Gerd

Dr. Parakrama Chandrasoma was born in Sri Lanka and received his medical education and initial pathology training in the Medical School of the University of Sri Lanka. He has postgraduate degrees in internal medicine, including the M.D. (Sri Lanka) and Membership of the Royal College of Physicians (UK). He immigrated to the United States in 1978. Upon completing his pathology residency, he assumed duties as Chief of Surgical Pathology at the Los Angeles County + University of Southern California Medical Center He has held this position since. After an initial interest in neuropathology, Dr. Chandrasoma joined Dr. Tom DeMeester's Foregut Surgery team as pathologist in 1991. This led to a productive study of gastroesophageal reflux disease spanning 16 years and resulting in the development of numerous original concepts relating to the pathogenesis of gastroesophageal reflux disease. Dr. Chandrasoma has written over 140 peer reviewed papers and 6 previous pathology textbooks, including a general text on Gastrointestinal Pathology and a text on Gastroesophageal Reflux Disease, and is a Professor of Pathology at the Keck School of Medicine at the University of Southern California. He is married with three children and lives in Pasadena, California.

GERD: A New Understanding of Pathology, Pathophysiology, and Treatment transforms the assessment of gastroesophageal reflux disease (GERD) from its present state, which is largely dependent on clinical definition and management, to a more objective scientific basis that depends on pathologic assessment. Sequential chapters in this single-author book describe the fetal development of the esophagus, the normal adult state, and the way exposure to gastric juice causes epithelial and lower esophageal sphincter damage at a cellular level. It allows recognition of the pathologic manifestations of lower esophageal sphincter damage and develops new histopathologic criteria for quantitating such damage. This understanding provides new pathologic criteria for definition and diagnosis of GERD from its earliest cellular stage. Algorithms based on measurement of sphincter damage can identify, even before the onset of clinical GERD, persons who will never develop GERD during life, those who develop GERD but remain with mild and easily controlled disease, and those who will progress to severe GERD with failure to control symptoms, Barrett esophagus and adenocarcinoma. Aggressive early intervention in the last group with the objective of preventing disease progression to its end points of uncontrolled symptoms and adenocarcinoma becomes feasible.

1. Definition of Gastroesophageal Reflux Disease: Past, Present and Future2. Present Diagnosis and Management of Gastroesophageal Reflux Disease: The Good, Bad and Ugly3. Fetal and Postnatal Development of the Esophagus and Proximal Stomach4. Histologic Definition and Diagnosis of Epithelia in the Esophagus and Proximal Stomach5. Definition of the Normal State - A Yet Unfinished Saga6. Definition of the Gastroesophageal Junction7. The Normal Lower Esophageal Sphincter8. The Pathogenesis of Early GERD9. Correlation of LES Damage and GERD10. The Effect of Damage to the Abdominal Segment of the LES: The Dilated Distal Esophagus11. Columnar-Lined Esophagus (Microscopic and Visible) and Barrett Esophagus12. Esophageal Adenocarcinoma13. Progression of GERD at the Clinical Level 14. Progression of GERD at a Pathological Level 15. Molecular Evolution of Esophageal Epithelial Metaplasia 16. Progression of GERD From the Perspective of LES Damage17. New Pathologic Test of LES Damage18. New Method of Functional Assessment of the LES19. Prediction of Future Progression of LES Damage20. Proof of Concept of the New Diagnostic Method21. Application of the New Method to Present and Future Management of GERD