الفهرس 
Anatomy of the esophagusOnly 14 pages are availabe for public view
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Abstract
Gastroesophageal reflux disease GERD is defined as the prescence of symptoms or lesions that can be attributed to the reflux of gastric juice or gastroduodenal contents into the esophagus. it is one of the most common disorders affecting the gastro intestinal tract.
GERD is a common condition, accounting approximately of 75% of esophageal pathology. GERD is alife long condition, of those can be healed about 80% relapse after stopping treatment and 30% relapse by year even if omeperazole continued in therapeutic dose.
The pathophysiology of GERD includes alteration in volume, distribution or composition of gastric contents, anatomical and\ or motor dysfunction of the anti-reflux barrier at GEJ, impaired clearance mechanisms and impaired mucosal resistance.
The prequisities for development of acid reflux is the occurrence of anatomical and\or motor dysfunction at GEJ.most patients with mild GERD results from Transient LES Relaxations (TLERs),can be controlled by life style modifications and appropriate medical treatment.A minority have more sevre disease associated with severe impairement of LES and motor dysfunction are more liable for complications as; ulceration, haemorrhage, perforation, peptic stricture,and Barrett’s esophagus.
Diagnosis of GERD is essentially clinical. Investigations are done to confirm diagnosis or to detect complications, also to differentiate GERD
from other motility disorders or heart burn like symptoms. Investigation include barium radiographs, upper gastrointestinal endoscopy esophageal biopsy and manometry.
Treatment of GERD includes life style modifications, medical treatment in the form of H2 antagonisti, PPIs and prokinetecs. Surgical treatment by anti-reflux repairs either by open or laparoscopic techniques is indicated when medical treatment fails, complicated GERD and large hiatal hernia or paraesophageal hernia.
Esophageal manometry manometry must be done to every patient will undergo fundoplication to exclude esophageal spasm, achalasia and scleroderma which may mimic GERD in symptoms.
With regards to laparoscopic fundoplication, it produces rapid recovery, minimal pain, rapid return of bowel transit early naturall feeding, short hospital stay, rapid return to work and similar outcoume as open fundoplication.