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Stretta procedure

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Stretta is a minimally invasive endoscopic procedure for the treatment of gastroesophageal reflux disease (GERD) that delivers radiofrequency energy in the form of electromagnetic waves through electrodes at the end of a catheter to the lower esophageal sphincter (LES) and the gastric cardia – the region of the stomach just below the LES. The energy heats the tissue, ultimately causing it to swell and stiffen; the way this works was not understood as of 2015, but it was thought that perhaps the heat causes local inflammation, collagen deposition and muscular thickening of the LES and that it may disrupt the nerves there.

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36-520: Its relative efficacy is controversial, with the American College of Gastroenterology recommending against its use in 2013, and in the same year the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) giving it a strong recommendation for people who refuse laparoscopic Nissen fundoplication , which involves making incisions in the torso and wrapping part of the stomach around

72-505: A biopsy from the stomach. The small and large intestines may be affected by infectious , autoimmune, and physiological states. Inflammation of the intestines is called enterocolitis , which may lead to diarrhea . Acute conditions affecting the bowels include infectious diarrhea and mesenteric ischaemia . Causes of constipation may include faecal impaction and bowel obstruction , which may in turn be caused by ileus , intussusception , volvulus . Inflammatory bowel disease

108-439: A medical history alone. Gastric diseases refer to diseases affecting the stomach . Inflammation of the stomach by infection from any cause is called gastritis , and when including other parts of the gastrointestinal tract called gastroenteritis . When gastritis persists in a chronic state, it is associated with several diseases, including atrophic gastritis , pyloric stenosis , and gastric cancer . Another common condition

144-539: A cause of liver failure , a state where the liver is unable to compensate for chronic damage, and unable to meet the metabolic demands of the body. In the acute setting , this may be a cause of hepatic encephalopathy and hepatorenal syndrome . Other causes of chronic liver disease are genetic or autoimmune disease, such as hemochromatosis , Wilson's disease , autoimmune hepatitis , and primary biliary cirrhosis . Acute liver disease rarely results in pain, but may result in jaundice . Infectious liver disease may cause

180-481: A feeling of incomplete emptying , or pencil-thin stools. In addition to regular tests, medical tests used to investigate the anus and rectum include the digital rectal exam and proctoscopy . Hepatic diseases refers to those affecting the liver . Hepatitis refers to inflammation of liver tissue, and may be acute or chronic . Infectious viral hepatitis , such as hepatitis A , B and C , affect in excess of (X) million people worldwide. Liver disease may also be

216-427: A fever. Chronic liver disease may result in a buildup of fluid in the abdomen , yellowing of the skin or eyes , easy bruising, immunosuppression , and feminization. Portal hypertension is often present, and this may lead to the development of prominent veins in many parts of the body, such as oesophageal varices , and haemorrhoids . In order to investigate liver disease, a medical history, including regarding

252-509: A fever. Tests that specifically examine the function of the large intestine include barium swallows, abdominal x-rays , and colonoscopy . Diseases affecting the rectum and anus are extremely common, especially in older adults. Hemorrhoids , vascular outpouchings of skin, are very common, as is pruritus ani , referring to anal itchiness. Other conditions, such as anal cancer may be associated with ulcerative colitis or with sexually transmitted infections such as HIV . Inflammation of

288-409: A malignancy. Segmental or diffuse gastrointestinal wall thickening is most often due to ischemic, inflammatory or infectious disease. Though less common, medications such as ACE inhibitors can cause angioedema and small bowel thickening. The small intestine consists of the duodenum , jejunum and ileum . Inflammation of the small intestine is called enteritis , which if localised to just part

324-581: A person's family history , travel to risk-prone areas, alcohol use and food consumption, may be taken. A medical examination may be conducted to investigate for symptoms of liver disease. Blood tests may be used, particularly liver function tests , and other blood tests may be used to investigate the presence of the Hepatitis viruses in the blood, and ultrasound used. If ascites is present, abdominal fluid may be tested for protein levels. Pancreatic diseases that affect digestion refers to disorders affecting

360-407: A potential treatment based on the 2012 review. In 2015 three reviews were published discussing the relative safety and effectiveness of the procedure compared with other endoscopic procedures delivered through the mouth, drug treatment (generally proton-pump inhibitors ), and fundoplication. One was a systematic review and meta-analysis of clinical trials conducted with Stretta, done in response to

396-490: A result of lifestyle factors, such as fatty liver and NASH . Alcoholic liver disease may also develop as a result of chronic alcohol use, which may also cause alcoholic hepatitis . Cirrhosis may develop as a result of chronic hepatic fibrosis in a chronically inflamed liver, such as one affected by alcohol or viral hepatitis. Liver abscesses are often acute conditions, with common causes being pyogenic and amoebic . Chronic liver disease, such as cirrhosis, may be

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432-517: Is gastric ulceration , peptic ulcers . Ulceration erodes the gastric mucosa , which protects the tissue of the stomach from the stomach acids. Peptic ulcers are most commonly caused by a bacterial Helicobacter pylori infection . Epstein–Barr virus infection is another factor to induce gastric cancer. As well as peptic ulcers, vomiting blood may result from abnormal arteries or veins that have ruptured, including Dieulafoy's lesion and Gastric antral vascular ectasia . Congenital disorders of

468-447: Is a condition of unknown aetiology, classified as either Crohn's disease or ulcerative colitis , that can affect the intestines and other parts of the gastrointestinal tract. Other causes of illness include intestinal pseudoobstruction , and necrotizing enterocolitis . Diseases of the intestine may cause vomiting , diarrhoea or constipation , and altered stool , such as with blood in stool . Colonoscopy may be used to examine

504-462: Is called duodenitis , jejunitis and ileitis , respectively. Peptic ulcers are also common in the duodenum. Chronic diseases of malabsorption may affect the small intestine, including the autoimmune coeliac disease , infective tropical sprue , and congenital or surgical short bowel syndrome . Other rarer diseases affecting the small intestine include Curling's ulcer , blind loop syndrome , Milroy disease and Whipple's disease . Tumours of

540-464: Is no evidence that Stretta results in improved outcomes as compared to surgical intervention. A more recent study published in 2020 evaluated 25 patients post Stretta Procedure and the results concluded significant improvement in reflux symptoms and quality of life, lowering Heartburn Score (DeMeester score) from 3.7 in women and 4.0 in men to 1.6±1 (p = 0.05) in women and 1.68±1.19 (p = 0.05) in men. A 2012 systematic review and meta-analysis upon which

576-491: Is strongly linked to alcohol use. Other rarer diseases affecting the pancreas may include pancreatic pseudocysts , exocrine pancreatic insufficiency , and pancreatic fistulas . Pancreatic disease may present with or without symptoms. When symptoms occur, such as in acute pancreatitis , a person may experience acute-onset, severe mid-abdominal pain, nausea and vomiting. In severe cases, pancreatitis may lead to rapid blood loss and systemic inflammatory response syndrome . When

612-440: The biliary duct is called cholangitis , which may be associated with autoimmune disease, such as primary sclerosing cholangitis , or a result of bacterial infection, such as ascending cholangitis . Disease of the biliary tree may cause pain in the upper right abdomen, particularly when pressed . Disease might be investigated using ultrasound or ERCP , and might be treated with drugs such as antibiotics or UDCA , or by

648-416: The biliary tree ), which secretes bile in order to aid digestion of fats. Diseases of the gallbladder and bile ducts are commonly diet-related, and may include the formation of gallstones that impact in the gallbladder ( cholecystolithiasis ) or in the common bile duct ( choledocholithiasis ). Gallstones are a common cause of inflammation of the gallbladder, called cholecystitis . Inflammation of

684-501: The exocrine pancreas , which is a part of the pancreas involved in digestion. One of the most common conditions of the exocrine pancreas is acute pancreatitis , which in the majority of cases relates to gallstones that have impacted in the pancreatic part of the biliary tree , or due to acute or chronic hazardous alcohol use or as a side-effect of ERCP . Other forms of pancreatitis include chronic and hereditary forms. Chronic pancreatitis may predispose to pancreatic cancer and

720-573: The gastrointestinal tract , namely the esophagus , stomach , small intestine , large intestine and rectum ; and the accessory organs of digestion , the liver , gallbladder , and pancreas . The oral cavity is part of the gastrointestinal system and as such the presence of alterations in this district can be the first sign of both systemic and gastrointestinal diseases. By far the most common oral conditions are plaque -induced diseases (e.g., gingivitis , periodontitis , dental caries ). Oral symptoms can be similar to lesions occurring elsewhere in

756-426: The large intestine may affect it in whole or in part. Appendicitis is one such disease, caused by inflammation of the appendix . Generalised inflammation of the large intestine is referred to as colitis , which when caused by the bacteria Clostridioides difficile is referred to as pseudomembranous colitis . Diverticulitis is a common cause of abdominal pain resulting from outpouchings that particularly affect

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792-414: The nutcracker oesophagus , achalasia , diffuse oesophageal spasm , and oesophageal stricture . Oesophageal disease may result in a sore throat , throwing up blood , difficulty swallowing or vomiting . Chronic or congenital diseases might be investigated using barium swallows , endoscopy and biopsy , whereas acute diseases such as reflux may be investigated and diagnosed based on symptoms and

828-688: The oesophagus . The most common condition of the oesophagus in Western countries is gastroesophageal reflux disease , which in chronic forms is thought to result in changes to the epithelium of the oesophagus, known as Barrett's oesophagus . Acute disease might include infections such as oesophagitis , trauma caused by the ingestion of corrosive substances, or rupture of veins such as oesophageal varices , Boerhaave syndrome or Mallory-Weiss tears . Chronic diseases might include congenital diseases such as Zenker's diverticulum and esophageal webbing , and oesophageal motility disorders including

864-490: The 2013 SAGES review (which did not include meta-analysis). This review found that quality of studies that had been conducted was generally poor, and that compared with sham therapy (used a placebo for medical device clinical trials), the procedure did not change time spent at a pH less than 4, did not increase lower esophageal sphincter pressure (LESP), did not allow people to stop treatment with proton-pump inhibitors, and did not improve health-related quality of life. Another of

900-618: The 2013 SAGES review had relied, had found that it improves GERD symptoms. American College of Gastroenterology The American College of Gastroenterology ( ACG ) is a Bethesda , Maryland –based medical association of gastroenterologists . The association was founded in 1932 and holds annual meetings and regional postgraduate continuing education courses, establishes research grants , and publishes The American Journal of Gastroenterology , Clinical and Translational Gastroenterology and The ACG Case Reports Journal . More than 18,000 physicians from 86 countries are members of

936-585: The 2015 reviews was a narrative literature review , noted its long history of use, and found the procedure safe and effective, and noted that the procedure complemented drug treatment and fundoplication, providing a useful option. The other 2015 review was a narrative literature review was more tentative, noting the long safety record but only willing to state that the procedure "may be effective in reducing symptom burden and quality of life scores up to 8 years post-intervention. However, there does not appear to be any sustained improvement in objective outcomes and there

972-530: The ACG. The ACG provides its members with scientific information on digestive health and the etiology , symptomatology and treatment of GI disorders . The current president (2023–24) is Jonathan A. Leighton, MD, FACG. This article about a United States health organization is a stub . You can help Misplaced Pages by expanding it . Gastrointestinal disease Gastrointestinal diseases (abbrev. GI diseases or GI illnesses ) refer to diseases involving

1008-446: The base of the esophagus, and which is considered the gold standard for efficacy. In 2015 an American Society for Gastrointestinal Endoscopy guideline noted that the quality of evidence was low for Stretta and the other available endoscopic treatment for GERD ( transoral incisionless fundoplication ) and called for better research to be conducted; it suggested that endoscopic treatments for GERD be considered. The device for carrying out

1044-439: The colon. Functional colonic diseases refer to disorders without a known cause, including irritable bowel syndrome and intestinal pseudoobstruction . Constipation may result from lifestyle factors, impaction of a rigid stool in the rectum, or in neonates , Hirschprung's disease . Diseases affecting the large intestine may cause blood to be passed with stool, may cause constipation , or may result in abdominal pain or

1080-479: The digestive tract, with a pattern of swelling, inflammation, ulcers, and fissures. If these signs are present, then patients are more likely to also have anal and esophageal lesions and experience other extra-intestinal disease manifestations. Some diseases which involve other parts of the GI tract can manifest in the mouth, alone or in combination, including: Oesophageal diseases include a spectrum of disorders affecting

1116-476: The large intestine, and a person's stool may be sent for culture and microscopy . Infectious disease may be treated with targeted antibiotics , and inflammatory bowel disease with immunosuppression . Surgery may also be used to treat some causes of bowel obstruction. The normal thickness of the small intestinal wall is 3–5 mm, and 1–5 mm in the large intestine. Focal, irregular and asymmetrical gastrointestinal wall thickening on CT scan suggests

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1152-405: The pancreas is unable to secrete digestive enzymes , such as with a pancreatic cancer occluding the pancreatic duct , result in jaundice. Pancreatic disease might be investigated using abdominal x-rays , MRCP or ERCP , CT scans , and through blood tests such as measurement of the amylase and lipase enzymes. Diseases of the hepatobiliary system affect the biliary tract (also known as

1188-452: The procedure was originally developed by a company called Curon which obtained FDA approval for the device in 2000 but then went bankrupt in 2006; the device was brought back to market by Mederi Therapeutics in 2010. The procedure costs between $ 3,000 and $ 4,000 as of 2004. An American Society of Gastrointestinal Endoscopy (ASGE) statement in June 2015 state that endoscopic antireflux therapy is

1224-548: The rectum is known as proctitis , one cause of which is radiation damage associated with radiotherapy to other sites such as the prostate . Faecal incontinence can result from mechanical and neurological problems, and when associated with a lack of voluntary voiding ability is described as encopresis . Pain on passing stool may result from anal abscesses , small inflamed nodules, anal fissures , and anal fistulas . Rectal and anal disease may be asymptomatic, or may present with pain when passing stools, fresh blood in stool ,

1260-518: The small intestine include gastrointestinal stromal tumours , lipomas , hamartomas and carcinoid syndromes . Diseases of the small intestine may present with symptoms such as diarrhoea , malnutrition , fatigue and weight loss . Investigations pursued may include blood tests to monitor nutrition, such as iron levels , folate and calcium , endoscopy and biopsy of the duodenum, and barium swallow . Treatments may include renutrition and antibiotics for infections. Diseases that affect

1296-467: The stomach include pernicious anaemia , in which a targeted immune response against parietal cells results in an inability to absorb vitamin B12 . Other common symptoms that stomach disease might cause include indigestion or dyspepsia , vomiting , and in chronic disease, digestive problems leading to forms of malnutrition . In addition to routine tests, an endoscopy might be used to examine or take

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