Reflusso esofageo

La malattia da reflusso gastroesofageo (GERD) è una condizione comune in cui il contenuto dello stomaco risale nell’esofago. Il reflusso diventa una malattia quando si presenta con una certa frequenza provocando una fastidiosi sintomi  o gravi o lesioni. a carico di esofago, faringe o tratto respiratorio.

Sintomatologia:

1. Pirosi gastrica: di solito si verifica dopo un pasto abbondante e in genere peggiora di notte o quando si è sdraiati.
2. Dolore toracico solitamente localizzato al centro del torace con irradiazione posteriore
3. Disfagia
4. senso di nodo alla gola
5. Tosse persistente

DIAGNOSI:

• anamnesi
• procedure diagnostiche:
  • • Endoscopia superiore:  consente di esaminare il rivestimento dell’esofago, dello stomaco e della prima parte dell’intestino tenue. È il test migliore per valutare le lesioni esofagee indotte dal reflusso e diagnosticare l’esofagite e l’esofago di Barrett . Può anche aiutare a diagnosticare una stenosi esofagea.
    • Test di reflusso (pH/impedenza pH wireless): consente di valutare l’attività del reflusso per un periodo di 48 ore mentre si continua con le normali attività.
    • Manometria esofagea: valuta la forza e la coordinazione delle contrazioni muscolari. Inoltre, testa la forza e la funzione di rilassamento dello sfintere esofageo inferiore. La manometria esofagea è una parte essenziale del processo di valutazione prima dell’intervento chirurgico antireflusso.
    • Esofagogramma con bario: sebbene non verifichi la presenza di reflusso, è utile per valutare lesioni esofagee.

TERAPIA

Esistono diversi approcci per trattare il GERD, tra cui farmaci e chirurgia. La maggior parte dei pazienti può usare efficacemente una combinazione di cambiamenti nello stile di vita e terapia farmacologica per trattare il GERD. Gli antiacidi possono offrire sollievo, i bloccanti dei recettori H2 possono ridurre la produzione di acido cloridrico mentre gli inibitori della pompa protonica possono bloccare la produzione di acido cloridrico.

• Neo-Bianacid® compresse masticabili, bustine (Poliprotect^® 528 mg, a base di Polisaccaridi (frazioni estrattive LPME di Malva e Altea; gel fogliare disidratato di Aloe Vera – 105 mg) e Minerali (Limestone e Nahcolite 423 mg); Frazione flavonoidica estrattiva LPME di Camomilla e Liquirizia – 46 mg; Zucchero di canna; Gomma arabica; Aroma di Menta/Limone).
• Digestivo Antonetto compresse masticabili

References:

1. Carroll W (14 October 2016). Gastroenterology & Nutrition: Prepare for the MRCPCH. Key Articles from the Paediatrics & Child Health journal. Elsevier Health Sciences. p. 130.
3. Hershcovici T, Fass R (April 2011). “Pharmacological management of GERD: where does it stand now?”. Trends in Pharmacological Sciences. 32 (4): 258–64.
4. Parker M (June 2010). “Book Review: Krause’s Food and Nutrition TherapyMahanLKEscott-StumpS. Krause’s Food and Nutrition Therapy. 12th ed. Philadelphia: Saunders; (2007). 1376 pp, $$149.95. 
5. Granderath FA, Kamolz T, Pointner R (2006). Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Springer Science & Business Media. p. 161.
6. Zajac P, Holbrook A, Super ME, et al. (March–April 2013). “An overview: Current clinical guidelines for the evaluation, diagnosis, treatment, and management of dyspepsia”. Osteopathic Family Physician. 5 (2): 79–85.
7. Kahrilas PJ (2008). “Gastroesophageal Reflux Disease”. The New England Journal of Medicine. 359 (16): 1700–7. 
8. Clarrett DM, Hachem C (May 2018). “Gastroesophageal Reflux Disease (GERD)”. Missouri Medicine. 115 (3): 214–218. 
9. “Esophagitis”. The Lecturio Medical Concept Library. Archived from the original on 22 July 2021. Retrieved 22 July 2021.
10. Shaheen NJ, Falk GW, Iyer PG, et al. (January 2016). “ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus”. Am. J. Gastroenterol. 111 (1): 30–50, quiz 51.
11. Lechien JR, Saussez S, Karkos PD (December 2018). “Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018”. Curr Opin Otolaryngol Head Neck Surg. 26 (6): 392–402.
12. Lechien JR, Bobin F, Muls V, et al. (December 2019). “Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response”. Laryngoscope. 130 (8): E479 – E489.
13. Fass R, Achem SR, Harding S, Mittal RK, Quigley E (December 2004). “Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux”. Alimentary Pharmacology & Therapeutics. 20 (Suppl 9): 26–38.
14. Ranjitkar S, Kaidonis JA, Smales RJ (2012). “Gastroesophageal Reflux Disease and Tooth Erosion”. International Journal of Dentistry. 2012: 479850.
15. Romano C, Cardile S (11 August 2014). “Gastroesophageal reflux disease and oral manifestations”. Italian Journal of Pediatrics. 40 (Suppl 1): A73.
16. ^ Lussi A, Jaeggi T (March 2008). “Erosion–diagnosis and risk factors”. Clinical Oral Investigations. 12 (Suppl 1): S5–13. doi:10.1007/s00784-007-0179-z. PMC 2238777. PMID 18228059.
17. ^ Donovan T (2009). “Dental erosion”. Journal of Esthetic and Restorative Dentistry. 21 (6): 359–364. doi:10.1111/j.1708-8240.2009.00291.x. PMID 20002921.
18. ^ and Barrett’s Esophagus Archived 19 April 2015 at the Wayback Machine. Retrieved on 1 February 2009.
19. ^ “Patient information: Barrett’s esophagus (Beyond the Basics)”. June 2009. Archived from the original on 9 September 2017.
20. ^ Sontag SJ (1999). “Defining GERD”. Yale J Biol Med. 72 (2–3): 69–80. PMC 2579007. PMID 10780568.
21. ^ Piesman M, Hwang I, Maydonovitch C, et al. (October 2007). “Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?”. American Journal of Gastroenterology. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791. S2CID 11965042.
22. ^ Ayazi S, Crookes PF, Peyre CG, et al. (September 2007). “Objective documentation of the link between gastroesophageal reflux disease and obesity”. American Journal of Gastroenterology. 102: S138 – S9. doi:10.14309/00000434-200709002-00059.
23. ^ Ayazi S, Hagen JA, Chan LS, et al. (August 2009). “Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms”. J. Gastrointest. Surg. 13 (8): 1440–7. doi:10.1007/s11605-009-0930-7. PMC 2710497. PMID 19475461.
24. ^ Morse CA, Quan SF, Mays MZ, et al. (2004). “Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?”. Clin. Gastroenterol. Hepatol. 2 (9): 761–8. doi:10.1016/S1542-3565(04)00347-7. PMID 15354276.
25. ^ Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). “Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review”. Sleep Med Rev. 11 (1): 47–58. doi:10.1016/j.smrv.2006.05.001. PMID 17198758.
26. ^ Tanaja J, Lopez RA, Meer JM (2022), “Cholelithiasis”, StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29262107, retrieved 30 October 2022
27. ^ O’Connor HJ (February 1999). “Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management”. Aliment Pharmacol Ther. 13 (2): 117–27. doi:10.1046/j.1365-2036.1999.00460.x. PMID 10102940. S2CID 41988457.
28. ^ El-Omar EM, Oien K, El-Nujumi A, et al. (1997). “Helicobacter pylori infection and chronic gastric acid hyposecretion”. Gastroenterology. 113 (1): 15–24. doi:10.1016/S0016-5085(97)70075-1. PMID 9207257.
29. ^ Fallone CA, Barkun AN, Mayrand S, et al. (October 2004). “There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori”. Aliment Pharmacol Ther. 20 (7): 761–8. doi:10.1111/j.1365-2036.2004.02171.x. PMID 15379836. S2CID 922610.
30. ^ Jump up to:^{a b c d e f g h i j k l m} Katz PO, Gerson LB, Vela MF (March 2013). “Guidelines for the diagnosis and management of gastroesophageal reflux disease”. American Journal of Gastroenterology. 108 (3): 308–28. doi:10.1038/ajg.2012.444. PMID 23419381.
31. ^ Jump up to:^{a b c d e f g} Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. (October 2008). “American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease”. Gastroenterology. 135 (4): 1383–91, 1391.e1–5. doi:10.1053/j.gastro.2008.08.045. PMID 18789939.
    • Lay summary in: “American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease”. National Guideline Clearinghouse. Archived from the original on 17 August 2010.
32. ^ Numans ME, Lau J, de Wit NJ, Bonis PA (April 2004). “Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics”. Annals of Internal Medicine. 140 (7): 518–27. doi:10.7326/0003-4819-140-7-200404060-00011. PMID 15068979. S2CID 53088422.
33. ^ Patient information: Barrett’s esophagus, archived from the original on 9 September 2017
34. ^ Mills, S (ed.) 2009.Sternberg’s Diagnostic Pathology. 5th Edition. ISBN 978-0-7817-7942-5
35. ^ Michael F. Vaezi, MD PhD MSc. “Testing for refractory gastroesophageal reflux disease” (PDF). Archived (PDF) from the original on 20 August 2018. Retrieved 20 August 2018.
36. ^ Stuart A. “Laryngopharyngeal Reflux (Silent Reflux): Causes, Treatment, Diet, and More”. WebMD. Retrieved 30 October 2022.
37. ^ Kellerman R, Kintanar T (December 2017). “Gastroesophageal Reflux Disease”. Primary Care. 44 (4): 561–573. doi:10.1016/j.pop.2017.07.001. ISSN 1558-299X. PMID 29132520.
38. ^ Jump up to:^{a b c d e} Using the Proton Pump Inhibitors to Treat Heartburn and Stomach Acid Reflux (PDF) (Report). Consumer Reports Best Buy Drugs. 2013. Archived (PDF) from the original on 22 February 2020. Retrieved 21 February 2020.
    • Lay summary in: “Choosing a PPI to Treat Heartburn, Acid Reflux & GERD” (PDF). Consumer Reports.
39. ^ Jump up to:^a b c Forgacs I, Loganayagam A (2008). “Overprescribing proton pump inhibitors”. BMJ. 336 (7634): 2–3. doi:10.1136/bmj.39406.449456.BE. PMC 2174763. PMID 18174564.
40. ^ Jump up to:^a b c Heidelbaugh JJ, Kim AH, Chang R, Walker PC (2012). “Overutilization of proton-pump inhibitors: What the clinician needs to know”. Therapeutic Advances in Gastroenterology. 5 (4): 219–232. doi:10.1177/1756283X12437358. PMC 3388523. PMID 22778788.
41. ^ Kaltenbach T, Crockett S, Gerson LB (2006). “Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach”. Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
42. ^ Newberry C, Lynch K (20 July 2017). “Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature”. Current Gastroenterology Reports. 19 (8): 38. doi:10.1007/s11894-017-0578-5. PMID 28730507. S2CID 39516312.
43. ^ Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Di Biase AR, Colecchia A (14 April 2009). “Body weight, lifestyle, dietary habits and gastroesophageal reflux disease”. World Journal of Gastroenterology. 15 (14): 1690–701. doi:10.3748/wjg.15.1690. PMC 2668774. PMID 19360912.
44. ^ Qiu K, Wang J, Chen B, Wang H, Ma C (March 2020). “The effect of breathing exercises on patients with GERD: a meta-analysis”. Annals of Palliative Medicine. 9 (2): 405–413. doi:10.21037/apm.2020.02.35. PMID 32233626.
45. ^ Gupta R, Marshall J, Munoz JC, et al. (2013). “Decreased acid suppression therapy overuse after education and medication reconciliation”. International Journal of Clinical Practice. 67 (1): 60–65. doi:10.1111/ijcp.12046. PMID 23241049. S2CID 37158104.
46. ^ Jump up to:^a b Nardino RJ, Vender RJ, Herbert PN (November 2000). “Overuse of acid-suppressive therapy in hospitalized patients”. American Journal of Gastroenterology. 95 (11): 3118–22. doi:10.1016/s0002-9270(00)02052-9. PMID 11095327.
47. ^ Jump up to:^a b McKay AB, Wall D (2008). “Overprescribing PPIs: An old problem”. BMJ. 336 (7636): 109.1–109. doi:10.1136/bmj.39458.462338.3A. PMC 2206261. PMID 18202040.
48. ^ Jump up to:^a b Tran T, Lowry AM, El-Serag HB (2007). “Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs”. Aliment Pharmacol Ther. 25 (2): 143–53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239. S2CID 24358990.
49. ^ Abbas AE, Deschamps C, Cassivi SD, et al. (2004). “The role of laparoscopic fundoplication in Barrett’s esophagus”. Annals of Thoracic Surgery. 77 (2): 393–6. doi:10.1016/S0003-4975(03)01352-3. PMID 14759403.
50. ^ Garg SK, Gurusamy KS (November 2015). “Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults”. Cochrane Database of Systematic Reviews. 2015 (11): CD003243. doi:10.1002/14651858.CD003243.pub3. PMC 8278567. PMID 26544951.
51. ^ Kurian AA, Bhayani N, Sharata A, et al. (January 2013). “Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia”. JAMA Surg. 148 (1): 85–90. doi:10.1001/jamasurgery.2013.409. PMID 23324843. S2CID 9136476.
52. ^ Ramos RF, Lustosa SA, Almeida CA, et al. (October–December 2011). “Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? systematic review and meta-analysis”. Arquivos de Gastroenterologia. 48 (4): 252–60. doi:10.1590/s0004-28032011000400007. PMID 22147130.
53. ^ Gatti C, di Abriola GF, Villa M, et al. (May 2001). “Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?”. Journal of Pediatric Surgery. 36 (5): 677–680. doi:10.1053/jpsu.2001.22935. hdl:2108/311079. PMID 11329564.
54. ^ Jump up to:^a b Morabito A, Lall A, Lo Piccolo R, et al. (May 2006). “Total esophagogastric dissociation: 10 years’ review”. Journal of Pediatric Surgery. 41 (5): 919–922. doi:10.1016/j.jpedsurg.2006.01.013. PMID 16677883.
55. ^ Goyal A, Khalil B, Choo K, et al. (June 2005). “Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?”. Journal of Pediatric Surgery. 40 (6): 915–919. doi:10.1016/j.jpedsurg.2005.03.004. PMID 15991170.
56. ^ Badillo R, Francis D (2014). “Diagnosis and treatment of gastroesophageal reflux disease”. World Journal of Gastrointestinal Pharmacology and Therapeutics. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
57. ^ Medical Device Approvals: LINX Reflux Management System – P100049 Archived 10 November 2013 at the Wayback Machine, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, Update of 17 January 2014
58. ^ Testoni, S, Hassan, C, Mazzoleni, G, Antonelli, G, Fanti, L, Passaretti, S, Correale, L, Cavestro, G, Testoni, P (2021). “Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis”. Endoscopy International Open. 9(2) (C2): E239 – E246. doi:10.1055/a-1322-2209. PMC 7857958. PMID 33553587.
59. ^ Jain D, Singhal S (March 2016). “Transoral Incisionless Fundoplication for Refractory Gastroesophageal Reflux Disease: Where Do We Stand?”. Clinical Endoscopy. 49 (2): 147–56. doi:10.5946/ce.2015.044. PMC 4821522. PMID 26878326.
60. Hopkins J, Switzer NJ, Karmali S (25 August 2015). “Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review”. World Journal of Gastrointestinal Endoscopy. 7 (11): 1039–44. 
61. Body C, Christie JA (June 2016). “Gastrointestinal Diseases in Pregnancy: Nausea, Vomiting, Hyperemesis Gravidarum, Gastroesophageal Reflux Disease, Constipation, and Diarrhea”. Gastroenterology Clinics of North America. 45 (2): 267–283.
62. Mahadevan U, Kane S (July 2006). “American gastroenterological association institute medical position statement on the use of gastrointestinal medications in pregnancy”. Gastroenterology. 131 (1): 278–82.
63. Katz PO, Gerson LB, Vela MF (March 2013). “Guidelines for the diagnosis and management of gastroesophageal reflux disease”. American Journal of Gastroenterology. 108 (3): 308–28.
64. Infant acid reflux – Diagnosis and treatment – Mayo Clinic”. www.mayoclinic.org. Archived from the original on 14 May 2020. Retrieved 28 September 2018.
65. ^ Tighe MP, Afzal NA, Bevan A, Beattie RM (2009). “Current pharmacological management of gastro-esophageal reflux in children: an evidence-based systematic review”. Paediatr Drugs. 11 (3): 185–202.
66. van der Pol RJ, Smits MJ, van Wijk MP, et al. (May 2011). “Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review”. Pediatrics. 127 (5): 925–35.
67. Elser HE (2012). “Positioning after feedings: what is the evidence to reduce feeding intolerances?”. Advances in Neonatal Care. 12 (3): 172–175.
68. Fedorak RN, Veldhuyzen van Zanten S, Bridges R (July 2010). “Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal reflux disease in Canada: Incidence, prevalence, and direct and indirect economic impact”. Canadian Journal of Gastroenterology. 24 (7): 431–4. 
69. Kim YS, Kim N, Kim GH (30 October 2016). “Sex and Gender Differences in Gastroesophageal Reflux Disease”. Journal of Neurogastroenterology and Motility. 22 (4): 575–588.
70. ^ HINES JR, GEURKINK RE, KORNMESSER TA, WIKHOLM L, DAVIS RP (1975). “Vagotomy and Double Pyloroplasty for Peptic Ulcer”. Annals of Surgery. 181 (1): 40–46. 
71. Jafri SM, Arora G, Triadafilopoulos G (July 2009). “What is left of the endoscopic antireflux devices?”. Current Opinion in Gastroenterology. 25 (4): 352–7. 
72. Lipka S, Kumar A, Richter JE (June 2015). “No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis”. Clinical Gastroenterology and Hepatology. 13 (6): 1058–67.e1.
73. Perry KA, Banerjee A, Melvin WS (August 2012). “Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis”. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 22 (4): 283–8.
74. Testoni PA, Vailati C (August 2012). “Transoral incisionless fundoplication with EsophyX® for treatment of gastro-oesphageal reflux disease”. Digestive and Liver Disease. 44 (8): 631–5.