Tríada de Herbst: acropaquías, hipoproteinemia y anemia ferropénica, asociadas a reflujo gastroesofágico

Herbst’s Triad as a Manifestation of Gastroesophageal Reflux Disease

“…The clinical manifestations of GER are diverse, epigastralgia, heartburn, and regurgitation ( 3 ) in older children and adults, and rumination or Sandifer syndrome in infants and young children ( 4 ). To this broad spectrum, HT must be added as an unusual manifestation of GERD ( 5 ).…”

“…However, in none of the described cases of HT described, chronic lung disease, hypoxemia, or venoarterial shunts that justify its presence have been found ( 1 , 6 , 7 , 12 ), so its pathophysiological mechanism remains enigmatic. However, due to the uniqueness of the disappearance of clubbing when treating GERD, it is reasonable to attribute its appearance to the presence of esophagitis ( 5 , 12 ).…”

“…After reviewing the literature, we found 14 cases of HT published, all in children under 14 years of age, the majority under 7 ( 1 , 5 – 7 , 12 – 18 ) which suggests that this condition mainly affects children (Table 2 ). This could be justified by the low suspicion of GER in early childhood, given that the classic clinical picture is infrequent at these ages, causing diagnostic delay and perpetuating the pathophysiological mechanism.…”

Triada de Herbst: Una presentación inusual de una patología común

“…De otro lado, las manifestaciones gastrointestinales son las típicas de la ERGE, e incluyen vómito y regurgitación frecuentes (incluso desde el nacimiento) (1, 2), epigastralgia (1), pirosis (7), singulto (1,5), dolor retroesternal (1, 2), dolor abdominal difuso (5) y hematemesis (2).…”

“…Las proteínas séricas se normalizaron entre 1 a 2 semanas (5), mientras que la anemia mejoró a las 6 semanas, mediante un tratamiento con sulfato ferroso oral. El hipocratismo digital disminuyó luego de 9 meses a 1 año, en promedio (2,5,7).…”