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Manifestações pulmonares do refluxo gastroesofágico : uma revisão teórica
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A doença de refluxo gastroesofágico (DRGE) é uma condição que se desenvolve quando o refluxo de conteúdo do estômago causa sintomas problemáticos e/ou complicações esofágicas ou extra-esofágicas, estando muitas vezes associada a doenças respiratórias crónicas.
Os principais mecanismos propostos são a lesão directa provocada pela microaspiração de conteúdo gástrico e o reflexo bronco-esofágico mediado pelo nervo vago. Do mesmo modo, as doenças respiratórias e o tratamento com broncodilatadores podem favorecer o RGE.
A associação entre a DRGE e diversas doenças pulmonares como a asma, o SAOS, a DPOC e a fibrose pulmonar tem sido estudada extensivamente.
Este diagnóstico pode passar despercebido em doentes que não apresentam sintomas típicos. Quando há suspeita de DRGE, um teste terapêutico com IBP está indicado. A pH-impedância é o exame diagnóstico de referência e permite evidenciar refluxo não-ácido, na qual os IBP não são eficazes.
O tratamento com da DRGE é, por vezes, complexo e pode mesmo incluir cirurgia.
Através da revisão literária da informação existente até à data da publicação desta revisão, esperamos que a compreensão das manifestações pulmonares da DRGE contribua para o desenvolvimento de novas abordagens para diversas doenças pulmonares e atenuação das consequências da DRGE.
The gastroesophageal reflux disease (GERD) is a condition that develops when the reflux content of the stomach causes symptoms and/or oesophageal/extraoesophageal complications and it’s often associated with chronic respiratory conditions. The main proposed mechanisms are a direct lesion caused by micro aspiration of gastric content and an oesophageal-bronchial reflex mediated by the vagus nerve. Likewise respiratory conditions and some medications might favour gastroesophageal reflux. The association between GERD and several pulmonary diseases like asma, OSAS, POCD and pulmonary fibrosis has been thoroughly studied. This diagnosis may be unnoticed in patients who don´t present with the typical symptoms. When there is a suspicion of GERD an empirical therapeutic test with proton pump inhibitors (PPI) is indicated. A pH-impedance test is the “gold standard” diagnostic test and it allows the differentiation between acidic and non-acidic reflux, the latter which PPI aren´t effective. The treatment of GERD is, sometimes, complex and may include cirgury. Through the revision of the latest information available to date we hope that the understanding of the pulmonary manifestations of GERD contributes to the development of new approaches of the pulmonary diseases and attenuation of the consequences of GERD.
The gastroesophageal reflux disease (GERD) is a condition that develops when the reflux content of the stomach causes symptoms and/or oesophageal/extraoesophageal complications and it’s often associated with chronic respiratory conditions. The main proposed mechanisms are a direct lesion caused by micro aspiration of gastric content and an oesophageal-bronchial reflex mediated by the vagus nerve. Likewise respiratory conditions and some medications might favour gastroesophageal reflux. The association between GERD and several pulmonary diseases like asma, OSAS, POCD and pulmonary fibrosis has been thoroughly studied. This diagnosis may be unnoticed in patients who don´t present with the typical symptoms. When there is a suspicion of GERD an empirical therapeutic test with proton pump inhibitors (PPI) is indicated. A pH-impedance test is the “gold standard” diagnostic test and it allows the differentiation between acidic and non-acidic reflux, the latter which PPI aren´t effective. The treatment of GERD is, sometimes, complex and may include cirgury. Through the revision of the latest information available to date we hope that the understanding of the pulmonary manifestations of GERD contributes to the development of new approaches of the pulmonary diseases and attenuation of the consequences of GERD.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Doença do refluxo gastroesofágico Tosse crónica Asma Apneia do sono tipo obstrutiva Transplante pulmonar Fibrose pulmonar idiopática