Reflux to Esophageal Adenocarcinoma


  • Tom DeMeester, University of Southern California, Keck School of Medicine, Los Angeles, California, USA


  • Parakrama Chandrasoma, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  • Parakrama Chandrasoma, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  • Tom DeMeester, University of Southern California, Keck School of Medicine, Los Angeles, California, USA

Gastroesophageal Reflux Disease (GERD) is one of the most common maladies of mankind. Approximately 40% of the adult population of the USA suffers from significant heartburn and the numerous antacids advertised incessantly on national television represents a $8 billion per year drug market. The ability to control acid secretion with the increasingly effective acid-suppressive agents such as the H2 blockers (pepcid, zantac) and proton pump inhibitors (nexium, prevacid) has given physicians an excellent method of treating the symptoms of acid reflux.Unfortunately, this has not eradicated reflux disease. It has just changed its nature. While heartburn, ulceration and strictures have become rare, reflux-induced adenocarcinoma of the esophagus is becoming increasingly common. Adenocarcinoma of the esophagus and gastric cardia is now the most rapidly increasing cancer type in the Western world.The increasing incidence of esophageal adenocarcinoma has created an enormous interest and stimulus for research in this area. GERD brings together a vast amount of disparate literature and presents the entire pathogenesis of reflux disease in one place. In addition to providing a new concept of how gastroesophageal reflux causes cellular changes in the esophagus, GERD also offers a complete solution to a problem that has confused physicians for over a century. Both clinical and pathological information about reflux disease and its treatment are presented. GERD is meant to be used as a comprehensive reference for gastroenterologists, esophageal surgeons, and pathologists alike.
View full description


Gastroenterologists, esophageal surgeons and pathologists.


Book information

  • Published: September 2006
  • Imprint: ELSEVIER
  • ISBN: 978-0-12-369416-4


“This is the most comprehensive book ever written about gastroesophageal reflux disease. Dr. Tom R. DeMeester has been the leading authority on this disease of the 20th century, and has headed for the last 15 years one of the most productive units of foregut surgery in the world. Dr. Chandrasoma has recently emerged as a leading pathologist in this area. The authors have extensively covered all aspects of gastroesophageal reflux disease, from the anatomy to the pathophysiology, from the diagnosis to the rationale for treatment. They have carefully reviewed the literature in view of their own experience, explaining how this disease can progress from symptoms to cancer. An essential reading for whoever treats patients with gastroesophageal reflux disease, from gastroenterologists to surgeons.” --Marco G. Patti, MD, Professor of Surgery, University of California, San Francisco "One would be hard pressed to find a better collaboration to characterize the total clinical spectrum of esophageal adenocarcinoma than Tom DeMeester and Para Chandrasoma. This textbook is rich with the fruits of the knowledge and experience of these two outstanding investigators, including not only the full range of commonly accepted knowledge and beliefs in this field but also developing concepts on the histopathologic relationship between chronic reflux and injury to the distal esophageal mucosa that have resulted from detailed observation and clinical research from this illustrious team. Failure to appreciate the histologic changes that occur with, and therefore predict, the process of development of adenocarcinoma leave the clinician with a false sense of understanding. As the authors state, “most influential physicians on the subject today simply do not look through the microscope and have no true understanding of histology.” The approach that this team follows at the University of Southern California is based on their belief that “to be successful, the super specialized clinical esophagologist must understand the significance of the microscopic pathology of the biopsies that are taken, and the super specialized esophageal pathologist must understand the clinical basis of columnar-lined esophagus." All of us who are involved in the care of patients with esophageal adenocarcinoma owe a debt of gratitude to Drs. DeMeester and Chandrasoma for producing the exceptional material contained within this text." --Donald O. Castell, MD, Professor of Medicine, Director, Esophageal Disorders Program, Medical University of South Carolina “Everyone interested in esophageal disease should read this book. It is unlike any other I have ever read on the subject and is likely the most controversial and thought provoking of any on this disease. The book represents the collected experience and opinions of the book’s 2 authors - an accomplished pathologist (Dr. Chandrasoma) and arguably the most accomplished esophageal surgeon of his time (Dr. DeMeester) - who have worked together at the same institution for approximately 15 years in a surgical esophageal and foregut group that sees complex and difficult gastroesophageal reflux disease (GERD) cases. This book is extremely well written, carefully and thoughtfully prepared, and offers the open-minded reader a view of GERD that they would not read in any standard textbook or review article on the subject. The rich descriptions of the histopathology, views on carditis, cardiac intestinal metaplasia; and the microscopic definition of the gastroesophageal junction are valuable to all that study this disease.” - Philp O. Katz, Thomas Jefferson University and Albert Einstein Medical Center, Philadelphia, PA, Gastroenterology, 2007 “This book describes a novel, fascinating, straight-forward approach towards understanding and management of gastroesophageal reflux disease(GERD), a disease that is ‘all about us’. The contribution, written by two outstanding authorities with world-wide reputation and acceptance in the field of esophagology, esophageal surgery and gastrointestinal histopathology, mediates a novel and easy to follow concept for every day clinical praxis in the management of persons with gastroesophageal reflux disease. The book is well written, clearly structured and easy to read. Numerous excellent cartoons, black/white and color images profoundly add to improve understanding of physiology and histopathology. In addition, the authors present a critical appraisal towards recent literature on the topic including their own work. The conclusions drawn by the authors are well founded by the literature. The book is highly recommended to those who want to become better in the management of their patients with gastroesophageal reflux disease.” - Johannes Lenglinger and Martin Riegler, European Surgery, 2007. "This timely and authoritative book was written by two masters in the field whose experiance spans two decades and includes supervision of studies involving more than 10,000 patients. The book is well written and demonstrates the advantages of having a limited number of authors and a narrow focus - namely; consistency of style and a cohesive philosophy." - Subhas Banerjee and Jacques Van Dam, Stanford University School of Medicine, 2007

Table of Contents

Overview of Gastroesophageal Reflux DiseaseThe Past, Present and Future of Columnar Lined (Barrett) EsophagusFetal Development of the Esophagus and StomachNormal Anatomy; Present Definition of the Gastroesophageal JunctionHistologic Definitions and Diagnosis of Epithelial TypesCardiac MucosaNew Histologic Definitions of Esophagus, Stomach and Gastroesophageal JunctionPathology of Reflux Disease at a Cellular Level: Part 1 - Damage to Squamous Epithelium and Transformation into Cardiac MucosaThe Pathology of Reflux Disease at Cellular Level: Part 2- Evolution of Cardiac Mucosa to Oxyntocardiac Mucosa and Intestinal MetaplasiaPathology of Reflux Disease at Cellular Level: Part 3 - Intestinal (Barrett) Metaplasia to CarcinomaPathology of Reflux Disease at Anatomic LevelReflux Disease Limited to the Dilated End-Stage Esophagus: The Pathologic Basis of NERDDefinition of Gastroesophageal Reflux Disease and Barrett EsophagusDiagnosis of Gastroesophageal Reflux Disease, Barrett Esophagus and DysplasiaResearch Strategies for preventing reflux-induced adenocarcinomaRationale of Treatment of Reflux Disease and Barrett EsophagusTreatment Strategies for preventing reflux-induced adenocarcinoma