{"id":13101,"date":"2022-09-01T07:00:00","date_gmt":"2022-09-01T07:00:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=13101"},"modified":"2022-09-06T19:54:34","modified_gmt":"2022-09-06T19:54:34","slug":"highlights-sobre-diagnostico-de-doenca-do-refluxo-gastroesofagico-drge-novo-guideline-do-american-college-of-gastroenterology-acg-2022","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/highlights-sobre-diagnostico-de-doenca-do-refluxo-gastroesofagico-drge-novo-guideline-do-american-college-of-gastroenterology-acg-2022\/","title":{"rendered":"Highlights sobre diagn\u00f3stico de doen\u00e7a do refluxo gastroesof\u00e1gico (DRGE) \u2013 novo guideline do American College of Gastroenterology (ACG)\u00a0 2022"},"content":{"rendered":"\n

\u201cA lot has changed, much remains the same<\/em>\u201d. Com essa premissa, o American College of Gastroenterology (ACG)<\/em> publicou o seu mais novo Guideline<\/em> para diagn\u00f3stico e conduta em Doen\u00e7a do Refluxo Gastroesof\u00e1gico (DRGE) no in\u00edcio de 2022, atualizando as suas recomenda\u00e7\u00f5es gerais neste tema ap\u00f3s quase 10 anos.<\/p>\n\n\n\n

Sabemos que o diagn\u00f3stico de certeza de DRGE pode ser desafiador. N\u00e3o h\u00e1 um padr\u00e3o-ouro e, portanto, por vezes \u00e9 necess\u00e1rio que montemos um quebra-cabe\u00e7a com manifesta\u00e7\u00f5es cl\u00ednicas, resposta \u00e0 terapia, achados endosc\u00f3picos e monitoriza\u00e7\u00e3o prolongada do refluxo. A Tabela 1 resume as principais recomenda\u00e7\u00f5es dessa diretriz, ao passo que o Fluxograma 1 sugere a abordagem sugerida para diagn\u00f3stico de DRGE.<\/p>\n\n\n\n

Tabela 1: Recomenda\u00e7\u00f5es diagnosticas<\/p>\n\n\n\n

Abordagem diagn\u00f3stica<\/strong><\/td>Coment\u00e1rios<\/strong><\/td>Recomenda\u00e7\u00e3o ACG 2022<\/strong><\/td><\/tr>
Diagn\u00f3stico cl\u00ednico (sintomas + terapia emp\u00edrica)<\/strong><\/td>– Pirose e regurgita\u00e7\u00e3o s\u00e3o os principais sintomas t\u00edpicos- Manifesta\u00e7\u00f5es extra-esof\u00e1gicas incluem rouquid\u00e3o, pigarro, tosse cr\u00f4nica, globus, laringite, faringite, fibrose pulmonar e exacerba\u00e7\u00e3o de asma. A avalia\u00e7\u00e3o deles \u00e9 desafiadora: mesmo em pacientes com diagn\u00f3stico estabelecido de DRGE, pode ser dif\u00edcil estabelecer que a DRGE \u00e9 realmente a causa desses problemas<\/td>– Para pacientes com sintomas t\u00edpicos sem sinais de alarme*: prescrever terapia emp\u00edrica com IBP 1x\/dia (em jejum) por 8 semanas
– Em pacientes com dor tor\u00e1cica n\u00e3o card\u00edaca sem pirose: recomendado teste objetivo para DRGE** ao inv\u00e9s de terapia emp\u00edrica
– Sintomas extraesof\u00e1gicos isolados n\u00e3o s\u00e3o suficientes para diagn\u00f3stico de DRGE: \u00e9 necess\u00e1rio realizar teste objetivo**<\/td><\/tr>
Esofagograma (EED)<\/strong><\/td>– Em um estudo prospectivo, apenas metade dos pacientes com refluxo anormal no exame baritado apresentavam altera\u00e7\u00e3o na pHmetria.<\/td>– N\u00e3o recomendado como teste diagn\u00f3stico em DRGE<\/td><\/tr>
Endoscopia digestiva alta (EDA)<\/strong><\/td>– Esofagite erosiva (EE) grau A de Los Angeles n\u00e3o \u00e9 suficiente para diagn\u00f3stico
– EE grau B pode ser diagn\u00f3stica se presen\u00e7a de sintomas t\u00edpicos e resposta ao IBP
– EE graus C e D ou Barrett longo (> 3 cm) confirmam o diagn\u00f3stico de DRGE<\/td>		– Primeiro exame a ser realizado se presen\u00e7a de sinais de alarme* ou em pacientes com m\u00faltiplos fatores de risco para Es\u00f4fago de Barrett
– Realizar se aus\u00eancia de resposta ao IBP emp\u00edrico por 8 semanas
– Realizar se recidiva dos sintomas ap\u00f3s suspens\u00e3o do IBP\u00a0
– Exame diagn\u00f3stico deve ser realizado idealmente 2-4 semanas ap\u00f3s suspens\u00e3o de IBP
– Em pacientes com EE graus C e D, deve-se repetir a EDA ap\u00f3s terapia para assegurar que houve cicatriza\u00e7\u00e3o e para avaliar a presen\u00e7a de poss\u00edvel Es\u00f4fago de Barrett (que pode ser dif\u00edcil de detectar em casos de esofagite grave)<\/td><\/tr>
Manometria esof\u00e1gica<\/strong><\/td>– Pode avaliar altera\u00e7\u00f5es de motilidade associadas \u00e0 DRGE (hipotonia da jun\u00e7\u00e3o esofagog\u00e1strica e motilidade esof\u00e1gica ineficaz), mas n\u00e3o s\u00e3o achados espec\u00edficos<\/td>– N\u00e3o recomendada como teste diagn\u00f3stico em DRGE
– Necess\u00e1ria antes de exames de monitoriza\u00e7\u00e3o de refluxo para definir a posi\u00e7\u00e3o da sonda
– Necess\u00e1ria antes de indicar procedimentos antirrefluxo, principalmente para descartar acal\u00e1sia<\/td><\/tr>
Monitoriza\u00e7\u00e3o prolongada de refluxo (pHmetria e imped\u00e2ncio-pHmetria)<\/strong><\/td>– A vari\u00e1vel mais importante \u00e9 o tempo total de exposi\u00e7\u00e3o \u00e1cida
– O uso de sondas de pHmetria com dois canais para documentar o refluxo em es\u00f4fago proximal \u00e9 question\u00e1vel (resultados muito vari\u00e1veis)<\/td>		– Realizar SEM IBP por pelo menos 7 dias se endoscopia sem evid\u00eancia objetiva de DRGE***
– Realizar EM USO DE IBP se j\u00e1 h\u00e1 evid\u00eancia objetiva de DRGE*** para avaliar sintomas refrat\u00e1rios (preferencialmente a imped\u00e2ncio-pHmetria, pois permite a avalia\u00e7\u00e3o de refluxo n\u00e3o \u00e1cido)<\/td><\/tr><\/tbody><\/table><\/div>
*Sinais de alarme: Disfagia, perda de peso, sangramento, v\u00f4mitos, anemia
**Teste objetivo para DRGE: EDA ou monitoriza\u00e7\u00e3o prolongada de refluxo
***Evid\u00eancia objetiva de DRGE em endoscopia: Esofagite erosiva Los Angeles C ou D, Barrett longo (> 3 cm)
<\/figcaption><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Fluxograma 1: Abordagem diagn\u00f3stica para Doen\u00e7a do Refluxo Gastroesof\u00e1gico (American College of Gastroenterology<\/em>, 2022)<\/p>\n\n\n\n

\"Diagrama\n\nDescri\u00e7\u00e3o<\/p><\/blockquote><\/figure>\n\n\n\n

Refer\u00eancia <\/strong><\/h2>\n\n\n\n

[1] Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022;117:27\u201356. doi:10.14309\/ajg.0000000000001538.<\/p>\n\n\n\n

Como citar este artigo<\/strong><\/h2>\n\n\n\n

Lages, RB. <\/span><\/span>Highlights Sobre Diagn\u00f3stico De Doen\u00e7a Do Refluxo Gastroesof\u00e1gico (Drge) \u2013 Novo Guideline Do American College Of Gastroenterology<\/em> (Acg)  2022. Endoscopia Terap\u00eautica 2022, vol II. Dispon\u00edvel em: endoscopiaterapeutica.net\/pt\/assuntosgerais\/highlights-sobre-diagnostico-de-doenca-do-refluxo-gastroesofagico-drge-novo-guideline-do-american-college-of-gastroenterology-acg-2022<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cA lot has changed, much remains the same\u201d. Com essa premissa, o American College…<\/p>\n","protected":false},"author":4158,"featured_media":13378,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[309],"tipo":[],"volume":[147],"class_list":["post-13101","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-309","volume-volume-ii"],"yoast_head":"\nHighlights sobre diagn\u00f3stico de doen\u00e7a do refluxo gastroesof\u00e1gico (DRGE) \u2013 novo guideline do American College of Gastroenterology (ACG)\u00a0 2022 • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/highlights-sobre-diagnostico-de-doenca-do-refluxo-gastroesofagico-drge-novo-guideline-do-american-college-of-gastroenterology-acg-2022\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Highlights sobre diagn\u00f3stico de doen\u00e7a do refluxo gastroesof\u00e1gico (DRGE) \u2013 novo guideline do American College of Gastroenterology (ACG)\u00a0 2022\" \/>\n<meta property=\"og:description\" content=\"\u201cA lot has changed, much remains the same\u201d. 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