Medical Management

Patients with GERD who are referred for treatment of a suspected short esophagus have usually been treated for a prolonged period of time with medication. Proton pump inhibitors and H2 receptor blockers are the recognized medications proven to offer relief of symptoms and healing of the esophagitis. However, in patients in whom an absent LES has been documented, medication alone does not offer definitive control of the abnormal refluxate and cannot reconstitute a normal esophagogastric junction. For these reasons, symptoms usually reappear when the medication is discontinued.34

Lifestyle changes are essential. Weight reduction by reducing alimentary intake while increasing caloric expenditure by exercise is often met with poor compliance. Smoking cessation and alcohol intake reduction are important as well. When a stricture is present and symptomatic, dilation can be offered while medical therapy is undertaken. Simple bougien-age or pneumatic dilation relieves dysphagia in 20-30% of patients after the first dilation session. Slowly progressive dilation sessions usually provide safe reopening of the eso-phageal lumen. In order not to impose additional healing damage to the esophageal wall, a limit of 10-French size increase per session is considered appropriate. Esophageal perforation from these manipulations is seen in <0.5% of patients.35,36

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