الفهرس 
ANATOMY OF THE ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION ANTIREFLUX MECHANISMSOnly 14 pages are availabe for public view
 |  | from | 155 |  |  |
| | | from | 155 | | |
Abstract
Gastroesophageal reflux disease (GERD) is a frequent clinical condition characterized by the reflux of gastric constituents into the esophagus or oropharynx via the lower esophageal sphincter (LES), producing discomfort and/or harm to esophageal tissue serious enough to disturb a patient’s life. Acid reflux into the esophagus may cause esophagitis, tracheobronchitis, stricture, Barrett’s esophagus and even esophageal cancer.
GERD is prevented in healthy individuals mainly by a natural antireflux mechanisms composed by the following elements, Lower esophageal sphincter, the skeletal muscles of the crural diaphragm, the presence of an intra-abdominal portion of the esophagus, the more acute the angle formed between the esophagus and the gastric fundus (angle of His), The phrenoesophageal membrane, Gubaroff valves and esophageal mucosa.
The pathophysiology of GERD remains complex and involves many different mechanisms, including components of the esophagus itself, the disruption of esophago-gastric junction (EGJ), the stomach and the nervous system.
there is evidence that suboptimal esophageal clearance, impaired esophageal mucosal defense, abnormalities of lower esophageal sphincter (LES), mainly the transient LES relaxations (TLESRs) and a reduced LES pressure, all can contribute to the development of GERD.
Symptoms of GERD include heartburn, regurgitation of food or sour liquid, chest pain, difficulty swallowing (dysphagia), and a sensation of a lump in the throat. These symptoms can significantly impact the quality of life and may vary in severity and frequency among individuals. chronic GERD can lead to more serious complications, including esophagitis, esophageal stricture, Barrett’s esophagus, and an increased risk of esophageal adenocarcinoma.
The first step in GERD diagnosis is a careful clinical history taking, other investigations include UGI endoscopy, esophageal manometry, and esophageal PH monitoring and barium radiography.
The initial treatment approach for GERD focuses on lifestyle modifications and pharmacological therapy. Lifestyle changes may include dietary adjustments, weight loss, and avoiding factors that trigger symptoms. Pharmacological treatment primarily involves proton pump inhibitors (PPIs), which are effective in reducing gastric acid production and healing esophagitis.
Surgical interventions for GERD have evolved significantly over the years, offering effective long-term solutions for patients who do not respond to medical therapy or lifestyle modifications. Among the various surgical options, fundoplication procedures, particularly the Nissen and Toupet fundoplication, stand out as the cornerstone treatment.
This study aimed to evaluate the surgical results of a partial 270 degree wrap (Toupet) versus a total 360 degree wrap (Nissen) in patients with gastroesophageal reflux disease (GERD) in accordance with symptom alleviation, and postoperative complications like dysphagia and gas bloat disorder.
This study is a retrospective cohort study. It was conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. The study period Between January 2023 and November 2023.
In this retrospective cohort study comparing Toupet versus Nissen fundoplication in GERD patients, baseline characteristics including age, BMI, and gender distribution were similar between groups (p > 0.05). Prevalence of hypertension and diabetes mellitus did not significantly differ between the two groups (p > 0.05). These findings suggest comparable baseline characteristics and comorbidity distributions among GERD patients undergoing either Toupet or Nissen fundoplication procedures.
The study was conducted on patients with no significant differences in UGI endoscopy grades (p = 0.442), reflux severity during GG meal testing (p = 0.540), or LES pressure (p = 0.204) preoperatively.
The study found a significant difference in operative time (p = 0.011) but not in hospitalization duration (p = 0.854), indicating shorter operative time for Nissen Fundoplication. No significant differences were observed in dysphagia (p = 0.080), heartburn (p = 0.388), regurgitation (p = 0.247), or gas bloat (p = 0.723), though trends suggested potential variations, requiring larger samples for confirmation.