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2015, Número 1-2

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Cir Gen 2015; 37 (1-2)


Tratamiento actual de la enfermedad por reflujo gastroesofágico

González-Izquierdo JJ, Hernández-Aguilar TJ, Palomares-Chacón UR, Castelltor HLF, Pérez NJV, Anaya-Prado R

Idioma: Español
Referencias bibliográficas: 47
Paginas: 38-43
Archivo PDF: 190.25 Kb.


RESUMEN

La enfermedad por reflujo gastroesofágico se define como una falla de la barrera antirreflujo que determina un paso anormal de secreciones digestivas altas al esófago y produce síntomas con daño esofágico y extraesofágico. Los mecanismos fisiológicos que impiden el reflujo son el aclaramiento, el esfínter esofágico inferior y el vaciamiento gástrico adecuado. El fracaso en estos mecanismos de defensa permite el reflujo gastroesofágico. El tratamiento quirúrgico de la enfermedad por reflujo gastroesofágico ha estado en constante evolución durante los últimos 70 años. La funduplicatura de Nissen, la de Belsey y la gastropexia de Hill han sido estudiadas y modificadas con el paso del tiempo; se han realizado diferentes tipos de abordajes. Un tratamiento efectivo es reducir la secreción ácida del estómago, bien sea con antagonistas de los receptores H2, bien con inhibidores de la bomba de protones; la dosis dependerá de la severidad de cada paciente, ya que cuanto mayor sea la exposición esofágica al ácido, mayor será el grado de supresión que se requerirá para sanar. Actualmente existe mucho debate en cuanto a los beneficios del tratamiento médico frente al quirúrgico y el papel de la laparoscopia como cirugía de primer tiempo o como segundo abordaje. El objetivo de este artículo es determinar las opciones terapéuticas quirúrgicas y médicas que tenemos actualmente en nuestro medio.


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