TY - CHAP M1 - Book, Section TI - Esophagus and Diaphragmatic Hernia A1 - Jobe, Blair A. A1 - Hunter, John G. A1 - Watson, David I. A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Kao, Lillian S. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. Y1 - 2019 N1 - T2 - Schwartz's Principles of Surgery, 11e AB - Key Points Benign esophageal disease is common and is best evaluated with thorough physiologic testing (high resolution esophageal motility, 24-hour ambulatory pH measurement, and/or esophageal impedance testing) and anatomic testing (esophagoscopy, video esophagography, and/or computed tomography [CT] scanning). Gastroesophageal reflux disease (GERD) is the most common disease of the gastrointestinal tract for which patients seek medical therapy. When GERD symptoms (heartburn, regurgitation, chest pain, and/or supraesophageal symptoms) are troublesome despite adequately dosed PPI, surgical correction may be indicated. Barrett’s esophagus is the transformation of the distal esophageal epithelium from squamous to a specialized columnar epithelium capable of further neoplastic progression. The detection of Barrett’s esophagus on endoscopy and biopsy increases the future risk of cancer by >40x compared to individuals without Barrett’s esophagus. Giant hiatal hernia, otherwise known as paraesophageal hernia, should be repaired when symptomatic or associated with iron deficiency anemia. Laparoscopic hiatal hernia repair with fundoplication is the most common approach to repair. Achalasia is the most common primary esophageal motor disorder. It is characterized by an absence of peristalsis and a hypertensive nonrelaxing lower esophageal sphincter. It is best treated with laparoscopic Heller myotomy and partial fundoplication. Most esophageal cancer presents with dysphagia, at which time it has invaded the muscularis of the esophagus and is often associated with lymph node metastases. The preferred treatment at this stage is multimodality therapy with chemoradiation therapy followed by open or minimally invasive esophagectomy. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1164316382 ER -