FISIOPATOLOGIA DEL REFLUJO GASTRO-ESOFAGICOEDUARDO MONGE2014

ANATOMIADELESOFAGO

MOTILIDAD

INERVACION DEL EEI

RELAJACIONES TRANSITORIAS DEL EEI

TIEMPO TRANSITO ESOFAGICO

Lquidos: 2-3 segundos

Slidos: 9-10 segundos

MONTREAL

LA ERGE ES UNA CONDICION QUE APARECE CUANDO EL REFLUJO DEL CONTENIDO DEL ESTOMAGO PRODUCE SINTOMAS MOLESTOS y/o COMPLICACIONES

ESOFAGITIS10-30%

NERD(No Erosiva)70-90%

ERGEEXTRA ESOFAGICO

COMPROMISO DENTAL

FRECUENCIA DEL PROBLEMA (Pirosis al menos 1/ semana)

FISIOPATOLOGIAERGE

FISIOPATOLOGICAMENTE

Alteracin del EEI

Falla en el aclaramiento esofgico (mala peristalsis)

Pathophysiology of GERDCastell Do et al. Aliment Pharmacol Ther 2004; 20 (Suppl 9):14Lower esophageal sphincter (LES)Impaired esophageal acid clearanceImpaired tissue resistanceDecreasing resting tone of LESDelayed gastric emptyingTransient LES relaxationDuodenumGERD / DyspepsiaII-4

REDUCEN TONO EEIAlcohol y CigarrilloGrasas en la dietaMentas y ChocolatesAnticolinergicosSedantes

Mal vaciamiento gstrico y la presin intragastrica.

DISTORSION BARRERA ANTIREFLUJO

LAS HERNIAS HIATALES

CIRCULO VICIOSOEEI y ERGE

EL PELIGRO DEL BARRETT

SENSIBILIDAD Y PERMEABILIDAD

HELICOBACTER PYLORI Y ERGE

*Pathophysiology of GERDThere are several factors which contribute to the development of GERD. Perhaps the most important factor is Transient Lower Esophageal Sphincter Relaxation (TLESR). This phenomenon occurs when the LES relaxes reflexively to permit gas venting in the absence of a swallow. There are hormonal and neural agents, in addition to medications and foods that are associated with the lowering of LES pressure.

Other key components involved in the development of GERD include the presence of a hiatal hernia, poor esophageal clearance, delayed gastric emptying, and impaired mucosal defensive factors. There are several studies which have shown that the presence and size of a hiatal hernia correlates with severity of reflux, Barretts esophagus and impairment of the barrier function that the LES is supposed to provide. Kahrilas PJ et al, Gut 1999; 44: 476-482. Jones MP et al, Am J Gastroenterol 2001; 96: 1711-1717. Cameron AJ, Am J Gastroenterol 1999; 94: 2054-2059. Two potential theories have been proposed to explain how hiatal hernias predispose to reflux. One of those theories is that hiatal hernias hinder LES function. Another thought is that hiatal hernias act as a reservoir for acid, which then gets pushed up into the esophagus during LES relaxation as the patient swallows.

Although the data on gastric emptying as a causative factor in GERD are conflicting, a recent study showed that 33% of patients with GERD had intragastric contents greater than the 95th percentile at 120 minutes postprandially and 26% had abnormal results at 240 minutes postprandially. Buckles DC et al, Am J Med Sci 2004; 327: 1-4 The proposed mechanisms for delayed gastric emptying resulting in GERD are felt to be an increase in refluxate as well as gastric distension.