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Diagnostic Atlas of Gastroesophageal Reflux Disease - A New Histology-based Method (Hardcover)
Loot Price: R3,805
Discovery Miles 38 050
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Diagnostic Atlas of Gastroesophageal Reflux Disease - A New Histology-based Method (Hardcover)
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Total price: R3,825
Discovery Miles: 38 250
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Gastroesophageal reflux 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.
At present, there is no histologic test that has any practical
value in the diagnosis of reflux disease. The only histologic
diagnostic criteria are related to changes in the squamous
epithelium which are too insensitive and nonspecific for effective
patient management. It is widely recognized that columnar
metaplasia of the esophagus (manifest histologically as cardiac,
oxyntocardiac and intestinal epithelia) is caused by reflux.
However, except for intestinal metaplasia, which is diagnostic for
Barrett esophagus, these columnar epithelia are not used to
diagnose reflux disease in biopsies. The reason for this is that
these epithelial types are indistinguishable from "normal"
"gastric" cardiac mucosa. In standard histology texts, this "normal
gastric cardia" is 2-3 cm long.
In the mid-1990s, Dr. Chandrasoma and his team at USC produced
autopsy data suggesting that cardiac and oxyntocardiac mucosa is
normally absent from this region and that their presence in
biopsies was histologic evidence of reflux disease. From this data,
they determined that the presence of cardiac mucosa was a
pathologic entity caused by reflux and could therefore be used as a
highly specific and sensitive diagnostic criterion for the
histologic diagnosis of reflux disease. They call this entity
"reflux carditis." In addition, the length of these metaplastic
columnar epithelia in the esophagus was an accurate measure of the
severity of reflux disease in a given patient.
At present, there is some controversy over whether cardiac mucosa
is totally absent or present normally to the extent of 0-4 mm.
While this should not be a deterrent to changing criteria which are
dependent on there normally being 20-30 cm of cardiac mucosa, there
has been little mainstream attempt to change existing endoscopic
and pathologic diagnostic criteria in the mainstream of either
gastroenterology or pathology.
The ATLAS will be the source of easily digestible practical
information for pathologists faced with biopsies from this region.
It will also guide gastroenterologists as they biopsy these
patients.
* The American Gastroenterological Association claims there are
14,500 members worldwide who are practicing physicians and
scientists who research, diagnose and treat disorders of the
gastrointestinal tract and liver
* According to the American Society for Clinical Pathology, there
are 12,000 board certified pathologists in the U.S.
* Adenocarcinoma of the esophagus and gastric cardia is now the
most rapidly increasing cancer type in the Western world
* Approximately 40% of the adult population of the U.S. suffers
from significant heartburn and the numerous antacids advertised on
national television represents an $8 billion per year drug market
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