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Pathophysiology of gastro-oesophageal reflux disease (GERD) with respect to reflux-induced carcinogenesis

Die Pathophysiologie der gastroösophagealen Refluxerkrankung unter Berücksichtigung der refluxinduzierten Karzinogenese

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Summary

Background: Gastro-oesophageal reflux disease has a complex pathophysiology. Therefore, therapeutic considerations should not only include the peptic component of the disease.

Methods: A variety of studies in rats and in humans demonstrate the consequences of gastro-oesophageal reflux and medical and surgical interventions in terms of inflammation, epithelial growth stimulation, apoptosis and oxidative stress in the epithelium of the oesophagus.

Results: Gastro-oesophageal reflux disease consists of a variety of pathophysiologically important factors. These include changes in the anatomy, gastro-oesophageal motility, epithelial growth, inflammation, apoptosis and molecular structure and may lead to carcinogenesis. Surgery restores the antireflux barrier and improves oesophageal and gastric motility, thus preventing the consequences of the disease.

Conclusions: Antireflux surgery provides a causative therapy of gastrointestinal reflux disease.

Zusammenfassung

Grundlagen: Die gastroösophageale Refluxkrankheit hat einen breiten pathophysiologischen Hintergrund und läßt sich somit auch in bezug auf die Therapie nicht auf die peptische Komponente reduzieren.

Methodik: In mehreren Untersuchungen sowohl an der Ratte als auch am Menschen werden die Auswirkungen des gastroösophagealen Refluxes und die Effekte medikamentöser und chirurgischer Maßnahmen in Hinblick auf Entzündung, Wachstumsstimulation, Apoptose und Auftreten von freien Sauerstoffradikalen am Ösophagusepithel demonstriert.

Ergebnisse: Die gastroösophageale Refluxkrankheit umspannt eine breite Palette von Veränderungen in bezug auf Anatomie, Motilität, Entzündung mit Freisetzung von Sauerstoffradikalen, Apoptose und DNA-Struktur bis hin zur Karzinogenese im distalen Ösophagus. Die chirurgische Therapie der Refluxkrankheit vermag eine ausreichende Barriere am Hiatus wiederherzustellen, verbessert die Magenmotilität und die Ösophagusperistaltik und ist in der Lage, dem gastroösophagealen Reflux mit all seinen Auswirkungen entgegenzuwirken.

Schlußfolgerungen: Die Antirefluxchirurgie stellt somit eine kausale Therapie der Refluxkrankheit dar.

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  1. Division of General Surgery, Department of Surgery, University of Innsbruck, Anichstraße 35, A-6020, Innsbruck

    H. Wykypiel, M. Gadenstätter, F. A. Granderath, P. J. Klingler & G. J. Wetscher

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  1. H. Wykypiel
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Wykypiel, H., Gadenstätter, M., Granderath, F.A. et al. Pathophysiology of gastro-oesophageal reflux disease (GERD) with respect to reflux-induced carcinogenesis. Eur. Surg. 34, 296–302 (2002). https://doi.org/10.1046/j.1563-2563.2002.02071.x

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