Doença do refluxo gastroesofágico

Abstract

The clinical picture of the gastroesophageal disease (GERD) is usually rather simple, composed by heartburn and/or regurgitation (typical manifestations). However atypical manifestations (chronic laryngeal symptoms, asthma) may also be the complaint. The manifestations should not be necessarily correlated with the severity of the esophageal lesions. GERD may be erosive (erosions in the upper endoscopy) or non-erosive (endoscopy negative). The findings of the physical examination in general are poor but obesity should be remembered as an aggravating factor of reflux. Erosions may be seen at endoscopy in around 50% of the cases. The method allows the biopsy in the cases of complications such as Barrett's esophagus, stenosis and ulceration. 24 hours pHmetry is a sensible and specific method but has several inconveniences including not detecting the gastroduodenal reflux. In this regard combined pH monitoring with esophageal impedance monitoring may be useful. The clinical treatment is divided in behaviour/dietetic measures (raising the head of the bed, loosing weight, avoiding smoking, fats, chocolate, etc) and pharmacologic approach based in the use of the proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole). The main surgical indications are the complications of the disease and the patients who require long term continuous maintenance treatment. Usually the best responded to the surgical treatment are the best responders to the medical treatment. © Copyright Moreira Jr. Editora.