Trastornos esofágicos de la interacción intestino-cerebro: actualización basada en Roma V
DOI:
https://doi.org/10.22516/25007440.1631Palabras clave:
trastornos de la interacción cerebro-intestino, Manometría esofágica, disfagia, enfermedades del esófagoResumen
Introducción: los trastornos esofágicos de la interacción intestino-cerebro se caracterizan por síntomas como pirosis, dolor torácico, sensación de globo y disfagia, en ausencia de alteraciones estructurales, inflamatorias, motoras o por reflujo que expliquen adecuadamente su presencia. Los criterios de Roma V incorporan los avances recientes en la evaluación fisiológica del esófago y deben interpretarse en conjunto con la Clasificación de Chicago v. 4.0 y el Consenso de Lyon 2.0.
Resultados: esta actualización revisa los cinco trastornos esofágicos de la interacción intestino-cerebro reconocidos por Roma V: dolor torácico funcional, pirosis funcional, hipersensibilidad esofágica, globo y disfagia funcional. Se analizan sus principales características clínicas, criterios diagnósticos, mecanismos fisiopatológicos y estrategias terapéuticas. Se destaca el papel central de la hipersensibilidad esofágica y de los mecanismos de procesamiento sensorial central, así como la influencia de la hipervigilancia y de factores cognitivos, afectivos y psicosociales en la percepción de los síntomas.
Conclusiones: Roma V propone un enfoque diagnóstico integrado que permite interpretar los síntomas esofágicos junto con los hallazgos endoscópicos y fisiológicos, con el fin de evitar la sobreinterpretación de alteraciones menores y la repetición innecesaria de estudios. Una vez excluidas las enfermedades estructurales, inflamatorias, motoras y por reflujo relevantes, el manejo debe orientarse hacia los mecanismos que mantienen los síntomas, incluidas la hipersensibilidad y la hipervigilancia. La educación del paciente, la neuromodulación y las intervenciones psicoconductuales constituyen herramientas relevantes, aunque la evidencia disponible para muchas de estas intervenciones continúa siendo limitada.
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