RGE y ERGE en lactantes: ¿Cuáles son sus estrategias de tratamiento?

Temas de la capacitación:

• Diferenciar el RGE de la ERGE en lactantes
• Los retos de obtener un diagnóstico definitivo de la ERGE
• Manejo no farmacológico y nutricional de la ERGE
•  Perlas de la práctica con alimentos espesados
•  Riesgos de los medicamentos supresores de ácido en lactantes
• Estudios de caso del RGE y la ERGE

Por qué es importante:
El reflujo gastroesofágico (RGE) es una ocurrencia extremadamente común en lactantes y se resuelve sin intervención en la mayoría de los bebés al año de edad. No obstante, el RGE es una causa común de preocupación y ansiedad por parte de los cuidadores, lo que puede conducir al uso excesivo de supresores de ácido en la población lactante. Dados los riesgos asociados con estos medicamentos en lactantes, es importante comprender las diferencias entre el RGE y la enfermedad por reflujo gastroesofágico (ERGE) y las estrategias de tratamiento recomendadas para estas afecciones.

Lo que aprenderá:
En este seminario web, las Dras. Khlevner y Rosen presentan una visión general completa del reflujo gastroesofágico (RGE) y la enfermedad por reflujo gastroesofágico (ERGE) en lactantes. Dado que la mayoría de los lactantes presentarán reflujo fisiológico, una ocurrencia normal, este seminario web se centra en las presentaciones comunes del RGE frente a la ERGE, las señales de alerta y la importancia de considerar los diagnósticos diferenciales. Exploraremos estrategias de manejo no farmacológico apropiadas que pueden mejorar los síntomas y reducir las preocupaciones de los cuidadores. Las farmacoterapias también se revisan en esta presentación, con énfasis en los supresores de ácido y su función, o la falta de ella, en el tratamiento del RGE sin complicaciones. El seminario web finaliza con dos estudios de caso que aplican los aprendizajes relevantes a escenarios clínicos del mundo real de lactantes que presentan RGE/ERGE.

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  Julie Khlevner, MD

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  Julie Khlevner, MD, is director of the Pediatric Gastrointestinal Motility Center and associate professor of pediatrics at Columbia University Medical Center in New York City. Dr. Khlevner obtained her medical degree from New York Medical College School of Medicine. She completed a residency and internship in pediatrics at Jacobi Medical Center/Albert Einstein College of Medicine and a fellowship in pediatric gastroenterology, hepatology and nutrition, with specialty training in motility, at Stony Brook University Medical Center.

  Pediatric neurogastroenterology and motility (PNGM) disorders are highly prevalent, accounting for approximately 40 percent of outpatient gastroenterology visits, but they can be challenging to diagnose, with patients often misdiagnosed or underdiagnosed. Many pediatric gastroenterologists lack the specialized knowledge required to manage PNGM conditions and there are few dedicated PNGM centers in North America, with 60 percent of states lacking such a facility.

  Recognizing the need for more medical training and support for pediatric gastroenterologists, Dr. Khlevner, who served as co-chair of the Neurogastroenterology and Motility Committee of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), helped to develop guidelines for PNGM training in North America. She worked with other pediatric neurogastroenterologists, NASPHGHAN, and the American Neurogastroenterology and Motility Society (ANMS) to establish a task force to identify the entrustable professional activities (EPAs) that a pediatric gastroenterologist, neurogastroenterologist, and/or motility expert should be capable of performing. The task force defined the core knowledge and skills necessary for each EPA and identified the diagnostic and therapeutic procedures clinicians should be able to perform and/or interpret associated with the EPAs. This new curriculum was published in the Journal of Pediatric Gastroenterology and Nutrition (JPGN) in January 2021. In addition to establishing the guidelines for training, Dr. Khlevner and her colleagues developed a database of centers offering PNGM services in North America, with the information published in the JPGN May 2022 issue. The information is designed to ensure that even if physicians have no direct access to a PNGM expert in their immediate area, they can easily locate the nearest center for advice.

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  Julie Khlevner, MD

  Associate Professor of Pediatrics at Columbia University Medical Center
  Pediatric Gastroenterology
  Director, Neurogastroenterology and Motility Center
  New York, New York

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  Rachel Lee Rosen, MD, MPH

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  Rachel Lee Rosen, MD, MPH, is a professor of pediatrics at Harvard Medical School, an attending physician in the Division of Gastroenterology, Hepatology and Nutrition, and director of the Aerodigestive Center at Boston Children’s Hospital. She obtained her medical degree from Dartmouth Medical School, completed an internship and residency at Duke University Medical Center, and a fellowship at Boston Children’s Hospital.

  The hospital’s pediatric gastroenterology division is ranked among the top four in the nation by US News & World Report, recording more than 60,000 outpatient visits and more than 9,500 procedures annually. The division offers 15 specialty programs for specific diagnoses for conditions such as inflammatory bowel disease (IBD), esophageal disorders, liver disease, and celiac disease. In addition, its clinicians are leaders in gastrointestinal research, searching for innovative ways to advance treatments, overcome challenges, and improve the quality of patient care.

  The division’s basic research program focuses on the study of epithelial cell/ developmental biology, neurobiology, and mucosal immunology in infection, inflammation, host defense, and gastrointestinal tract development. The clinical research program focuses on IBD, celiac disease, esophageal disorders, congenital enteropathies, liver and biliary disorders, pancreatic disorders, allergic diseases, polyposis syndromes, aerodigestive disease, global nutrition, motility, and functional disorders. Dr. Rosen and her colleagues are currently conducting a number of clinical trials to evaluate therapies to treat IBD, liver and biliary disorders, intestinal failure, motility disorders and allergic gastrointestinal diseases.

  The Aerodigestive Center at Boston Children’s Hospital, led by Dr. Rosen, sees children who have trouble swallowing or breathing or who have gastrointestinal issues in addition to respiratory symptoms. The center treats functional and structural disorders of the upper gastrointestinal tract and lungs due to congenital or developmental abnormality or injury, swallowing dyscoordination, feeding problems, genetic diseases, and neurodevelopmental disability. It is the only center in the United States to be funded by the National Institutes of Health and the model upon which most centers are now based.

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  Rachel Lee Rosen, MD, MPH

  Professor of Pediatrics
  Director, Aerodigestive Center
  Harvard Medical School
  Boston Children's Hospital
  Boston, Massachusetts