Vol. 13. Núm. 7.
Páginas 374-383 (Abril 2020)

Actualización
Enfermedad por reflujo gastroesofágico

Gastro-oesophageal reflux disease

A. JardíJ. López Díaz
Doi : https://10.1016/j.med.2020.05.002
Opciones
Resumen

La enfermedad por reflujo gastroesofágico (ERGE) representa una complicación de un reflujo patológico mantenido, existiendo un disbalance entre factores protectores y factores agresivos, a favor de estos últimos. Se postula que el principal mecanismo responsable son las relajaciones transitorias del esfínter esofágico inferior (EEI), aunque la presencia de una hernia de hiato o un EEI hipopresivo podrían contribuir al mismo. Las principales manifestaciones clínicas son la pirosis y la regurgitación, aunque se pueden presentar otras muchas como la disfagia, la odinofagia e incluso manifestaciones extraesofágicas. El diagnóstico de la ERGE puede ser establecido por una mejoría clínica tras dos meses de tratamiento médico, siendo en ocasiones necesaria la endoscopia digestiva alta u otras pruebas complementarias para descartar otras entidades. El tratamiento médico tiene como pilar el uso de inhibidores de la bomba de protones (IBP), aunque en ocasiones es necesaria la cirugía.

Palabras clave
Enfermedad por reflujo gastroesofágico
Inhibidor de la bomba de protones
Pirosis
Hernia de hiato
pH-metría
Impedanciometría
Abstract

Gastro-oesophageal reflux disease (GERD) is a complication of maintained pathological reflux, in which there is an imbalance between protective and aggressive factors, favouring the latter. It has been postulated that the primary mechanism responsible is the transient relaxation of the lower oesophageal sphincter (LOS), although the presence of a hiatal hernia or a hypopressive LOS might contribute to the disease. The main clinical manifestations are pyrosis and regurgitation, although numerous other symptoms can present, such as dysphagia, odynophagia and even extraoesophageal manifestations. The diagnosis of GERD can be established by clinical improvement after 2 months of medical treatment; occasionally, upper endoscopy and other complementary tests are needed to rule out other entities. The mainstay of medical treatment is proton pump inhibitors, although surgery is sometimes required.

Keywords
Gastroesophageal reflux disease
Proton pump inhibitor
Pyrosis
Hiatal hernia
pH-metry
Impedance audiometry

Identifíquese

¿Aún no es suscriptor de la revista?

Comprar el acceso al artículo

Comprando el artículo el pdf del mismo podrá ser descargado

Teléfono para incidencias

De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h

Llamadas desde España 932 415 960
Llamadas desde fuera de España +34 932 415 960
Bibliografía
[1]
202005200821479558
J. Alcedo González.
Enfermedad por reflujo gastroesofágico.
Gastroenterología y Hepatología, 1ª ed, CTO Editorial, S.L, pp. 147-161
[2]
202005200821479559
J.E. Richter, J.H. Rubenstein.
Presentation and epidemiology of gastroesophageal reflux disease.
Gastroenterology., (2018), 154 pp. 267-276
[3]
2020052008214795510
H.B. El-Serag, S. Sweet, C.C. Winchester, J. Dent.
Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review.
[4]
2020052008214795511
J. Richter, F. Friedenberg.
Gastroesophageal reflux disease.
Sleisenger and Fordtrańs. gastrointestinal and liver diseases, 10th ed., Elsevier, pp. 733-753
[5]
R. Mittal, R. McCallum.
Characteristics of transient lower esophageal sphincter relaxation in humans.
Am J Physiol., (1987), 252 pp. G636-G641
[6]
J. Pandofino, G. Shi, B. Trueworthy, P. Kahrilas.
Esophagogastric junction opening during relaxation distinguishes non-hernia reflux patients, hernia patients and normal subjects.
Gastroenterology., (2003), 125 pp. 1018-1024
[7]
J. Dent, R. Holloway, J. Toouli, W. Dodds.
Mechanisms of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux.
Gut., (1988), 29 pp. 1020-1028
[8]
2020052008214795512
H. Pohl, K. Wrobel, C. Bojarski, W. Voderholzer, A. Sonnenberg, T. Rösch, et al.
Risk factors in the development of esophageal adenocarcinoma.
Am J Gastroenterol., (2013), 108 pp. 200-207
[9]
H. Beaumont, R.J. Bennink, J. de Jong, G.E. Boeckxstaens.
The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD.
Gut., (2010), 59 pp. 441-451
[10]
2020052008214795513
S.K. Dutta, K. Agrawal, M.A. Mahmoud.
Modulation of salivation and heartburn in response to the site of acid infusion in the human oesophagus.
Aliment Pharmacol Ther., (2010), 32 pp. 795-800
[11]
2020052008214795514
R. Orlando, E. Lacey, N. Tobey, K. Cowart.
Barriers to paracellular permeability in rabbit esophageal epithelium.
Gastroenterology., (1992), 102 pp. 910-923
[12]
2020052008214795515
H. Stein, A. Barlow, T. DeMeester, R. Hinder.
Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.
[13]
2020052008214795516
A.M. Saad, A. Choudhary, M.L. Bechtold.
Effect of Helicobacter pylori treatment on gastroesophageal reflux disease (GERD): meta-analysis of randomized controlled trials.
Scand J Gastroenterol., (2012), 47 pp. 129-135
[14]
2020052008214795517
A. Gasiorowska, T. Navarro-Rodríguez, C. Wendel, E. Krupinski, Z.H. Perry, K. Koenig, et al.
Comparison of the degree of duodenogastroesophageal reflux and acid reflux between patients who failed to respond and those who were successfully treated with a proton pump inhibitor once daily.
Am J Gastroenterol., (2009), 104 pp. 2005-2013
[15]
D. Johnson, M. Fennerty.
Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease.
Gastroenterology., (2004), 126 pp. 660-664
[16]
U. Gustafsson, L. Tibbling.
The effect of edrophonium chloride-induced chest pain on esophageal blood flow and motility.
Scand J Gastroenterol., (1997), 32 pp. 104-107
[17]
American Lung Association Asthma Clinical Research Centers
2020052008214795518
2020052008214795519
, J.G. Mastronarde, N.R. Anthonisen, M. Castro, J.T. Holbrook, F.T. Leone, W.G. Teague, et al.
Efficacy of esomeprazole for treatment of poorly controlled asthma.
N Engl J Med., (2009), 360 pp. 1487-1499
[18]
2020052008214795520
N.J. Shaheen, S.D. Crockett, S.D. Bright, et al.
Randomised clinical trial: High-dose acid suppression for chronic cough—A double-blind, placebo-controlled study.
Aliment Pharmacol Ther., (2011), 33 pp. 225-234
[19]
2020052008214795521
2020052008214795522
N. de Bortoli, S. Tolone, M. Frazzoni, I. Martinucci, G. Sgherri, E. Albano, et al.
Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders.
Ann Gastroenterol., (2018), 31 pp. 639-648
[20]
2020052008214795523
E. Savarino, E. Marabotto, G. Bodini, G. Pellegatta, C. Coppo, E. Giambruno, et al.
Epidemiology and natural history of gastroesophageal reflux disease.
Minerva Gastroenterol Dietol., (2017), 63 pp. 175-183
[21]
Rodríguez
2020052008214795524
Acevedo M, Vaamonde Lago P, González Paz T. Disfagia Orofaríngea. Actualización y manejo en poblaciones específicas. [Internet] 1ª ed. España. Sociedad Gallega de Otorrinolaringología y Patología Cérvico- Facial. [actualizado 23/11/2018] Disponible en: http://sgorl.org/index.php option=com_content&view=article&id=146&Itemid=520.
[22]
2020052008214795525
C. Amadi, P. Gatenby.
Barrett's oesophagus: Current controversies.
World J Gastroenterol., (2017), 23 pp. 5051-5067
[23]
2020052008214795526
2020052008214795527
N. Vakil, S.V. van Zanten, P. Kahrilas, J. Dent, R. Jones, Global Consensus Group.
The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.
Am J Gastroenterology., (2006), 101 pp. 1900-1920
[24]
2020052008214795528
M.E. Numans, J. Lau, N.J. de Wit, P.A. Bonis.
Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics.
Ann Intern Med., (2004), 140 pp. 518-527
[25]
2020052008214795529
B.F. Kessing, A.J. Bredenoord, P.W. Weijenborg, G.J. Hemmink, C.M. Loots, A.J. Smout.
Esophageal acid exposure decreses intraluminal baseline impedance levels.
Am J Gastroenterol., (2011), 106 pp. 2093-2097
[26]
2020052008214795530
P. Woodland, M. Al-Zinaty, E. Yazaki, D. Sifrim.
In vivo evaluation of acid-induced changes in esophageal mucosa integrity and sensitivity in non erosive reflux disease.
Gut, (2013), 62 pp. 12566-21261
[27]
2020052008214795531
2020052008214795532
L.R. Lundell, J. Dent, J.R. Bennett, A.L. Blum, D. Armstrong, J.P. Galmiche, et al.
Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification.
Gut., (1999), 45 pp. 172-180
[28]
2020052008214795533
P.J. Kahrilas, E.M. Quigley.
Clinical esophageal pH recording: a technical review for practice guideline development.
Gastroenterology., (1996), 110 pp. 1982-1996
[29]
2020052008214795534
F. Johnsson, B. Joelsson, P.E. Isberg.
Ambulatory 24hours intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease.
Gut., (1987), 28 pp. 1145-1150
[30]
2020052008214795535
2020052008214795536
S. Roman, C.P. Gyawali, E. Savarino, R. Yadlapati, F. Zerbib, J. Wu, et al.
The GERD consensus group (2017). Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group.
Neurogastroenterol Motil., (2017), 29 pp. 1-15
[31]
D. Podolsky, M. Camilleri, F. Shanahan, J. Fitz, T. Wang, T. Yamada, et al.
Yamada's textbook of gastroenterology.
Wiley Blackwell, (2016),
[32]
J.J. Sebastián Domingo
2020052008214795537
.
Los nuevos criterios de Roma (IV) de los trastornos funcionales digestivos en la práctica clínica.
Med Clin (Barc)., (2017), 148 pp. 464-468
[33]
2020052008214795538
2020052008214795539
B.C. Jacobson, S.C. Somers, C.S. Fuchs, C.P. Kelly, C.A. Camargo Jr..
Body-mass index and symptoms of gastroesophageal reflux in women.
N Engl J Med., (2006), 354 pp. 2340-2348
[34]
2020052008214795540
2020052008214795541
K.R. DeVault, D.O. Castell.
American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.
Am J Gastroenterol., (2005), 100 pp. 190-200
[35]
2020052008214795542
I.M. Gralnek, G.S. Dulai, M.B. Fennerty, B.M. Spiegel.
Esomeprazole ver- sus other proton pump inhibitors in erosive esophagitis: ameta-analysis of randomized clinical trials.
Clin Gastroenterol Hepatol., (2006), 4 pp. 1452-1458
[36]
D.A. Corley.
Safety and complications of long-term proton pump inhibitor therapy: getting closer to the truth.
Gastroenterology., (2019), 157 pp. 604-607
[37]
2020052008214795543
Y. Xiao, S. Zhang, N. Dai, G. Fei, K.L. Goh, H.J. Chun, et al.
Phase III, randomised, double-blind, multicentre study to evaluate the efficacy and safety of vonoprazan compared with lansoprazole in Asian patients with erosive oesophagitis.
[38]
2020052008214795544
2020052008214795545
E.M.M. Quigley.
Prokinetics in the management of functional gastrointestinal disorders.
Curr Gastroenterol Rep., (2017), 19 pp. 53
[39]
2020052008214795546
N. Viazis, G. Karamanolis, E. Vienna, D.G. Karamanolis.
Selective-serotonin reuptake inhibitors for the treatment of hypersensitive esophagus.
Therap Adv Gastroenterol., (2011), 4 pp. 295-300
[40]
2020052008214795547
2020052008214795548
A. Pauwels, V. Boecxstaens, C.N. Andrews, S.E. Attwood, R. Berrisford, R. Bisschops, et al.
How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery).
Gut., (2019), 68 pp. 1928-1941
[41]
2020052008214795549
Z. Nabi, D.N. Reddy.
Update on endoscopic approaches for the management of gastroesophageal reflux disease.
Gastroenterol Hepatol (NY)., (2019), 15 pp. 369-376