Abordaje terapéutico de la enfermedad por reflujo gastroesofágico

Autores/as

  • Mariela Dulbecco Unidad de Neurogastroenterología, Servicio de Gastroenterología, Hospital Interzonal General de Agudos General José de San Martín, Universidad Nacional de La Plata, Buenos Aires.
  • Mauricio Guzmán Unidad de Neurogastroenterología, Servicio de Gastroenterología, Hospital Interzonal General de Agudos General José de San Martín, Universidad Nacional de La Plata, Buenos Aires.

DOI:

https://doi.org/10.52787/agl.v52i2.207

Palabras clave:

Enfermedad por reflujo gastroesofágico, fenotipos, enfermedad por reflujo no erosiva, esófago de Barrett

Resumen

La enfermedad por reflujo gastroesofágico constituye uno de los motivos de consulta más frecuentes en la práctica gastroenterológica. Su diagnóstico es un desafío ya que los síntomas típicos suelen tener una baja sensibilidad y especificidad. No menos desafiante es su abordaje terapéutico, ya que requiere de un enfoque integral que debe tener en cuenta la presentación sintomática (síntomas típicos esofágicos o síntomas extraesofágicos), los hallazgos estructurales endoscópicos y las características motoras y funcionales. La correcta identificación de los fenotipos de la enfermedad por reflujo gastroesofágico es crucial para direccionar en cada caso el mejor tratamiento. En esta revisión, se propone otorgar al lector las mejores opciones terapéuticas según cada fenotipo y de acuerdo con las mejores evidencias disponibles en la actualidad.

Citas

-1. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology. 2022;117(1):27-56.

-2. Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 2020 Nov 23;371:m3786. doi: 10.1136/bmj.m3786. PMID: 33229333

-3. Katzka DA, Pandolfino JE, Kahrilas PJ. Phenotypes of Gastroesophageal Reflux Disease: Where Rome, Lyon, and Montreal Meet. Vol. 18, Clinical Gastroenterology and Hepatology. W.B. Saunders. 2020. Pp. 767-76.

- 4. Gyawali CP, Fass R. Management of Gastroesophageal Reflux Disease. Gastroenterology. 2018;154(2):302-18.

- 5. Olmos JA, Piskorz MM, Vela MF. REVISIÓN Gastroesophageal Reflux Disease Review (GERD) Revisión sobre enfermedad por reflujo gastroesofágico (ERGE) [Internet]: Acta Gastroenterol Latinoam 2016;46: 160-172. Disponible en: www.actagastro.org

- 6. Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: Why we feel the burn. Vol. 11, Journal of Thoracic Disease. AME Publishing Company; 2019. Pp. S1594-601.

- 7. El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: A cross sectional study in volunteers. Gut. 2005;54(1):11-7.

- 8. Schuitenmaker JM, van Dijk M, Oude Nijhuis RAB, Smout AJPM, Bredenoord AJ. Associations Between Sleep Position and Nocturnal Gastroesophageal Reflux: A Study Using Concurrent Monitoring of Sleep Position and Esophageal pH and Impedance. American Journal of Gastroenterology. 2022;117(2):346-51.

-9. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clinical Gastroenterology and Hepatology. 2016;14(2):175-182.e3.

-10. Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Weight loss and reduction in gastroesophageal reflux. a prospective population- based cohort study: The HUNT study. American Journal of Gastroenterology. 2013;108(3):376-82.

-11. Fass R, Boeckxstaens GE, El-Serag H, Rosen R, Sifrim D, Vaezi MF. Gastro-oesophageal reflux disease. Vol. 7, Nature Reviews Disease Primers. Nature Research; 2021.

-12. Khan M, Santana J, Donnellan C, Preston C, Moayyedi P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2007.

-13. Hatlebakk JG, Katz PO, Camacho-Lobato L, Castell DO. Proton pump inhibitors: better acid suppression when taken before a meal than without a meal. Aliment Pharmacol Ther. 2000 Oct;14(10):1267-72. doi: 10.1046/j.1365-2036.2000.00829.x. PMID: 11012470.

-14. Sharma P, Shaheen NJ, Perez MC, Pilmer BL, Lee M, Atkinson SN, et al. Clinical trials: Healing of erosive oesophagitis with dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed-release formulation - Results from two randomized controlled studies. Alimentary Pharmacology and Therapeutics. 2009;29(7):731-41.

-15. Fass R, Frazier R. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease. Vol. 10, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2017. Pp. 243-51.

-16. Gralnek IM, Dulai GS, Fennerty MB, Spiegel BMR. Esomeprazole Versus Other Proton Pump Inhibitors in Erosive Esophagitis: A Meta-Analysis of Randomized Clinical Trials. Clinical Gastroenterology and Hepatology. 2006;4(12):1452-8.

-17. Fass R, Sontag SJ, Traxler B, Sostek M. Treatment of Patients With Persistent Heartburn Symptoms: A Double-Blind, Randomized Trial. 2006.

-18. Hillman L, Yadlapati R, Thuluvath AJ, Berendsen MA, Pandolfino JE. A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease. Vol. 30, Diseases of the Esophagus. Oxford University Press; 2017. Pp. 1-15.

-19. Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology [Internet]. 2022 Feb. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S001650852104083X

-20. Björnsson E, Abrahamsson H, Simrén M, Mattsson N, Jensen C, Agerforz P, et al. Discontinuation of proton pump inhibitors in patients on long-term therapy: A double-blind, placebo-controlled trial. Alimentary Pharmacology and Therapeutics. 2006;24(6):945-54.

-21. Freedberg DE, Kim LS, Yang YX. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Vol. 152, Gastroenterology. W.B. Saunders; 2017. Pp. 706-15.

-22. Ma C, Shaheen AA, Congly SE, Andrews CN, Moayyedi P, Forbes N. Interpreting Reported Risks Associated With Use of Proton Pump Inhibitors: Residual Confounding in a 10-Year Analysis of National Ambulatory Data. Gastroenterology. 2020;158(3):780-2.e3.

-23. Moayyedi P, Eikelboom JW, Bosch J, Connolly SJ, Dyal L, Shestakovska O, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology. 2019;157(3):682-691.e2.

-24. Fackler WK, Ours TM, Vaezi MF, Richter JE. Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterology. 2002;122(3):625-32.

-25. Suspensión preventiva y retiro del mercado de todos los medicamentos que contengan RANITIDINA [Internet]. argentina.gob.ar.2020 [citado 4 mayo 2022]. Disponible en: https://www.argentina.gob.ar/noticias/suspension-preventiva-y-retiro-del-mercado-de-todos-los-medicamentos-que-contengan

-26. Kim J, Blackett JW, Jodorkovsky D. Strategies for Effective Discontinuation of Proton Pump Inhibitors. Vol. 20, Current Gastroenterology Reports. Current Medicine Group LLC 1; 2018.

-27. Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, et al. Randomised clinical trial: Vonoprazan, a novel potassium- competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Alimentary Pharmacology and Therapeutics. 2016;43(2):240-51.

-28. Cheng Y, Liu J, Tan X, Dai Y, Xie C, Li X, et al. Direct Comparison of the Efficacy and Safety of Vonoprazan Versus Proton-Pump Inhibitors for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis. Vol. 66, Digestive Diseases and Sciences. Springer; 2021. Pp. 19-28.

-29. Iwakiri K, Fujiwara Y, Manabe N, Ihara E, Kuribayashi S, Akiyama J, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021. Vol. 57, Journal of Gastroenterology. Springer Japan; 2022. Pp. 267-85.

-30. Tytgat GN, Simoneau G. Clinical and laboratory studies of the antacid and raft-forming properties of Rennie alginate suspension. Alimentary Pharmacology and Therapeutics. 2006;23(6):759-65.

-31. Kwiatek MA, Roman S, Fareeduddin A, Pandolfino JE, Kahrilas PJ. An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial “acid pocket” in symptomatic GERD patients. Alimentary Pharmacology and Therapeutics. 2011;34(1):59-66.

-32. Leiman DA, Riff BP, Morgan S, Metz DC, Falk GW, French B, Umscheid CA, Lewis JD. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus. 2017 May 1;30(5):1-9. doi: 10.1093/dote/dow020. PMID: 28375448; PMCID: PMC6036656.

-33. Huestis MJ, Keefe KR, Kahn CI, Tracy LF, Levi JR. Alternatives to Acid Suppression Treatment for Laryngopharyngeal Reflux. Vol. 129, Annals of Otology, Rhinology and Laryngology. SAGE Publications Inc.; 2020. Pp. 1030-9.

-34. Ren LH, Chen WX, Qian LJ, Li S, Gu M, Shi RH. Addition of prokinetics to PPI therapy in gastroesophageal reflux disease: A meta-analysis. World Journal of Gastroenterology. 2014;20(9):2412-9.

-35. Kessing BF, Smout AJPM, Bennink RJ, Kraaijpoel N, Oors JM, Bredenoord AJ. Prucalopride decreases esophageal acid exposure and accelerates gastric emptying in healthy subjects. Neurogastroenterology and Motility. 2014;26(8):1079-86.

-36. Vela MF, Tutuian R, Katz PO, Castell DO. Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH. Alimentary Pharmacology and Therapeutics. 2003;17(2):243-51.

-37. Grossi L, Spezzaferro M, Sacco LF, Marzio L. Effect of baclofen on oesophageal motility and transient lower oesophageal sphincter relaxations in GORD patients: A 48-h manometric study. Neurogastroenterology and Motility. 2008;20(7):760-6.

-38. Armstrong D, Sifrim D. New Pharmacologic Approaches in Gastroesophageal Reflux Disease. Vol. 39, Gastroenterology Clinics of North America. 2010. Pp. 393-418.

-39. Koek GH, Sifrim D, Lerut T, Janssens J, Tack J. Effect of the GABA B agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors [Internet]. Disponible en: www.gutjnl.com

-40. Simon B, Ravelli GP, Goffin H. Sucralfate gel versus placebo in patients with non-erosive gastro-oesophageal reflux disease. Vol. 10, Aliment Pharmacol Ther. 1996.

-41. Campos GMR, Peters JH, Demeester TR. Multivariate Analysis of Factors Predicting Outcome After Laparoscopic Nissen Fundoplication.

-42. Richter JE. Gastroesophageal Reflux Disease Treatment: Side Effects and Complications of Fundoplication. Clinical Gastroenterology and Hepatology. 2013;11(5):465-71.

-43. Shaker A, Stoikes N, Drapekin J, Kushnir V, Brunt LM, Gyawali CP. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. American Journal of Gastroenterology. 2013;108(11):1706-12.

-44. Du X, Wu JM, Hu ZW, Wang F, Wang ZG, Zhang C, et al. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastroesophageal reflux disease. Vol. 96, Medicine (United States). Lippincott Williams and Wilkins; 2017.

-45. Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term Outcome of Medical and Surgical Therapies for Gastroesophageal Reflux Disease Follow-up of a Randomized Controlled Trial [Internet]. Disponible en: http://jama.jamanetwork.com/

-46. Rickenbacher N, Kötter T, Kochen MM, Scherer M, Blozik E. Fundoplication versus medical management of gastroesophageal reflux disease: Systematic review and meta-analysis. Surgical Endoscopy. 2014;28(1):143-55.

-47. Garg SK, Gurusamy KS. Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Vol. 2015, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2015.

-48. Vaezi MF, Shaheen NJ, Muthusamy VR. State of Evidence in Minimally Invasive Management of Gastroesophageal Reflux: Findings of a Scoping Review. Gastroenterology. 2020;159(4):1504-25.

-49. Bell R, Lipham J, Louie B, Williams V, Luketich J, Hill M, et al. Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial [Internet]. Disponible en: www.giejournal.org

-50. Lipham JC, Taiganides PA, Louie BE, Ganz RA, Demeester TR. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Diseases of the Esophagus. 2015;28(4):305-11.

-51. Shah A, Shibli F, Kitayama Y, Fass R. The Natural Course of Gastroesophageal Reflux Disease: A Critical Appraisal of the Literature. Vol. 55, Journal of Clinical Gastroenterology. Lippincott Williams and Wilkins; 2021. Pp. 12-20.

-52. Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Esophageal disorders. Gastroenterology. 2016 May 1;150(6):1368-79.

-53. Savarino V, Marabotto E, Zentilin P, Furnari M, Bodini G, de Maria C, et al. Pathophysiology, diagnosis, and pharmacological treatment of gastro-esophageal reflux disease. Vol. 13, Expert Review of Clinical Pharmacology. Taylor and Francis Ltd; 2020. Pp. 437-49.

-54. Prakash Gyawali C, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, et al. Modern diagnosis of GERD: The Lyon Consensus. Vol. 67, Gut. BMJ Publishing Group; 2018. Pp. 1351-62.

-55. Ronkainen J, Talley NJ, Storskrubb T, Johansson SE, Lind T, Vieth M, et al. Erosive esophagitis is a risk factor for barrett’s esophagus: A community-based endoscopic follow-Up study. American Journal of Gastroenterology. 2011;106(11):1946-52.

-56. Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, et al. Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline. American Journal of Gastroenterology [Internet]. 2022;117(4):559-87. Disponible en: https://journals.lww.com/10.14309/ajg.0000000000001680

-57. Katzka DA, Pandolfino JE, Kahrilas PJ. Phenotypes of Gastroesophageal Reflux Disease: Where Rome, Lyon, and Montreal Meet. Vol. 18, Clinical Gastroenterology and Hepatology. W.B. Saunders; 2020. Pp. 767-76.

-58. Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with barrett’s oesophagus: A systematic review and meta-Analysis. Vol. 63, Gut. BMJ Publishing Group; 2014. Pp. 1229-37.

-59. Jankowski JAZ, de Caestecker J, Love SB, Reilly G, Watson P, Sanders S, et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial. The Lancet. 20184;392(10145):400-8.

-60. Pace F, Tonini M, Pallotta S, Molteni P, Porro GB. Systematic review: Maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken “on-demand.” Vol. 26, Alimentary Pharmacology and Therapeutics. 2007. Pp. 195-204.

-61. Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-42.

-62. Surdea Blaga T, Dumitrascu D, Galmiche JP, Bruley Des Varannes S. Functional heartburn: Clinical characteristics and outcome. European Journal of Gastroenterology and Hepatology. 2013;25(3):282-90.

-63. Fass R, Zerbib F, Gyawali CP. AGA Clinical Practice Update on Functional Heartburn: Expert Review. Gastroenterology. 2020;158(8):2286-93.

-64. Patel D, Fass R, Vaezi M. Untangling Nonerosive Reflux Disease From Functional Heartburn. Vol. 19, Clinical Gastroenterology and Hepatology. W.B. Saunders; 2021. Pp. 1314-26.

-65. Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, et al. Clinical trial: Acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Alimentary Pharmacology and Therapeutics. 2007;26(10):1333-44.

-66. Riehl ME, Pandolfino JE, Palsson OS, Keefer L. Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn. Diseases of the Esophagus. 2016;29(5):490-6.

-67. Vakil N, van Zanten S v, Kahrilas P, Dent J, Jones R, Bianchi LK, et al. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Vol. 101, American Journal of Gastroenterology. 2006.

-68. Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. The BMJ. 2020;371.

Descargas

Publicado

2022-06-27

Cómo citar

Dulbecco, M., & Guzmán, M. (2022). Abordaje terapéutico de la enfermedad por reflujo gastroesofágico. Acta Gastroenterológica Latinoamericana, 52(2), 153–165. https://doi.org/10.52787/agl.v52i2.207