Venezuelan consensus on gastroesophageal reflux diseases [Primer consenso Venezolano de Enfermedad por Reflujo Gastroesofágico]
Por:
González J.C., Louis C.E., Piñero R.E., Rangel R., Aldana L., Angelosante S., Aponte R., Aure C., Bandres D., Bethelmy A., Bronstein M., Castillo J., Castro D., Dib J., Dolfo W., Fernandez S., Folkmanas W., Fonseca A., Galvis E., Garcia J.G., Gumina C., Guzmán A., Latuff Z., Lindado C.E., López O., Mago V., Marichal J., Marín B., Mora N., Parra C., Parra L., Ruiz M.E., Saavedra M., Salas Z., Salazar P., Silva O., Sosa L., Tenia J.C., Useche E., Urbina B., Urquiola G., Uzcategui A., Valenciano M., Velasco V., Yasin G., Rojas G., Sánchez N., Soles R., Castellano C., Medina G., Sacca F., Santamaría L., Betancourt C., Cova J., Tepedino D., Pérez H., Dos Reis V.
Publicada:
1 ene 2011
Resumen:
The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela. The coordinators established the consensus lines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome and in esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility, increase the tone of the lower esophagic sphincter and accelerate gastric emptying (Grade B). Surgical treatment is indicated in selected patients where laparoscopy and the partial fundoplication have less complications (Grade B). Endoscopic treatment is controversial and is not recommended by this consensus until new techniques arise or the existent ones are perfected. (Grade B).
Filiaciones:
Servicio y Cátedra de Clínica Gastroenterológica, Hospital Universitario de Caracas, Facultad de Medicina. Universidad Central de Venezuela, Caracas. Distrito Capital, Venezuela
Cátedra de Gastroenterología, Hospital Vargas, Facultad de Medicina. Universidad Central de Venezuela, Distrito Capital, Venezuela
Hospital Universitario de Maracaibo, Estado Zulia, Venezuela
Centro Médico Maracay, Estado Aragua, Venezuela
Centro Médico Dr. Rafael Guerra Méndez, Valencia. Estado Carabobo, Venezuela
Centro Médico Docente La Trinidad, Estado Miranda, Venezuela
Hospital Universitario Antonio María Pineda, Barquisimeto. Estado Lara, Venezuela
Hospital Oncológico Padre Machado, Caracas. Distrito Capital, Venezuela
Policlínica Barquisimeto, Barquisimeto. Estado Lara, Venezuela
Centro de Control de Cáncer Dr. Luis E. Anderson, San Cristóbal. Estado Táchira, Venezuela
Hospital General Dr. Jesús Yerena, Lídice. Caracas. Distrito Capital, Venezuela
CAMIULA Universidad de los Andes, Mérida. Estado Mérida, Venezuela
Hospital General del Oeste Dr. José Gregorio Hernández, Los Magallanes. Caracas. Distrito Capital, Venezuela
Centro Policlínico Valencia (La Viña), Valencia. Estado Carabobo, Venezuela
Clinica San Pablo, Carúpano. Estado Sucre, Venezuela
Policlínica Paraguaná, Punto Fijo. Estado Falcón, Venezuela
Hospital General César Rodríguez IVSS, Grupo Médico Puerto La Cruz, Puerto La Cruz. Estado Anzoátegui, Venezuela
Clínica San Vicente de Paul, Cumaná. Estado Sucre, Venezuela
Policlínica Maturín, Maturín. Estado Monagas, Venezuela
Clínica Centro Médico El Valle, Estado Nueva Esparta, Venezuela
Hospital Central Pedro Emilio Carrillo, Valera. Estado Trujillo, Venezuela
Hospital El Rosario, Maracaibo. Estado Zulia, Venezuela
Clínica Chilemex, Puerto Ordaz. Estado Bolívar, Venezuela
Instituto de Anatomía Patológica, Dr. José Antonio O'Daly, Universidad Central de Venezuela, Distrito Capital, Venezuela
Cátedra de Otorrinolaringología, Facultad de Medicina, Universidad Central de Venezuela, Caracas. Distrito Capital, Venezuela
Centro Médico Paso Real, Charallave. Estado Miranda, Venezuela
Hospital Luis Razetti, Barinas. Estado Barinas, Venezuela
Centro Profesional Costa Verde, San Carlos. Estado Cojedes, Venezuela
Clínica Loira, Caracas. Distrito Capital, Venezuela
Unidad Gastroquirúrgica Vemotilecos, Caracas. Distrito Capital, Venezuela
Centro Médico Paraíso, Maracaibo. Estado Zulia, Venezuela
Gastroenterólogos en curso de ampliación de endoscopia terapéutica, Servicio de Gastroenterología, Hospital Universitario de Caracas, Venezuela
Residentes de Gastroenterología, Servicio y Cátedra de Clínica Gastroenterológica, Hospital Universitario de Caracas. Facultad de Medicina. Universidad Central de Venezuela, Caracas. Distrito Capital, Venezuela
Docente de la Cátedra de Gastroenterología Escuela de Medicina Luis Razetti, Facultad de Medicina, UCV, Venezuela
Adjunto Servicio de Gastroenterología, HUC, Venezuela
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