Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders

200 Pages·2001·4.66 MB·English

by  Shyam Varadarajulu MD

DISEASES OF THE GASTROESOPHAGEAL MUCOSA
CLINICAL GASTROENTEROLOGY
George Y. Wu,
MD, PhD SERIES EDITOR
Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders, edited
by James W. Freston, 2001.
DISEASES
OF THE
GAsTROESOPHAGFAL
MUCOSA
THE ACID-RELATED DISORDERS
Edited by
W.
JAMES FRESTON, MD, PhD
Division ofG astroenterology and Hepatology,
University ofC onnecticut Health Center,
Farmington, CT
© 2001 Humana Press Inc.
Softcover reprint of the hardcover 1s t edition 2001
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Library of Congress Cataloging-in-Publication Data
Diseases of the gastroesophageal mucosa: the acid-related disorders / edited by James
W. Freston.
p. ;cm.
Inc1udes bibliographical references and index.
ISBN 978-1-4684-9642-0 ISBN 978-1-59259-103-9 (eBook)
DOI 10.1007/978-1-59259-103-9
1. Indigestion. 2. Peptic ulcer. 3. Gastroesophageal reflux. 4. Gastrointestinal mucosa.
5. Gastric acid--Pathophysiology. 1. Freston, James W.
[DNLM: 1. Peptic Ulcer. 2. Dyspepsia. 3. Gastric Mucosa--pathology. 4.
Gastroesophageal Reflux. 5. Helicobacter Infections--physiopathology. WI 350 D611 2001]
RC827 .D575 2001
616.3'3--dc21 2001016575
PREFACE
Acid-related diseases are among the most commonly encountered disorders
in clinical practice. The last decade has witnessed profound changes in the clini
cal approach to this family of conditions, which includes gastroesophageal reflux
disease (GERD) in its protean manifestations, peptic ulcers of all etiologies, and
dyspepsia of the uninvestigated and investigated (nonulcer dyspepsia) varieties.
The changes have arisen largely from the discovery of H. pylori's important role
in various acid-related diseases and in response to the rising tide of patients with
GERO. Major alterations in health care delivery, spawned by efforts to control
health care costs, have also had an impact on the way clinicians deal with these
diseases. One result has been the introduction of various practice guidelines that
are intended to assist clinicians in managing their patients in a fashion that
reflects recent advances in medical science as well as economics. In this field,
however, the pace of advances quickly renders most guidelines obsolete. Dis
eases oft he Gastroesophageal Mucosa: The Acid-Related Disorders is intended
to help primary care physicians and clinical gastroenterologists stay abreast of
the important developments in this field.
The emphasis is on diagnosis and treatment, but epidemiology and patho
physiology are not neglected in instances where their understanding sets the
stage for management recommendations. The first section addresses the clinical
evaluation of patients suspected of harboring peptic ulcers, and it provides spe
cific information about drugs used in treating acid-related diseases. Subsequent
chapters address ulcers of various causes, with particular emphasis on new as
pects of H. pylori infection. A chapter is devoted to dyspepsia because this
condition is ubiquitous in practice and new information is available to assist
clinicians in efficiently managing patients with this condition. The section on
GERD contains important developments in epidemiology, mechanisms of dis
ease, and practical aspects of diagnosis and treatment. The extraesophageal
manifestations of GERD, recognized increasingly in primary care, are addressed
in a separate chapter in recognition of the new approaches to their management
that have been described recently. Finally, upper gastrointestinal bleeding is
addressed because an understanding of new management modalities can assist
clinicians in triaging bleeding patients more effectively. No attempt has been
made to include nonacid-related diseases of the upper gastrointestinal tract, such
as esophageal opportunistic infections, malignancies, except those related to
v
vi Preface
GERD or H. pylori infection, and motor disturbances of the esophagus and
stomach. The focus is on conditions in which gastric acid is fundamentally
important in the pathophysiology and in which modulation of gastric acidity
influences the clinical response.
The editor is grateful for the secretarial and administrative assistance of
Dana A. Finello.
James W. Freston, MD, PhD
CONTENTS
Preface ......................................................................................... v
List of Contributors .................................................................... ix
Part I. Peptic Ulcer Diseases
1 Peptic Ulcer Disease: Overview and Management. ............. 3
Shyam Varadarajulu and James W. Freston
2 Hylicobacter pylori-Related Diseases:Demographics,
Epidemiology, Pathophysiology of Gastritis, Ulcers,
and Cancer. ................................................................... 29
James S. Hoffman and David R. Cave
3 H. pylori-Related Diseases: Diagnosis and Treatment... ... .43
Colin W. Howden
4 NSAID Ulcers: Overview and Management... ..................... 59
David J. Bjorkman and Kathryn Tessnow
5 Nonvariceal Upper Gastrointestinal Bleeding .................... 75
Gustavo A. Machicado and Dennis M. Jensen
6 Zollinger-Ellison Syndrome and Other Acid-
Hypersecretory States ..................................................... 89
Paul N. Maton
Part II. Dyspepsia: Classification and Management
7 Dyspepsia and Nonulcer Dyspepsia ................................ 10 5
Nimish Vakil
Part III. Gastroesophageal Reflux Disease
8 Gastroesophageal Reflux Disease: Epidemiology
and Pathophysiology. ................................................... 121
Philip O. Katz and Amine Hila
9 Gastroesophageal Reflux Disease: Diagnosis
and Treatment ............................................................ 137
Jaroslaw H. Cymorek and James W. Freston
10 Barrett's Esophagus and Adenocarcinoma ..................... 167
John Yalam and Richard E. Sampliner
11 Extraesophageal Manifestations of Gastroesophageal
Reflux Disease ............................................................. 177
John E. Pandolfino and Peter J. Kahrilas
Index ...................................................................................... 193
vii
CONTRIBUTORS
DAVID J. BJORKMAN, MD, MSPH, SM· Division of Gastroenterology, University
of Utah, Salt Lake City, UT
DAVID R. CAVE, MD, PhD· Section of Gastroenterology, St. Elizabeth's Medical
Center, Brighton, MA
JAROSLAW H. CYMOREK, MD· Division of Gastroenterology and
Hepatology, University of Connecticut Health Center, Farmington, CT
JAMES W. FRESTON, MD, PhD • Division of Gastroenterology and Hepatology,
University of Connecticut Health Center, Farmington, CT
AMINE HILA, MD • Department ofM edicine, Graduate Hospital, Philadephia, PA
JAMES S. HOFFMAN, MD, • Section of Gastroenterology, St. Elizabeth's Medical
Center, Brighton, MA
COLIN W. HOWDEN, MD • Division of Gastroenterology and Hepatology,
Northwestern, University Medical School, Northwestern Center for Clinical
Research, Chicago, IL
DENNIS M. JENSEN, MD· CURE Digestive Disease Research Center, VA
Greater Los Angeles Healthcare System, Los Angeles, CA
PETER J. KAHRILAS, MD • Northwestern University Medical School, Division of
Gastroenterology and Hepatology, Department of Medicine, Chicago, IL
PHILIP O. KATZ, MD • Graduate Hospital, Department of Medicine,
Philadelphia, PA
GUSTAVO A. MACHICADO, MD· UCLA Center for the Health Sciences, CURE
Digestive Disease Research Center and VA Greater Los Angeles
Healthcare System, Los Angeles; and Northbridge Hospital Medical
Center, Van Nuys, CA
PAUL N. MATON, MD • Digestive Disease Research Institute, Oklahoma City, OK
JOHN E. PANDOLFINO, MD· Department of Medicine, Northwestern University
Medical School, Chicago, IL
RICHARD E. SAMPLINER, MD • University of Arizona Health Sciences Center,
Southern Arizona VA Health Care System, Tucson, AZ
KATHRYN TESSNOW, MD • Division of Gastroenterology, University of Utah,
Salt Lake City, UT
NIMISH VAKIL, MD· University of Wisconsin Medical School, Sinai Samaritan
Medical Center, Milwaukee, WI
SHYAM VARADARAJULU, MD· Division of Gastroenterology and Hepatology,
University of Connecticut Health Center, Farmington, CT
JOHN YA LAM, MD • University of Arizona Health Science Center, Southern
Arizona VA Health Care System, Tucson, AZ
ix
I
PEPTIC ULCER DISEASES
1
Peptic Ulcer Disease
Overview and Management
Shyam Varadarajulu, MD
and James W Freston, MD, PhD
CONTENTS
INTRODUCTION
CHANGING EPIDEMIOLOGY OF PEPTIC ULCER DISEASE
PATHOGENESIS AND ETIOLOGY OF PEPTIC ULCER NSTEROIDAL
ANTI-INFLAMMATORY DRUGS
DIAGNOSIS OF PEPTIC ULCER DISEASE
PHARMACOLOGY OF ANTIULCER MEDICATIONS
MEDICAL TREATMENT OF PEPTIC ULCER DISEASE
REFERENCES
INTRODUCTION
In the past decade, the causes of peptic ulcer disease (PUD) have been
clarified. Infection with Helicobacter pylori has emerged as the most
frequent cause, and the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) has become an increasingly important cause. PUD, a term
encompassing both gastric and duodenal ulcers continues to be a serious
medical problem, primarily because of its ubiquity: approximately
500,000 new cases develop each year in the United States and 4 million
recur. The high prevalence of PUD results in significant morbidity,
mortality, and economic costs. Over 80% of patients experience pain or
gastrointestinal bleeding; more than 5000 patients die each year of ulcer
complications, and the economic costs of this are staggering. The
estimated annual direct costs, such as physician visits, diagnostic
From: Clinical Gastroenterology:
Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders
Edited by: J. W. Freston © Humana Press Inc., Totowa, NJ
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