Trastornos funcionales y motores digestivos | Gastroenterología y Hepatología

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Resumen

Resumimos y comentamos los trabajos que nos han parecido de mayor interés de los que fueron presentados en el congreso de la Asociación Gastroenterológica Americana (Digestive Diseases Week [DDW]). Los trastornos funcionales digestivos (TFD) son muy complejos, tanto desde el punto de vista clínico como fisiopatológico. Es poco probable que una sola causa pueda explicar síntomas tan heterogéneos como los presentes en la dispepsia funcional (DF) o el síndrome del intestino irritable (SII). Por tanto, es más fácil (y más útil) intentar comprender los TFD de acuerdo a un modelo biopsicosocial. Además, cada vez son más convincentes los datos que refuerzan la importancia conjunta de los factores genéticos, orgánicos y psicológicos en la aparición y permanencia de los TFD. De hecho, este año se aportan nuevos datos sobre farmacogenética en la gastroparesia, sobre microinflamación o alteraciones en la modulación de la sensibilidad somática y visceral en la DF, o sobre el impacto de los factores psicológicos en el SII. Desde el punto de vista terapéutico se aporta más información acerca del papel de los probióticos, sobre el efecto antinociceptivo demostrado en varios trabajos presentados este año de la linaclotida, o sobre la elevada eficacia de la hipnoterapia en pacientes con SII. Finalmente, también son interesantes los datos presentados para el manejo clínico de los pacientes con estreñimiento por disinergia del suelo pélvico, y respecto de la seguridad y la eficacia de prucaloprida en pacientes con estreñimiento grave.

Palabras clave:

Trastornos funcionales digestivos

Dispepsia funcional

Síndrome del intestino irritable

Estreñimiento funcional ;Incontinencia

Abstract

We summarize and discuss the studies presented at the congress of the American Association of Gastroenterology (Digestive Disease Week) that, in our opinion, are of greatest interest. Both clinically and physiopathologically, functional gastrointestinal (GI) disorders are highly complex. A single cause is unlikely to explain symptoms as heterogeneous as those of functional dyspepsia and irritable bowel syndrome (IBS). Therefore, it is easier (and more useful) to try to understand functional GI disorders using a bio-psycho-social model. Moreover, data supporting the combined importance of genetic, organic and psychological factors in the onset and persistence of functional GI disorders are increasingly convincing. This year, new data have been provided on pharmacogenetics in gastroparesis, on microinflammation or alterations in the modulation of somatic and visceral sensitivity in functional dyspepsia, and on the impact of psychological factors in IBS. From the therapeutic point of view, further information has been provided on the role of probiotics, the antinociceptive effect of linaclotide (demonstrated in several studies presented this year), and on the high efficacy of hypnotherapy in patients with IBS. Finally, data on the clinical management of patients with constipation due to pelvic floor dyssynergia and on the safety and efficacy of prucalopride in patients with severe constipation were also of interest.

Keywords:

Functional gastrointestinal disorders

Functional dyspepsia

rritable bowel syndrome

Functional constipation

Incontinence

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