Peptic Esophagitis, Peptic Stricture, and Short Esophagus

Peptic Esophagitis

• Peptic esophagitis occurs in 40% of patients with GERD
• Impaired esophageal acid clearance may play a pivotal role
• It may be associated with hiatal hernia
• Peptic esophagitis precedes stricture and short esophagus
• Proton pump inhibitor therapy resolves 90%
• Continuous medical therapy required unless surgically treated

Peptic Stricture

• It occurs in 8% to 23% of patients with untreated esophagitis
• Peptic stricture is short (~1 cm)concentric, and immediately proximal to the squamocolumnar junction
• Associated with short esophagus
• Proton pump inhibitor therapy, dilation, and surgery are complimentary

Short Esophagus

• The diagnosis can only be confirmed intraoperatively: the intra-abdominal esophagus is less than 2.5-cm long.
• Associated with large hiatal hernia
• True, reducible short esophagus (requiring mobilization): up to 20% of surgically treated GERD patients
• True, non-reducible short esophagus (requiring gastroplasty): < 5% of surgically treated GERD patients
• Large (Giant) hiatal hernia repair with gastroplasty and fundoplication has a recurrence requiring reoperation in less than 10% in select, experienced centers.