RESUMEN
INTRODUCTION AND AIMS: Since the 1960s, several studies have shown the effect of aging on esophageal motility, with inconsistent results. The aim of the present study was to evaluate the manometric results in older adult patients (=60 years of age) with an esophageal disorder and compare them with adults under 60 years of age. MATERIALS AND METHODS: A cross-sectional, retrospective study was conducted that included a sample of 1,175 patients (936 older adults and 239 non-older adults). The patients were evaluated and compared with respect to (i) sex, (ii) main complaint for which esophageal manometry was indicated, (iii) comorbidities, (iv) current medications, (v) smoking, and (vi) manometry results. RESULTS: Patient age ranged from 19 to 92 years (women made up 76.5% of the older adults and 72.8% of the non-older adults). Normal lower esophageal sphincter relaxation and normal peristalsis were more frequent in the non-older patient group (91.1% vs. 84.8% and 87.4% vs. 76%, respectively). The manometry results for the non-older adults vs. the older adults, respectively, were: achalasia (2.9% vs. 5.9%); hypercontractile disorder (9.2% vs. 10.4%); hypocontractile disorder (38.5% vs. 47.6%); and normal values (49.4% vs. 36.1%). After excluding the variables that could change esophageal motility, the results revealed significant differences between the two study groups. CONCLUSIONS: Esophageal manometry demonstrated statistically significant differences between the older adult and non-older adult study population evaluated.
Asunto(s)
Enfermedades del Esófago/fisiopatología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Manometría , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
To assess adherence to proton pump inhibitor (PPI) treatment and associated variables in patients with gastroesophageal reflux disease (GERD). Cross-sectional and prospective comprising 240 consecutive adult patients, diagnosed with GERD for whom continuous use of standard or double dose of omeprazole had been prescribed. Patients were ranked as ne-GERD (162: 67.5%) or e-GERD classified according to the Los Angeles classification as A (48:20.0%), B (21:8.6%), C (1:0.5%), D (1:0.5%), and Barrett's esophagus (7:2.9%). The Morisky questionnaire was applied to assess adherence to therapy and a GERD questionnaire to assess symptoms and their impact. Adherence was correlated with demographics, cotherapies, comorbidities, treatment duration, symptoms scores, endoscopic findings, and patient awareness of their disease. 126 patients (52.5%) exhibited high level of adherence and 114 (47.5%) low level. Youngers (P= 0.002) or married (O.R. 2.41, P= 0.03 vs. widowers) patients had lower levels of adherence; symptomatic patients exhibited lower adherence (P= 0.02). All other variables studied had no influence on adherence. Patients with GERD attending a tertiary referral hospital in São Paulo exhibited a high rate of low adherence to the prescribed PPI therapy that may play a role in the therapy failure. Age <60 years, marital status and being symptomatic were risk factors for low adherence.
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Reflujo Gastroesofágico/tratamiento farmacológico , Cumplimiento de la Medicación , Omeprazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Patients' socioeconomic status is rarely assessed during medical consultations. OBJECTIVE: To correlate patients' socioeconomic conditions with symptoms of heartburn. METHODS: 1184 patients who answered a questionnaire in three cities on the coast of the State of Sä Paulo, Brazil, were evaluated prospectively. Socioeconomic status was assessed using several criteria: number of bathrooms, consumer goods present at home, health conditions at home, comfort (cars and/or home helps), monthly family income and head of household's educational level. RESULTS: 583 patients (49.2%) reported occurrences of heartburn over the 30 days preceding the consultation, with frequencies ranging from five to thirty episodes over this period. Among patients from the city of Guarujá (low socioeconomic condition), 9.7% had never felt heartburn, while 65.7% reported occurrences, reaching statistical significance in relation to patients of medium socioeconomic condition (city of Sä Vicente) (p = 0.012). There was no difference between patients from medium socioeconomic condition and patients from Santos (high socioeconomic condition) (p = 0.997). There was a statistically significant difference in occurrence of heartburn between the patients with high socioeconomic condition and those of low socioeconomic condition (p = 0.002). CONCLUSIONS: The least favored socioeconomic status patients, as confirmed according to a variety of socioeconomic factors, presented greater incidence of heartburn than did the most favored social class.
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Pirosis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Adulto JovenRESUMEN
INTRODUCTION: Helicobacter pylori infection is very prevalent in Brazil, infecting almost 65% of the population. The aim of this study was to evaluate the presence of this bacterium in the oral cavity of patients with functional dyspepsia (epigastric pain syndrome), establish the main sites of infection in the mouth, and assess the frequency of cagA and vacA genotypes of oral H. pylori. METHODS: All 43 outpatients with epigastric pain syndrome, who entered the study, were submitted to upper gastrointestinal endoscopy to rule out organic diseases. Helicobacter pylori infection in the stomach was confirmed by a rapid urease test and urea breath tests. Samples of saliva, the tongue dorsum and supragingival dental plaque were collected from the oral cavity of each subject and subgingival dental plaque samples were collected from the patients with periodontitis; H. pylori infection was verified by polymerase chain reaction using primers that amplify the DNA sequence of a species-specific antigen present in all H. pylori strains; primers that amplify a region of urease gene, and primers for cagA and vacA (m1, m2, s1a, s1b, s2) genotyping. RESULTS: Thirty patients harbored H. pylori in the stomach, but it was not possible to detect H. pylori in any oral samples using P1/P2 and Urease A/B. The genotype cagA was also negative in all samples and vacA genotype could not be characterized (s-m-). CONCLUSION: The oral cavity may not be a reservoir for H. pylori in patients with epigastric pain syndrome, the bacterium being detected exclusively in the stomach.
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Dispepsia/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/fisiología , Boca/microbiología , Antígenos Bacterianos/análisis , Proteínas Bacterianas/análisis , Proteínas Portadoras/análisis , Citotoxinas/análisis , ADN Bacteriano/análisis , Placa Dental/microbiología , Femenino , Gastroscopía , Genotipo , Helicobacter pylori/clasificación , Humanos , Masculino , Persona de Mediana Edad , Periodontitis/microbiología , Reacción en Cadena de la Polimerasa , Saliva/microbiología , Gastropatías/microbiología , Lengua/microbiología , Ureasa/análisisRESUMEN
RATIONALE: Mixed connective tissue disease is a systemic inflammatory disorder that results in both pulmonary and esophageal manifestations. OBJECTIVES: We sought to evaluate the relationship between esophageal dysfunction and interstitial lung disease in patients with mixed connective tissue disease. METHODS: We correlated the pulmonary function data and the high-resolution computed tomography findings of interstitial lung disease with the results of esophageal evaluation in manometry, 24-hour intraesophageal pH measurements, and the presence of esophageal dilatation on computed tomography scan. MEASUREMENTS AND MAIN RESULTS: Fifty consecutive patients with mixed connective tissue disease, according to Kasukawa's classification criteria, were included in this prospective study. High-resolution computed tomography parenchymal abnormalities were present in 39 of 50 patients. Esophageal dilatation, gastroesophageal reflux, and esophageal motor impairment were also very prevalent (28 of 50, 18 of 36, and 30 of 36, respectively). The presence of interstitial lung disease on computed tomography was significantly higher among patients with esophageal dilatation (92% vs. 45%; p<0.01) and among patients with severe motor dysfunction (90% vs. 35%; p<0.001). CONCLUSIONS: Although we were not able to prove a causal relationship between esophageal and pulmonary involvement, our series revealed a strong association between esophageal motor dysfunction and interstitial lung disease in patients with mixed connective tissue disease.
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Reflujo Gastroesofágico/complicaciones , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Adulto , Anciano , Dilatación Patológica/diagnóstico , Monitorización del pH Esofágico , Esófago/patología , Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/fisiopatología , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Manometría , Persona de Mediana Edad , Enfermedad Mixta del Tejido Conjuntivo/diagnóstico por imagen , Enfermedad Mixta del Tejido Conjuntivo/fisiopatología , Estudios Prospectivos , Pruebas de Función Respiratoria , Fumar/epidemiología , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
Esophageal functional abnormalities may lead to regurgitation, chronic esophagitis and life-threatening conditions such as aspiration pneumonia. In mixed connective tissue disease patients, previous reports showed that esophageal dysfunction varies according to the method employed for investigation. Our study was conceived to: (i) assess esophageal motility and mucosal aspects in patients with mixed connective tissue disease by endoscopy, cine-esophogram and scintigraphy focusing on the prevalence of each exam; and (ii) verify the association between pulmonary and esophageal dysfunctions. Twenty-four mixed connective tissue disease patients were enrolled for this study. Cine-esophogram and upper digestive endoscopy with mucosal biopsy were performed according to previous standardization. Radionuclide esophageal scintigraphy was performed with a semisolid meal with (99m)Tc. Eleven healthy individuals voluntarily submitted to scintigraphy as controls. Cine-esophogram showed esophageal delayed emptying in 90% of patients. At scintigraphy there was a significant delay in total esophageal transit time in the group of patients when compared to healthy controls (35.3 +/- 8.2 s. vs. 13.6 +/- 9.5 s.; P < 0.0001). The whole esophageal body showed dysmotility in 96% of patients. The cine-esophogram detected functional esophageal impairment similar to scintigraphic findings. Histopathologic examination found esophagitis in 95% of studied patients. Reduced lung volumes were associated with esophagitis and delayed esophageal clearance at scintigraphy, observed at the distal portion of the esophagus. Esophageal scintigraphy is easy to perform, with good acceptance by patients with low radiation exposition. It is a useful non-invasive test for follow-up and interventional studies concerning esophagus dysfunction.
Asunto(s)
Trastornos de la Motilidad Esofágica/complicaciones , Trastornos de la Motilidad Esofágica/diagnóstico por imagen , Enfermedades Pulmonares/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Adulto , Estudios de Casos y Controles , Trastornos de Deglución/etiología , Endoscopía del Sistema Digestivo , Esofagitis/diagnóstico por imagen , Femenino , Gastritis/complicaciones , Pirosis/etiología , Hernia Hiatal/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Depuración Mucociliar , Cintigrafía , Pruebas de Función Respiratoria , Encuestas y CuestionariosRESUMEN
The effect of the reduction of intra-abdominal pressure on the lower esophageal sphincter pressure (LESP) and the 24-hour pH monitoring were studied in 16 patients with ascites before and after paracentesis. LESP did not change (P > 0.05) with the reduction of intra-abdominal pressure (before paracentesis: 17.48 mmHg and postparacentesis: 18.67 mmHg). The results were divided into two groups according to the achieved reduction in intra-abdominal pressure group A were those in who the reduction was greater than 70% and B consisted of those a reduction of less than 70%. LESP did not change even when results for each group were considered separately (P > 0.05): group A (before: 15.60 mmHg; after: 18.09 mmHg); group B (before: 23.09 mmHg; after: 20.40 mmHg). However the 24-h pH monitoring showed pathological reflux in patients with ascites that was reduced with the paracentesis (P < 0.05; total number of reflux episodes before paracentesis was 520.26, and after, 136.26). All pH-monitoring parameters were statistically different (P < 0.05) before and after the reduction of intra-abdominal pressure for group A but not for group B. LESP does not change significantly (P > 0.05) when the intra-abdominal pressure is significantly reduced (P < 0.05). Patients with ascites showed gastroesophageal reflux. Intra-abdominal pressure reduction greater than 70% lead to a significant reduction in gastroesophageal reflux.
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Abdomen/fisiología , Ascitis/fisiopatología , Unión Esofagogástrica/fisiología , Reflujo Gastroesofágico/prevención & control , Estudios de Casos y Controles , Humanos , Concentración de Iones de Hidrógeno , Hepatopatías/fisiopatología , Monitoreo Fisiológico , Paracentesis , Presión , Estudios ProspectivosRESUMEN
The sensitivity of endoscopic examinations, acid perfusion test and 24-hour esophageal pH-monitoring, were studied in patients with heartburn. Thirty six adult patients with histological esophagitis were included in this prospective study. Endoscopy showed esophageal lesion in 18/36 (sensitivity of 50%): esophagitis grade I in 10 (55.6%) and, grade II in eight (44.4%). Acid perfusion test was positive in 10/25 (sensitivity of 40%) of the patients submitted to the test. Twenty-four-hour pH-monitoring was positive in 17/29 patients (sensitivity of 58.6%): eight (61.5%) did not have esophageal lesion at endoscopy, two (25%) had esophagitis grade I and seven (87.5%) had esophagitis grade II. In the patients submitted to 24-hour pH-monitoring, a greater number or reflux episodes in orthostatic position than in supine position (P < 0.0001) was observed. The total number of reflux episodes, the most prolonged reflux and the total pH time < 4 were statistically higher in post-prandial period than during meals (P = 0.005).
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Endoscopía del Sistema Digestivo , Esofagitis/diagnóstico , Ácido Gástrico , Pirosis/diagnóstico , Perfusión , Adolescente , Adulto , Anciano , Femenino , Reflujo Gastroesofágico , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Estudios Prospectivos , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Desde a primeira descricao de uma estrutura esfincteriana no ducto biliar terminal, em 1681, por Glisson, inumeras publicacoes contribuiram para melhor compreensao da funcao do esfincter de Oddi. Estudos manometricos do esfincter de Oddi abriram novas perspectivas para redefinicao de velhos conceitos como a discinesia biliar e a sindrome pos-colecistectomia, e permitiram uma avaliacao mais racional dos resultados obtidos apos esfincterotomia. Os autores realizaram revisao da literatura no que se refere aos aspectos fisiologicos, farmacologicos, diagnosticos e terapeuticos das disfuncoes do esfincter de Oddi.
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Enfermedades del Conducto Colédoco/fisiopatología , Esfínter de la Ampolla Hepatopancreática/fisiopatología , Enfermedades del Conducto Colédoco/diagnóstico , Enfermedades del Conducto Colédoco/terapiaRESUMEN
Since the first description by Glisson in 1681 many papers about the sphincter of Oddi have been published contributing to the understanding of its physiology. Sphincter manometry has brought to light new facts that allow a better understanding of old concepts such as the biliary dyskinesia and the post-cholecystectomy syndrome as well as a more rational evaluation of the clinical results of the sphincterectomy. A review of the physiologic, pharmacologic, diagnostic and therapeutic aspects of the dysfunction of the sphincter of Oddi is presented.