cover

Contents

Contributors

Preface

Foreword

PART 1: Pathobiology of the Esophagus and Stomach

1: Anatomy, Embryology, and Congenital Malformations of the Esophagus and Stomach,
Lori A. Orlando and Roy C. Orlando

Anatomy

Embryology

Congenital Malformations of the Esophagus and Stomach

References

2: Esophageal and Gastric Motor Function,
Kenneth R. DeVault, Ernest P. Bouras, and Nicholas J. Talley

Esophageal Motor Function

Gastric Motor Function

References

3: Gastric Acid Secretion and Hormones,
Geoffrey Spencer and David C. Metz

Introduction

Functional Anatomy

Gastric Acid Secretion

Mediators of Gastric Acid Secretion

Regulation of Acid Secretion in Health and Disease

References

PART 2: Esophago gastroduodenoscopy

4: Preparation and Sedation,
Benjamin E. Levitzky and John J. Vargo, II

Introduction

Guidelines for Training

Preprocedural Assessment

Analgesia and Sedation

Standard Agents for Sedation and Analgesia

Reversal Agents

Documentation

Postprocedural Monitoring

References

5: Endoscopic Anatomy and Postsurgical Anatomy,
Mark E. Stark

Normal Endoscopic Anatomy of the Esophagus and Stomach

Endoscopic Appearance of Surgical Anastomoses

Surgery for Motility Disorders and Diverticuli

Endoscopic Appearance after Antireflux Surgery

Endoscopic Appearance after Gastric Surgery for Cancer or Ulcers

Endoscopic Appearance after Bariatric Surgery

References

6: Technique of Esophagogastroduodenoscopy,
David Greenwald and Jonathan Cohen

Introduction

Indications for Esophagogastroduodenoscopy

Patient Preparation and Informed Consent

Procedure for Esophagogastroduodenoscopy

Troubleshooting Common Problems in Esophagogastroduodenoscopy

References

7: Complications of Esophagogastroduodenoscopy,
Herbert C. Wolfsen

Introduction

Reports of Complications

Specific Aspects and Complications of EGD

References

8: Advanced Esophagogastroduodenoscopy Techniques,
Heiko Pohl, Stuart Gordon, and Richard I. Rothstein

Definition

Diagnostic Techniques

Enteroscopy

Endoscopic Antireflux Therapies

Endoscopic Treatment for Obesity

Final Thoughts

References

9: Esophageal Dilation Technique,
David A. Johnson

Introduction

Categories of Esophageal Dilators

Technique of Dilation

Dilation Procedure

Adjuncts to Dilation

References

10: Endoscopic Mucosal Resection,
Hendrik Manner and Oliver Pech

Preinterventional Staging

Overview of Methods and Technology

Indications for Endoscopic Mucosal Resection

References

11: Ablation of Upper Gastrointestinal Neoplasia,
Virender K. Sharma

Introduction

Endoscopic Management of Early -stage Esophageal Cancer

References

12: Benefits and Delivery of Enteral Nutrition,
Stephen A. McClave

Introduction

Conclusion

References

13: Foreign Bodies in the Esophagus and Stomach,
Gregory G. Ginsberg

Introduction

Epidemiology

Pathophysiology

Endoscopy

Treatment

Food Bolus Impaction

Sharp and Pointed Objects

Long Objects

Narcotic Packets

Complications

References

14: Endoluminal Surgery (NOTES),
C. Daniel Smith

Definitions

NOTES History

NOTES Principles

NOTES Development

Future of NOTES

References

PART 3: Other Diagnostic Modalities

15: Radiologic Approach to Diagnosis in the Upper Gastrointestinal Tract,
Stephen W. Trenkner and James E. Huprich

Esophagus

Stomach

References

16: Esophageal Motility Testing,
Jason R. Roberts and Donald O. Castell

Introduction

Equipment

Acquisition

Measurements and Normal Values

Bolus Transit Assessment

Provocative Testing

References

17: Ambulatory Refl ux Monitoring,
Philip O. Katz and Ellen Stein

Technical Aspects of Reflux Monitoring

Clinical Use of Reflux Monitoring

Specific Clinical Scenarios: How to Evaluate?

Combined pH and Impedance Monitoring

References

18: Gastric Motility Testing,
Jan Tack

Introduction

Gastric Motility Testing

References

19: Capsule Endoscopy for Esophageal Disease,
Roberto de Franchis

Equipment and Review of Technology

Clinical Applications of Esophageal Capsule Endoscopy

Conclusions

References

20: Unsedated Endoscopy,
Deepak Agrawal and Amitabh Chak

Introduction

Equipment

Technique

Clinical Considerations

References

PART 4: Problem-based Approach to Diagnosis and Differential Diagnosis

21: General Approach to History Taking and Physical Exam of the Upper Gastrointestinal Tract,
Evan S. Dellon and Eugene M. Bozymski

Setting the Stage

Heartburn

Dysphagia

Nausea/Vomiting

Abdominal Pain

Diarrhea

Finishing the Visit

References

22: Heartburn and Regurgitation,
Joel E. Richter

Symptom Complex

Heartburn Symptoms as Predictors of GERD

Mechanisms of Heartburn

References

23: Chest Pain,
Ronnie Fass and Guy D. Eslick

Introduction

Cardiac or Noncardiac Chest Pain?

Differentiating Esophageal from Nonesophageal Causes of NCCP

Evidence-based Facts about Chest Pain

Esophageal Mechanisms for NCCP

Motility Disorders

Esophageal Hypersensitivity

Psychological Evaluation

Treatment

References

24: Dysphagia,
Dawn L. Francis

Introduction

Pathophysiology

Clinical Features

Diagnosis

Therapeutics

Prognosis

References

25: Rumination,
H. Jae Kim

Definition and Epidemiology

Clinical Features, Pathophysiology, and Diagnosis

Treatment

References

26: Halitosis,
Ganesh R. Veerappan and James H. Lewis

Definition and Epidemiology

Etiology and Pathophysiology

Diagnosis

Therapeutics

References

27: Hiccups,
Ganesh R. Veerappan and James H. Lewis

Definition and Epidemiology

Pathophysiology/Clinical Features

Evaluation

Therapeutics

Conclusions

References

28: Dyspepsia and Indigestion,
Neelendu Dey and Kenneth McQuaid

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Treatment

References

29: Nausea and Vomiting,
John K. DiBaise

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Differential Diagnosis

Therapeutics

References

30: Hematemesis,
Thomas O.G. Kovacs and Dennis M. Jensen

Introduction

Initial Approach to the Patient

History

Physical Examination

Laboratory Studies

Nasogastric Aspiration

Triage

Medical Therapy

Acknowledgments

References

PART 5: Diseases of the Esophagus

31: Gastroesophageal Refl ux Disease,
Kenneth R. DeVault

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Therapeutics

References

32: Extraesophageal Gastroesophageal Refl ux Disease,
Christen Klochan and Michael F. Vaezi

Definition and Epidemiology

Epidemiology

Pathophysiology, Clinical Features, and Differential Diagnosis

Diagnostic Approach

pH Monitoring

Therapeutic Approach

References

33: Barrett Esophagus,
Yvonne Romero, Vikneswaran Namasivayam, and Kee Wook Jung

Barrett Esophagus

Risk Factors

Intestinal Metaplasia of the Cardia

References

34: Eosinophilic Esophagitis,
Jeffrey A. Alexander

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Differential Diagnosis

Therapeutics

Prognosis

References

35: Esophageal Motility Disorders,
Kenneth R. DeVault

Introduction

Spastic Motility Disorders

Disorders with Weak or Ineffective Peristalsis

References

36: Infections in the Immunocompetent and Immunocompromised Patient,
Colin Brown and C. Mel Wilcox

Introduction

Overview of the Immune System

Other Infections

References

37: Strictures, Rings, and Webs,
Peter D. Siersema

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Differential Diagnosis

Treatment

Stents

Management of Refractory Benign Esophageal Strictures

References

38: Medication-induced Esophageal Disease,
Peter Bytzer

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Differential Diagnosis

Therapeutics

Prognosis and Prevention

References

39: Radiation Injury,
Matthew D. Callister

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Therapeutics

References

40: Caustic Esophageal Injury,
David A. Katzka

Introduction

Definitions and Pathophysiology

Initial Diagnosis and Assessment

Airway and Esophageal Visualization

Management of Caustic Esophageal Injury

References

41: Surgery for Benign Esophageal Disease,
Roger P. Tatum and Carlos A. Pellegrini

Introduction

Surgery for GERD

Paraesophageal Hernia

Surgery for Esophageal Motility Disorders

Surgery for Epiphrenic Diverticulum

Pharyngoesophageal (Zenker) Diverticulum

Conclusion

References

42: Esophageal Cancer,
Michael S. Smith and Charles J. Lightdale

Epidemiology

Pathophysiology

Clinical Features

Diagnosis and Staging

Therapeutics Endoscopic Approaches

References

PART 6: Diseases of the Stomach

43: Peptic Ulcer Disease,
Vincent W.S. Wong and Francis K.L. Chan

Background and Epidemiology

Etiologies

Clinical Features

Diagnosis

Therapeutics H. pylori Ulcers

References

44: Helicobacter pylori,
Barry J. Marshall, Helen M. Windsor, and Kazufumi Kimura

Bacteriology

Epidemiology and Transmission

Pathogenesis and Disease Associations

Diagnosis

Treatment

Controversies in Management Who to Diagnose and Who to Treat

References

45: Gastritis,
Massimo Rugge and David Y Graham

Definitions

Assessment

Basic Morphology

Classification

Main Forms of Gastritis

References

46: Gastroparesis,
Henry P. Parkman

Introduction

Etiology of Gastroparesis

Clinical Presentation of Gastroparesis

Evaluation of Patients with Suspected Gastroparesis

Treatment of Gastroparesis

References

47: Non-variceal Upper Gastrointestinal Bleeding,
Thomas J. Savides

Introduction

Initial Assessment and Management of UGI Bleeding

Endoscopy in UGI Bleeding

Peptic Ulcer Bleeding

Variceal Bleeding

Esophagitis

Stress Ulcers

Dieulafoy Lesion

Mallory–Weiss Tear

Cameron Erosions

UGI Malignancy

Gastric Antral Vascular Ectasia

Portal Hypertensive Gastropathy

Hemobilia

Hemosuccus Pancreaticus

Postsphincterotomy Bleeding

Aortoenteric Fistula

Angiomas

References

48: Gastric Adenocarcinomas,
Kazuki Sumiyama and Hisao Tajiri

Definition and Epidemiology

Pathophysiology

Environmental Risk Factors

Clinical Features

Diagnosis

Differential Diagnosis

Staging

Screening

Therapeutics

Prognosis

References

49: Other Gastric Tumors (Benign and Malignant),
Yasser M. Bhat and Michael L. Kochman

Mucosal Tumors (Table 49.1)

Submucosal Tumors (Table 49.1)

References

50: Eosinophilic Gastroenteritis,
Joseph Y Chang and Nicholas J. Talley

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Therapeutics

References

51: Hernias and Volvulus,
Rebecca R. Cannom, Rodney J. Mason, and Tom R. DeMeester

Definition and Epidemiology

Pathophysiology

Clinical Features

Diagnosis

Differential Diagnosis

Therapeutics

Prognosis

References

52: Surgery for Peptic Ulcer Disease,
Henry Lin and Daniel B. Jones

Epidemiology

Pathophysiology

Clinical Features

Perforation

Bleeding

Refractory PUD

Complications of Surgery

References

53: Esophageal and Gastric Involvement in Systemic and Cutaneous Diseases,
John M. Wo

Connective Tissue Diseases

Endocrine and Metabolic Diseases

Inflammatory Diseases

Neuromuscular Diseases

Cutaneous Syndromes

References

PART 7: Functional Disease

54: Functional Esophageal Disorders,
Sami R. Achem and Kenneth R. DeVault

Introduction

Functional Heartburn

Functional Dysphagia

References

55: Functional Gastroduodenal Disorders,
Gerald Holtmann

Introduction

Epidemiology

Categorization of Functional Disorders of the Stomach and Gastroduodenal Region

Pathogenesis

Management

Diagnostic Approach and Treatment

References

Index

A companion website for this book is available at: practicalgastrohep.com

Companion website

This book has a companion website:

practicalgastrohep.com

with:

• Videos demonstrating procedures

• The videos are all referenced in the text where you see this symbol:

Contributors

Sami R. Achem, MD

Professor of Medicine

Gastroenterology Consultant

Division of Gastroenterology and Hepatology

Mayo Clinic

Jacksonville, FL, USA

Deepak Agrawal, MD

Director of Endoscopy

Parkland Hospital

Assistant Professor Digestive and Liver Diseases

University Texas Southwestern Medical Center

Dallas, TX, USA

Jeffrey A. Alexander, MD

Assistant Professor of Medicine

Department of Gastroenterology and Hepatology

Division of Internal Medicine

Mayo Clinic

Rochester, MN, USA

Yasser M. Bhat, MD

Director, Interventional Endoscopy

Assistant Clinical Professor of Medicine

Division of Digestive Diseases

David Geffen School of Medicine at UCLA

Los Angeles, CA, USA

Ernest P. Bouras, MD

Assistant Professor of Medicine

Division of Gastroenterology and Hepatology

Mayo Clinic

Jacksonville, FL, USA

Eugene M. Bozymski, MD

Professor of Medicine

Department of Medicine

University of North Carolina Medical Center

Chapel Hill, NC, USA

Adjunct Professor of Medicine

Department of Medicine

Division of Gastroenterology and Hepatology

Duke University Medical Center

Durham, NC, USA

Colin Brown, MD

Fellow in Gastroenterology and Hepatology

Division of Gastroenterology and Hepatology

University of Alabama, Birmingham

Birmingham, AL, USA

Peter Bytzer, MD, PhD

Professor of Medicine

Copenhagen University

Department of Medicine

Køge University Hospital

Køge, Denmark

Matthew D. Callister, MD

Assistant Professor of Oncology

Department of Radiation Oncology

Mayo Clinic

Scottsdale, AZ, USA

Rebecca R. Cannom, MD, MS

General Surgery Resident

Division of Thoracic Foregut Surgery

Department of Surgery, Keck School of Medicine

University of Southern California

Los Angeles, CA, USA

Donald O. Castell, MD

Professor of Medicine

Division of Gastroenterology and Hepatology

Medical University of South Carolina

Charleston, SC, USA

Amitabh Chak, MD

Professor of Medicine and Oncology

Division of Gastroenterology

Case Western Reserve University School of Medicine

Cleveland, OH, USA

Francis K.L. Chan, MD

Professor of Medicine

Chief of Gastroenterology & Hepatology

Assistant Dean (General Affairs)

Department of Medicine and Therapeutics

The Chinese University of Hong Kong

Shatin, NT, Hong Kong SAR, China

Joseph Y. Chang, MD, MPH

Instructor in Medicine

Division of Gastroenterology and Hepatology

Mayo Clinic

Rochester, MN, USA

Jonathan Cohen, MD

Clinical Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

New York University School of Medicine

New York, NY, USA

Roberto de Franchis, MD

Department of Medical Sciences

University of Milan

Head, Gastroenterology Unit

IRCCS Ca’ Granda Ospedale

Maggiore Policlinico Foundation

Milan, Italy

Evan S. Dellon, MD, MPH

Assistant Professor of Medicine

Division of Gastroenterology and Hepatology

Department of Medicine

University of North Carolina School of Medicine

Chapel Hill, NC, USA

Tom R. DeMeester, MD

Professor, General and Thoracic Surgery

Department of Surgery

Keck School of Medicine

University of Southern California

Los Angeles, CA, USA

Neelendu Dey, MD

Fellow in Gastroenterology

University of California

San Francisco San Francisco, CA, USA

John K. DiBaise, MD

Professor of Medicine

Divisions of Gastroenterology and Hepatology

Mayo Clinic

Scottsdale, AZ, USA

Guy D. Eslick, PhD, MMedSc (Clin Epi),
MMedStat

Associate Professor of Epidemiology

Discipline of Surgery

The University of Sydney

Nepean Hospital

Penrith, NSW, Australia

Ronnie Fass, MD

Professor of Medicine

Department of Medicine

Section of Gastroenterology

University of Arizona

Head, Neuroenteric Clinical Research Group;

Chief of Gastroenterology

Section of Gastroenterology

Southern Arizona VA Health Care System

Tucson, AZ, USA

Dawn L. Francis, MD, MHS

Assistant Professor of Medicine

Associate Chair

Division of Gastroenterology and Hepatology

Mayo Clinic

Rochester, MN, USA

Gregory G. Ginsberg, MD

Professor of Medicine

Department of Medicine

Division of Gastroenterology

University of Pennsylvania School of Medicine

Executive Director of Endoscopic Services

University of Pennsylvania Health Systems

Philadelphia, PA, USA

Stuart Gordon, MD

Associate Professor of Medicine

Department of Medicine

Dartmouth Medical School

Director of Endoscopy

Section of Gastroenterology and Hepatology

Dartmouth Hitchcock Medical Center

Lebanon, NH, USA

David Y. Graham, MD

Professor of Medicine, Molecular Virology and Microbiology

Michael E. DeBakey Veterans Affairs Medical Center and

Baylor College of Medicine Houston, TX, USA

David Greenwald, MD

Associate Professor of Clinical Medicine

Albert Einstein College of Medicine

Associate Director

Division of Gastroenterology

Montefiore Medical Center

New York, NY, USA

Gerald Holtmann, MD, PhD

Professor of Medicine

University Hospital Essen

Essen, Germany;

Faculty of Health Sciences

University of Adelaide

Adelaide, SA, Australia

James E. Huprich, MD

Division of Radiology

Mayo Clinic

Rochester, MN, USA

Dennis M. Jensen, MD

Professor of Medicine

Department of Medicine

David Geffen School of Medicine at UCLA

Los Angeles, CA, USA

David A. Johnson, MD

Professor of Medicine

Chief of Gastroenterology

Division of Gastroenterology

Eastern VA Medical School

Norfolk, VA, USA

Daniel B. Jones, MD, MS

Professor

Harvard Medical School

Chief, Section Minimally Invasive Surgery

Beth Israel Deaconess Medical Center

Boston, MA, USA

Kee Wook Jung, MD

Advanced Fellow, Diseases of the Esophagus

Division of Gastroenterology and Hepatology

Department of Medicine

Mayo Clinic

Rochester, MN, USA

Philip O. Katz, MD

Chairman, Division of Gastroenterology

Albert Einstein Medical Center

Clinical Professor of Medicine

Jefferson Medical College

Philadelphia, PA, USA

David A. Katzka

Professor of Medicine

Division of Gastroenterology and Hepatology

Mayo Clinic

Rochester, MN, USA

H. Jae Kim, MD, MSc

Assistant Professor of Medicine

Divisions of Gastroenterology and Hepatology

Mayo Clinic

Scottsdale, AZ, USA

Kazufumi Kimura, MD, PhD

Research Fellow

Microbiology and Immunology

School of Biomedical, Biomolecular and Chemical Sciences

University of Western Australia

Perth, WA, Australia

Christen Klochan, MD

Resident, Department of Internal Medicine

Vanderbilt University Medical Center

Nashville, TN, USA

Michael L. Kochman, MD

Wilmott Family Professor of Medicine

Professor of Medicine in Surgery

Division of Gastroenterology

University of Pennsylvania Health System

Philadelphia, PA, USA

Thomas O.G. Kovacs, MD

Professor of Medicine

CURE/Digestive Diseases Research Center

Department of Medicine

David Geffen School of Medicine at UCLA

Los Angeles, CA, USA

Benjamin E. Levitzky, MD

Digestive Disease Institute

Cleveland Clinic Foundation

Cleveland, OH, USA

James H. Lewis, MD

Professor of Medicine

Division of Gastroenterology

Georgetown University Medical Center

Washington, DC, USA

Charles J. Lightdale, MD

Professor of Clinical Medicine

Division of Digestive and Liver Diseases

Columbia University Medical Center

New York, NY, USA

Henry Lin, MD

Head of Bariatrics

National Naval Medical Center and Walter Reed

Army Medical Center

Bethesda, MD, USA

Hendrik Manner, MD

Internal Medicine Specialist

Department of Gastroenterology and Hepatology

Horst Schmidt Klinik (HSK)

Wiesbaden, Germany

Barry J. Marshall, MD

Clinical Professor

Microbiology and Immunology

School of Biomedical, Biomolecular and Chemical Sciences

University of Western Australia

Perth, WA, Australia

Rodney J. Mason, MD, PhD

Associate Professor of Surgery

Division of General and Laparoscopic Surgery

University of Southern California

Los Angeles Los Angeles, CA, USA

Stephen A. McClave, MD

Professor of Medicine

Division of Gastroenterology/Hepatology

University of Louisville School of Medicine

Louisville, KY, USA

Kenneth McQuaid, MD

Professor of Clinical Medicine

University of California San Francisco

Chief, GI Section

San Francisco VA Medical Center

San Francisco, CA, USA

David C. Metz, MD

Professor of Medicine

Division of Gastroenterology

University of Pennsylvania School of Medicine

Philadelphia, PA, USA

Vikneswaran Namasivayam, MB, BS

Advanced Fellow, Diseases of the Esophagus

Division of Gastroenterology and Hepatology

Department of Medicine

Mayo Clinic

Rochester, MN, USA

Lori A. Orlando, MD, MHS

Assistant Professor of Medicine

Division of General Internal Medicine

Duke University Medical Center

Durham, NC, USA

Roy C. Orlando, MD

Mary Kay and Eugene Bozymski and Linda and William

Heizer Distinguished Professor of Gastroenterology

Adjunct Professor of Cell and Molecular Physiology

Division of Gastroenterology and Hepatology

University of North Carolina School of Medicine

Chapel Hill, NC, USA

Henry P. Parkman, MD

Professor of Medicine

Director of GI Motility Laboratory

Temple University School of Medicine

Philadelphia, PA, USA

Oliver Pech, MD, PhD

Associate Professor

Gastroenterology Attending Physician

Department of Gastroenterology and Hepatology

Horst Schmidt Klinik (HSK)

Wiesbaden, Germany

Carlos A. Pellegrini, MD

The Henry N. Harkins Professor and Chair

Department of Surgery

University of Washington

Seattle, WA, USA

Heiko Pohl, MD

Assistant Professor of Medicine

Section of Gastroenterology

Dartmouth Medical School

VAMC White River Junction, VT;

Section of Gastroenterology and Hepatology

Dartmouth Hitchcock Medical Center

Lebanon, NH, USA

Joel E. Richter, MD

Professor of Medicine

The Richard L. Evans Chair

Department of Medicine

Temple University School of Medicine

Philadelphia, PA, USA

Jason R. Roberts, MD

Fellow

Division of Gastroenterology and Hepatology

Medical University of South Carolina

Charleston, SC, USA

Yvonne Romero, MD

Assistant Professor of Medicine

GI Epidemiology/Outcomes Unit

Division of Gastroenterology and Hepatology

Department of Medicine

Mayo Clinic

Rochester, MN, USA

Richard I. Rothstein, MD

Professor of Medicine and of Surgery

Dartmouth Medical School

Chief, Section of Gastroenterology and Hepatology

Dartmouth Hitchcock Medical Center

Lebanon, NH, USA

Massimo Rugge, MD

Professor of Pathology

Department of Diagnostic Medical Sciences and

Special Therapies

Pathology Unit

University of Padova

Padova, Italy

Thomas J. Savides, MD

Professor of Clinical Medicine

Division of Gastroenterology

University of California, San Diego

San Diego, CA, USA

Virender K. Sharma, MD

Director

Arizona Center for Digestive Health

Phoenix, AZ, USA

Peter D. Siersema, MD, PhD

Professor of Gastroenterology

Department of Gastroenterology and Hepatology

University Medical Center Utrecht

Utrecht, The Netherlands

C. Daniel Smith, MD

Professor and Chair

Department of Surgery

Mayo Clinic

Jacksonville, FL, USA

Michael S. Smith, MD, MBA

Assistant Professor of Medicine

Associate Director, Esophageal Program

Gastroenterology Section

Department of Medicine

Temple University School of Medicine

Philadelphia, PA, USA

Geoffrey Spencer, MD, MSCE

Instructor of Medicine

Division of Gastroenterology

Hospital of the University of Pennsylvania

Philadelphia, PA, USA

Mark E. Stark, MD

Consultant in Gastroenterology

Associate Professor of Medicine

Division of Gastroenterology and Hepatology

Mayo Clinic

Jacksonville, FL, USA

Ellen Stein, MD

Fellow in Gastroenterology

Division of Gastroenterology

Albert Einstein Medical Center

Philadelphia, PA, USA

Kazuki Sumiyama, MD, PhD

Clinical Associate, Consultant Endoscopist

Department of Endoscopy

The Jikei University School of Medicine

Minato-ku, Tokyo, Japan

Jan Tack, MD, PhD

Professor of Medicine

Department of Pathophysiology

Gastroenterology Section

University of Leuven

Leuven, Belgium

Hisao Tajiri, MD, PhD

Chairman and Professor

Division of Gastroenterology and Hepatology

Department of Internal Medicine

The Jikei University School of Medicine

Minato-ku, Tokyo, Japan

Roger P. Tatum, MD

Assistant Professor

Department of Surgery

University of Washington

Seattle, WA, USA

Stephen W. Trenkner, MD

Associate Professor

Division of Radiology

Mayo Clinic

Rochester, MN, USA

Michael F. Vaezi, MD, PhD, MSc(Epi)

Professor of Medicine

Director, Clinical Research and Center for Swallowing and

Esophageal Disorders

Clinical Director, Division of Gastroenterology, Hepatology

and Nutrition

Vanderbilt University Medical Center

Nashville, TN, USA

John J. Vargo, II, MD, MPH

Associate Professor of Medicine

Cleveland Clinic Lerner College of Medicine of Case Western

Reserve University

Head, Section of Therapeutic and Hepatobiliary Endoscopy

Digestive Disease Institute

Cleveland Clinic Foundation

Cleveland, OH, USA

Ganesh R. Veerappan, MD

Senior Fellow in Gastroenterology

Gastroenterology Service

Walter Reed Army Medical Center

Washington, DC, USA

C. Mel Wilcox, MD

Professor of Medicine

Division of Gastroenterology and Hepatology

University of Alabama at Birmingham

Birmingham, AL, USA

Helen M. Windsor, PhD

Research Fellow

Microbiology and Immunology

School of Biomedical, Biomolecular and Chemical Sciences

University of Western Australia

Perth, WA, Australia

John M. Wo, MD

Professor of Medicine

Director of Swallowing and Motility Center

Division of Gastroenterology/Hepatology

University of Louisville School of Medicine

Louisville, KY, USA

Herbert C. Wolfsen, MD

Professor of Medicine

Mayo Clinic

Rochester, MN, USA

Consultant, Division of Gastroenterology and Hepatology

Mayo Clinic

Jacksonville, FL, USA

Vincent W.S. Wong, MD, MRCP

Associate Professor

Department of Medicine and Therapeutics

The Chinese University of Hong Kong

Shatin, NT, Hong Kong SAR, China

Preface

Welcome to Practical Gastroenterology and Hepatology, a new comprehensive three volume resource for everyone training in gastroenterology and for those certifying (or re - certifying) in the subspecialty. We have aimed to create three modern, easy to read and digest stand - alone textbooks. The entire set covers the waterfront, from clinical evaluation to advanced endoscopy to common and rare diseases every gastroenterologist must know.

Volume one specifically deals with disorders of the upper GI tract including mainly the stomach and esophagus. Each chapter highlights, where appropriate, a clinical case which demonstrates a common clinical situation, its approach, and management. Simple easy to follow clinical algorithms are demonstrated throughout the relevant chapters. Endoscopy chapters provide excellent video examples, all available electronically.

Each chapter has been written by the best of the best in the field, and carefully peer reviewed and edited for accuracy and relevance. We have guided the writing of this textbook to help ensure experienced gastroenterolo-gists, fellows, residents, medical students, internists, primary care physicians, as well as surgeons all will find something of interest and relevance.

Each volume and every chapter has followed a standard template structure. All chapters focus on key knowledge, and the most important clinical facts are highlighted in an introductory abstract and as take home points at the end; irrelevant or unimportant information is omitted. The chapters are deliberately brief and readable; we want our readers to retain the material, and immediately be able to apply what they learn in practice. The chapters are illustrated in color, enhanced by a very pleasant layout. A Web based version has been created to complement the textbook including endoscopy images and movies.

In this volume, section one addresses the pathobiology of the esophagus and stomach, providing a scientific basis for disease. The emphasis here is, as in all volumes, on the practical and clinically relevant, as opposed to the esoteric. Section two deals with endoscopy issues including preparation, endoscopic anatomy and both routine and advanced (EMR, ablation of neoplasia, NOTES and other) procedures. Section three covers the other “ non -endoscopic ” approaches to the upper gastrointestinal tract including radiologic, motility, refl ux and capsule testing and physiologic testing. Section four approaches disorders from a problem or symptom based standpoint with a simple, clear guide to diagnosis and management strategies. Section five covers important diseases of the esophagus including GERD and its complications, motil-ity disorders, other mucosal diseases, esophageal cancer and others. Section six addresses diseases of the stomach including peptic ulcer disease, gastritis, gastroparesis, cancer, other mucosal diseases and surgical issues. Section eight covers functional gastrointestinal disorders of the upper gastrointestinal tract.

We have been thrilled to work with a terrific team in the creation of this work, and very much hope you will enjoy reading this volume as much as we have enjoyed developing it for you.

Nicholas J. Talley
David E. Fleischer
Kenneth R. DeVault

Foreword

Dr. Talley and colleagues are to be congratulated for providing a very informative and thorough review of diseases affecting the upper portion of the gastrointestinal tract, including the clinical presentations, diagnostic testing and management. In this first volume of their complete treatise, they have assembled experts from around the world to succinctly discuss individual aspects of upper gastrointestinal disorders. They have identired the right individuals to share their knowledge in each one of the individual chapters. What a delight it was for me to have my personal knowledge and awareness of the various conditions and their management expanded by reviewing this collection. I can easily promise that the reader will find their personal knowledge enhanced and gain a greater awareness to the clinical aspects of esopha-geal and gastric disorders. I applaud Dr. Talley and his associates for their conscientious effort and I thank them for providing this exceptional work to the GI community. I believe it will find a place in the active personal library of clinicians worldwide.

Donald O. Castell, MD, AGAF, MACG
Professor of Medicine
Director, Esophageal Disorders Program
Medical University of South Carolina

PART 1

Pathobiology of the Esophagus and Stomach