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Reflujo Gastroesofagico
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Reflujo Gastroesofagico

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DEFINICIÓN

El reflujo gastroesofágico consiste en el paso del contenido gástrico al esófago, a través del esfínter esofágico inferior. 

El material refluido puede ser contenido del estómago o del intestino.

La regurgitación consiste en el ascenso a la boca o faringe de material proveniente del estómago o del esófago. El reflujo gastroesofágico puede cursar asintomático sin causar lesiones en cualquier persona.





 INCIDENCIA

El reflujo gastroesofágico es frecuente, ya que el 7 % de las personas tienen pirosis a diario y el 15 % cada mes. Es más el 27% de las personas toman antiácidos más de dos veces al mes.

La mayoría de estas personas tienen reflujo gastroesofágico y la mitad de ellos lesiones de esofagitis. En las personas mayores de 50 años es más frecuente.

 SÍNTOMAS

La pirosis, es el más frecuente. Es una sensación de quemazón o ardor detrás del esternón hasta el cuello, más frecuente con ciertos alimentos (grasas, chocolate, alcohol, café y tabaco).
La disfagia o dificultad para deglutir alimentos.
Sequedad de boca.
Infecciones dentales más frecuentes.
Tos crónica o asma.
Sangrado oculto por ulceras en la mucosa esofágica.
 CAUSAS

Son diversas en parte se deben a:

Relajación del esfínter esofágico inferior. La alteración de la motilidad del esfínter esofágico inferior por alteración de diversos mediadores (VIP, péptido YY, motilina, colecistoquinina y neurotensina).
El aclaramiento esofágico disminuido por:
Disminución de la actividad peristáltica esofágica.
La salivación aumenta (más viscosa y con pH más alto) en caso de Reflujo Gastroesofágico, como mecanismo de defensa. El tabaco, disminuye el aclaramiento esofágico, reduciendo la salivación.
La mucosa esofágica. No es una mucosa preparada para aguantar el ácido del estómago, por ello se lesiona con facilidad. Trata de defenderse a base de una salivación más intensa.
La actividad motora del estómago y el retraso del vaciamiento gástrico contribuyen a favorecer el reflujo Gastroesofágico.
Otras causas secundarias de reflujo gastroesofágico son:
Embarazo
Estenosis pilórica
Enfermedades respiratorias
Enfermedades sistémicas (colagenosis)
Hernia hiatal
En la mayoría de los casos se trata de un reflujo mixto debido a la suma de los factores.

 COMPLICACIONES

Si el reflujo es normal puede dar pirosis y poco más, pero si es patológico llega a producir lesiones de esofagitis. 
La esofagitis es una inflamación de la mucosa esofágica, que si persiste en el tiempo degenera en lesiones precancerosas (esofagitis de Barret) y en cáncer.

La esofagitis puede ser causa o ser secundaria a la hernia hiatal, que es el paso de una parte del estómago hacia la cavidad torácica, a través del diafragma.
 
 DIAGNÓSTICO

Se realiza una exploración radiológica con contraste, y se toman diversas posiciones, de pie, tumbado etc... para observar grandes movimientos de líquidos entre las cavidades intestinales. Sirve para diagnosticar grandes reflujos.

Otra exploración es la gastroscopia mediante un tubo de luz fría y visión en un monitor.Se utiliza para observar las lesiones de la mucosa esofágica y el propio reflujo.

Para saber las características del reflujo se realizan estudios de la pHmetría de 24 horas, lo cual debe diferenciar entre un reflujo normal o patológico.

El reflujo normal ó fisiológico se presenta en episodios de reflujo inferiores a 5 minutos, siendo excepcional encontrar un episodio con una duración superior a 10 minutos. Cuando monitorizamos por pHmetría esofágica a un sujeto normal durante 24 horas el tiempo en el que el pH permanece por debajo de 4 en el esófago es menor de 3,4 %. El reflujo patológico cursa por episodios de reflujo con pH<4 por mucho tiempo, y de aparición por la noche o en decúbito -tumbado-.

 TRATAMIENTO

Cambios de estilo de vida, dieta y reducción de peso, en caso de obesidad.
Subir la cabecera de la cama 3 a 8 cm.
Cenar o tomar cualquier comida 3 ó 4 horas antes de dormir o de tumbarse.
Evitar ciertos alimentos que relajan el esfínter esofágico inferior, cafeína, alcohol, tabaco, especias, menta, chocolate.
Medicación
Se usan los antiH2, que disminuyen la acción de la histamina sobre las células gástricas y por ello disminuyen la acidez gástrica. Cimetidina (Tagamet®), ranitidina (Zantac®), famotidina.
Inhibidores de la bomba de protones, que secan la producción de ácidos en el estómago. Omeprazol (Losec®), lansoprazol.
Estimuladores de la motilidad del esfínter esofágico. Metaclopramida (Primperam®) y urecholine (Betancol®).
La cirugía se realiza para síntomas incontrolados o por complicaciones de esofagitis de Barret. Principalmente trata de corregir las hernias (de deslizamiento) de hiato, devolviendo el estómago a la cavidad abdominal y cerrando el paso por el diafragma para que no vuelva a ocurrir. tuotromedico
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