Article information
Resumen
Como cada año en el congreso de la Asociación Gastroenterológica Americana (Digestive Diseases Week [DDW]), se han presentado muchísimos trabajos, unos mejores y otros no tan buenos, de los que hemos intentado hacer una labor de discriminación y de síntesis. En términos generales, podemos decir que se consolidan ciertos avances tecnológicos, con incorporación plena a la práctica clínica, como la impedanciometría y la manometría de alta resolución. Surgen nuevos datos fisiopatológicos que apuntan aún más a la unificación y conexión inexorable de los aspectos orgánicos y psicológicos (modelo biopsicosocial) en los trastornos funcionales digestivos (TFD).
Se pusieron muchas esperanzas en los criterios de Roma III para mejorar el diagnóstico de los TFD y, en especial, de la dispepsia funcional. Sin embargo, su aplicación práctica ha sido bastante desalentadora. Además, al menos 2 estudios han comprobando que dichos criterios son poco discriminativos para diferenciar los subtipos de DF y que existe mucho solapamiento con la enfermedad por reflujo gastroesofágico.
Respecto a los 2 principales TFD, la dispepsia funcional y el síndrome del intestino irritable (SII), se presentaron nuevos datos sobre la importancia de los factores genéticos, microinflamatorios o psicológicos en la etiopatogenia de ambos trastornos. Desde el punto de vista terapéutico se presentaron resultados de la eficacia y seguridad de acotiamida en la dispepsia funcional, y de linaclotida y prucaloprida en el estreñimiento, tanto idiopático como asociado al SII.
Diversos estudios, e incluso metaanálisis, han demostrado la utilidad del biofeedback en el tratamiento del estreñimiento. Aun así, su eficacia se ha puesto en duda debido a ciertas deficiencias metodológicas de algunas investigaciones. En este DDW se presentaron trabajos que confirman la utilidad del biofeedback, ya sea hospitalario o domiciliario, en el estreñimiento por disinergia.
Se recogen también algunos aspectos de especial interés en el diagnóstico y tratamiento del síndrome de rumiación, del dolor torácico de posible origen esofágico y del síndrome de hiperemesis por canabinoides.
Palabras clave:
Acalasia
Dispepsia funcional
Estreñimiento funcional
Linaclotida
Motilidad digestiva
Incontinencia
Síndrome del intestino irritable
Trastornos funcionales digestivos
Prucaloprida
Abstract
As in previous years, a huge number of studies were presented at the Congress of the American Gastroenterology Association (Digestive Diseases Week [DDW]), some of which were better than others. The present article attempts to extract and summarize the most interesting findings reported. In general terms, certain technological advances have been consolidated, with full incorporation into clinical practice, such as impedancemetry and high-resolution manometry. New physiopathological data are coming to light that increasingly indicate the inextricable link between organic and psychological factors (the biopsychosocial model) in functional gastrointestinal disorders (FGID).
Despite the high hopes that the Rome III criteria would improve the diagnosis of FGID and especially that of functional dyspepsia, their practical application has been fairly discouraging. Moreover, at least two studies have demonstrated that these criteria cannot be used to differentiate subtypes of functional dyspepsia and that there is wide overlap with gastroesophageal reflux disease.
New data were presented on the role of genetic, microinflammatory and psychological factors in the etiopathogenesis of the two main FGID: functional dyspepsia and irritable bowel syndrome (IBS). The results on the safety and efficacy of acotiamide in functional dyspepsia and of linaclotide and prucalopride in idiopathic and IBS-associated constipation were also presented.
Several studies, and even meta-analyses, have demonstrated the utility of biofeedback in the treatment of constipation. Even so, the efficacy of this therapy has been questioned due to certain methodological deficiencies in some studies. In DDW 2011, studies confirming the utility of biofeedback, whether hospital- or home-based were presented, in dyssynergy constipation.
The present article also mentions certain features of special interest in the diagnosis and treatment of rumination syndrome, thoracic pain of possible esophageal origin and cannabinoid-induced hyperemesis syndrome.
Keywords:
Achalasia
Functional dyspepsia
Functional constipation
Linaclotide
Gastrointestinal motility
Incontinence
Irritable bowel syndrome
Functional gastrointestinal disorders
Prucalopride
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