ENFERMEDAD POR REFLUJO GASTROESOFAGICO Y HERNIA HIATAL

UMAE   IMSS CD OB. SON

ENFERMEDAD POR REFLUJO GASTROESOFAGICO Y HERNIA HIATAL

Radiology: Volume 243: Number 2—May 2007

ERGE

 

 

 

Radiology: Volume 243: Number 2—May 2007

ERGE

Radiology: Volume 243: Number 2—May 2007

 

 

 

ERGE

Radiology: Volume 243: Number 2—May 2007

Objetivo de el  esofagograma en ERGE:

Presencia de hernia hiatal  o reflujo  GE .

morfologia de secuelas  de esofagitis por reflujo , estenosis pepticas,esofago de Barret  y adenocarcinoma

ERGE  COMPLICACIONES

Radiology: Volume 243: Number 2—May 2007

žThe purpose of barium studies in patients

žwith reflux symptoms is not simply to

ždocument the presence of a hiatal hernia

žor gastroesophageal reflux but to detect

žthe morphologic sequelae of reflux, including reflux esophagitis, peptic strictures,

žBarrett esophagus, and esophageal

žadenocarcinoma.

ERGE  COMPLICACIONES

La esofagitis   por reflujo  es la enfermedad inflamatoria

Mas comun que involucra  al esofago.

El esofago en fase de doble contraste  ha demostrado tener una sensibilidad de aproximada de 90% para la detection de   esofagitis  por reflujo , debido a la capacidade demostrar anormalidades de la mucosa no evidente en fase simple

.

Most cases that are missed

occur in patients with milder forms of

esophagitis, which manifest at endoscopy

as mucosal erythema and friability.

Most cases that are missed

occur in patients with milder forms of

esophagitis, which manifest at endoscopy

as mucosal erythema and friability.

The single most common sign of reflux

esophagitis on double-contrast esophagrams

is a finely nodular or granular appearance

with poorly defined radiolucencies

that fade peripherally due to edema

and inflammation of the mucosa (Fig 3)

(6,7).

The single most common sign of reflux

esophagitis on double-contrast esophagrams

is a finely nodular or granular appearance

with poorly defined radiolucencies

that fade peripherally due to edema

and inflammation of the mucosa (Fig 3)

(6,7).

This nodularity or granularity almost

always extends proximally from the

gastroesophageal junction as a continuous

area of disease.

This nodularity or granularity almost

always extends proximally from the

gastroesophageal junction as a continuous

area of disease.

.

Barium studies may also reveal shallow

ulcers and erosions in the distal esophagus.

The ulcers can have a punctate, linear,

or stellate configuration and are often

associated with a surrounding halo of

edematous mucosa, radiating folds, or

sacculation of the adjacent wall (Fig 4)

(8).

ESOFAGOGRAMA  TECNICA

.

Barium studies may also reveal shallow

ulcers and erosions in the distal esophagus.

The ulcers can have a punctate, linear,

or stellate configuration and are often

associated with a surrounding halo of

edematous mucosa, radiating folds, or

sacculation of the adjacent wall (Fig 4)

(8).

 

ESOFAGOGRAMA  TECNICA

ERGE

Some patients have a solitary ulcer at

or near the gastroesophageal junction,

often on the posterior wall of the distal

esophagus, presumably as a result of prolonged

exposure to refluxed acid that

pools posteriorly when patients sleep in

the supine position (9).

Radiology: Volume 243: Number 2—May 2007

ERGE

Some patients have a solitary ulcer at

or near the gastroesophageal junction,

often on the posterior wall of the distal

esophagus, presumably as a result of prolonged

exposure to refluxed acid that

pools posteriorly when patients sleep in

the supine position (9).

Radiology: Volume 243: Number 2—May 2007

ERGE

Other patients have more widespread ulceration of the distal third or half of the thoracic esophagus,but this ulceration always extends proximally from the gastroesophageal junction.

 Thus, the presence of ulcers

that are confined to the upper or middle

parts of the esophagus should suggest another

cause for the patient’s disease.

ESOFAGO DE BARRET

Barrett esophagus is characterized by progressive columnar metaplasia of the distal esophagus caused by chronic gastroesophageal reflux and reflux esophagitis.

Barrett esophagus is thought to develop in about 10% of all patients with reflux esophagitis (16).

Double-contrast esophagrams can be used to classify, on

the basis of specific radiologic criteria,patients with reflux symptoms as being  at high, moderate, or low risk for Barrett

esophagus (17).

ERGE    COMPLICACIONES

ESOFAGO DE BARRET

Patients are classified at high risk when a barium study reveals a midesophageal stricture (Fig 10) or ulcer or a reticular pattern of the mucosa (usually associated with a hiatal hernia

and/or gastroesophageal reflux) (17).

In such cases, endoscopy and biopsy should

be performed to help obtain a definitive

diagnosis.

Radiology: Volume 243: Number 2—May 2007

ESOFAGO DE BARRET

Although a reticular mucosal

pattern has been found in only 5%–10%

of all patients with Barrett esophagus

(18,19), this finding has been recognized

as a highly specific sign of Barrett esophagus,

particularly if the pattern is adjacent

to the distal aspect of a midesophageal stricture (see Fig 10) (18).

Radiology: Volume 243: Number 2—May 2007

ESOFAGO DE BARRET

The reticular pattern is characterized by tiny barium-filled grooves or crevices resembling the areae gastricae in the stomach.

Patients are classified at moderate risk

for Barrett esophagus when a barium study

reveals esophagitis or peptic strictures in

the distal esophagus (17).

These radiographic findings reflect chronic inflammatory disease and scarring; the decision to perform endoscopy in this group should be based on the severity of symptoms, the age, and the overall health of the patient.

ESOFAGO DE BARRET

Finally, patients are classified at low

risk for Barrett esophagus when barium

studies reveal no structural abnormalities

(regardless of the presence or absence of reflux or a hiatal hernia).

žThe majority of patients are found to be in the low-risk category, and the prevalence of Barrett  esophagus is so small in this group that such individuals can be treated empirically for their reflux symptoms without the need for endoscopy (17).

ESOFAGITIS  INFECCIOSA

CANDIDA

HERPETICA

CITOMEGALAVIRUS

ESOFAGITIS INDUCIDA POR DROGAS

Tetracycline and doxycycline are the two

agents most commonly responsible for

drug-induced esophagitis in the United

States, but other causative agents include

potassium chloride, quinidine, aspirin or

other nonsteroidal antiinflammatory

drugs, and alendronate sodium (33–35).

Affected individuals typically ingest the

medication with little or no water immediately

before going to bed. The capsule

or pill then usually becomes lodged in

the midesophagus, where it is compressed

by the adjacent aortic arch or left

main bronchus.

Prolonged contact of the

esophageal mucosa with these medications

presumably causes an irritant contact

esophagitis. Affected individuals

may present with severe odynophagia,

but marked clinical improvement usually

occurs after withdrawal of the offending

agent.

The radiographic findings in drug-induced

esophagitis depend on the nature

of the offending medication. Tetracycline

and doxycycline are associated with

the development of small shallow ulcers

in the upper or middle part of the esophagus

and are indistinguishable from

those in herpes esophagitis

(Fig 16)

(36,37). Because of their superficial nature,

these ulcers almost always heal

without scarring or strictures. In contrast,

potassium chloride, quinidine, and nonsteroidal

antiinflammatory drugs may

cause more severe esophageal injury leading

to the development of larger ulcers

and possible stricture formation (38–40).

Alendronate sodium (an inhibitor of os

osteoclast

mediated bone resorption, used

to prevent osteoporosis in postmenopausal

women) may cause severe esophagitis

with extensive ulceration and strictures

that are usually confined to the distal

esophagus (41).

ESOFAGITIS INDUCIDA POR RADIACION

A radiation dose of 5000 cGy or more to

the mediastinum may cause severe injury

to the esophagus. Acute radiationinduced

esophagitis usually occurs 2–4

weeks after the initiation of radiation

therapy (42).

The mucosa typically has

a granular appearance because of edema

and inflammation of the irradiated segment

(42). Ulceration and decreased luminal

distensibility are other frequent

findings (42). The extent of disease conforms

to the margins of the radiation

portal.

Most cases of acute radiation

esophagitis are self-limited, but some

patients may have progressive dysphagia

due to the development of radiation

strictures 4–8 months after completion

of radiation therapy (43). Such strictures

typically appear as smooth tapered

areas of concentric narrowing

within a preexisting radiation portal

(Fig 17).

ENFERMEDAD POR REFLUJO GE

ENFERMEDAD POR REFLUJO GE

Figure 8. Upright LPO spot image from double-

contrast esophagography shows short ringlike

peptic stricture (white arrow) in distal

esophagus above a hiatal hernia (black arrows).

Although this stricture could be mistaken for a

Schatzki ring, it has a longer vertical height

than does a true Schatzki ring.

 

 

Facebook Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

Este sitio usa Akismet para reducir el spam. Aprende cómo se procesan los datos de tus comentarios.

Do NOT follow this link or you will be banned from the site!