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DIAGNOSTICA FUNZIONALE NERD SINTOMI ATIPICI

DIAGNOSTICA FUNZIONALE NERD SINTOMI ATIPICI. Endoscopic categorization of GERD patients. Esophagitis. 35%. NERD. 60%. Complicated GERD. 5%. Martinez S et al, A P T 2003;17:537 . Prevalence of dyspepsia symptoms in the various subgroups of a NERD population (n=200).

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DIAGNOSTICA FUNZIONALE NERD SINTOMI ATIPICI

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  1. DIAGNOSTICA FUNZIONALE NERD SINTOMI ATIPICI

  2. Endoscopiccategorization of GERD patients Esophagitis 35% NERD 60% Complicated GERD 5% Martinez S et al, A P T 2003;17:537

  3. Prevalence of dyspepsiasymptoms in the varioussubgroups of a NERD population(n=200) Savarino E et al, Gut 2009

  4. DISPEPSIA GERD • RITARDATO SVUOTAMENTO GASTRICO • ALTERATA ACCOMODAZIONE • ESPOSIZIONE ALL’ACIDO • IPERSENSIBILITA’ VISCERALE Post PN, Aliment Pharmacol Ther, 2006

  5. Svuotamento gastrico

  6. Patogenesi del sintomo L’insulto acido-peptico (1) allenta le “tight” junctions (2) allargando lo spazio intercellulare e favorendo l’ ulteriore penetrazione dell’acido (3) 1 2 3 Acido PepsinaBicarbonato “Tight junctions” Giunzioni cellullari allargate Terminazioni nervose Orlando R, AJG, 1996

  7. Intercellular space dilations = ISD score 0 score 2 score 1 Zentilin et al, Am J Gastroenterol 2005

  8. L’Impedenzometria nella diagnosi del RGE Esophageal Body Impedance pH LES

  9. L’Impedenzometria nella diagnosi del RGE Impedance BolusPresent Bolus entry Bolus exit Time Impedance Ring Set

  10. L’Impedenzometria nella diagnosi del RGE Cosa ci dice l’ MII? Caratterizza il Movimento del Bolo nell’Esofago Qualifica il Bolo (Liquido, Misto o Gassoso) Senza Radiazioni

  11. L’Impedenzometria nella diagnosi del RGE L’MII rileva il movimento del Bolo Anterogrado Retrogrado

  12. Symptom of pyrosis during an episode of acid reflux

  13. Esophageal impedance-pHmetry can detect and quantify both acid and non acid reflux sw sw sw Impedance 1 3 k Impedance 2 3 k Impedance 3 3 k Impedance 4 3 k 7 pH esophagus 4 1 10s 10s Acid reflux Non-acid reflux

  14. Symptom Index 100 %(19/19)

  15. IPERSENSIBILITA’VISCERALE • SENSITIZZAZIONE PERIFERICA • SENSITIZZAZIONE CENTRALE • INTERAZIONI PSICONEUROIMMUNI

  16. NERD pH –ve ↑ afferent sensitivity Upregulation of TRPV-1 nerve fibres NERD pts form a continuum of esophageal afferent sensitivity

  17. MODELLO BIOPSICOSOCIALE

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