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Impacto de la optimización del tratamiento en pacientes con enfermedad por reflujo gastroesofágico que tienen falta de respuesta clínica al IBP. Fase 1

dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional
dc.contributor.advisorOtero Regino, William Alberto
dc.contributor.authorLozano Martínez, Janer Nelson
dc.date.accessioned2020-08-24T21:54:30Z
dc.date.available2020-08-24T21:54:30Z
dc.date.issued2020-06-01
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/78202
dc.description.abstractIntroduction: Gastroesophageal reflux disease (GERD) affects one in eight people in Colombia. Its characteristic symptoms are heartburn and regurgitation. The cornerstone of treatment is proton pump inhibitors (PPIs) with a clinical response of 58%-80%. In non-responders 75%-90% have a superimposed functional disorder and could be treated by adding visceral neuromodulators such as amitriptyline. Objective: To evaluate the impact of optimizing treatment in patients with GERD when there is no response to esomeprazole (ESO). Materials and methods: Prospective study in patients with no clinical response (> 2 episodes of reflux/week) treated with ESO half an hour before meals and simultaneously recommendations for weight loss if BMI> 25, stop smoking, stress control and finally increased the dose of ESO to 40 mg on an empty stomach and before dinner. When all the above was done and symptoms persisted, amitriptyline 12.5 mg was added overnight. Every 12 weeks the response was evaluated. Results: 149 patients were included. Optimizing treatment, 111 patients had a clinical response without using amitriptyline (74.5%; 95% CI 67.2%-81.4%). In 22 amitriptyline was added (14.8%), responding 15 patients, 68.2% (95% CI 47.04%-89.32%). A relationship was found between PPI compliance and clinical response (p <0.0001). Conclusion: In patients with GERD and non-response to PPI (ESO), sequential optimization achieved cumulative improvement in symptom control in 86% (95% CI 78.6% -90.4%) of patients, avoiding costly esophageal studies. Key Words: Optimize treatment, PPI, neuromodulator, compliance, clinical response.
dc.description.abstractIntroducción: La Enfermedad por reflujo gastroesofágico (ERGE) afecta en Colombia a una de cada ocho personas. Sus síntomas característicos son pirosis y regurgitación. La piedra angular del tratamiento son los inhibidores de bomba de protones (IBP) con respuesta clínica en 58%-80%. En quienes no responden 75%-90% tienen un trastorno funcional superpuesto y se podrían tratar adicionando neuromoduladores viscerales como la amitriptilina. Objetivo: Evaluar el impacto que tiene optimizar el tratamiento en pacientes con ERGE cuando no hay respuesta a esomeprazol (ESO). Materiales y métodos: Estudio prospectivo en pacientes sin respuesta clínica (>2 episodios de reflujo/semana) tratados con ESO media hora antes de las comidas y simultáneamente recomendaciones para bajar de peso si el IMC>25, dejar de fumar, control del estrés y finalmente aumentado la dosis de ESO a 40 mg en ayunas y antes de cena. Cuando se cumplió todo lo anterior y persistían los síntomas, se adicionó amitriptilina 12,5 mg por la noche. Cada 12 semanas se evaluaba la respuesta. Resultados: Se incluyeron 149 pacientes. Optimizando el tratamiento, 111 pacientes tuvieron respuesta clínica sin utilizar amitriptilina (74,5%; IC95% 67,2%-81,4%). En 22 se adicionó amitriptilina (14.8%), respondiendo 15 pacientes, 68.2% (IC95% 47,04%-89,32%). Se encontró relación entre cumplimiento del tratamiento con IBP y la respuesta clínica (p<0.0001). Conclusión: En pacientes con ERGE y falta de respuesta al IBP (ESO), la optimización secuencial logró mejoría acumulativa en el control de los síntomas del 86% (IC95% 78,6%-90,4%) de los pacientes evitando estudios esofágicos costosos. Palabras Clave: Optimización, IBP, neuromodulador, cumplimiento, respuesta clínica.
dc.format.extent103
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc610 - Medicina y salud
dc.subject.ddc616 - Enfermedades
dc.subject.ddc611 - Anatomía humana, citología, histología
dc.titleImpacto de la optimización del tratamiento en pacientes con enfermedad por reflujo gastroesofágico que tienen falta de respuesta clínica al IBP. Fase 1
dc.typeOtro
dc.rights.spaAcceso abierto
dc.type.driverinfo:eu-repo/semantics/other
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Especialidad en Gastroenterología
dc.description.degreelevelEspecialidades Médicas
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.proposaloptimize treatment
dc.subject.proposaloptimización
dc.subject.proposalgastroesophageal reflux disease
dc.subject.proposalenfermedad por reflujo gastroesofágico
dc.subject.proposalinhibidor de bomba de protones IBP
dc.subject.proposalproton pump inhibitor PPI
dc.subject.proposalcompliance
dc.subject.proposalcumplimiento
dc.subject.proposalneuromodulador
dc.subject.proposalneuromodulator
dc.subject.proposalclinical response
dc.subject.proposalrespuesta clínica
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dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
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