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gastroesophageal reflux disease:From pathophysiology to treatment

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World Journal of gastroenterology 2010年第30期16卷 3745-3749页

作者： Fernando A Herbella marco g patti Department of Surgery University of Chicago Pritzker School of MedicineChicagoIL 60637United States

This review focuses on the pathophysiology of gastroesophageal reflux disease (gERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of gERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for gERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with gERD.

关键词： gastroesophageal reflux disease Pathophysiology Acid reflux Non-acid reflux Esophageal manometry Ambulatory pH Barrett’s esophagus Esophageal adenocarcinoma

gastroesophageal reflux disease:From heartburn to cancer

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World Journal of gastroenterology 2010年第30期16卷 3743-3744页

作者： marco g patti Irving Waxman Department of Surgery University of ChicagoPritzker School of MedicineChicagoIL 60637United States Center for Endoscopic Research and Therapeutics (CERT) University of Chicago Pritzker School of MedicineChicagoIL 60637United States

About 10%-15% of patients with gastroesophageal reflux disease develop Barrett’s esophagus. This is considered a premalignant condition because it can progress from metaplasia to high-grade dysplasia, and eventually to adenocarcinoma. Recently, major advances have been made in the endoscopic treatment of Barrett’s esophagus, therefore limiting the role of surgery in the treatment of this disease.

关键词： gastroesophageal reflux disease Barrett’s esophagus Esophageal adenocarcinoma Laparoscopic fundoplication Radiofrequency ablation Esophageal endoscopic mucosal resection Minimally invasive esophagectomy

gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

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World Journal of gastroenterology 2017年第13期23卷 2269-2275页

作者： Fabrizio Rebecchi marco E Allaix marco g patti Francisco Schlottmann Mario Morino Department of Surgical Sciences University of Torino Center for Esophageal Diseases and Swallowing University of North Carolina

Laparoscopic sleeve gastrectomy(LSg) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSg on gastroesophageal reflux disease(gERD). The interpretation of the current evidence is challenged by the fact that the LSg technique is not standardized, and most studies investigate the presence of gERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative gERD, and occurrence of de novo gERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative gERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSg to laparoscopic Rouxen-Y gastric bypass are the available options for the management of gERD after LSg. Recently, new minimally invasive approaches have been proposed in patients with gERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and gERD control have led to a wider acceptance of LSg as bariatric procedure also in obese patients with gERD, as recently stated in the 5^(th) International Consensus Con

关键词： Sleeve gastrectomy gastroesophageal reflux Morbid obesity Ambulatory p H monitoring Esophageal manometry

Impact of minimally invasive surgery on the treatment of benign esophageal disorders

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World Journal of gastroenterology 2012年第46期18卷 6764-6770页

作者： Brian Bello Fernando A Herbella marco E Allaix marco g patti Department of Surgery University of Chicago Pritzker School of Medicine

Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these tec

关键词： gastroesophageal reflux disease Esophageal achalasia Hiatal hernia Laparoscopic fundoplication Laparoscopic Heller myotomy

Multidisciplinary approach for patients with esophageal cancer

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World Journal of gastroenterology 2012年第46期18卷 6737-6746页

作者： Victoria M Villaflor marco E Allaix Bruce Minsky Fernando A Herbella marco g patti Department of Medicine Section Hematology/Oncology University of Chicago Medicine Department of Surgery University of Chicago Medicine Radiation Oncology University of Chicago Medicine

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage Ⅲ or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.

关键词： Esophageal Cancer Multimodality therapy Multidisciplinary therapy Chemoradiotherapy Esophageal resection Esophagectomy

Can high resolution manometry parameters for achalasia be obtained by conventional manometry?

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World Journal of gastrointestinal Pathophysiology 2015年第3期6卷 58-61页

作者： Fernando AM Herbella marco g patti Hospital Sao Paulo Surgical GastroenterologyDivision of Esophagus and StomachFederal University of Sao Paulo Department of Surgery Pritzker School of MedicineUniversity of Chicago

High resolution manometry(HRM) is a new technology that made important contributions to the field of gastrointestinal physiology. HRM showed clear advan-tages over conventional manometry and it allowed the creation of different manometric parameters. On the other side, conventional manometry is still wild available. It must be better studied if the new technology made possible the creation and study of these parameters or if they were always there but the colorful intuitive panoramic view of the peristalsis from the pharynx to the stomach HRM allowed the human eyes to distinguish subtle parameters unknown or uncomprehend so far and if HRM parameters can be reliably obtained by conventional manometry and data from conventional manometry still can be accepted in achalasia studies. Conventional manometry relied solely on the residual pressure to evaluate lower esophageal sphincter(LES) relaxation while HRM can obtain the Integrated Relaxation Pressure. Esophageal body HRM parameters defines achalasia subtypes, the Chicago classification, based on esophageal pressurization after swallows. The characterization of each subtype is very intuitive by HRM but also easy by conventional manometry since only wave amplitudes need to be measured. In conclusion, conventional manometry is still valuable to classify achalasia according to the Chicago classification. HRM permits a better study of the LES.

关键词： Achalasia Esophagus High resolution manometry Conventional manometry Lower esoph- ageal sphincter Esophageal body Chicago classification

面向城镇住宅建筑光伏一体化的gIS开放数据协同仿真平台

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Engineering 2023年第7期26卷 198-213,I0008页

作者： marco Massano Enrico Macii Andrea Lanzini Edoardo patti Lorenzo Bottaccioli Interuniversity Department of Regional and Urban Studies and Planning Politecnico di TorinoTorino 10129Italy Department of Energy“galileo Ferraris” Politecnico di TorinoTorino 10129Italy Department of Control and Computer Engineering Politecnico di TorinoTorino 10129Italy

The rising awareness of environmental issues and the increase of renewable energy sources(RESs)has led to a shift in energy production toward RES,such as photovoltaic(PV)systems,and toward a distributed generation(Dg)model of energy production that requires systems in which energy is generated,stored,and consumed *** this work,we present a methodology that integrates geographic information system(gIS)-based PV potential assessment procedures with models for the estimation of both energy generation and consumption *** particular,we have created an innovative infrastructure that co-simulates PV integration on building rooftops together with an analysis of households’electricity *** model relies on high spatiotemporal resolution and considers both shadowing effects and real-sky conditions for solar radiation *** integrates methodologies to estimate energy demand with a high temporal resolution,accounting for realistic populations with realistic consumption *** a solution enables concrete recommendations to be drawn in order to promote an understanding of urban energy systems and the integration of RES in the context of future smart *** proposed methodology is tested and validated within the municipality of Turin,*** the whole municipality,we estimate both the electricity absorbed from the residential sector(simulating a realistic population)and the electrical energy that could be produced by installing PV systems on buildings’rooftops(considering two different scenarios,with the former using only the rooftops of residential buildings and the latter using all available rooftops).The capabilities of the platform are explored through an in-depth analysis of the obtained *** power and energy profiles are presented,emphasizing the flexibility of the resolution of the spatial and temporal *** energy indicators are presented for the self-consumption of produced energy and the avoidance of CO_(

关键词： Energy informatics geographic information system Load estimation Open data Photovoltaic Residential Urban planning Co-simulation