Talley NJ, Vakil NB, Moayedi P

Idioma: Español
Referencias bibliográficas: 291
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FRAGMENTO

Debido a la publicación de la revisión técnica inicial de dispepsia en 1998, la estrategia de estudiar y tratar para Helicobacter pylori ha sido ampliamente aceptada como el enfoque de elección en la dispepsia crónica sin signos de alarma. Sin embargo, esta elección está basada principalmente en los resultados de los análisis de decisión, ya que la evidencia del ensayo de manejo limitado estaban disponibles desde hace siete años. De hecho, en la atención primaria, la terapia antisecretora empírica se prescribe con frecuencia, pero aún continúa el debate acerca de si éste es el enfoque más costo-efectivo y seguro. Además, los gastroenterólogos con frecuencia eligen llevar a cabo una esofagogastroduodenoscopia temprana (EGD) en todos los casos para tranquilizar al paciente y al médico y para tratar la enfermedad específica (por ejemplo, úlcera péptica, esofagitis, esófago de Barrett o malignidad) en lugar de confiar en el enfoque empírico. Sin embargo, se sabe que la prevalencia de la infección por H. pylori ha tenido un descenso dramático, al igual que la identificación de enfermedad ulcerosa péptica y adenocarcinoma gástrico (pero no del cardias o del esófago) en EGD. Además, la prevalencia de la infección por H. pylori varía ampliamente a todo lo largo de Estados Unidos y varía según la edad y raza.10 El uso de antiinflamatorios no esteroideos selectivos (AINEs) ciclooxygenasa-2 fue muy frecuente, pero ahora es menos común, mientras que el uso profiláctico de aspirina en dosis bajas es creciente, con efecto variable en las tasas de úlceras. Por otro lado, la prevalencia de esofagitis detectada en EGD puede estar aumentando a pesar de una clasificación más rigurosa y confiable (por ejemplo, la clasificación LA). Los bloqueadores de H2 y los inhibidores de bomba de protones (IBPs) que se venden sin receta significan que muchos pacientes terminan en terapia antisecretora como primera opción, sin importar lo que recomiendan los médicos, y su uso puede impedir la capacidad de la EGD para detectar esofagitis o ulcerasa péptica.

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