RESUMO
BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.
Assuntos
Úlcera Duodenal/diagnóstico , Úlcera Duodenal/microbiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Feminino , Seguimentos , Genótipo , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RecidivaRESUMO
Non ulcer dyspepsia is defined as the presence of pain and/or discomfort localized to the upper abdomen, episodic or persistent, with a duration superior of 4 weeks, in the absecence of any organic lesion or sistemic disease. In order to facilitate its management, non ulcer dyspepsia is classified in five typres: 1) gastroesophageal reflux disease; 2) ulcer-like disease; 3) motility disorders; 4) aerophagia; 5) diopatic. The main clinic and pathophysiologic characteristics of each type are discussed. The diagnosis is basead in the clinical picture and in the negative results of some exams (endoscopy, ultrasound) and sugestive results of others (manometry, contrast X-ray, 24 hour pHmetry and gastric emptying time). The treatment may be divided in general (diet, behaviour, phychologic measures) and pharmacological approach (antiacids, H2blockers, procinetic agents). Each case should be individualized in terms of the presence of its main symptoms. Emphasis is put on the psychologic features and their adequate approach by the physician
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Dispepsia , Ansiolíticos/uso terapêutico , Antiácidos/uso terapêutico , Antidepressivos/uso terapêutico , Domperidona/uso terapêutico , Dispepsia/classificação , Dispepsia/diagnóstico , Dispepsia/dietoterapia , Dispepsia/fisiopatologia , Dispepsia/terapia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Metoclopramida/uso terapêuticoRESUMO
A esofagite de refluxo, segundo estatísticas americanas acomete perto de 10% da populaçäo americana. Por ter patogênese multifatorial é imperativo a obtençäo de história clínica detalhada e a realizaçäo de exames complementares. O presente discorre sobre as várias técnicas de diagnóstico e tratamento desta afecçäo