Enfermedad por reflujo gastroesofágico, diagnóstico clínico y fisiopatología
Gastroesophageal reflux disease, clinical diagnosis and pathophysiology
Palabras clave:
Enfermedad por reflujo gastroesofágico, unión gastroesofágica, esfínter esofágico inferior, mucosa esofágica, percepción sintomática
Resumen
La enfermedad por reflujo gastroesofágico (ERGE) es una enfermedad crónica y altamente prevalente en Venezuela. La fisiopatología es multifactorial. Los eventos involucrados se inician en el estómago, y en forma ascendente, afectan la unión gastroesofágica y el esófago. Las alteraciones en el aclaramiento esofágico junto con el tipo de material refluido probablemente sean los mayores determinantes para el desarrollo de una enfermedad de tipo erosiva, mientras que la sensibilidad de la mucosa lo sea para la percepción sintomática. La comprensión de los nuevos conceptos en la fisiopatología es de fundamental importancia para el uso racional de los métodos diagnósticos y la implementación de la terapéutica apropiada en cada situación clínica.
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Dent J, Brun J, Fendrick A, et al. An evidence-based appraisal of reflux disease management--the Genval Workshop Report. Gut. 1999;44 Suppl 2(Suppl 2):S1-S16. doi:10.1136/gut.44.2008.s1
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920
González JC, Louis C, y col. Primer consenso venezolano de enfermedad por reflujo gastroesofágico. Archivos Venezolanos de Farmacología y Terapéutica. AVFT 2011;30(1):1-28.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease [published correction appears in Am J Gastroenterol. 2013 Oct;108(10):1672]. Am J Gastroenterol. 2013;108(3):308-329. doi:10.1038/ajg.2012.444
Huerta-Iga F, Bielsa-Fernández, Remes-Troche JM, Valdovinos-Díaz MA, Tamayo-de la Cuesta JL. Diagnóstico y tratamiento de la enfermedad por reflujo gastroesofágico: recomendaciones de la Asociación Mexicana de Gastroenterologia. Rev Gastroenterol Mex 2016; 81(4):208-222. Doi:10.1016/j.rgmx.2016.04.003
Olmos JA, Pandolfino JE, Piskorz MM, Zamora N, Valdovinos-Díaz MA, Remes-Troche JM, y col. Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico Acta Gastroenterol Latinoam 2022;52(2):175-240
Olmos JA, Piskorz MM, Vela MF. Revisión sobre enfermedad por reflujo gastroesofágico (ERGE) Acta Gastroenterol Latinoam 2016; 46:160-172
Moayyedi P, Talley NJ, Fennerty MB. Can the clinical history distinguish between organic and functional dyspepsia? JAMA 2006; 295: 1566-1576
Numans ME, Lau J, de Wit NJ. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a metaanalysis of diagnostic test characteristics. Ann Intern Med 2004; 140: 518-527.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol., 108 (2013), pp. 308-312 http://dx.doi.org/10.1038/ajg.2012.444 | Medline M.E.
DeVault KP, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol, 100 (2005), pp. 190-200 http://dx.doi.org/10.1111/j.1572-0241.2005.41217. Medline M.E
Bolier EA, Kessing BF, Smout AJ, et al. Systematic review: Questionnaires for assessment of gastroesophageal reflux disease. Dis Esoph, 28 (2015), pp. 105-120
Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastroesophageal reflux disease. Digestion, 75 (2007), pp. 48-54 http://dx.doi.org/10.1159/000101082 | Medline
Carlsson R, Dent J, Bolling-Sternevald E, et al. The usefulness of a structured questionnaire in the assesment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol, 33 (1998), pp. 1023-1029 Medline
Gómez-Escudero O, Remes-Troche JM, Ruíz J, et al. Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD). Rev Gastroenterol Mex., 69 (2004), pp. 16-23
Argüero J, Sifrim D. Actualización en la fisiopatología de la enfermedad por reflujo gastroesofágico. Acta Gastroenterol Latinoam 2022; 52(2):135-152
Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 2001; 121:775-783.
McColl KEL, Clarke A, Seenan J. Acid pocket, hiatus hernia and acid reflux. Gut 2010; 59:430-431.
Emerenziani S, Zhang X, Blondeau K, et al. Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux. Am J Gastroenterol 2005; 100:1251-1256
Sifrim D, Holloway R, Silny J, et al. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology 2001; 120:1588-1598
Pandolfino JE, Zhang Q, Ghosh SK, Post J, Kwiatek M, Kahrilas PJ. Acidity Surrounding the Squamocolumnar Junction in GERD Patients: “Acid Pocket” Versus “Acid Film” [Internet]. The American Journal of Gastroenterology. 2007; 102:2633-41. http://dx.doi.org/10.1111/j.1572-0241.2007.01488.x
Clarke AT, Wirz AA, Manning JJ, Ballantyne SA, Alcorn DJ, McColl KEL. Severe reflux disease is associated with an enlarged unbuffered proximal gastric acid pocket. Gut 2008; 57:2927 http://dx.doi.org/10.1136/gut.2006.109421
Farré R. Pathophysiology of gastro-esophageal reflux disease: a role for mucosa integrity? Neurogastroenterol Motil 2013; 25: 783-799
Gotley DC, Morgan AP, Cooper MJ. Bile acid concentrations in the refluxate of patients with reflux oesophagitis. Br J Surg 1988; 75: 587-590.
Mittal R, Vaezi MF. Esophageal Motility Disorders and Gastroesophageal Reflux Disease [Internet]. New England Journal of Medicine. 2020; 383:1961-72. Disponible en: http://dx.doi. org/10.1056/nejmra2000328
Schoeman MN, Tippett MD, Akkermans LM, Dent J, Holloway RH. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology. 1995; 108(1):83-91.
Penagini R, Schoeman MN, Dent J, Tippett MD, Holloway RH. Motor events underlying gastrooesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil. 1996; 8(2):131-41.
Mittal R, Vaezi MF. Esophageal Motility Disorders and Gastroesophageal Reflux Disease. New England Journal of Medicine 2020; 383:1961-1972.
Jiang Y, Bhargava V, Mittal RK. Mechanism of stretch-activated excitatory and inhibitory responses in the lower esophageal sphincter. Am J Physiol Gastrointest Liver Physiol 2009; 297: G397-405.
Mittal RK. Current concepts of the antireflux barrier. Gastroenterol Clin North Am 1990; 19:501-516. 29.
Hill LD, Kozarek RA. The gastroesophageal flap valve. Journal of clinical gastroenterology 1999;28:194-197.
Sifrim D, Tack J, Lerut T, et al. Transient lower esophageal sphincter relaxations and esophageal body muscular contractile response in reflux esophagitis. Dig Dis Sci 2000; 45: 1293-1300
DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, et al. Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg. 1980; 79(5):656-70.
Smith JL, Lacey Smith J, Opekun AR, Larkai E, Graham DY. Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease [Internet]. Gastroenterology. 1989; 96:683-9. Disponible en: http://dx.doi.org/10.1016/0016-5085(89)90890-1
Weusten BL, Akkermans LM, vanBerge-Henegouwen GP, Smout AJ. Symptom perception in gastroesophageal reflux disease is dependent on spatiotemporal reflux characteristics. Gastroenterology. 1995; 108(6):1739-44.
Zerbib F, Duriez A, Roman S, Capdepont M, Mion F. Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut. 2008; 57(2):156-60.
Tipnis NA, Rhee P-L, Mittal RK. Distension during gastroesophageal reflux: effects of acid inhibition and correlation with symptoms. Am J Physiol Gastrointest Liver Physiol. 2007; 293(2):G469-74.
Ribolsi M, Balestrieri P, Emerenziani S, Guarino MPL, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014; 109(1):46-51.
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis [Internet]. Gastroenterology. 1986; 91:897-904. Disponible en: http://dx.doi.org/10.1016/0016-5085 (86)90692-x
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920
González JC, Louis C, y col. Primer consenso venezolano de enfermedad por reflujo gastroesofágico. Archivos Venezolanos de Farmacología y Terapéutica. AVFT 2011;30(1):1-28.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease [published correction appears in Am J Gastroenterol. 2013 Oct;108(10):1672]. Am J Gastroenterol. 2013;108(3):308-329. doi:10.1038/ajg.2012.444
Huerta-Iga F, Bielsa-Fernández, Remes-Troche JM, Valdovinos-Díaz MA, Tamayo-de la Cuesta JL. Diagnóstico y tratamiento de la enfermedad por reflujo gastroesofágico: recomendaciones de la Asociación Mexicana de Gastroenterologia. Rev Gastroenterol Mex 2016; 81(4):208-222. Doi:10.1016/j.rgmx.2016.04.003
Olmos JA, Pandolfino JE, Piskorz MM, Zamora N, Valdovinos-Díaz MA, Remes-Troche JM, y col. Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico Acta Gastroenterol Latinoam 2022;52(2):175-240
Olmos JA, Piskorz MM, Vela MF. Revisión sobre enfermedad por reflujo gastroesofágico (ERGE) Acta Gastroenterol Latinoam 2016; 46:160-172
Moayyedi P, Talley NJ, Fennerty MB. Can the clinical history distinguish between organic and functional dyspepsia? JAMA 2006; 295: 1566-1576
Numans ME, Lau J, de Wit NJ. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a metaanalysis of diagnostic test characteristics. Ann Intern Med 2004; 140: 518-527.
Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol., 108 (2013), pp. 308-312 http://dx.doi.org/10.1038/ajg.2012.444 | Medline M.E.
DeVault KP, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol, 100 (2005), pp. 190-200 http://dx.doi.org/10.1111/j.1572-0241.2005.41217. Medline M.E
Bolier EA, Kessing BF, Smout AJ, et al. Systematic review: Questionnaires for assessment of gastroesophageal reflux disease. Dis Esoph, 28 (2015), pp. 105-120
Bardhan KD, Stanghellini V, Armstrong D, et al. International validation of ReQuest in patients with endoscopy-negative gastroesophageal reflux disease. Digestion, 75 (2007), pp. 48-54 http://dx.doi.org/10.1159/000101082 | Medline
Carlsson R, Dent J, Bolling-Sternevald E, et al. The usefulness of a structured questionnaire in the assesment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol, 33 (1998), pp. 1023-1029 Medline
Gómez-Escudero O, Remes-Troche JM, Ruíz J, et al. Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD). Rev Gastroenterol Mex., 69 (2004), pp. 16-23
Argüero J, Sifrim D. Actualización en la fisiopatología de la enfermedad por reflujo gastroesofágico. Acta Gastroenterol Latinoam 2022; 52(2):135-152
Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 2001; 121:775-783.
McColl KEL, Clarke A, Seenan J. Acid pocket, hiatus hernia and acid reflux. Gut 2010; 59:430-431.
Emerenziani S, Zhang X, Blondeau K, et al. Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux. Am J Gastroenterol 2005; 100:1251-1256
Sifrim D, Holloway R, Silny J, et al. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology 2001; 120:1588-1598
Pandolfino JE, Zhang Q, Ghosh SK, Post J, Kwiatek M, Kahrilas PJ. Acidity Surrounding the Squamocolumnar Junction in GERD Patients: “Acid Pocket” Versus “Acid Film” [Internet]. The American Journal of Gastroenterology. 2007; 102:2633-41. http://dx.doi.org/10.1111/j.1572-0241.2007.01488.x
Clarke AT, Wirz AA, Manning JJ, Ballantyne SA, Alcorn DJ, McColl KEL. Severe reflux disease is associated with an enlarged unbuffered proximal gastric acid pocket. Gut 2008; 57:2927 http://dx.doi.org/10.1136/gut.2006.109421
Farré R. Pathophysiology of gastro-esophageal reflux disease: a role for mucosa integrity? Neurogastroenterol Motil 2013; 25: 783-799
Gotley DC, Morgan AP, Cooper MJ. Bile acid concentrations in the refluxate of patients with reflux oesophagitis. Br J Surg 1988; 75: 587-590.
Mittal R, Vaezi MF. Esophageal Motility Disorders and Gastroesophageal Reflux Disease [Internet]. New England Journal of Medicine. 2020; 383:1961-72. Disponible en: http://dx.doi. org/10.1056/nejmra2000328
Schoeman MN, Tippett MD, Akkermans LM, Dent J, Holloway RH. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology. 1995; 108(1):83-91.
Penagini R, Schoeman MN, Dent J, Tippett MD, Holloway RH. Motor events underlying gastrooesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil. 1996; 8(2):131-41.
Mittal R, Vaezi MF. Esophageal Motility Disorders and Gastroesophageal Reflux Disease. New England Journal of Medicine 2020; 383:1961-1972.
Jiang Y, Bhargava V, Mittal RK. Mechanism of stretch-activated excitatory and inhibitory responses in the lower esophageal sphincter. Am J Physiol Gastrointest Liver Physiol 2009; 297: G397-405.
Mittal RK. Current concepts of the antireflux barrier. Gastroenterol Clin North Am 1990; 19:501-516. 29.
Hill LD, Kozarek RA. The gastroesophageal flap valve. Journal of clinical gastroenterology 1999;28:194-197.
Sifrim D, Tack J, Lerut T, et al. Transient lower esophageal sphincter relaxations and esophageal body muscular contractile response in reflux esophagitis. Dig Dis Sci 2000; 45: 1293-1300
DeMeester TR, Wang CI, Wernly JA, Pellegrini CA, Little AG, Klementschitsch P, et al. Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg. 1980; 79(5):656-70.
Smith JL, Lacey Smith J, Opekun AR, Larkai E, Graham DY. Sensitivity of the esophageal mucosa to pH in gastroesophageal reflux disease [Internet]. Gastroenterology. 1989; 96:683-9. Disponible en: http://dx.doi.org/10.1016/0016-5085(89)90890-1
Weusten BL, Akkermans LM, vanBerge-Henegouwen GP, Smout AJ. Symptom perception in gastroesophageal reflux disease is dependent on spatiotemporal reflux characteristics. Gastroenterology. 1995; 108(6):1739-44.
Zerbib F, Duriez A, Roman S, Capdepont M, Mion F. Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut. 2008; 57(2):156-60.
Tipnis NA, Rhee P-L, Mittal RK. Distension during gastroesophageal reflux: effects of acid inhibition and correlation with symptoms. Am J Physiol Gastrointest Liver Physiol. 2007; 293(2):G469-74.
Ribolsi M, Balestrieri P, Emerenziani S, Guarino MPL, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014; 109(1):46-51.
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis [Internet]. Gastroenterology. 1986; 91:897-904. Disponible en: http://dx.doi.org/10.1016/0016-5085 (86)90692-x
Publicado
2023-03-09
Cómo citar
Louis-Pérez, C. (2023). Enfermedad por reflujo gastroesofágico, diagnóstico clínico y fisiopatología: Gastroesophageal reflux disease, clinical diagnosis and pathophysiology. Revista Profesional HígadoSano, (25), 3-10. https://doi.org/10.5281/zenodo.7714103
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