RESUMO
This report deals with the preparation of a 'true' artificial phrenoesophageal ligament aimed at restoring effective anchoring of the esophagus to the diaphragm, keeping the esophagogastric sphincter in the abdomen. A total of 24 mongrel dogs were assigned to four groups: (i) Group I (n = 4): the esophageal diaphragm hiatus left wide open; (ii) Group II (n = 8): the anterolateral esophagus walls were attached to the diaphragm by the artificial ligament and the esophageal hiatus was left wide opened; (iii) Group III (n = 5): in addition to the use of the artificial ligament, the esophageal hiatus was narrowed with two retroesophageal stitches; (iv) Group IV (n = 7): the only procedure was the esophageal hiatus narrowing with two retroesophageal stitches. The phrenoesophagogastric connections were released, sparing the vagus nerves. Five animals of groups III and IV, which did not develop hiatal hernia, were submitted to esophageal manometry immediately before and 15 days after surgery. In group I, all animals developed huge sliding hiatal hernias. In group II, two dogs (25%) had a paraesophageal hernia between the two parts of the artificial ligament. In group III, neither sliding hiatal hernia nor paraesophageal hernia occurred. In group IV, two animals (28.6%) developed sliding esophageal hiatus hernia. Regarding esophageal manometry, postoperative significant difference between groups III and IV (P = 0.008) was observed. Thus, the artificial phrenoesophageal ligament maintained the esophagus firmly attached to the diaphragm in all animals and the esophagogastric sphincter pressure was significantly higher in this group.
Assuntos
Esofagoscopia/métodos , Esôfago/transplante , Implantes Experimentais , Ligamentos/transplante , Animais , Diafragma/cirurgia , Cães , Junção Esofagogástrica/cirurgia , Esofagoscopia/efeitos adversos , Hérnia Hiatal/etiologia , Manometria , Resultado do TratamentoRESUMO
Saliva is an important factor in the neutralization of the acidity of the refluxed material that comes from the stomach to the esophagus. The impairment of saliva transit from oral cavity to distal esophagus may be one of the causes of esophagitis and symptoms in gastroesophageal reflux disease (GERD). With the scintigraphic method, the transit of 2 mL of artificial saliva was measured in 30 patients with GERD and 26 controls. The patients with GERD had symptoms of heartburn and acid regurgitation, a 24-hour pH monitoring with more than 4.2% of the time with pH below four, 26 with erosive esophagitis, and four with non-erosive reflux disease. Fourteen had mild dysphagia for solid foods. Twenty-one patients had normal esophageal manometry, and nine had ineffective esophageal motility. They were 15 men and 15 women, aged 21-61 years, mean 39 years. The control group had 14 men and 12 women, aged 19-61 years, mean 35 years. The subjects swallowed in the sitting and supine position 2 mL of artificial saliva labeled with 18 MBq of (99m) Technetium phytate. The time of saliva transit was measured from oral cavity to esophageal-gastric transition, from proximal esophagus to esophageal-gastric transition, and the transit through proximal, middle, and distal esophageal body. There was no difference between patients and controls in the time for saliva to go from oral cavity to esophageal-gastric transition, and from proximal esophagus to esophageal-gastric transition, in the sitting and supine positions. In distal esophagus in the sitting position, the saliva transit duration was shorter in patients with GERD (3.0 ± 0.8 seconds) than in controls (7.6 ± 1.7 seconds, P = 0.03). In conclusion, the saliva transit from oral cavity to the esophageal-gastric transition in patients with GERD has the same duration than in controls. Saliva transit through the distal esophageal body is faster in patients with GERD than controls.
Assuntos
Transtornos da Motilidade Esofágica/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Trânsito Gastrointestinal , Saliva Artificial , Saliva/fisiologia , Adulto , Estudos de Casos e Controles , Transtornos de Deglutição/complicações , Transtornos da Motilidade Esofágica/complicações , Monitoramento do pH Esofágico , Esofagite/complicações , Junção Esofagogástrica , Feminino , Refluxo Gastroesofágico/etiologia , Azia/etiologia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Boca , Posicionamento do Paciente , Cintilografia , Fatores de Tempo , Adulto JovemRESUMO
Stroke is a frequent cause of oropharyngeal dysphagia but may also cause alterations in esophageal motility. The aim of this investigation was to evaluate the effect of bolus taste on the esophageal transit of patients with stroke and controls. Esophageal transit and clearance were evaluated by scintigraphy in 36 patients in the chronic phase of stroke (44-82 years, mean: 63 years) and in 30 controls (33-85 years, mean: 59 years). The patients had a stroke 1-84 months (median: 5.5 months) before the evaluation of esophageal transit. Eight had dysphagia. Each subject swallowed in random order and in the sitting position 5 mL of liquid boluses with bitter (pH=6.0), sour (pH=3.0), sweet (pH=6.9), and neutral (pH=6.8) taste. Transit and clearance duration and the amount of residues were measured in the proximal, middle, and distal esophageal body. There was no difference between patients and controls in esophageal transit or clearance duration. In the distal esophagus, the transit and clearance durations were longer with the sour bolus than with the other boluses in both patients and controls. The amount of residues in the esophageal body was greater in patients than in controls after swallows of the neutral bolus. In control subjects, after swallows of a sour bolus, there was an increase in the amount of residues in the middle and distal esophagus compared with the other boluses. In conclusion, a sour bolus with low pH causes a longer transit and clearance duration in the distal esophageal body. There was no effect of bolus taste or pH on the esophageal transit of patients in the chronic phase of stroke compared with normal volunteers. The longer transit and clearance duration in the distal esophageal body with the sour bolus appears to be a consequence of the low pH of the bolus.
Assuntos
Esôfago/fisiopatologia , Alimentos , Trânsito Gastrointestinal/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Paladar/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Deglutição/fisiologia , Transtornos de Deglutição/fisiopatologia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio , Faringe/diagnóstico por imagem , Faringe/fisiopatologia , Ácido Fítico , Cintilografia , Compostos Radiofarmacêuticos , Fatores de TempoRESUMO
Chagas' disease and idiopathic achalasia patients have similar impairment of distal esophageal motility. In Chagas' disease, the contractions occurring in the distal esophageal body are similar after wet or dry swallows. Our aim in this investigation was to evaluate the effect of wet swallows and dry swallows on proximal esophageal contractions of patients with Chagas' disease and with idiopathic achalasia. We studied 49 patients with Chagas' disease, 25 patients with idiopathic achalasia, and 33 normal volunteers. We recorded by the manometric method with continuous water perfusion the pharyngeal contractions 1 cm above the upper esophageal sphincter and the proximal esophageal contractions 5 cm from the pharyngeal recording point. Each subject performed in duplicate swallows of 3-mL and 6-mL boluses of water and dry swallows. We measured the time between the onset of pharyngeal contractions and the onset of proximal esophageal contractions (pharyngeal-esophageal time [PET]), and the amplitude, duration, and area under the curve (AUC) of proximal esophageal contractions. Patients with Chagas' disease and with achalasia had longer PET, lower esophageal proximal contraction amplitude, and lower AUC than controls (P≤ 0.02). In Chagas' disease, wet swallows caused shorter PET, higher amplitude, and higher AUC than dry swallows (P≤ 0.03).There was no difference between swallows of 3- or 6-mL boluses. There was no difference between patients with Chagas' disease and with idiopathic achalasia. We conclude that patients with Chagas' disease and with idiopathic achalasia have a delay in the proximal esophageal response and lower amplitude of the proximal esophageal contractions.
Assuntos
Doença de Chagas , Deglutição , Acalasia Esofágica , Manometria , Plexo Mientérico/patologia , Adulto , Idoso , Doença de Chagas/diagnóstico , Doença de Chagas/fisiopatologia , Pesquisa Comparativa da Efetividade , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/fisiopatologia , Esfíncter Esofágico Superior/patologia , Esfíncter Esofágico Superior/fisiopatologia , Feminino , Motilidade Gastrointestinal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Individuals with dentofacial deformities have masticatory muscle changes. The objective of the present study was to determine the effect of interdisciplinary treatment in patients with dentofacial deformities regarding electromyographic activity (EMG) of masticatory muscles three years after surgical correction. Thirteen patients with class III dentofacial deformities were studied, considered as group P1 (before surgery) and group P3 (3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were studied as controls. The participants underwent EMG examination of the temporal and masseter muscles during mastication and biting. Evaluation of the amplitude interval of EMG activity revealed a difference between P1 and P3 and no difference between P3 and the control group. In contrast, evaluation of root mean square revealed that, in general, P3 values were higher only when compared with P1 and differed from the control group. There was an improvement in the EMG activity of the masticatory muscles, mainly observed in the masseter muscle, with values close to those of the control group in one of the analyses.
Assuntos
Má Oclusão Classe III de Angle/cirurgia , Músculos da Mastigação/fisiologia , Terapia Miofuncional/métodos , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Adulto , Estudos de Casos e Controles , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Osteotomia/métodos , Valores de Referência , Resultado do Tratamento , Adulto JovemRESUMO
Disturbed gastric contractility has been found in manometric studies in patients with gastro-oesophageal reflux disease (GORD), but the pathophysiological role of this abnormality is unclear. We aimed at assessing postprandial gastric antral contractions and its relationships with gastric emptying and gastro-oesophageal reflux in GORD patients. Fasted GORD patients (n = 13) and healthy volunteers (n = 13) ingested a liquid meal labelled with 72 MBq of 99mTechnetium-phytate. Gastric images were acquired every 10 min for 2 h, for measuring gastric emptying half time. Dynamic antral scintigraphy (one frame per second), performed for 4 min at 30-min intervals, allowed estimation of both mean dominant frequency and amplitude of antral contractions. In GORD patients (n = 10), acidic reflux episodes occurring 2 h after the ingestion of the same test meal were determined by ambulatory 24-h oesophageal pH monitoring. Gastric emptying was similar in GORD patients and controls (median; range: 82 min; 58-126 vs 80 min; 44-122 min; P = 0.38). Frequency of antral contractions was also similar in both groups (3.1 cpm; 2.8-3.6 vs 3.2 cpm; 2.4-3.8 cpm; P = 0.15). In GORD patients, amplitude of antral contractions was significantly higher than in controls (32.7%; 17-44%vs 23.3%; 16-43%; P = 0.01), and correlated positively with gastric emptying time (R(s) = 0.58; P = 0.03) and inversely with the number of reflux episodes (R(s) = -0.68; P = 0.02). Increased amplitude of postprandial gastric antral contractions in GORD may comprise a compensatory mechanism against delayed gastric emptying and a defensive factor against acidic gastro-oesophageal reflux.
Assuntos
Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/fisiopatologia , Contração Muscular/fisiologia , Período Pós-Prandial/fisiologia , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/fisiologia , Adolescente , Adulto , Feminino , Esvaziamento Gástrico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peristaltismo/fisiologia , Cintilografia/métodos , Estômago/diagnóstico por imagem , Estômago/fisiologiaRESUMO
There seems to be controversy on the anorectal sphincter presentation and anatomical division, as well as on its functional representation. Evaluation of the anorectal sphincter musculature has been achieved through several methods, including anorectal manometry and computerized tomography, but to date there is no experimental model allowing a detailed manometric study of this muscle complex. In this work, we have developed such a model, which should enable the manometric and radiographic study of the anatomical features and functional mechanisms of sphincteric injuries, as well as the assessment of drug effects on the anorectal musculature upon incontinence and constipation. Twenty-two piglets (aged 25-30 days, weighing 5-7 kg) were studied by anorectal manometry (rectoanal inhibitory reflex and vector volume) and computerized tomography (anorectal angle and anal canal length). The data obtained for the rectoanal inhibitory reflex, represented here as the average and standard deviation, were the following: relaxation duration = 14.75 +/- 3.62 s, sphincter basal pressure = 41.58 +/- 8.20 mmHg, relaxation index = 87.26 +/- 11.52%, speed of relaxation = 5.90 +/- 2.10 mm/s, and speed of relaxation recovery = 4.03 +/- 1.78 mm/s. As for the vector volume, results were as follows: vector volume = 2692.32 +/- 1298.12 mm Hg2 cm, sphincter length = 11.82 +/- 2.74 mm, high pressure zone length = 5.09 +/- 1.34 mm, maximum pressure = 61.50 +/- 20.58 mmHg, and asymmetry index = 43.50 +/- 10.03%. Radiographic evaluation led to the following results: anal canal length = 9.61 +/- 2.14 mm and anorectal angle = 137.91 +/- 7.75 degrees . The experimental model designed here allows both anorectal manometry and computerized tomography to be carried out in the same way it is performed in human beings, as long as animal sedation is strictly controlled.
Assuntos
Canal Anal/diagnóstico por imagem , Canal Anal/fisiologia , Manometria/métodos , Contração Muscular/fisiologia , Animais , Feminino , Pressão , Sus scrofa , Tomografia Computadorizada por Raios XRESUMO
Chagas' disease and idiopathic achalasia have similar esophageal manifestations such as absent or incomplete lower esophageal sphincter relaxation and aperistalsis in the esophageal body (alterations seen mainly in the distal esophageal body). Our aim in this paper was to study the response of the proximal esophageal body to wet swallows in patients with Chagas' disease and patients with idiopathic achalasia. We retrospectively analyzed the time interval between the onset of the pharyngeal contractions 1 cm proximal to the upper esophageal sphincter, as well as 5 cm distal to the pharyngeal measurement. Amplitude, duration and area under the curve of contractions in the proximal esophagus were also determined in 42 patients with Chagas' disease (15 with associated esophageal dilatation), 21 patients with idiopathic achalasia (14 with concomitant esophageal dilatation) and 31 control subjects. The time between the onset of pharyngeal and proximal esophageal contractions was longer in patients with Chagas' disease and in those with esophageal dilatation (1.39 +/- 0.16 s) than in control subjects (0.86 +/- 0.04 s, P < 0.01). The amplitude of proximal esophageal contractions was lower in patients with idiopathic achalasia and esophageal dilatation (60.9 +/- 16.3 mmHg) than in control subjects (89.7 +/- 6.9 mmHg, P = 0.06). The authors conclude that in patients with advanced esophageal disease, the proximal esophageal contractions in Chagas' disease have a delayed response to wet swallows when compared with controls, and that the amplitude of proximal esophageal contractions was lower than expected in patients with idiopathic achalasia.
Assuntos
Doença de Chagas/fisiopatologia , Deglutição/fisiologia , Acalasia Esofágica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfato de Bário , Estudos de Casos e Controles , Doença de Chagas/diagnóstico por imagem , Meios de Contraste , Acalasia Esofágica/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Músculos Faríngeos/diagnóstico por imagem , Músculos Faríngeos/fisiopatologia , Radiografia , Estudos Retrospectivos , Fatores de TempoRESUMO
We studied the primary and secondary esophageal peristalsis in 36 patients with heartburn and acid regurgitation and in 14 asymptomatic volunteers. Primary peristalsis was elicited by ten swallows of a 5-mL bolus of water and secondary peristalsis was elicited by intra-esophageal infusion of 5, 10, and 15 mL water, 0.1 N hydrochloric acid and air. Esophageal contractions were measured by an 8-lumen manometric catheter assembly incorporating a 6-cm sleeve device. Contractions were registered at 3, 9, and 15 cm from the upper margin of the sleeve and the infusion was done through a side hole located at 12 cm. Twenty patients had normal endoscopic esophageal examination, 10 with normal (group I) and 10 with abnormal pH-metric examination (group II), and 16 had esophagitis (group III). The amplitude of contractions after swallows was lower (97.8 +/- 10.0 mmHg) in the distal esophagus of group III patients than in controls (142.3 +/- 14.0 mmHg). Patients of group III had fewer secondary contractions (water: 25% of infusion) than patients of the other groups and controls (67% of infusion). Patients of group III also had a lower amplitude of secondary peristalsis in the distal esophagus (water: 70.1 +/- 9.6 mmHg) than controls (129.2 +/- 18.2 mmHg). We conclude that patients with esophagitis have an impairment of primary and secondary peristalsis in the distal esophagus.
Assuntos
Esofagite/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Adolescente , Adulto , Esofagoscopia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Peristaltismo/fisiologiaRESUMO
We studied the primary and secondary esophageal peristalsis in 36 patients with heartburn and acid regurgitation and in 14 asymptomatic volunteers. Primary peristalsis was elicited by ten swallows of a 5-mL bolus of water and secondary peristalsis was elicited by intra-esophageal infusion of 5, 10, and 15 mL water, 0.1 N hydrochloric acid and air. Esophageal contractions were measured by an 8-lumen manometric catheter assembly incorporating a 6-cm sleeve device. Contractions were registered at 3, 9, and 15 cm from the upper margin of the sleeve and the infusion was done through a side hole located at 12 cm. Twenty patients had normal endoscopic esophageal examination, 10 with normal (group I) and 10 with abnormal pH-metric examination (group II), and 16 had esophagitis (group III). The amplitude of contractions after swallows was lower (97.8 ± 10.0 mmHg) in the distal esophagus of group III patients than in controls (142.3 ± 14.0 mmHg). Patients of group III had fewer secondary contractions (water: 25 percent of infusion) than patients of the other groups and controls (67 percent of infusion). Patients of group III also had a lower amplitude of secondary peristalsis in the distal esophagus (water: 70.1 ± 9.6 mmHg) than controls (129.2 ± 18.2 mmHg). We conclude that patients with esophagitis have an impairment of primary and secondary peristalsis in the distal esophagus.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esofagite/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Esofagoscopia , Manometria , Peristaltismo/fisiologiaRESUMO
Individuals with dentofacial deformities present changes in masticatory muscles. The objective of the present study was to determine the influence of interdisciplinary treatment in cases of class III dentofacial deformities regarding the EMG activity of the temporal (T) and masseter (M) muscles. The study was conducted on 15 patients with class III dentofacial deformities who were submitted to orthodontic, oromyofunctional and surgical treatment and assigned to groups P1 (before surgery) and P2 (6-9 months after surgery). Fifteen individuals with no alterations in facial morphology or dental occlusion and without signs or symptoms of temporomandibular joint dysfunction were used as controls (CG). The T and M muscles were submitted to EMG bilaterally in the situations of mastication and mastication plus biting, with analysis of amplitude interval and root mean square. For all muscles tested, there was a difference between CG, P1 and P2; CG was higher than P2 and P2 higher than P1 in all situations assessed. We conclude that there was an increase in EMG activity in the T and M muscles after surgical correction of the dentofacial deformity accompanied by interdisciplinary treatment, although the values were still lower than those obtained for CG.
Assuntos
Má Oclusão Classe III de Angle/terapia , Músculo Masseter/fisiologia , Músculo Temporal/fisiologia , Adulto , Estudos de Casos e Controles , Eletromiografia , Feminino , Humanos , Masculino , Mastigação , Estatísticas não ParamétricasRESUMO
Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infra-junctional area was similar for patients and controls: 23% (range: 20-30) vs 27% (range: 19-30%; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.
Assuntos
Junção Esofagogástrica/fisiopatologia , Esvaziamento Gástrico/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Adulto , Estudos de Casos e Controles , Junção Esofagogástrica/diagnóstico por imagem , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/etiologia , Motilidade Gastrointestinal/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio , Ácido Fítico , Cintilografia , Fatores de TempoRESUMO
Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infra-junctional area was similar for patients and controls: 23 percent (range: 20-30) vs 27 percent (range: 19-30 percent; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Junção Esofagogástrica/fisiopatologia , Esvaziamento Gástrico/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Estudos de Casos e Controles , Junção Esofagogástrica , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico , Motilidade Gastrointestinal/fisiologia , Concentração de Íons de Hidrogênio , Compostos de Organotecnécio , Ácido Fítico , Fatores de TempoRESUMO
Most frequently, ten swallows of a 5-mL bolus of water are performed during oesophageal manometry. Our hypothesis is that five swallows may produce the same results. We studied the oesophageal contraction parameters of 40 volunteers, 75 patients with Chagas' disease and 14 patients with idiopathic achalasia. Motility was recorded at 5, 10 and 15 cm above the lower oesophageal sphincter. The subjects performed ten swallows of a 5-mL bolus of water alternated with ten dry swallows with an interval of at least 30 s. We measured the amplitude, duration, peristaltic velocity, number of failed and number of simultaneous contractions of the initial five and final five dry and wet swallows. The comparison of dry and wet swallows showed the differences already known. The comparison of the parameters of the initial five swallows with those of the final five swallows showed no differences. Thus, when the initial five or the final five swallows were considered, there was no change in the conclusions reached by the comparison of patients and volunteers and of dry and wet swallows. We conclude that five swallows may be sufficient for the manometric examination of oesophageal parameters in Chagas' disease and idiopathic achalasia.
Assuntos
Doença de Chagas/fisiopatologia , Deglutição/fisiologia , Acalasia Esofágica/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Manometria , Adulto , Idoso , Esôfago/fisiopatologia , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-IdadeRESUMO
The study investigated the esophageal motility of 98 patients with Chagas' disease and 40 asymptomatic volunteers, with the objective of comparing patients with vigorous achalasia (distal amplitude contractions >/= 37 mmHg) and patients with classical achalasia (amplitude < 37 mmHg). The Chagas' disease patients had normal esophageal radiologic transit (n=60) or esophageal slow transit and retention without dilation (n=38). The manometric method with continuous perfusion was used to study esophageal motility. Comparison of classical and vigorous achalasia showed no difference in duration of contractions, lower and upper esophageal sphincter pressure, proportion of patients with dysphagia, or the number of multipeaked contractions. The number of failed contractions was higher in patients with classic achalasia than in patients with vigorous achalasia. We conclude that the distinction between classical and vigorous achalasia does not seem to be important for the classification of Chagas' disease.
Assuntos
Doença de Chagas/complicações , Acalasia Esofágica/etiologia , Esôfago/fisiopatologia , Adulto , Idoso , Doença de Chagas/classificação , Doença de Chagas/fisiopatologia , Acalasia Esofágica/diagnóstico por imagem , Acalasia Esofágica/fisiopatologia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , RadiografiaRESUMO
Chagas' disease causes degeneration and reduction of the number of intrinsic neurons of the esophageal myenteric plexus, with consequent absent or partial lower esophageal sphincter relaxation and loss of peristalsis in the esophageal body. The impairment of esophageal motility is seen mainly in the distal smooth muscle region. There is no study about esophageal striated muscle contractions in the disease. In 81 patients with heartburn (44 with esophagitis) taken as controls, 51 patients with Chagas' disease (21 with esophageal dilatation) and 18 patients with idiopathic achalasia (11 with esophageal dilatation) we studied the amplitude, duration and area under the curve of esophageal proximal contractions. Using the manometric method and a continuous perfusion system we measured the esophageal striated muscle contractions 2 to 3 cm below the upper esophageal sphincter after swallows of a 5-ml bolus of water. There was no significant difference in striated muscle contractions between patients with heartburn and esophagitis and patients with heartburn without esophagitis. There was also no significant difference between patients with heartburn younger or older than 50 years or between men and women or in esophageal striated muscle contractions between patients with heartburn and Chagas' disease. The esophageal proximal amplitude of contractions was lower in patients with idiopathic achalasia than in patients with heartburn. In patients with Chagas' disease there was no significant difference between patients with esophageal dilatation and patients with normal esophageal diameter. Esophageal striated muscle contractions in patients with Chagas' disease have the same amplitude and duration as seen in patients with heartburn. Patients with idiopathic achalasia have a lower amplitude of contraction than patients with heartburn.
Assuntos
Doença de Chagas/fisiopatologia , Acalasia Esofágica/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Contração Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Azia/fisiopatologia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Peristaltismo , Estudos RetrospectivosRESUMO
Chagas' disease causes degeneration and reduction of the number of intrinsic neurons of the esophageal myenteric plexus, with consequent absent or partial lower esophageal sphincter relaxation and loss of peristalsis in the esophageal body. The impairment of esophageal motility is seen mainly in the distal smooth muscle region. There is no study about esophageal striated muscle contractions in the disease. In 81 patients with heartburn (44 with esophagitis) taken as controls, 51 patients with Chagas' disease (21 with esophageal dilatation) and 18 patients with idiopathic achalasia (11 with esophageal dilatation) we studied the amplitude, duration and area under the curve of esophageal proximal contractions. Using the manometric method and a continuous perfusion system we measured the esophageal striated muscle contractions 2 to 3 cm below the upper esophageal sphincter after swallows of a 5-ml bolus of water. There was no significant difference in striated muscle contractions between patients with heartburn and esophagitis and patients with heartburn without esophagitis. There was also no significant difference between patients with heartburn younger or older than 50 years or between men and women or in esophageal striated muscle contractions between patients with heartburn and Chagas' disease. The esophageal proximal amplitude of contractions was lower in patients with idiopathic achalasia than in patients with heartburn. In patients with Chagas' disease there was no significant difference between patients with esophageal dilatation and patients with normal esophageal diameter. Esophageal striated muscle contractions in patients with Chagas' disease have the same amplitude and duration as seen in patients with heartburn. Patients with idiopathic achalasia have a lower amplitude of contraction than patients with heartburn
Assuntos
Humanos , Masculino , Feminino , Adolescente , Pessoa de Meia-Idade , Adulto , Doença de Chagas , Músculo Esquelético , Estudos de Casos e Controles , Acalasia Esofágica , Junção Esofagogástrica , Azia , Manometria , Peristaltismo , Estudos RetrospectivosRESUMO
Clearance and transit time are parameters of great value in studies of digestive transit. Such parameters are nowadays obtained by means of scintigraphy and videofluoroscopy, with each technique having advantages and disadvantages. In this study we present a new, noninvasive method to study swallowing pharyngeal clearance (PC) and pharyngeal transit time (PTT). This new method is based on variations of magnetic flux produced by a magnetic bolus passing through the pharynx and detected by an AC biosusceptometer (ACB). These measurements may be performed in a simple way, cause no discomfort, and do not use radiation. We measured PC in 8 volunteers (7 males and 1 female, 23-33 years old) and PTT in 8 other volunteers (7 males and 1 female, 21-29 years old). PC was 0.82 +/- 0.10 s (mean +/- SD) and PTT was 0.75 +/- 0.03 s. The results were similar for PC but longer for PTT than those determined by means of other techniques. We conclude that the biomagnetic method can be used to evaluate PC and PTT.
Assuntos
Deglutição/fisiologia , Magnetismo , Faringe/fisiologia , Adulto , Feminino , Humanos , Magnetismo/instrumentação , MasculinoRESUMO
Chagas' disease and idiopathic achalasia have the same neuropathic lesion--the loss of ganglion cells within the esophageal myenteric plexus--with similar clinical, radiologic, and manometric features. However, it is suggested that there are some differences between them. We studied the esophageal motility of 45 patients with Chagas' disease (seven with esophageal dilation), 27 patients with idiopathic achalasia (13 with esophageal dilation), and 40 asymptomatic volunteers. We used the manometric method with continuous perfusion. The lower esophageal sphincter (LES) pressure was measured by the rapid pull-through method. Esophageal contractions was evaluated at 5, 10, and 15 cm above the LES, after 10 swallows of a 5-ml bolus of water alternated with 10 dry swallows. LES pressure was higher in achalasia than in Chagas' disease patients and controls (P < 0.05). Amplitude of contraction was lower in all patient groups compared with controls (P < 0.01) and lower in patients with dilation compared with patients without dilation (P < 0.05). The contraction duration was longer in patients with achalasia than in patients with Chagas' disease and controls (P < 0.05). The percentage of failed contractions was higher in Chagas' disease than in achalasia and controls (P < 0.05), and the percentage of simultaneous contractions was higher in patients with idiopathic achalasia than in patients with Chagas' disease and controls (P < 0.05). The results suggest the possibility that the extent of impairment of esophageal innervation differs between Chagas' disease and idiopathic achalasia.