa
Fig. 2.1 Anatomy and histology in normal and increasing severity of chronic reflux disease. (a) In the normal patient, the esophagus is lined by squamous epithelium (gray) and the stomach…
The Relation of Hiatal Hernia to Gastroesophageal Reflux Disease
Fig. 6.1 Comparison of gastroesophageal and anorectal junctions. When the anorectal junction is graphically rotated (middle image), note the similarity in conformations of the rectum and the esophagus/stomach. In both…
Side Effects of Fundoplications and How to Deal with Them
Fig. 23.1 Steroids can possibly accelerate recovery. However, if no contrast passes into the stomach, urgent intervention is necessary. The choice of method is between endoscopy and dilatation versus surgery….
Medical Therapy for GERD
Lifestyle modification Evidence of strength Reasonable to recommend? Sleep with head elevated Equivocal Not generally Avoid fatty meals Equivocal Not generally Avoid carbonated beverages Moderate Yes Select decaffeinated beverages Equivocal…
Epidemiology and Socioeconomics of Reflux Disease
Prevalence Basis Geographic location Prevalence (%) 95 % CI (%) Reference GERD symptoms United States 24.2 18.2–30.5 [1] GERD/dyspeptic symptoms United States 35.2 14.8–58.9 [1] Any heartburn South Australia 50 …
Indications for Antireflux Surgery
Presenting problem 24 h pH + 24 h pH − GERD symptoms Regurgitation ++++ +++ Heartburn +++ + Regurg and HB ++++ +++ Esophagitis +++ ++ Dysphagia ++ + Barretts…
Pilonidal Disease
Fig. 13.1 Pathogenesis of pilonidal disease Fig. 13.2 Pathogenesis of lose hair inserting and burrowing under the skin, forming a sinus tract 13.3 Clinical Presentation How does one recognize pilonidal…
Chronic Anal Pain
Fig. 11.1 Diagnostic algorithm in patients with suspected nonfunctional causes of anal pain Should initial physical exam fail to provide the diagnosis, ancillary tests may be performed. An office test,…
CT and MRI of the Pelvis for Anorectal Disease
Density (Hounsfield units) Air −1000 Fat −30 to −100 Simple fluid −10 to 20 Water 0 Blood 30–50 Muscle 45 Cortical bone 200–600 A limitation often encountered with CT…
