RESUMO
We measured the lower (LES) and upper esophageal sphincter (UES) pressure in 22 Chagas' disease patients with dysphagia and abnormal radiologic esophageal examination, and in 12 normal volunteers. We compared the station pull-through (SPT) and rapid-through (RPT) techniques of sphincter pressure measurement, using an infused round catheter 5 mm in outer diameter, and with four side orifices at the same level. The LES pressure was higher when measured by RPT than by SPT and at inspiration than expiration (P/0.05). In Chagas' disease patients, LES pressure was lower than in volunteers, with significance when measured by RPT at expiration (P/0.05). In normal volunteers, but not in patients, the UES pressure was higher when measured by RPT at expiration than when measured by SPT. When measured by RPT the UES pressure of Chagas' disease patients was lower than in volunteers. In conclusion, LES pressure was higher when measured at inspiration and by the RPT technique. There was a considerable overlap of LES individual pressures between patients and volunteers, but the pressure was lower in patients when we used RPT at expiration. In normal volunteers the RPT technique recorded higher UES pressures than the SPT, and higher pressures than in Chagas' disease patients.
Assuntos
Doença de Chagas/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Pressão , Reprodutibilidade dos TestesRESUMO
Contraction of the crural diaphragm increases the lower esophageal sphincter (LES) pressure, which is important for preventing gastroesophageal reflux. Our objective in this study was to compare the influence of diaphragmatic contraction on LES pressure of Chagas' disease patients with dysphagia, and control volunteers. We studied 17 patients with positive serologic reactions for Chagas' disease, dysphagia and slow transit of barium sulphate through the esophagus. Two also had esophageal dilatation. Twelve healthy volunteers were the control group. LES pressure was measured by the station pull-through (SPT) method with a round manometric catheter with four side holes opened at the same level, 10 cm from the end of the catheter, infused with water at a flow of 0.5 ml/minute. The catheter was introduced through the nose until the four side holes reached the stomach. After five minutes of stabilization it was withdrawn 1 cm every 15 seconds while the patient or volunteer breathed normally. We measured the difference in LES pressure recorded at inspiration and expiration, which is the contribution of the diaphragmatic contraction to LES pressure. There was no difference in this value between controls (18.5 +/- 9.6 mmHg, mean +/- SD) and patients (17.9 +/- 7.6 mmHg, P > 0.05). The value increased with LES pressure, suggesting that the diaphragm may participate in LES pressure asymmetry. We conclude that the diaphragmatic contribution to LES pressure in Chagas' disease patients is the same as that of normal subjects.
Assuntos
Doença de Chagas/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Diafragma/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Doença de Chagas/complicações , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-IdadeRESUMO
We measured the lower (LES) and upper esophageal sphincter (UES) pressure in 22 Chagas disease patients with dysphagia and abnormal radiologic esophageal examination, and in 12 normal volunteers. We compared the station pull-through (SPT) and rapid-through (RPT) techniques of sphincter pressure measurement, using an infused round catheter 5 mm in outer diameter, and with four side orifices at the same level. The LES pressure was higher when measured by RPT than by SPT and at inspiration than expiration (P/0.05). In Chagas disease patients, LES pressure was lower than in volunteers, with significance when measured by RPT at expiration (P/0.05). In normal volunteers, but not in patients, the UES pressure was higher when measured by RPT at expiration than when measured by SPT. When measured by RPT the UES pressure of Chagas disease patients was lower than in volunteers. In conclusion, LES pressure was higher when measured at inspiration and by the RPT technique. There was a considerable overlap of LES individual pressures between patients and volunteers, but the pressure was lower in patients when we used RPT at expiration. In normal volunteers the RPT technique recorded higher UES pressures than the SPT, and higher pressures than in Chagas disease patients.
RESUMO
We measured the lower (LES) and upper esophageal sphincter (UES) pressure in 22 Chagas disease patients with dysphagia and abnormal radiologic esophageal examination, and in 12 normal volunteers. We compared the station pull-through (SPT) and rapid-through (RPT) techniques of sphincter pressure measurement, using an infused round catheter 5 mm in outer diameter, and with four side orifices at the same level. The LES pressure was higher when measured by RPT than by SPT and at inspiration than expiration (P/0.05). In Chagas disease patients, LES pressure was lower than in volunteers, with significance when measured by RPT at expiration (P/0.05). In normal volunteers, but not in patients, the UES pressure was higher when measured by RPT at expiration than when measured by SPT. When measured by RPT the UES pressure of Chagas disease patients was lower than in volunteers. In conclusion, LES pressure was higher when measured at inspiration and by the RPT technique. There was a considerable overlap of LES individual pressures between patients and volunteers, but the pressure was lower in patients when we used RPT at expiration. In normal volunteers the RPT technique recorded higher UES pressures than the SPT, and higher pressures than in Chagas disease patients.
RESUMO
We studied the effect of aging on lower esophageal sphincter (LES) pressure of 52 normal subjects, 129 patients with Chagas' disease and 63 patients with systemic sclerosis. Three groups were compared: with ages between 10 to 29 years, 30 to 49 years and 50 to 70 years. We used a perfused catheter and the station pull-through (SPT) technique, at end expiratory phase. There was no difference in LES pressure between the three groups in normal subjects (p = 0.72) and patients with systemic sclerosis (p = 0.33). In Chagas' disease the patients with ages between 50 to 70 years had LES pressure (17 +/- 8 mmHg, mean +/- SD) lower (p = 0.03) than patients with ages between 10 to 29 years (22 +/- 9 mmHg). We conclude that in Chagas' disease the patients with ages over 50 years have LES pressure lower than patients with ages under 30 years, what does not happen with normal subjects nor systemic sclerosis patients.