REFLUSSO GASTROESOFAGEO: PAZIENTI DIFFICILMENTE TRATTABILI
In civilized countries, those defined as "rich", 20% of adults complain of gastroesophageal disorders (heartburn, acid regurgitation) and of these 10% are afflicted daily.
Gastroesophageal reflux is a disease whose cause is pathological regurgitation of acid stomach contents into the esophagus, resulting in inflammation of its mucous membrane.
In a recent study by Italian famous clinics assessed the direct medical costs of disease and concluded that "in some cases despite therapy with the adoption of Proton Pump Inhibitors (PPIs), patients remain symptomatic and are therefore defined as" difficult " because it is difficult to achieve improvement.
costs for 10 years of drug treatment and / or preservation of the chronic gastropathy were significantly higher than those of surgical treatment.
Statistics showed that 10% of the 10 million Italians with gastro esophageal reflux disease (GERD) complain about noise offenders can not be treated pharmacologically.
The causes are many: atonic lower esophageal sphincter, hiatal hernia, acid irritation of the juice and / or hypertrophy, or spasticity of the lower sphincter of the stomach, namely the pylorus.
One of the reasons more consistent, but also among the most difficult to diagnose, is the slow gastric emptying. The survey
more frequent and useful for a correct diagnosis is endoscopy, however, is not efficient to investigate the movements of the muscles esophageal, gastric and duodenal ulcers.
The most useful test is to run with the X-ray barium meal because it simulates the passage of food bolus, and allows you to see the behavior of the sphincter of the esophagus and gastric motility.
When gastroesophageal reflux is continuous and lasts over time can lead, years later, chronic esophagus (Barrett esophagus) that may become dangerous cancer.
For patients recently treated pharmacologically ("difficult patients"), the only therapeutic alternative può essere quella chirurgica che va indicata a seconda delle caratteristiche più o meno complesse del singolo individuo.
(vedi CURENTI MEDICAL DIAGNOSIS & TREATMENT e SURGICAL CLINICS OF NORTH AMERICA)
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