When did gastro-esophageal reflux become a disease? A historical perspective on GER(D) nomenclature.

BACKGROUND: Within the span of a few decades, gastro-esophageal reflux (GER) evolved from a rare entity to the most commonly diagnosed upper gastro-intestinal disease, i.e. gastro-esophageal reflux disease (GERD). The boundaries of GERD remain matter of controversy and appear to be ever expanding in both children and adults. Our aim is to answer the questions: when did GER become a disease? And when did it become specifically a pediatric disease? METHODS: We performed a comprehensive historical review of the original medical literature using Medline and Google, along with a compilation of original and secondary texts in English, French and German. RESULTS: Our finding is that those actively involved in treating the reflux, first surgeons in the 1960s and then gastroenterologists in the 1970s, initiated naming it a disease. In pediatrics, the possible correlation between reflux events and sudden infant death syndrome accelerated the management of reflux associated with respiratory symptoms with surgery in the 1970s. Surgeons were also the first specialists to formulate the term pediatric GERD in 1982. CONCLUSION: Understanding the genesis of GERD may shed light upon its expansion as a disease category and its persistent controversial nature in pediatrics.

Mucosal impedance for esophageal disease: evaluating the evidence.

Impedance has traditionally been employed in esophageal disease as a means to assess bolus flow and reflux episodes. Recent and ongoing research has provided new and novel applications for this technology. Measurement of esophageal mucosal impedance, via either multichannel intraluminal impedance catheters or specially designed endoscopically deployed impedance catheters, provides a marker of mucosal integrity. Mucosal impedance has been shown to segregate gastroesophageal reflux disease (GERD) and eosinophilic esophagitis from non-GERD controls and may play a role in predicting response to reflux intervention. More data are needed with regard to other esophageal subgroups, outcome studies, and functional disease. Our paper reviews the history of impedance in esophageal disease, the means of assessing baseline and mucosal impedance, data with regard to the newly developed mucosal impedance probes, the clinical utility of mucosal impedance in specific clinical conditions, and limitations in our existing knowledge, along with suggestions for future studies.

The University of Chicago contribution to the treatment of gastroesophageal reflux disease and its complications: a tribute to David B. Skinner 1935-2003.

OBJECTIVE: To highlight the contributions from the University of Chicago under the leadership of Dr David B. Skinner to the understanding of gastroesophageal reflux disease (GERD) and its complications. BACKGROUND: The invention of the esophagoscope confirmed that GERD was a premorbid condition. The medical world was divided between those who believed in a morphological lower esophageal sphincter (LES) and those who did not. Those who did not believe attempted to rearrange the anatomy of the foregut organs to stop reflux with minimal success. The discovery of the LES focused attention on the sphincter as the main deterrent to reflux and the hope that measurement of a low LES pressure would mark the presence of GERD. This turned out not to be so. In July 1973, with this history of confusion, Dr Skinner at the age of 36 assumed the chair of surgery at the University of Chicago. METHODS: The publications of the University of Chicago's esophageal group were collected from private and public (PubMed) databases, reviewed, and seminal contributions selected. RESULTS: Twenty-four-hour esophageal pH monitoring led to the understanding of the LES, its contribution to GERD, and the complication of Barrett's esophagus. The relationship of Barrett's to adenocarcinoma was clarified. The rising incidence of esophageal adenocarcinoma led to contributions in the staging of esophageal cancer and its treatment with an en bloc resection. CONCLUSIONS: Ten years after the death of Dr Skinner, we can appreciate the monumental contributions to benign and malignant esophageal disease under his leadership.

Review article: historic changes of Helicobacter pylori-associated diseases.

BACKGROUND: The long-term time trends of multiple gastrointestinal diseases are characterised by a striking rise and fall. These temporal changes provide important clues about disease aetiology. AIM: To highlight the importance of Helicobacter pylori infection in shaping the temporal trends of many common gastrointestinal diseases. METHODS: Literature review of the time trends associated with common digestive diseases. RESULTS: The general trends of gastric ulcer, duodenal ulcer, gastric cancer, colon cancer, rectum cancer have all been shaped by a similar underlying birth-cohort phenomenon. Mortality associated with these diagnoses increased in all generations born during the nineteenth century. It peaked among generations born shortly before the turn of the century and then decreased in all subsequent generations born throughout the twentieth century. These patterns can be observed in the incidence, hospitalisation and mortality data from many different countries. They reflect similar rising and falling trends of H. pylori infection in the general population. Diseases that are inversely associated with H. pylori, such as reflux disease, erosive oesophagitis, Barrett's oesophagus, and oesophageal adenocarcinoma, have seen a striking rise during the recent decline of H. pylori infection. CONCLUSION: The temporal variations of H. pylori infection have affected the occurrence of gastroenterology's most common disorders.

Gastroesophageal reflux disease in Asia: A historical perspective and present challenges.

Gastroesophageal reflux disease (GERD), previously uncommon in Asia, has now become an important disease in the region. Although much variability exists between studies, most endoscopy-based studies show a prevalence of erosive esophagitis of more than 10%. Symptom-based studies also show a prevalence of 6-10%. Two longitudinal follow-up studies on GERD symptoms have shown an increase with time, and several endoscopy-based time trend studies have also shown a significant increase in erosive reflux esophagitis. Studies on Barrett's esophagus have been confounded by the description of short (SSBE) and long segment (LSBE) Barrett's esophagus. Great variation in prevalence rates has been reported. SSBE vary from 0.1% to more than 20% while LSBE vary from 1-2%. Of the putative causative factors, obesity has been the most important. Many studies have linked GERD-esophagitis as well as occurrence of reflux symptoms with an increase in body mass index (BMI), obesity, especially visceral or central obesity, and metabolic syndrome. A decline in Helicobacter pylori infection with growing affluence in Asia has been broadly thought to result in healthier stomachs and a higher gastric acid output resulting in reflux disease. However, variable results have been obtained from association and H. pylori eradication studies.

Rudolf Nissen (1896-1981)-perspective.

INTRODUCTION: Rudolf Nissen was one of the outstanding general surgeons of the last century. Between the years 1921 and 1933, he was the pupil and protégé of the famous surgeon Ferdinand Sauerbruch. He was nominated professor of surgery in 1930. Forced by the Nazi-Regime to resign his position, Nissen emigrated in 1933 first to Turkey and then in 1939 to the USA. Here, he held positions in hospitals at New York. Having been appointed to the Chair of Surgery at the University of Basle, Switzerland, he returned to Europe in 1952. Nissen was a critical prolific writer and excellent researcher, surgeon, and teacher. CONCLUSION: The first successful pneumectomy and lung lobectomy in man, as well as the description of surgical pathophysiology and treatment of gastroesophageal reflux disease, including hiatus hernia, are considered to be his most important pioneer work.

Laparoscopic upper gut surgery.

Australian surgeons have been prominent in the introduction, development, and consolidation of laparoscopic surgery of the upper gut. In doing this, some of the very best principles of surgical innovation have been in evidence: preliminary animal work in which to test hypotheses and techniques, followed by careful application and documentation in the clinical setting, randomized clinical trials and finally academic reporting and ongoing development. This review documents the introduction of laparoscopic surgery for gastroesophageal reflux, hiatus hernia, achalasia, gastroesophageal malignancy, obesity, and a range of emergency conditions in Australia. Those involved are regarded as world leaders in their field. A vital component of this success has been the close cooperation between surgeons and gastroenterologists within the Gastroenterological Society of Australia.

Overview of 50 years' progress in upper gastrointestinal diseases.

There have been numerous and dramatic advances in our understanding of the mechanisms, causes and treatments of upper gastrointestinal diseases in the past 50 years. This review focuses on a few, not dealt with elsewhere in this special issue of the Journal. The early history of the recognition that nonsteroidal anti-inflammatory drugs are a major cause of peptic ulcer is described, with particular attention to the work of the pioneering Australian investigators. The story of the development of the histamine H(2)-receptor antagonists and the proton pump inhibitors is also outlined.

Landmarks in the understanding and treatment of reflux disease.

The last 50 years have seen a transformation in the understanding and treatment of reflux disease. The development and wide use of flexible endoscopy and progressively more sophisticated approaches to measurement of pathophysiological factors have been major drivers of advances. The recognition and progressive elucidation of the mechanical events that comprise the transient lower esophageal sphincter relaxation and how they lead to reflux provide a novel and firm foundation for tailoring therapies that act directly to reduce occurrence of reflux episodes, either surgically or pharmacologically. Novel GABA(B) agonist drugs have been shown to inhibit transient relaxations and are currently being evaluated in clinical trials on patients with reflux disease. Better understanding has extended to recognition of the extraordinarily high prevalence of reflux disease and of the ability of proton pump inhibitor drugs to deliver major benefits to a high proportion of patients with reflux disease. The life of the Gastroenterological Society of Australia has spanned the period of these major advances. A large number of the members of the Society and their associates have contributed substantially to these advances.

Rudolf Nissen (1896-1981): his contributions to surgery and his role in Turkey.

Eminent surgeon Rudolf Nissen performed innovative studies in surgery during his time in Turkey, to which he fled from Germany before the Second World War. This paper discusses Nissen's invaluable contribution not only to Istanbul University's surgical department but also to the universal field of surgery.

The Medicine and GERD of Immanuel Kant (1724-1804).

We can place Kant as one of the pillars of contemporary medicine. Firstly, as an Illuminist, his work subordinates the collection of empirical data, which in medical science is constitutional to reason. This was the basis of a rational medical science. Secondly, he is the father of medical regulation, having set the philosophical control ground stone for physicians by the State. His work "Critique of Practical Reason" drafts all the future codes of ethics and bioethics. We will hereby study his relationship with medicine based on the text "The Conflict with the Faculty of Medicine" and other auxiliary texts.We can find in Kant's works the description of a series of symptoms that were related to a nonspecific dyspeptic syndrome that nowadays would be diagnosed as a strong indication that he suffered from gastroesophageal reflux disease (GERD).