Doença do refluxo gastroesofágico: Revisão ampliada

Abstract

Background - Gastroesophageal reflux disease, considered one of the most common digestive diseases in western countries, has been very much studied. The great number of publications in medical literature based upon this issue must be pointed out. However, some of its aspects remain controversial. Aims - To emphasize important topics of the disease and to present a review on the theme. The following topics were reviewed: definition, prevalence, clinical complaints, indications and limitations of the major diagnostic methods and medical, surgical and endoscopic treatments. Material and methods - We searched, by internet: selected review articles, consensus, guidelines and systematic reviews with meta-analysis, published in the last 5 years (from 2000 to 2005), in the following data bases: Cochrane Central Register of Controlled Trials (The Cochrane Library) and PubMed. Among lots of papers which were found, we selected nine systematic reviews with meta-analysis, five review articles, five guidelines and four consensus, that dealt with the topics we had decided to review. It must be pointed out that, as it has been observed in our bibliographical references, not only the publications found were taken into account; other relevant ones (some of them published previously to the analyzed time period) were considered in the composition of this present paper. Conclusions - Among the 12 conclusions presented, two have to be emphasized: 1. the esophageal multichannel intraluminal impedance has largely contributed to the better knowledge of the gastroesophageal refl ux disease and it suggests, when associated with pHmetry (esophageal impedance-pHmetry), as a new gold standard to the gastroesophageal refl ux diagnosis and 2: among the gastroesophageal refl ux disease symptoms some of them may be considered acid dependents and can usually get good responses to the proton pump inhibitors. Nevertheless, there are also some symptoms which are more dependent on the physical presence of the refl ux rather than its acidity. Such symptoms, which do not depend so much on the acidity of the refl ux, are not well controlled by the proton pump inhibitors.