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Manifestaciones de esclerosis sistémica en el aparato digestivo. Clínicas, endoscópicas y por manometría
Resumen
Introducción: las alteraciones gastrointestinales se presentan hasta en 90 % de los pacientes con esclerosis sistémica. El objetivo de esta investigación fue determinar las manifestaciones gastroesofágicas clínicas, endoscópicas y por manometría en dicha enfermedad.
Material y métodos: se estudiaron 60 pacientes con edad promedio de 48 ± 11 años, y evolución de la enfermedad de 11 ± 8 años. Se les realizó endoscopia del tubo digestivo superior y manometría esofágica.
Resultados: las manifestaciones clínicas fueron disfagia 80 %, pirosis y regurgitación 78 %; las endoscópicas, esofagitis 60 %, hernia hiatal 65 %, hiato laxo 15 % y esófago de Barrett 18 %; en la manometría, esfínter esofágico inferior hipotenso 95 %. Se encontró aperistalsis 41 %, hipomotilidad leve 30 % e hipomotilidad intensa 27 %. Las manifestaciones gástricas fueron saciedad temprana 45 %, dolor en epimesogastrio 35 %, náusea 20 %, vómito 10 %. Por endoscopia se observó alteraciones gastricas en 80%, de los cuales 40 % de gastropatía no erosiva, 30 % erosiva y 10 % nodular.
Conclusiones: las alteraciones endoscópicas más frecuente fueron esofagitis y hernia hiatal; por manometría, esfínter esofágico inferior hipotenso y aperistalsis, alteraciones que traducen trastornos de la motilidad y disfunción del esfínter esofágico inferior. El esófago de Barrett siempre se asoció a hernia hiatal.
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