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      Beneficio del agonista gaba B (Baclofen) sobre los hallazgos clínicos y endoscópicos en pacientes con esofagitis por enfermedad de reflujo gastroesofágico

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          Abstract

          Este trabajo se realizó con la finalidad de comprobar el beneficio del agonista GABA B (Baclofen) sobre los hallazgos clínicos y endoscópicos en pacientes con esofagitis por enfermedad de reflujo gastroesofágicos. En atención a ésto, se establecieron los siguientes objetivos específicos: 1. Evaluar el efecto del agonista GABA-B sobre la sintomatología de los pacientes con esofagitis por reflujo gastroesofágico utilizando la escala del dolor del 0 al 10. 2. Evaluar los hallazgos endoscópicos de la esofagitis por reflujo gastroesofágico en pacientes que reciben 40mg de Baclofen diario, a través de las escala de Los Ángeles. 3. Evaluar la tolerancia de la droga (BACLOFEN). 4. Evaluar si el efecto es distinto con respecto a al edad, sexo, tiempo de la evolución de la enfermedad. El trabajo partió de una revisión detallada de la fisiología, fisiopatología de las relajaciones transitorias del esfínter esofágico inferior y del mecanismo de acción del medicamento Baclofen (GABA-B). El estudio corresponde a una investigación longitudinal, prospectiva y experimental. La población estuvo comprendida por 16 pacientes que acudieron a la consulta de gastroenterología de la C.H.E.T presentando síntomas de ERGE, pero se trabajo con una muestra total de 10 pacientes que cumplieron con los criterios establecidos para la inclusión en el estudio y que completaron el mes de tratamiento. Se realizó historia clínica, estudio endoscópico pre y post tratamiento, laboratorio pre y post tratamiento y finalmente se determino la concentración de hormona de crecimiento. Los resultados fueron representados en cuadro y gráficos y se procedió a la interpretación de los resultados, donde se comprueba el beneficio del Baclofen en la ERGE y finalmente se presentan las conclusiones y recomendaciones.

          Translated abstract

          This study was made with the purpose of verifying the benefit of agonist GABA B (Baclofen) on the clinical and endoscopic findings in patients with esophagitis due to gastroesophageal reflux disease (GERD). In attention to this, specific objectives were established. 1-To evaluate the effect of agonist GABA-B on the symptoms of patients with GERD, we used the pain scale from 0 to 10. 2- To evaluate the endoscopic findings of GERD esophagitis in patients receiving 40mg daily of Baclofen, using Los Angeles classification. 3- To evaluate the tolerance of the drug (BACLOFEN). 4- To evaluate if the effect is different with respect to age, sex, time of evolution of the disease. The study started with a detailed revision of the physiology, physiopathology of the transitory relaxations of the inferior esophageal sphincter and the mechanism of action of Baclofen (GABA-B). The study corresponds to a longitudinal, prospective and experimental investigation. The population included were 16 patients who attended the gastroenterology unit of the C.H.E.T presenting GERD symptoms, but we only included 10 patients who fulfilled the criteria established for inclusion in the study and completed the month of treatment. A medical history, pre and post treatment endoscopic studies and laboratory were performed, and finally we determined the growth hormone concentration. The results were represented in graphics and charts and then they were interpreted. The benefits of Baclofen in GERD were demonstrated and final conclusions and recommendations were presented.

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          Transient lower esophageal sphincter relaxation.

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            Mechanisms of gastroesophageal reflux in patients with reflux esophagitis.

            We evaluated the mechanisms of gastroesophageal reflux in 10 patients with reflux esophagitis and compared the results with findings from 10 controls. The patients had more episodes of reflux (35 +/- 15 in 12 hours, as compared with 9 +/- 8 in the controls) and a lower pressure of the lower esophageal sphincter (13 +/- 8 mm Hg as compared with 29 +/- 9 in the controls) (P less than 0.001). Reflux occurred by three different mechanisms: transient complete relaxation of the lower esophageal sphincter, a transient increase in intra-abdominal pressure, or spontaneous free reflux associated with a low resting pressure of the lower esophageal sphincter. In controls 94 per cent of reflux episodes were caused by transient sphincter sphincter relaxation. In the patients 65 per cent of episodes of reflux accompanied transient sphincter relaxation, 17 per cent accompanied a transient increase in intra-abdominal pressure, and 18 per cent occurred as spontaneous free reflux. The predominant reflux mechanism in individual patients varied: some had normal resting sphincter pressure and reflux that occurred primarily during transient sphincter relaxation, whereas others with low resting sphincter pressures had spontaneous free reflux or reflux that occurred during an increase in intra-abdominal pressure.
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              Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux.

              Patterns of lower oesophageal sphincter (LOS) function associated with the onset of 644 reflux episodes were recorded and analysed in 67 patients referred for evaluation of gastro-oesophageal reflux (GOR). Patients were studied recumbent, for one hour before and four hours after a standard meal. Transient LOS relaxation was the most prevalent mechanism and overall accounted for 82% of reflux episodes. With increasing severity of oesophagitis, absent basal LOS pressure became a progressively more common mechanism, accounting for 23% of episodes in the patients with severe oesophagitis. Patients commonly exhibited more than one mechanism. The timing of most (69%) LOS relaxations associated with reflux was not compatible with triggering by swallowing. Prolonged transient LOS relaxations were associated with inhibition of oesophageal peristalsis suggesting that this response is produced by neural inhibition. This study suggests the primary importance of transient LOS relaxations as the cause of GOR across the spectrum of severity of reflux disease.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                September 2007
                : 61
                : 3
                : 188-191
                Affiliations
                [1 ] Hospitalaria Dr. Enrique Tejera Venezuela
                Article
                S0016-35032007000300006
                66cf4c3b-034c-493e-91d8-6a997dbf4fb4

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                GERD,transitory Relaxations of the IES,enfermedad por reflujo gastroesofágico,relajaciones transitorias del EEI

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