Doença do Refluxo Gastroesofágico
Palavras-chave:
doença do refluxo gastroesofágico, esofagiteResumo
A doença do refluxo gastroesofágico (DRGE), considerada uma das afecções mais prevalentes em todo o mundo, compromete de forma significativa a qualidade de vida dos pacientes. Suas manifestações clínicas incluem pirose e regurgitação (sintomas típicos) e sintomas atípicos como dor torácica, tosse, manifestações otorrinolaringológicas (rouquidão, pigarro, laringite) e asma, dentre outras. Do ponto de vista endoscópico, é classificada em não erosiva, erosiva e complicada, quando ocorre ulceração, estenose ou metaplasia intestinal (esôfago de Barrett). O principal mecanismo fisiopatológico é o relaxamento transitório do esfíncter esofágico inferior (EEI), e a presença de hérnia hiatal pode agravar a doença. O principal método diagnóstico é a endoscopia digestiva alta, sendo necessário em alguns casos duvidosos o emprego da esofagomanometria e pHmetria esofágica de 24 horas. O tratamento baseia-se em medidas comportamentais e em antissecretores, sendo estes últimos representados pelos inibidores da bomba de prótons e, mais recentemente, os bloqueadores da bomba de potássio. Em raros casos a cirurgia antirrefluxo está indicada.
Referências
Moraes-Filho JP, Chinzon D, Eisig JN, et al. Prevalence of heartburn and gastroesophageal reflux disease in the urban Brazilian population. Arq Gastroenterol 2005;42(2):122-7, doi:S0004-28032005000200011[pii]/S0004-28032005000200011
Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101(8):1900-20; quiz 1943, doi:AJG630 [pii]10.1111/j.1572-0241.2006.00630.x
Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology 2001;121(4):775-83, doi:10.1053/gast.2001.27997
Labenz J, Malfertheiner P. Treatment of uncomplicated reflux disease. World J Gastroenterol 2005;11(28):4291-9, doi:10.3748/wjg.v11.i28.4291
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45(2):172-80, doi:10.1136/gut.45.2.172
Saleh CM, Smout AJ, Bredenoord AJ. The diagnosis of gastro-esophageal reflux disease cannot be made with barium esophagograms. Neurogastroenterol Motil 2015;27(2):195-200, doi:10.1111/nmo.12457
Moraes-Filho JP, Navarro-Rodriguez T, Barbuti R, et al. Guidelines for the diagnosis and management of gastroesophageal reflux disease: an evidence-based consensus. Arq Gastroenterol 2010;47(1):99-115, doi:S0004-28032010000100017 [pii]
Aziz Q, Fass R, Gyawali CP, et al. Functional Esophageal Disorders. Gastroenterology 2016, doi:10.1053/j.gastro.2016.02.012
Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2023, doi:10.1136/gutjnl-2023-330616
Khoury RM, Camacho-Lobato L, Katz PO, et al. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94(8):2069-73, doi:10.1111/j.1572-0241.1999.01279.x
Farup PG, Weberg R, Berstad A, et al. Low-dose antacids versus 400 mg cimetidine twice daily for reflux oesophagitis. A comparative, placebo-controlled, multicentre study. Scand J Gastroenterol 1990;25(3):315-20.
Weberg R, Berstad A. Symptomatic effect of a low-dose antacid regimen in reflux oesophagitis. Scand J Gastroenterol 1989;24(4):401-6, doi:10.3109/00365528909093066
McCallum RW, Fink SM, Winnan GR, et al. Metoclopramide in gastroesophageal reflux disease: rationale for its use and results of a double-blind trial. Am J Gastroenterol 1984;79(3):165-72.
Guslandi M, Testoni PA, Passaretti S, et al. Ranitidine vs metoclopramide in the medical treatment of reflux esophagitis. Hepatogastroenterology 1983;30(3):96-8
Maton PN. Profile and assessment of GERD pharmacotherapy. Cleve Clin J Med 2003;70 Suppl 5(S51-70, doi:10.3949/ccjm.70.suppl_5.s51
Masci E, Testoni PA, Passaretti S, et al. Comparison of ranitidine, domperidone maleate and ranitidine + domperidone maleate in the short-term treatment of reflux oesophagitis. Drugs Exp Clin Res 1985;11(10):687-92.
Lowe RC, Wolfe MM. The pharmacological management of gastroesophageal reflux disease. Minerva Gastroenterol Dietol 2004;50(3):227-37.
Sontag SJ. The medical management of reflux esophagitis. Role of antacids and acid inhibition. Gastroenterol Clin North Am 1990;19(3):683-712.
Sabesin SM, Berlin RG, Humphries TJ, et al. Famotidine relieves symptoms of gastroesophageal reflux disease and heals erosions and ulcerations. Results of a multicenter, placebo-controlled, dose-ranging study. USA Merck Gastroesophageal Reflux Disease Study Group. Arch Intern Med 1991;151(12):2394-400.
Tytgat GN, Nicolai JJ, Reman FC. Efficacy of different doses of cimetidine in the treatment of reflux esophagitis. A review of three large, double-blind, controlled trials. Gastroenterology 1990;99(3):629-34, doi:10.1016/0016-5085(90)90947-y
Feldman M, Burton ME. Histamine2-receptor antagonists. Standard therapy for acid-peptic diseases. 1. N Engl J Med 1990;323(24):1672-80, doi:10.1056/NEJM199012133232405
Colin-Jones DG. The role and limitations of H2-receptor antagonists in the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 1995;9 Suppl 1(9-14, doi:10.1111/j.1365-2036.1995.tb00778.x
Chiba N. Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview. Can J Gastroenterol 1997;11 Suppl B(66B-73B.
Caro JJ, Salas M, Ward A. Healing and relapse rates in gastroesophageal reflux disease treated with the newer proton-pump inhibitors lansoprazole, rabeprazole, and pantoprazole compared with omeprazole, ranitidine, and placebo: evidence from randomized clinical trials. Clin Ther 2001;23(7):998-1017, doi:10.1016/s0149-2918(01)80087-4
Katz PO, Anderson C, Khoury R, et al. Gastro-oesophageal reflux associated with nocturnal gastric acid breakthrough on proton pump inhibitors. Aliment Pharmacol Ther 1998;12(12):1231-4, doi:10.1046/j.1365-2036.1998.00419.x
Ashida K, Sakurai Y, Nishimura A, et al. Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment Pharmacol Ther 2015;42(6):685-95, doi:10.1111/apt.13331
Ashida K, Sakurai Y, Hori T, et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther 2016;43(2):240-51, doi:10.1111/apt.13461
Moraes-Filho JP, Navarro-Rodriguez T, Barbuti R, et al. Guidelines for the diagnosis and management of gastroesophageal reflux disease: an evidence-based consensus. Arq Gastroenterol 2010;47(1):99-115, doi:10.1590/s0004-28032010000100017
