Publication: Calibración intraoperatoria de la funduplicatura tipo Nissen laparoscópica: resultados de la bujía intraluminal y la manometría de alta resolución
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2017-09-04
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Universidad Complutense de Madrid
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Abstract
La importancia de la enfermedad por reflujo gastroesofágico (ERGE) radica en la gran afectación de la calidad de vida que produce en los individuos que la padecen así como en la posibilidad de desembocar en complicaciones graves. Hoy en día entendemos por ERGE la condición que se produce cuando el contenido ácido del estómago en el esófago causa sintomatología que afecta a la calidad de vida del paciente y/o complicaciones2, 3. Esta sintomatología la constituyen pirosis, regurgitación, disfagia y otros síntomas no tan típicos como el dolor torácico o la tos nocturna. La prevalencia de la enfermedad ha ido en aumento progresivamente en los últimos años, sobre todo en el mundo occidental4, en probable relación con los hábitos higiénicodietéticos y del estilo de vida. La clave para entender y tratar la ERGE está en el conocimiento de su fisiopatología, y con ella, de la barrera antirreflujo5, constituida por todos aquellos factores que intervienen en el control del paso del contenido ácido del estómago hacia el esófago. Esta barrera tiene cuatro componentes fundamentales: fibras musculares oblicuas del cardias, “crura” diafragmática, anclaje del esófago intraabdominal mediante la membrana frenoesofágica y el esfínter esofágico inferior en sí mismo6. Todos estos componentes están íntimamente relacionados. Así, la presencia o ausencia de reflujo ácido patológico en el esófago no sólo está relacionada con una pérdida de la integridad del EEI, sino también con alteraciones anatómicas que alteran la disposición de la UGE o alteraciones de la motilidad gástrica que a su vez tiene repercusión en la relajación del EEI...
The importance of gastroesophageal reflux disease (GERD) resides in the restriction of quality of life for the people who suffer from the disease, as well as the possibility of developing serious complications. Nowadays we refer to GERD as the disease that is produced when acid content from the stomach in contact with the esophageal mucosa causes symptoms which affect the quality of life of the patient or produce complications. The possible symptoms are pyrosis, regurgitation, dysphagia, and other less frequent symptoms such as chest pain or nighttime cough. The prevalence of this disease has increased progressively in the past few years, mostly in the western hemisphere, probably related to diet and lifestyle. The key to understanding and treating GERD lies in knowing its pathophysiology, as well as that of the antireflux barrier, which consists of all factors involved in regulating the passage of acidic gastric content into the esophagus. This barrier has four main components: the oblique muscle fibers in the cardias, the diaphragmatic "crura", the phrenoesophageal membrane that provides anchorage to the esophagus, and the lower esophageal sphincter (LES) itself. All these components are intimately related. The presence or absence of pathologic reflux is not only due to the loss of integrity of the LES, but also to anatomic alterations that interfere with the gastroesophageal junction (GEJ) and gastric motility problems with repercussions on LES relaxation...
The importance of gastroesophageal reflux disease (GERD) resides in the restriction of quality of life for the people who suffer from the disease, as well as the possibility of developing serious complications. Nowadays we refer to GERD as the disease that is produced when acid content from the stomach in contact with the esophageal mucosa causes symptoms which affect the quality of life of the patient or produce complications. The possible symptoms are pyrosis, regurgitation, dysphagia, and other less frequent symptoms such as chest pain or nighttime cough. The prevalence of this disease has increased progressively in the past few years, mostly in the western hemisphere, probably related to diet and lifestyle. The key to understanding and treating GERD lies in knowing its pathophysiology, as well as that of the antireflux barrier, which consists of all factors involved in regulating the passage of acidic gastric content into the esophagus. This barrier has four main components: the oblique muscle fibers in the cardias, the diaphragmatic "crura", the phrenoesophageal membrane that provides anchorage to the esophagus, and the lower esophageal sphincter (LES) itself. All these components are intimately related. The presence or absence of pathologic reflux is not only due to the loss of integrity of the LES, but also to anatomic alterations that interfere with the gastroesophageal junction (GEJ) and gastric motility problems with repercussions on LES relaxation...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 01-02-2016