1st Edition

Reflux to Esophageal Adenocarcinoma

Print ISBN: 9781493300730
eBook ISBN: 9780080464749
Imprint: Elsevier Science
Published Date: 18th September 2006
Page Count: 464
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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.

Key Features

Outlines how gastroesophageal reflux causes cellular changes in the esophagus Brings together the pathogenesis of the disease in one source and applies it toward clinical treatment Tom DeMeester is THE leading international expert on reflux disease; Parakrama Chandrasoma is one of the leading pathologists in the area Book contains approximately 350 illustrations *Ancillary web site features color illustrations:


Gastroenterologists, esophageal surgeons and pathologists.

Table of Contents

Overview of Gastroesophageal Reflux Disease The Past, Present and Future of Columnar Lined (Barrett) Esophagus Fetal Development of the Esophagus and Stomach Normal Anatomy; Present Definition of the Gastroesophageal Junction Histologic Definitions and Diagnosis of Epithelial Types Cardiac Mucosa New Histologic Definitions of Esophagus, Stomach and Gastroesophageal Junction Pathology of Reflux Disease at a Cellular Level: Part 1 – Damage to Squamous Epithelium and Transformation into Cardiac Mucosa The Pathology of Reflux Disease at Cellular Level: Part 2- Evolution of Cardiac Mucosa to Oxyntocardiac Mucosa and Intestinal Metaplasia Pathology of Reflux Disease at Cellular Level: Part 3 – Intestinal (Barrett) Metaplasia to Carcinoma Pathology of Reflux Disease at Anatomic Level Reflux Disease Limited to the Dilated End-Stage Esophagus: The Pathologic Basis of NERD Definition of Gastroesophageal Reflux Disease and Barrett Esophagus Diagnosis of Gastroesophageal Reflux Disease, Barrett Esophagus and Dysplasia Research Strategies for preventing reflux-induced adenocarcinoma Rationale of Treatment of Reflux Disease and Barrett Esophagus Treatment Strategies for preventing reflux-induced adenocarcinoma


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“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