A prospective study functional endoscopic sinus surgery pdf performed in a tertiary referral center. Fifty-eight patients affected by chronic rhinosinusitis with nasal polyposis underwent endoscopic sinus surgery from January 2011 to April 2013 and followed for 1 year. A strongly statistically significant reduction was seen between the mean scores on RSDI before and after FESS . In multiple regression model, only four preoperative characteristics predicted the outcomes.
The high mucosal eosinophilia density was the most important preoperative predictor. There is evidence which supports the efficacy of FESS to improve long-term QOL outcomes in patients with CRS. The mucosal eosinophilia density and prior sinus surgery appeared to be the most predictive factors of surgical outcomes. Check if you have access through your login credentials or your institution.
Treatment is typically via lifestyle changes, medications, and sometimes surgery. Lifestyle changes include not lying down for three hours after eating, losing weight, avoiding certain foods, and stopping smoking. Surgery may be an option in those who do not improve with other measures. The classic symptoms had been described earlier in 1925. GERD sometimes causes injury of the esophagus. Symptoms may vary from typical adult symptoms.
One theory for this is the “fourth trimester theory” which notes most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests there may have once been a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems. Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true when a family history of GERD is present. GERD is caused by a failure of the lower esophageal sphincter. GERD due to mechanical and motility factors.
Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach. GERD patients are any different than non-infected GERD patients. 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity. This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing.
The diagnosis of GERD is usually made when typical symptoms are present. Reflux can be present in people without symptoms and the diagnosis requires both symptoms or complications and reflux of stomach content. PPIs and is not needed in those in whom Barrett’s esophagus is seen. The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis.
24-hr pH monitoring results among patients with symptoms suggestive of GERD. Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett’s esophagus. GERD, is more consistent with GERD than EE. Reflux changes may not be erosive in nature, leading to “nonerosive reflux disease”.
The treatments for GERD include lifestyle modifications, medications, and possibly surgery. Certain foods and lifestyle are considered to promote gastroesophageal reflux, but most dietary interventions have little supporting evidence. Avoidance of specific foods and of eating before lying down should be recommended only to those in which they are associated with the symptoms. Foods that have been implicated include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. A wedge pillow that elevates the head may inhibit gastroesophageal reflux during sleep. Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them.
If a once daily PPI is only partially effective they may be used twice a day. They should be taken one half to one hour before a meal. There is no significant difference between agents in this class. When these medications are used long term, the lowest effective dose should be taken. They may also be taken only when symptoms occur in those with frequent problems. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. It is recommended only for those who do not improve with PPIs.