MANIFESTĂRI EXTRADIGESTIVE ÎN BOALA DE REFLUX

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  • UNIVERSITATEA DE MEDICIN I FARMACIE GRIGORE T. POPA IAI

    MANIFESTRI EXTRADIGESTIVE N BOALA DE

    REFLUX GASTROESOFAGIAN

    Rezumatul tezei de doctorat

    Conductor tiinific:

    PROF. UNIV. DR. GHEORGHE BLAN

    Doctorand:

    OANA-BOGDANA LEONTE (BRBOI)

    2016

  • 1

    CUPRINS

    LISTA ABREVIERILOR ................................................................................................................ i

    INTRODUCERE ............................................................................................................................ ii

    PARTEA GENERAL

    I. DATE GENERALE. ISTORIC. DEFINIII .............................................................................. 1

    II. EPIDEMIOLOGIE ..................................................................................................................... 3

    II.1. Boala de reflux gastroesofagian .......................................................................................... 3

    II.2. Boala de reflux gastroesofagian cu manifestri extradigestive ........................................... 5

    III. ETIO-FIZIOPATOGENIE ....................................................................................................... 7

    III.1. Mecanisme fiziopatogenice ............................................................................................... 7

    III.1.1. Incompetena barierei antireflux .................................................................................. 7

    III.1.2. Dezechilibrul dintre factorii de agresiune i de aprare a mucoasei esofagiene ......... 9

    III.2. Factori etiopatogenici......................................................................................................... 9

    III.2.1. Oxidul nitric ................................................................................................................. 9

    III.2.2. Factorii comportamentali ............................................................................................. 9

    III.2.3. Infecia cu Helicobacter pylori .................................................................................. 10

    III.2.4. Stresul psihic.............................................................................................................. 11

    III.2.5. Factorii genetici ......................................................................................................... 11

    III.3. Boala de reflux gastroesofagian cu manifestri extradigestive ........................................ 11

    III.3.1. Boala de reflux gastroesofagian i laringita cronic .................................................. 12

    III.3.2. Boala de reflux gastroesofagian i tusea cronic ....................................................... 12

    III.3.3. Boala de reflux gastroesofagian i astmul bronic .................................................... 13

    III.3.4. Boala de reflux gastroesofagian i eroziunile dentare ............................................... 13

    III.3.5. Boala de reflux gastroesofagian i pseudoangina ...................................................... 13

    IV. DIAGNOSTIC ........................................................................................................................ 13

    IV.1. Diagnosticul clinic ........................................................................................................... 13

    IV.1.1. Boala de reflux gastroesofagian i laringita cronic ................................................. 14

    IV.1.2. Boala de reflux gastroesofagian i astmul bronic .................................................... 15

    IV.1.3.Boala de reflux gastroesofagian i tusea cronic ........................................................ 15

    IV.1.4. Boala de reflux gastroesofagian i pseudoangina ...................................................... 15

    IV.1.5. Boala de reflux gastroesofagian i eroziunile dentare ............................................... 16

    IV.1.6. Boala de reflux gastroesofagian i tulburrile de somn ............................................ 16

    IV.1.7. Alte simptome ........................................................................................................... 16

    IV.1.8. Afectarea calitii vieii ............................................................................................. 16

    IV.2. Diagnosticul paraclinic .................................................................................................... 17

    IV.2.1. Tehnici de diagnostic................................................................................................. 17

    IV.2.2. Boala de reflux gastroesofagian i laringita cronic ................................................. 24

    IV.2.3. Boala de reflux gastroesofagian i astmul bronic .................................................... 26

    IV.2.4. Boala de reflux gastroesofagian i tusea cronic ....................................................... 27

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    IV.2.5. Boala de reflux gastroesofagian i pseudoangina ...................................................... 28

    IV.2.6. Boala de reflux gastroesofagian i eroziunile dentare ............................................... 29

    V. TRATAMENT ......................................................................................................................... 29

    V.1. Modificarea stilului de via ............................................................................................. 29

    V.2. Tratamentul medicamentos ............................................................................................... 30

    V.2.1. Antiacide ..................................................................................................................... 30

    V.2.2. Alginai ....................................................................................................................... 30

    V.2.3. Antagoniti de receptori histaminici H2 ...................................................................... 30

    V.2.4. Prokinetice .................................................................................................................. 30

    V.2.5. Inhibitori ai pompei de protoni ................................................................................... 31

    V.2.6. Ageni noi ................................................................................................................... 31

    V.3. Tratamentul endoscopic .................................................................................................... 32

    V.4. Tratamentul chirurgical ..................................................................................................... 32

    V.5. Tratamentul bolii de reflux gastroesofagianasociat cu laringita cronic ......................... 32

    V.6. Tratamentul bolii de reflux gastroesofagianasociat cu astmul bronic ........................... 34

    V.7. Tratamentul bolii de reflux gastroesofagianasociat cu tusea cronic .............................. 35

    V.8. Tratamentul bolii de reflux gastroesofagianasociat cu pseudoangina ............................. 35

    V.9. Tratamentul bolii de reflux gastroesofagianasociat cu eroziunile dentare ...................... 36

    VI. BOALA DE REFLUX GASTROESOFAGIAN I FIBRILAIA ATRIAL ...................... 36

    VI.1. Mecanisme fiziopatologice .............................................................................................. 37

    VI.1.1.Dezechilibrul simpato-vagal ....................................................................................... 37

    VI.1.2. Hernia hiatal ............................................................................................................ 37

    VI.1.3. Inflamaia ................................................................................................................... 38

    VI.1.4. Alte mecanisme posibile ........................................................................................... 38

    VI.2. Dovezi ale asocierii dintre boala de reflux gastroesofagian i fibrilaia atrial ............... 38

    VI.3. Tratamentul bolii de reflux gastroesofagian asociat cu fibrilaia atrial ........................ 39

    PARTEA PERSONAL

    VII. MOTIVAIA CERCETRII PERSONALE. STRUCTURA STUDIULUI PERSONAL.

    OBIECTIVELE GENERALE ...................................................................................................... 40

    VIII. EVALUAREA PACIENILOR CU LARINGIT CRONIC CU POTENIAL

    ETIOLOGIC BOALA DE REFLUX GASTROESOFAGIAN .................................................... 42

    VIII.1. Scopul............................................................................................................................ 42

    VIII.2. Material i metod ......................................................................................................... 42

    VIII.2.1. Pacieni ................................................................................................................... 42

    VIII.2.2. Protocol de studiu ................................................................................................... 43

    VIII.2.3. Prelucrarea statistic ............................................................................................... 46

    VIII.3. Rezultate........................................................................................................................ 47

    VIII.4. Discuii .......................................................................................................................... 80

    VIII.5. Concluzii ....................................................................................................................... 93

    IX. EVALUAREA PACIENILOR CU ASTM BRONIC CU POTENIAL ETIOLOGIC

    BOALA DE REFLUX GASTROESOFAGIAN .......................................................................... 95

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    IX.1. Scopul .............................................................................................................................. 95

    IX.2. Material i metod ........................................................................................................... 95

    IX.2.1. Pacieni ...................................................................................................................... 95

    IX.2.2. Protocol de studiu ...................................................................................................... 96

    IX.2.3. Prelucrarea statistic .................................................................................................. 97

    IX.3. Rezultate .......................................................................................................................... 97

    IX.4. Discuii ........................................................................................................................... 127

    IX.5. Concluzii ........................................................................................................................ 136

    X. EVALUAREA PACIENILOR CU TUSE CRONIC CU POTENIAL ETIOLOGIC

    BOALA DE REFLUX GASTROESOFAGIAN ........................................................................ 138

    X.1. Scopul.............................................................................................................................. 138

    X.2. Material i metod ........................................................................................................... 138

    X.2.1. Pacieni ..................................................................................................................... 138

    X.2.2. Protocol de studiu ..................................................................................................... 138

    X.2.3. Prelucrarea statistic ................................................................................................. 139

    X.3. Rezultate.......................................................................................................................... 139

    X.4. Discuii ............................................................................................................................ 167

    X.5. Concluzii ......................................................................................................................... 175

    XI. EVALUAREA COMPARATIV A MANIFESTRILOR EXTRADIGESTIVE

    POSIBIL INDUSE DE BOALA DE REFLUX GASTROESOFAGIAN ................................. 176

    XI.1. Scopul ............................................................................................................................ 176

    XI.2. Material i metod ......................................................................................................... 176

    XI.3. Rezultate ........................................................................................................................ 176

    XI.4. Discuii ........................................................................................................................... 183

    XI.5. Concluzii ........................................................................................................................ 185

    XII. BOALA DE REFLUX GASTROESOFAGIAN I FIBRILAIA ATRIAL .................. 186

    XII.1. Scopul ........................................................................................................................... 186

    XII.2. Material i metod ........................................................................................................ 186

    XII.2.1. Pacieni ................................................................................................................... 186

    XII.2.2. Protocol de studiu................................................................................................... 187

    XII.2.3. Analiza statistic .................................................................................................... 188

    XII.3. Rezultate ....................................................................................................................... 188

    XII.4. Discuii ......................................................................................................................... 202

    XII.5. Concluzii ...................................................................................................................... 206

    XIII. DIFICULTI I LIMITE ALE CERCETRII .............................................................. 208

    XIV. ORIGINALITATEA STUDIULUI ................................................................................... 208

    XV. PERSPECTIVE DESCHISE DE CERCETAREA PERSONAL I DIRECII

    VIITOARE DE STUDIU ............................................................................................................ 209

    XVI. CONCLUZII GENERALE ................................................................................................ 211

    XVII.REFERINE BIBLIOGRAFICE ................................................................