/ Publicado en Gastroenterología Quirúrgica

Enfermedad por Reflujo Gastroesofágico (RGE)

Enfermedad por Reflujo Gastroesofágico (RGE)
Se produce cuando los contenidos ya sean líquidos o alimentos sólidos se devuelven desde el estómago hacia el esófago (conducto que va desde la boca hacia el estómago). Esto irrita al esófago causando acidez y otros síntomas y consecuencias.

Causas y Factores

El estómago es una “bolsa” o reservorio en dónde el alimento inicia su digestión, esto se lleva a cabo con la saliva y los ácidos gástricos que prevalecen en el estómago. Así que los “jugos gástricos” son muy ácidos y así permanecen las 24 hrs del día, aún y que el estómago no tena alimento. Ver dibujo 1
Existe un conjunto de fibras musculares entre el esófago y el estómago que se denominan Esfínter Esofágico Inferior, éste es el responsable de impedir que el ácido y los alimentos se devuelvan hacia el esófago. Sin embargo existen condiciones, alimentos o situaciones en las cuales ese Esfínter no cierra bien y el alimento y el ácido gástrico pueden devolverse hacia el esófago, lo cual se denomina Reflujo Gastroesofágico (RGE). Este reflujo puede causar síntomas o incluso dañar el esófago. Ver Cuadro 1

Síntomas
• Sensación de que el alimento no “baja” o se atora en el pecho
• Acidez en la “boca del estómago” o en el pecho que puede aumentar al agacharse, acostarse y que sea peor por la noche requiriendo dormir con más almohadas. Estos síntomas tienden a aliviarse temporalmente con antiácidos.
• Nauseas después de comer o al levantarse por la mañana
Otros síntomas menos comunes incluyen
• Devolver el alimento (regurgitación)
• Tos o sibilancias que perduran o aparecen inexplicablemente
• Dificultad para deglutir o pasar alimentos
• Ronquera crónica
• Hipo
• Dolor de garganta

Pruebas o Exámenes para el Diagnóstico
Si sus síntomas no son graves y no son recurrentes tal vez no necesite de exámenes.
Si los síntomas son graves, insidiosos, crónicos y reaparecen después de recibir tratamiento con medicamentos auto recetados o de venta al público, será necesario y prudente realizar algún estudio para diagnosticar el reflujo o cualquiera de sus complicaciones. Ver cuadro 2
Estos son algunos de los estudios que su médico le recomendará:
• Esofagoastroduodenoscopía (EGD) también llamada Endoscopía superior
• Serie Esofago-gastro-duodenal, realizada en rayos X
• Monitoreo de pH esofágico de 24 hrs.
• Manometría esofágica

Tratamiento
El cambio en algunos estilos de vida pueden ayudar en mucho para el alivio de los síntomas; Evitando alimentos o bebidas que le causen problemas, tomando los alimentos más temprano, antes de ir a dormir, elevando el respaldo de su cama o utilizando más almohadas para dormir.
Evite medicamentos que le irriten el estómago, tómelos con abundante agua y si es posible tómelos junto con los alimentos.
Puede tomar antiácidos de libre venta, pero recuerde que sus efectos no son tan efectivos por largo tiempo y que como efecto secundario se puede presentar diarrea o estreñimiento.
Otros medicamentos prescritos por su médico pueden ser:
• Los inhibidores de la bomba de protones (IBP), los cuales disminuyen la cantidad de ácido producida en el estómago. (Ejemplos: Pantoprazol, Pantoprazol, Omeprazol, Esomeprazol, Rabeprazol)
• Los Bloqueadores de H2, que disminuyen la cantidad de ácido liberada en el estómago. (Ejemplos: Famotidina, Cimetidina, Ranitidina, Nazatidina)

Complicaciones de la Enfermedad
En caso de no llevar a cabo un tratamiento efectivo y que la enfermedad se instale de manera crónica, se pudiesen presentar complicaciones como:
• Ulcera en esófago con o sin sangrado
• Estenosis (estrechamiento) del esófago
• Asma o Broncoespasmo
• Esófago de Barret (cambio en el revestimiento del esófago que puede aumentar el riesgo de cáncer)
• Tos o ronquera crónica
• Problemas dentales

Tratamiento Quirúrgico
La operación funduplicatura tipo Nissen es una cirugía para corregir el problema del Esfínter Esofágico Inferior, en este procedimiento también se repara la hernia hiatal. (ver cuadro de indicaciones para cirugía)
Es un procedimiento que se realiza generalmente por laparoscopía, es decir, es mínimamente invasivo. Durante el procedimiento el cirujano:
1. Repara la hernia hiatal con suturas y a menudo se utiliza algún tipo de malla o prótesis para reforzar el área.
2. Se utiliza la parte superior del estómago, colocando unas suturas, para envolver el extremo inferior del esófago (en donde se encuentra el Esfínter Esofágico Inferior) para así crear presión en esa área y ayudar a impedir que el ácido gástrico y el alimento se regresen hacia el esófago.
3. Es un procedimiento que se realiza con anestesia general y tarda de 1hr y media a 2 hrs. en realizarse.
Otro tratamiento que está a punto de ser adquirido por el Centro Médico AVE , es una pulsera con imanes que se coloca en la parte inferior del esófago y ayuda a reforzar el esfínter, esta nueva técnica implica un menor tiempo en cirugía, no es necesario hospitalizarse y no se requieren de tantas suturas. Dicho tratamiento actualmente está aceptado y se practica en Estados Unidos con mucho éxito.

ANEXOS
EnfermedadPorReflujo1
Factores de Riesgo
•Alcohol
•Hernia de hiato (una afección en la cual parte del estómago pasa por encima del diafragma, el músculo que separa el tórax de la cavidad abdominal)
•Obesidad
•Embarazo
•Tabaquismo

Síntomas importantes por los cuales usted debe de acudir con su médico inmediatamente
•Sangrado
•Ahogamiento (tos, dificultad para respirar)
•Sentirse lleno rápidamente al comer
•Vómitos frecuentes
•Ronquera
•Inapetencia
•Problemas para deglutir (disfagia) o dolor con la deglución (odinofagia)
•Pérdida de peso

Indicaciones de cirugía antireflujo
• Cuando hay mejoría con medicamentos, pero usted NO desea seguir tomándolos
• Cuando hay problemas para deglutir alimentos o líquidos
• Cuando persisten los síntomas de acidez en garganta y pecho
• Cuando existe una hernia hiatal importante y por lo tanto está en riesgo el estómago de dañarse
• Cuando existe una complicación de la enfermedad por reflujo como: ulcera, sangrado, estenosis (estrechamiento) esofágica, neumonía por aspiración, ronquera o tos crónica.

 

Dr. Jorge E. Balli Martínez

Cirugía Laparoscópica

Gastroenterología Quirúrgica

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