RESUMEN
STUDY DESIGN: Cross-sectional and nonexperimental. OBJECTIVE: To detect and compare functional abnormalities in the esophagus and esophagogastric junction in 2 groups with chronic spinal injuries, 1 with injuries at the phrenic innervation level and the other at upper thoracic levels, and to relate these to gastroesophageal reflux containment. SUMMARY OF BACKGROUND DATA: There are no studies on esophageal manometry with pH metering among spinal cord injury patients. Worldwide statistics reveal that the prevalence of gastroesophageal reflux disease among spinal cord injury patients is greater than among the general population, at around 22% to 27%. The "diaphragmatic crura" has been recognized as an important antireflux barrier and should functionally be considered to be a muscle separated from the costal diaphragm. However, doubts remain regarding whether this difference relates to its innervation. METHODS: This was a cross-sectional study on 29 patients with complete spinal cord injuries: 14 quadriplegics (level C4) and 15 paraplegics (levels T1-T7). Functional abnormalities of the esophagogastric junction, esophagus, and diaphragm were investigated using esophageal manometry and diaphragmatic video fluoroscopy. Presence of gastroesophageal reflux was investigated subjectively (pyrosis and regurgitation) and objectively (pH metering and endoscopy). RESULTS: The incidence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crural pressures were compared (quadriplegics: 37.5 +/- 17.8; paraplegics: 26.6 +/- 7.2; P = 0.048). It was also significant in relation to the prevalence of at least one of the objective and/or subjective reflux findings and/or esophageal peristaltism (quadriplegics: 85.7%; paraplegics: 40.0%; P = 0.011). CONCLUSION: Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics toward greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crural contractility among the quadriplegics.
Asunto(s)
Diafragma/fisiología , Reflujo Gastroesofágico/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Adulto , Estudios Transversales , Femenino , Reflujo Gastroesofágico/etiología , Humanos , Masculino , Paraplejía/complicaciones , Paraplejía/fisiopatología , Cuadriplejía/complicaciones , Cuadriplejía/fisiopatología , Traumatismos de la Médula Espinal/complicaciones , Adulto JovenRESUMEN
A lesão medular apresenta-se como um grande problema de saúde pública, uma vez que a maior parte dos pacientes lesados medulares são jovens e, portanto, encontram-se no auge de sua produtividade, tanto profissional, quanto pessoal. Neste trabalho procurou-se estudar o perfil epidemiológico dos pacientes atendidos no Lar Escola São Francisco, Escola Paulista de Medicina - Universidade Federal de São Paulo. Foram revisados 171 prontuários de pacientes atendidos no período de 1999 a 2001 e foi encontrado um predomínio de pacientes jovens (média 35,4 anos) e do sexo masculino (62,6 por cento). A principal causa de lesão medular encontrada foi o ferimento por arma de fogo (30,1 por cento) e a principal lesão foi a incompleta (59,6 por cento) e espástica (57,3 por cento). O nível neurológico mais frequente foi o torácico, em 59 por cento dos pacientes.