Enfoque diagnóstico y terapéutico de dispepsia y dispepsia funcional: ¿qué hay nuevo en el 2019? / Diagnostic and therapeutic approach to dyspepsia and functional dyspepsia: what's new in 2019?

La dispepsia abarca un conjunto de síntomas que se originan en la región gastroduodenal. Se caracteriza por dolor o ardor epigástrico, saciedad precoz y llenura pos-prandial. Según la relación de los síntomas con las comidas se divide en síndrome de dolor epigástrico y síndrome de malestar pos-prandial. Sin embargo, en la práctica clínica, frecuentemente se sobreponen. En los últimos años se ha cambiado el paradigma de las alteraciones fisiológicas gástricas y han aumentado las evidencias que apoya a la eosinofilia duodenal, como una alteración primaria que altera la fisiología gástrica y puede inducir la sintomatología. Así mismo, cada día hay mayor interés en la alteración de la microbiota. El tratamiento se basa en la supresión de ácido, procinéticos, neuromoduladores, psicoterapia, terapias alternativas y complementarias. Ningún tratamiento es universalmente eficaz en todos los pacientes.

Dyspepsia encompasses a set of symptoms that originate in the gastroduodenal region. It is characterized by pain or epigastric burning, early satiety and post-prandial fullness. According to the relationship of symptoms with meals, it is divided into epigastric pain syndrome and postprandial distress syndrome. However, in clinical practice, they frequently overlap. In recent years the paradigm of gastric physiological alterations has been changed and evidence supporting duodenal eosinophilia has increased, as a primary alteration that alters gastric physiology and can induce symptomatology. Every day there is more interest in the alteration of the microbiota. The treatment is based on the suppression of acid, neuromodulators, prokinetics, psychotherapy, alternative and complementary therapies. No treatment is effective in all patients.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Trastornos funcionales gastrointestinales: metoclopramida, domperidona y trimebutina / Functional gastrointestinal disorders: metoclopramide, domperidone and trimebutine

Muchos de los síntomas digestivos en niños, no están asociados a cambios patológicos, osea, en los trastornos funcionales no hay alteración en la mucosa, como tampoco en la endoscopia. Estas alteraciones son muy amplias, no solamente incluye el reflujo gastroesofágico. Los procinéticos aumentan la actividad colinérgica. La metoclopramida, es un antagonista dopaminérgico que aumenta el tono del esfínter esofágico inferior y mejora el vaciamiento gástrico. La domperidona, es un antagonista periférico de la dopamina con propiedades procinéticas y antieméticas. La trimetutina, es un regulador de la motilidad del tracto digestivo inferior.

Many of the gastrointestinal symptoms in children are not associated with pathological changes, that is, in functional disorders there is no alteration in the mucosa, nor in endoscopy. These changes are extensive, not only includes gastroesophageal reflux. Prokinetics increase cholinergic activity. Metoclopramide is a dopaminergic antagonist that increases lower esophageal sphincter tone and enhances gastric emptying. Domperidone is a peripheral dopamine antagonist with prokinetic and antiemetic properties. Trimetubine, is a regulator of the lower digestive tract motility.

Grandes síndromes gastrointestinales (2): Dispepsia o síndrome del aparato digestivo alto relacionado con alimentos (I) / Major Gastrointestinal Syndromes (2: Dyspepsia Syndrome or High Digestive Diseases associated with food (I)

Exponemos, esta vez, nuestras ideas y hallazgos sobre la definición, la clasificación y los síntomas cardinales del síndrome dispepsia.

We expose, this time, our ideas and findings on the definition, the classification and thecardinal symptoms of the dyspeptic syndrome.

Dispepsia funcional / Functional dyspepsia

Functional dyspepsia is a digestive alteration, characterized by pain or discomfort, localized in upper abdome, with-out evidence of organic or morphological alterations. This is a review on dyspepsia, its classification, etiology, physiopathology, with emphasis ondiagnosis and treatment

Dispepsia: análisis de un tema controversial / Dyspepsia: analysis of a controversial matter

Se analiza el concepto actual de dispepsia, tema de permanente controversia y revisión, que reúne síntomas de alta prevalencia en todo el mundo.En los últimos años se ha pretendido precisar su definición, establecer sus mecanismos etiopatogénicos y su relación con la clínica, así como la clasificación en subgrupos con el fin de orientar hacia una indicación más racional de las técnicas complementarias de diagnóstico.Una mayor aproximación parece alcanzarse pero aún estamos lejos de conocer con exactitud lo que realmente ocurre.En relación con los nuevos conceptos, se plantea la selección de una terapéutica más específica dentro del amplio arsenal de medicamentos donde no resulta fácil diferenciar el efecto placebo del real beneficio

Re-definiendo dispepsia / Dyspepsia

En los últimos años el concepto de dispepsia está en discusión, por su prevalencia y porque sus síntomas podrían indicar una enfermedad seria. Hay problemas de terminología, se consideran aspectos funcionales u orgánicos, se llama dispepsia ulcerosa ó dispepsia no ulcerosa, cuestiones de ubicación de sub grupos de dispepsia, de diagnóstico y de manejo. En este trabajo se hace una revisión sobre la definición y etiología de la dispepsia

Dispepsia näo-ulcerosa / Non ulcer dyspepsia

Non ulcer dyspepsia is defined as the presence of pain and/or discomfort localized to the upper abdomen, episodic or persistent, with a duration superior of 4 weeks, in the absecence of any organic lesion or sistemic disease. In order to facilitate its management, non ulcer dyspepsia is classified in five typres: 1) gastroesophageal reflux disease; 2) ulcer-like disease; 3) motility disorders; 4) aerophagia; 5) diopatic. The main clinic and pathophysiologic characteristics of each type are discussed. The diagnosis is basead in the clinical picture and in the negative results of some exams (endoscopy, ultrasound) and sugestive results of others (manometry, contrast X-ray, 24 hour pHmetry and gastric emptying time). The treatment may be divided in general (diet, behaviour, phychologic measures) and pharmacological approach (antiacids, H2blockers, procinetic agents). Each case should be individualized in terms of the presence of its main symptoms. Emphasis is put on the psychologic features and their adequate approach by the physician