RESUMO
Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes symptoms or damage to the esophageal mucosa. It is managed with proton pump inhibitors, however, up to 45% of patients with suspected GERD are refractory to treatment. It is necessary to establish a true GERD diagnosis by means of a digestive endoscopy, which does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If, in addition to not presenting esophageal lesions, they have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders. These require a different approach from that of GERD or NERD, as the symptoms are not due to pathological exposure to gastric acid. The aim was to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with suspected NERD. This was a cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, 166 patients were selected. The frequency for functional disorders was 86.15%, being 46.9% for functional heartburn and 39.2% for esophageal hypersensitivity. The frequency of functional disorders was higher than that reported in previous studies. In conclusion, age, psychological conditions, dietary, cultural, ethnic or lifestyle factors inherent to our environment might play important roles in the development of functional disorders.
La enfermedad por reflujo gastroesofágico (ERGE) es una condición clínica en la que el reflujo gástrico provoca síntomas o daños en la mucosa esofágica. Se maneja con inhibidores de la bomba de protones; sin embargo, hasta el 45% de los pacientes con sospecha de ERGE son refractarios al tratamiento. Por lo cual, es necesario establecer un verdadero diagnóstico de ERGE mediante una endoscopia digestiva, que no muestra lesiones en aproximadamente el 70% de los pacientes. En este escenario, es necesario realizar una medición de pH-impedancia esofágica, procedimiento que permite determinar si la exposición al ácido gástrico es patológica. De este grupo, los pacientes con exposición patológica al ácido son diagnosticados como verdadera enfermedad por reflujo no erosiva (ERNE). Si además de no presentar lesiones esofágicas, tienen una exposición fisiológica al ácido gástrico, padecen hipersensibilidad esofágica o pirosis funcional, que son trastornos funcionales. Estos requieren un enfoque diferente al ERGE o ERNE, ya que los síntomas no se deben a una exposición patológica al ácido gástrico. El objetivo fue calcular la frecuencia de hipersensibilidad esofágica y pirosis funcional en pacientes con sospecha de ERNE. Este fue un estudio transversal. Los datos se recopilaron mediante la revisión de informes de pH-impedancia y manometría, se seleccionaron 166 pacientes. La frecuencia de trastornos funcionales fue de 86,15%, siendo 46,9% de pirosis funcional y 39,2% de hipersensibilidad esofágica. La frecuencia de trastornos funcionales fue superior a la reportada en estudios previos. En conclusión, la edad, las condiciones psicológicas, los factores dietéticos, culturales, étnicos o de estilo de vida inherentes a nuestro entorno podrían jugar un papel importante en el desarrollo de trastornos funcionales.
RESUMO
Therapeutic intervention to skin wounds requires covering the affected area with wound dressings. Interdisciplinary efforts have focused on the development of smart bandages that can perform multiple functions. In this direction, here, we designed a low cost (U$0.012 per cm2) multifunctional therapeutic wound dressing fabricated by loading curcumin (CC) into poly(ϵ-caprolactone) (PCL) nanofibers using solution blow spinning (SBS). The freestanding PCL/CC bandages were characterized by distinct physicochemical approaches and were successful in performing varied functions, including controlled release of CC, colorimetric indication of the wound conditions, barrier against microorganisms, being biocompatible, and providing a photosensitive platform for antimicrobial photodynamic therapy (aPDT). The chemical nature of PCL and CC and the interactions between these components allowed CC to be released for 192 h (ca. 8 days), which could be correlated with the Korsmeyer-Peppas model, with a burst release suitable to treat the inflammatory phase. Due to the CC keto-enol tautomerism, an optical indication of the healing status could be obtained using PCL/CC, which occurred immediately, ranging between red/orange and yellow shades. The effect against pathogenic microorganisms evaluated by agar disc-diffusion, affected skin wound simulation (ex vivo), and microbial penetration tests demonstrated the ability to block and inhibit microbial permeation in different environments. The biocompatibilities of PCL and PCL/CC were verified by in vitro cytotoxicity study, which demonstrated that cell viabilities average above 94 and 96% for human dermal fibroblasts. In addition, the proposed bandage responded to aPDT applied to an in vivo assay, showing that, when irritated, PCL/CC was able to reduce the bacteria present on the real wound of mice. In summary, our findings demonstrate that using PCL and CC to produce nonwovens by the SBS technique offers potential for the rapid fabrication of biocompatible and multifunctional wound dressings, paving the way for large-scale production and utilization of such dressings in the treatment of skin wounds.
Assuntos
Anti-Infecciosos , Curcumina , Nanofibras , Camundongos , Humanos , Animais , Nanofibras/química , Curcumina/farmacologia , Pele , BandagensRESUMO
OBJECTIVE: To assess the reliability of the KidZ Health Castle formula (KHC-F) to determine the correct probe position of a multichannel intraluminal impedance pH. STUDY DESIGN: A retrospective cohort study was performed on 222 children between 1 month and 18 years of age undergoing multichannel intraluminal impedance pH. The primary outcome was the comparison of the pH sensor location determined by the KHC-F with the radiological target position. The margin of error was defined as 1 cm from the target position. Performance of the KHC-F and existing formulas was determined via the percentage with a correct position, mean error, 95% limits of agreement (Bland-Altman plots), and Spearman correlation. A post hoc analysis was performed with an updated KHC-F v2, subtracting -0.5 cm from the KHC-F. RESULTS: Positioning with KHC-F was correct in two-thirds of the participants, with a very strong correlation (ρ = 0.91) with the target position. Bland-Altman plots showed good agreement between KHC-F and target position (mean error of -0.44 cm, lower limit -3.2 cm, upper limit 2.3 cm). A post hoc analysis with the KHC-F v2 showed a correct positioning in 74% of patients. Comparison with other formulas showed a stronger performance of KHC-F and KHC-F v2 on correct positioning, mean error, and 95% limits of agreement. CONCLUSIONS: The KHC-F leads to reliable results. KHC-F v2 outperforms all other existing formulas in children, thereby reducing the need for repositioning and the amount of x-ray exposure. The age distribution of the sample may be a limitation, as well as the retrospective nature of the study.
Assuntos
Refluxo Gastroesofágico , Humanos , Criança , Monitoramento do pH Esofágico/métodos , Estudos Retrospectivos , Impedância Elétrica , Reprodutibilidade dos Testes , Concentração de Íons de HidrogênioRESUMO
BACKGROUND: Gastroesophageal reflux disease (GERD) pathophysiology is multifactorial. Greater importance has been attributed to a defective lower esophageal sphincter (LES) in comparison to an altered transdiaphragmatic pressure gradient (TPG). This study aims to evaluate the role of the TPG and LES disfunction in GERD pathogenesis. METHODS: Five hundred consecutive esophageal function tests from patients with clinically suspected GERD were reviewed. Patients were classified according to the pH monitoring in GERD positive or GERD negative. Abdominal pressure, thoracic pressure, TPG (abdominal-thoracic pressures), LES resting pressure (mid-respiratory, expiratory, and EGJ-CI), and LES retention pressure (LES resting pressure-TPG) were determined. RESULTS: GERD was present in 296 (59%) individuals. GERD-positive patients were mostly males. LES resting pressure (by all parameters) and thoracic pressure were not different between groups. Abdominal pressure and TPG were higher in GERD-positive patients. LES retention pressure (by all parameters) was lower in GERD-positive patients. DeMeester score had a positive correlation with LES resting pressure, TPG, and LES retention pressure (by all parameters) but not with abdominal pressure and thoracic pressure. CONCLUSIONS: LES valvular competency as measured by absolute resting pressure was not reliable to predict GERD; however, it was associated with GERD severity. Relative LES pressure (LES retention pressure) predicted GERD presence and severity, but no parameter showed superiority. TPG plays an important role in the pathophysiology of GERD since it is related to GERD presence and severity; still TPG is altered mostly based on a higher abdominal pressure.
Assuntos
Esfíncter Esofágico Inferior , Refluxo Gastroesofágico , Masculino , Humanos , Feminino , Manometria/efeitos adversos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , PressãoRESUMO
INTRODUCTION: Laparoscopic Heller Myotomy (LHM) with partial anterior or posterior fundoplication is the standard surgical procedure for treating achalasia patients. The results reported are mainly based on symptomatic evaluations and have less than 5 years of follow-up and none more than ten. OBJECTIVE: To determine the late results of LHM, performing endoscopic, histologic, manometric, and functional studies in addition to clinical evaluations. MATERIALS AND METHODS: Eighty-nine consecutive patients were included in a prospective study from 1993 to 2008. Inclusion criteria corresponded to achalasia patients with Types I to III (radiological evaluation). Exclusion criteria included patients with grade IV, patients with previous procedures (surgical or endoscopic), or giant hiatal hernia. They were submitted to a radiological evaluation, over two endoscopic procedures with biopsy samples, manometric assessments, and 24-h pH monitoring late after surgery. RESULTS: There was no operative mortality nor postoperative complications. The average hospital stay was two days. Nine patients (10.1%) were lost from follow-up. The mean late follow-up was 17 years (10-26). Visick I and II (success) corresponded to 78.7% of patients and grades III-IV (failure) to 21.3%, mainly due to gastroesophageal reflux disease (GERD). Manometric evaluations showed a significant and permanent decrease in lower esophageal sphincter pressure (LESP). 24-h pH monitoring was normal among Visick I patients and showed pathologic acid reflux in patients with GERD. Two patients (2.5%) developed Barrett's esophagus. Squamous-cell carcinoma (SCC) appeared in three patients (3.7%). CONCLUSION: LHM controlled symptoms in 79% of achalasia patients very late (17 years) after surgery. This was corroborated by endoscopic, manometric, and functional studies. GERD symptoms developed in 18.7% and SCC in 3.7% in previously asymptomatic patients. Endoscopic surveillance at regular intervals is recommended for all patients who have had surgery. These very long-term results are a real challenge to POEM endoscopic treatment. Unique Identifying Registration Number 3743.
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Acalasia Esofágica , Laparoscopia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/cirurgia , Esofagoscopia/métodos , Seguimentos , Humanos , Laparoscopia/métodos , Estudos Prospectivos , Resultado do TratamentoRESUMO
El reflujo gastroesofágico es una situación frecuente en el primer año de vida. En ausencia de signos y síntomas de alarma, se lo considera fisiológico. No requiere estudios y puede ser abordado por el pediatra con medidas no farmacológicas. La enfermedad por reflujo (definidaporsíntomasmolestosocomplicaciones) debe ser manejada por el gastroenterólogo. Los exámenes complementarios tienen indicaciones precisas y el tratamiento incluye medidas no farmacológicas, farmacológicas y quirúrgicas (si fuera necesario). Nuestro objetivo es describir los diferentes métodos diagnósticos, sus indicaciones y limitaciones, así como los recursos terapéuticos disponibles, incluidas las indicaciones y los efectos adversos
Gastro esophageal reflux is a frequent condition in infants. In the absence of warning symptoms and signs, it is considered physiologic. No exam is required and a non-pharmacologic approach can be instituted by pediatricians. Gastro esophageal reflux disease is characterized by troublesome symptoms or complications and should be managed by a pediatric gastroenterologist. Diagnostic tests have accurate indications and treatment includes pharmacologic and non-pharmacologic measures as well as surgery. Our objective is to describe the different diagnostic methods, their indications and limitations as well as the therapeutic resources available, including indications and adverse effects.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapiaRESUMO
Gastro esophageal reflux is a frequent condition in infants. In the absence of warning symptoms and signs, it is considered physiologic. No exam is required and a non-pharmacologic approach can be instituted by pediatricians. Gastro esophageal reflux disease is characterized by troublesome symptoms or complications and should be managed by a pediatric gastroenterologist. Diagnostic tests have accurate indications and treatment includes pharmacologic and nonpharmacologic measures as well as surgery. Our objective is to describe the different diagnostic methods, their indications and limitations as well as the therapeutic resources available, including indications and adverse effects.
El reflujo gastroesofágico es una situación frecuente en el primer año de vida. En ausencia de signos y síntomas de alarma, se lo considera fisiológico. No requiere estudios y puede ser abordado por el pediatra con medidas no farmacológicas. La enfermedad por reflujo (definida por síntomas molestos o complicaciones) debe ser manejada por el gastroenterólogo. Los exámenes complementarios tienen indicaciones precisas y el tratamiento incluye medidas no farmacológicas, farmacológicas y quirúrgicas (si fuera necesario). Nuestro objetivo es describir los diferentes métodos diagnósticos, sus indicaciones y limitaciones, así como los recursos terapéuticos disponibles, incluidas las indicaciones y los efectos adversos.
Assuntos
Refluxo Gastroesofágico , Criança , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Humanos , LactenteRESUMO
INTRODUCTION: An increased transdiaphragmatic pressure gradient (TGP) is a main element for distal gastroesophageal reflux disease (GERD). The role of TGP for proximal reflux is still unclear. This study aims to evaluate the presence, severity, and importance of proximal reflux in relationship to the TGP, comparing healthy volunteers, obese individuals, and patients with chronic obstructive pulmonary disease (COPD). METHODS: We studied 114 individuals comprising 19 healthy lean volunteers, 47 obese individuals (mean body mass index 45 ± 7 kg/m2), and 48 patients with COPD. All patients underwent high-resolution manometry and dual-channel esophageal pH monitoring. Esophageal motility, thoracic pressure (TP), abdominal pressure (AP), TGP, DeMeester score, and % of proximal acid exposure time (pAET) were recorded. RESULTS: Pathologic distal GERD was found in 0, 44, and 57% of the volunteers, obese, and COPD groups, respectively. pAET was similar among groups, only higher for obese individuals GERD + as compared to obese individuals GERD - and COPD GERD -. pAET did not correlate with any parameter in healthy individuals, but it correlated with AP in the obese, TP in the COPD individuals, and TGP and DeMeester score in both groups. When all individuals were analyzed as a total, pAET correlated with AP, TGP, and DeMeester score. DeMeester score was the only independent variable that correlated with pAET. CONCLUSIONS: Our results show that (a) TGP is an important mechanism associated with distal esophageal acid exposure and this fact is linked with proximal acid exposure and (b) obesity and COPD both seem to be primary causes for GERD but not directly for proximal reflux.
Assuntos
Esofagite Péptica , Refluxo Gastroesofágico , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/etiologia , Humanos , ManometriaRESUMO
SUMMARY OBJECTIVE: To demonstrate the need of performing esophageal pH monitoring and manometry in patients with clinical suspicion of Gastroesophageal reflux disease, as more accurate and practical complementary exams in the indication of surgical treatment. METHODS: A systematic review was carried out in the PubMed/Medline database, based on the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, selecting studies in humans, published in Portuguese, Spanish, and English, from January 1, 2009 to August 5, 2020. The following descriptors were used: "reflux gastroesophageal" AND "surgery" AND "surgical treatment" AND "esophageal manometry" OR "pH monitoring". After that, retrospective or prospective observational studies with a sample of less than 100 individuals, or with limited access, reports or case series, review articles, letters, comments, or book chapters were excluded. To facilitate the application of the exclusion criteria, the Rayyan management base was used. RESULTS: Out of the 676 studies found, 19 valid and eligible studies were selected to make inferences. CONCLUSIONS: Based on the best evidence, currently, considering national particularities, performing a 24-hour esophageal pH monitoring and esophageal manometry for all patients undergoing anti-reflux surgery.
Assuntos
Humanos , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/diagnóstico , Monitoramento do pH Esofágico , Estudos Retrospectivos , Estudos Observacionais Veterinários como Assunto , ManometriaRESUMO
INTRODUCTION: Many laryngeal-related problems have been attributed to laryngopharyngeal reflux including dysphonia, frequent throat clearing, chronic cough, and globus sensation. However, there is still controversy regarding diagnosis and clinical presentation of this disorder. OBJECTIVE: The main objective of this study is to describe laryngopharyngeal reflux characteristics of different reflux position patterns in laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. METHODS: A retrospective chart review was conducted for 161 laryngopharyngeal reflux patients diagnosed with 24h oro-pharyngeal pH monitoring. Study subjects were categorized into upright and supine laryngopharyngeal reflux groups based on the pH results. The two groups were compared regarding the clinical presentation and pH characteristics. RESULTS: Significant higher rates of upright laryngopharyngeal reflux position than supine laryngopharyngeal reflux position (P<0.0001) were reported among the study group. Reflux symptoms index results were significantly higher in the upright larybgopharyngeal reflux group compared to the supine laryngopharyngeal reflux group. 24h oropharyngeal pH measurements composite Ryan score was significantly higher in the upright group compared to the supine group (P<0.0001). No significant difference was found between the upright and supine laryngopharyngeal reflux groups regarding the frequency of clinical presentation or voice handicap index ratings. CONCLUSION: Laryngopharyngeal reflux was found to be more prevalent occurring in the upright position among the study group. Reflux-related characteristics including pH parameters were more evident in the upright laryngopharyngeal reflux position.
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Disfonia , Refluxo Laringofaríngeo , Humanos , Concentração de Íons de Hidrogênio , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/diagnóstico , Faringe , Estudos RetrospectivosRESUMO
ABSTRACT Background: The catheter of the esophageal pH monitoring is associated with nasal and throat discomfort, and different behave in patients. The capsule of the wireless pH monitoring may cause chest pain and complications. Aim: To compare the wireless and conventional pH monitoring concerning the degree of discomfort and limitations in daily activities, complications, ability to diagnose pathological reflux, and costs. Methods: Twenty-five patients with symptoms of gastroesophageal reflux were prospectively submitted, in a simultaneous initial period, to 24-hour catheter esophageal pH monitoring and 48-hour wireless system. After removing each system, patients underwent a specific clinical questionnaire. Results: Fifteen patients (60%) pointed a higher discomfort in the introduction of the capsule (p=0.327). Discomfort and limitations in daily activities were lower on 2nd day (p<0.05); however, continued to be expressive (32% to 44%). Chest pain occurred in 13 (52%) patients. The diagnostic gain of pathological reflux was 12% with the wireless system (p=0.355). Conclusions: 1) There is no significant difference between the discomfort mentioned in the introduction of the capsule and the catheter; 2) during reflux monitoring, the wireless system provides significant less discomfort and limitations in daily activities; 3) there is no significant difference between the two methods in the ability to diagnose pathological reflux; 4) wireless pH monitoring has higher cost.
RESUMO Racional: O cateter da pHmetria esofágica associa-se ao desconforto nasal e na garganta, e comportamento diferente nos pacientes. A cápsula da pHmetria sem cateter pode causar dor torácica e complicações. Objetivo: Comparar as pHmetrias sem cateter e a convencional, em relação ao desconforto e limitações das atividades diárias, complicações, capacidade de diagnosticar refluxo patológico, e custos. Métodos: Vinte e cinco pacientes com sintomas de refluxo gastroesofágico foram prospectivamente submetidos, em um período inicial simultâneo, à pHmetria esofágica com cateter durante 24 h e à pHmetria sem cateter durante 48 h. Após a retirada de cada método, pacientes responderam o questionário clínico específico. Resultados: Quinze pacientes (60%) relataram maior desconforto na introdução da cápsula (p=0,327). Desconforto e limitações das atividades diárias foram menores no 2º dia (p< 0,05); entretanto, continuaram sendo expressivos (32% a 44%). Dor torácica ocorreu em 13 (52%) pacientes. O ganho diagnóstico no refluxo patológico foi de 12% com o sistema sem cateter (p=0,355). Conclusões: 1) Não há diferença significativa entre o desconforto relatado na introdução da cápsula e do cateter; 2) durante a monitorização do refluxo, o sistema sem cateter proporciona significativo menor desconforto e limitações das atividades diárias; 3) não há diferença significativa entre os dois métodos na capacidade de diagnosticar o refluxo patológico; 4) pHmetria sem cateter tem custo maior.
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Humanos , Refluxo Gastroesofágico/diagnóstico , Monitoramento do pH Esofágico , Inquéritos e Questionários , Catéteres , Concentração de Íons de HidrogênioRESUMO
O processo de alisamento capilar é uma prática comum realizada nos salões de beleza. O procedimento exige a utilização de substâncias com capacidade de rompimento das cadeias dissulfídricas da fibra capilar com posterior modelamento para o efeito desejado, sendo o formol um dos compostos mais utilizados para esta finalidade, porém indevidamente. De acordo com a legislação vigente, o formol só pode ser utilizado em produtos cosméticos com a função de conservante em uma concentração máxima de 0,2%. Devido a seu uso incorreto em produtos capilares o presente trabalho teve como objetivo realizar uma análise semi-quantitativa da presença de formol em amostras de alisantes capilares, bem como verificar o pH destes produtos. Foram obtidas 22 amostras de alisantes capilares doadas por salões de beleza da região de Umuarama - PR. A determinação da presença de formol foi realizada através da reação de Shiff e comparação com escala colorimétrica de concentrações padronizadas de formaldeído variando de 0,005% a 10%. A verificação do pH foi realizada através da preparação de soluções aquosas de 10% do alisante e posterior aferição em pHmetro digital. Das amostras analisadas, verificou-se 22,72% encontraram-se em conformidade, apresentando quantidade de formaldeído adequada com a legislação (até 0,2%) ou ausência do composto, enquanto que 77,28% apresentaram valores acima do permitido. Já o pH adequado foi constatado em apenas 13,64% amostras. O uso incorreto ou exagerado do formol pode acarretar danos à saúde, como cefaléia, dispnéia, queimadura, edema pulmonar e até câncer. Uma maior fiscalização deve ser realizada nos estabelecimentos que realizam procedimentos de alisamento capilar, bem como nas indústrias produtoras e ainda em importadoras, para uma melhor garantia do cumprimento da legislação tanto para a preservação da saúde dos profissionais quando dos usuários.
The hair-straightening process is a common practice in most beauty salons. The procedure requires the use of substances capable of disrupting the disulfide chains of the hair fiber with subsequent modeling for the desired effect, with formaldehyde being one of the most commonly but improperly used compounds for this purpose. According to the current legislation, formaldehyde can only be used in cosmetic products as a preservative function in a maximum concentration of 0.2%. Due to its incorrect use in capillary products, this work has the purpose of developing a semi-quantitative analysis of the presence of formaldehyde in samples of hair straighteners, as well as verifying the pH of those products. Twenty-two samples of hair straighteners were donated by beauty salons from the region of Umuarama-PR. The determination of the presence of formaldehyde was performed using the Shiff reaction and compared using the colorimetric scale for standard formaldehyde concentrations varying from 0.005% to 10%. The pH verification was carried out by the preparation of 10% aqueous solutions of the straightener and subsequent measurement in a digital pH meter. From the analyzed samples, 22.72% were found to be in compliance, presenting the amount of formaldehyde within the legislation (up to 0.2%) or absence of the compound, while 77.28% presenting values above the legal limitations. Additionally, adequate pH was verified in only 13.64% of the samples. Incorrect or exaggerated use of formaldehyde can lead to health issues, such as headache, dyspnea, burns, pulmonary edema and even cancer. Greater surveillance should be carried out in establishments that perform hair straightening procedures as well as in the producing and importing industries in order to guarantee better compliance with the legislation both for the preservation of the health of professionals and users alike.
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Colorimetria/métodos , Formaldeído/toxicidade , Cabelo/química , Edema Pulmonar , QueimadurasRESUMO
BACKGROUND: Gastroesophageal reflux disease (GERD) impacts choice and outcomes of bariatric surgery. However, GERD diagnosis based solely on symptoms yields inaccurate results. OBJECTIVE: To determine the factors associated with a positive 24h pH-monitoring (pH-test) or esophagitis in patients with severe obesity seeking bariatric surgery. SETTING: Private practice. METHODS: 93 patients with severe obesity underwent prospective evaluation for GERD symptoms, body composition, upper gastrointestinal endoscopy, esophageal manometry and pH-test. Correlation analyses were performed. RESULTS: 50 patients (53.8%) had GERD symptoms, 49 (52.7%) had esophagitis and 33 (35.5%) had a positive pH-test. Among patients with GERD symptoms, 18% had normal pH-test and no esophagitis, while 34.9% of patients without GERD symptoms had positive pH-test, esophagitis or both. Factors independently associated with positive pH-test were esophagitis (PR:3.08, 95%CI: 1.4-6.9, Pâ¯=â¯0.006) and defective lower esophageal sphincter (PR:1.88, 95%CI: 1.09-3.21, Pâ¯=â¯0.02). Factors independently associated with esophagitis were hiatal hernia (PR: 2.46; 95%CI: 1.6-3.7, P<0.001), GERD symptoms (PR:2.09; 95%CI: 1.3-3.4, Pâ¯=â¯0.003) and positive pH-test (PR:1.82; 95%CI: 1.2-2.7, Pâ¯=â¯0.003). The combined presence of GERD symptoms and esophagitis had a low positive predictive value for a positive pH-test (57%). On the other hand, the absence of both GERD symptoms and esophagitis had a 90% predictive value for a negative pH-test. CONCLUSIONS: Investigation for GERD before bariatric surgery should consist of routine upper endoscopy and GERD symptom evaluation in all patients. Patients with GERD symptoms and no esophagitis may need a pH-test for GERD diagnosis. Prospective studies are needed to understand significance of GERD diagnosis prior to bariatric surgery.
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Cirurgia Bariátrica , Esofagite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Obesidade Mórbida/cirurgia , Adulto , Composição Corporal , Brasil , Endoscopia do Sistema Digestório , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Manometria , Cuidados Pré-Operatórios , Estudos ProspectivosRESUMO
BACKGROUND: Symptoms may be unreliable to diagnose gastroesophageal reflux disease (GERD) in patients with minor psychiatric disorders (MPD). This study aims to evaluate the influence of MPD in the diagnosis of GERD. METHODS: We prospectively studied 245 patients (based on a sample size calculation) with suspected GERD. All patients underwent manometry and pH monitoring and MPD evaluation based on the Hospital Anxiety and Depression Scale (HADS). RESULTS: Based on the results of the pH monitoring, patients were classified as GERD + (n = 136, 55% of the total, mean age 46 years, 47% females) or GERD - (n = 109, 45% of the total, mean age 43 years, 60% females). The mean HADS score for GERD + and GERD - for anxiety was 7.8 and 8.5, respectively (p = 0.8) and for depression was 5.4 and 6.1, respectively (p = 0.1). DeMeester score (DS) did not correlate with total HADS score (p = 0.08) or depression domain (p = 0.9) but there was a negative correlation between DS and anxiety level (p < 0.001). A significant threshold accuracy value for HADS to diagnose GERD was not found on receiver operating characteristics curve analysis. CONCLUSION: Almost half of the patients evaluated for GERD did not have the disease on objective evaluation. GERD + and GERD - patients had similar levels of MPD. However, the amount of reflux correlated negatively with the severity of anxiety. Symptoms and HADS cannot accurately diagnose or exclude GERD. pH monitoring should be more liberally used especially in patients with high levels of anxiety.
Assuntos
Ansiedade/diagnóstico , Depressão/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Adulto , Idoso , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Gastroesophageal reflux disease (GERD) clinical presentation may encompass a myriad of symptoms that may mimic other esophageal and extra-esophageal diseases. Thus, GERD diagnosis by symptoms only may be inaccurate. Upper digestive endoscopy and barium esophagram may also be misleading. pH monitoring must be added often for a definitive diagnosis. The DeMeester score (DMS) is a composite score of the acid exposure during a prolonged ambulatory pH monitoring that has been used since 1970s to categorize patients as GERD+ or GERD-. We showed in this review that DMS has some limitations and strengths. Although there is not a single instrument to precisely diagnose GERD in all of its variances, pH monitoring analyzed at the light of DMS is still a reliable method for scientific purposes as well as for clinical decision making. There are no data that show that acid exposure time is superior-or for that matter inferior-as compared to DMS.
Assuntos
Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , HumanosRESUMO
ABSTRACT BACKGROUND: Prolonged monitoring increased our knowledge on gastroesophageal reflux (GER), and the disease became known as gastroesophageal reflux disease (GERD). Prolonged reflux monitoring permits the diagnosis of GERD when endoscopic findings are not enough to characterize it. OBJECTIVE: The objective of this paper is to review the current knowledge on impedance-pH monitoring, taking into account the published literature and the authors experience with 1,200 exams. METHODS: The different types of prolonged reflux monitoring, namely: conventional pHmetry, catheter-free pHmetry and impedance-pHmetry will be briefly described. The new possibilities of evaluation with impedance-pHmetry are emphasized, namely: the study of symptomatic patients in use of proton pump inhibitors (PPIs); evaluation of patients with symptoms suggestive of GERD although with normal endoscopy and normal pHmetry, diagnostic elucidation of patients with atypical symptoms or supra-esophageal symptoms, mainly chronic cough, study of patients complaining of belch, differentiating gastric and supra-gastric belching, and the proper work-up before anti-reflux surgery. RESULTS: When impedance was associated to pH monitoring, an impressive technological evolution became apparent, when compared to pH monitoring alone. The main advantages of impedance-pHmetry are: the ability to detect all types of reflux: acid, non-acid, liquid, gaseous. In addition, other important measurements can be made: the ability of the esophagus in transporting the bolus, the measurement of basal mucosal impedance and the evaluation of primary peristalsis post reflux. CONCLUSION: Impedance-pHmetry is a promising method, with great advantages over conventional pHmetry. The choice between these two types of monitoring should be very judicious. The authors suggest the importance of careful evaluation of each reflux episode by the physician responsible for the examination, necessary for the correct interpretation of the tracings.
RESUMO CONTEXTO: A monitorização prolongada ampliou o conhecimento sobre o refluxo gastroesofágico; a afecção decorrente do mesmo, passou a ser designada por doença do refluxo gastroesofágico (DRGE). O estudo prolongado do refluxo viabiliza o diagnóstico da DRGE nos casos sem alterações endoscópicas suficientes para caracterização da afecção. OBJETIVO: O objetivo do presente trabalho é apresentar uma revisão sobre a monitorização do refluxo por impedâncio-pHmetria, ponderando-se os dados de literatura com a experiência dos autores com o método em 1.200 exames realizados. MÉTODOS: São apresentados detalhes dos diferentes tipos de monitorização prolongada do refluxo; ou seja, a pHmetria convencional, a pHmetria sem cateter e a impedâncio-pHmetria. Salientam-se as novas possibilidades de avaliação que a impedâncio-pHmetria propicia e suas principais indicações: estudo de pacientes que permanecem sintomáticos durante o tratamento do refluxo com antissecretores; análise de pacientes com sintomas sugestivos de DRGE que não apresentem esofagite ao exame endoscópico e que tenham pHmetria normal; esclarecimento diagnóstico de pacientes com sintomas atípicos e supraesofágicos - em especial na tosse crônica; estudo da eructação diferenciando-as em dois grupos: gástricas e supragástricas e no auxílio na indicação do tratamento cirúrgico do refluxo. RESULTADOS: A monitorização associando duas modalidades de avaliação: a impedancio-pHmetria representa evolução tecnológica expressiva em relação à modalidade baseada apenas na análise do pH (pHmetria). As principais vantagens da impedâncio-pHmetria são: possibilidade de avaliação de todas modalidades de refluxo; ou seja, ácido, não-ácido, líquido e gasoso e também a possibilidade de estudo de outras variáveis importantes; ou seja: capacidade de transporte do bolus, impedância basal do esôfago e peristalse pós refluxo. CONCLUSÃO: A impedancio-pHmetria é um método promissor, com grandes vantagens sobre a pHmetria convencional. A escolha do tipo de monitorização a ser utilizada, deve ser criteriosa. Os autores destacam a importância da análise cuidadosa de cada episódio de refluxo, pelo médico responsável pela execução do exame, para correta interpretação e valorização dos dados obtidos.
Assuntos
Humanos , Refluxo Gastroesofágico/diagnóstico , Impedância Elétrica , Monitoramento do pH Esofágico/métodosRESUMO
BACKGROUND/AIMS: Evaluation of esophageal clearance by orange juice swallowing could be useful to identify different categories of gastroesophageal reflux disease. We determined whether a juice test at the beginning of esophageal pH monitoring can identify nonerosive reflux disease (NERD) among heartburn patients. METHODS: Multiple swallows of orange juice (pH 3) were performed at the beginning of esophageal pH monitoring in 71 heartburn patients off acid-suppressive therapy. The area between pH drop below 5 and recovery to 5 was calculated from pH tracings and named Delta5 (mmolâL⻹âsec). Fifteen healthy subjects served to determine Delta5 cutoff (95th percentile). Patients were classified as NERD, non-NERD (a mix of reflux hypersensitivity, functional heartburn, and undetermined), and erosive disease depending on acid exposure, reflux symptom analysis, and upper endoscopy. RESULTS: Delta5 cutoff in healthy subjects was 251 mmol·L⻹âsec. Among 71 patients, 23 had NERD, 26 had non-NERD, and 22 had erosive disease. Compared to non-NERD, Delta5 was higher in both NERD (median [interquartile range]: 316 [213-472] vs 165 [105-225]; P ï¼ 0.01) and erosive disease (310 [169-625] vs 165 [105-225]; P ï¼ 0.01). An elevated Delta5 (ï¼ 251 mmolâL⻹âsec) showed sensitivity of 74% and specificity of 81% for identification of NERD. Positive and negative likelihood ratios were 3.84 and 0.32 respectively, whereas test accuracy was 78%. CONCLUSIONS: A juice test with calculation of Delta5 helps in the identification of true NERD among heartburn patients with endoscopy-negative reflux disease. In these patients, an elevated Delta5 could make prolonged reflux testing unnecessary.
RESUMO
BACKGROUND: Proton pump inhibitors are the most effective medical therapy for gastroesophageal reflux disease, but their onset of action may be slow. OBJECTIVES: To assess the available literature regarding the efficacy of omeprazole/sodium bicarbonate in gastroesophageal reflux patients. METHODS: A systematic review was conducted. A systematic literature search starting from 2000. Reviewed manuscripts concerning the effectiveness of omeprazole/sodium bicarbonate treatment in gastroesophageal reflux disease were reviewed and the data were extracted. Data were subsequently analyzed with descriptive statistics. RESULTS: This review included information of four studies. Two trials compared the efficacy of omeprazole/sodium bicarbonate versus omeprazole. One study compared the efficacy of once-daily morning or nighttime dosing. And another study compared omeprazole/sodium bicarbonate/alginate versus omeprazole. In total, there was no difference between omeprazole/sodium bicarbonate and omeprazole. However, there is a trend towards more sustained response and a greater proportion of patients with sustained total relief by 30 minutes with omeprazole/sodium bicarbonate. CONCLUSION: Omeprazole/sodium bicarbonate therapy is not more effective than omeprazole in the treatment of gastroesophageal reflux disease. However, data obtained suggest that it can have a more sustained response and sustained total relief.
INTRODUCCIÓN: Los inhibidores de la bomba de protones son la terapia médica más efectiva para la enfermedad de reflujo gastroesofágico, pero su inicio de acción puede ser lento. OBJETIVO: Evaluar la literatura referida a la eficacia del omeprazol y bicarbonato de sodio en la enfermedad por reflujo gastroesofágico. MÉTODOS: Revisión sistemática de la literatura desde el año 2000. Se revisaron los manuscritos relativos a la efectividad del tratamiento de la enfermedad por reflujo gastroesofágico. Se extrajo la información relevante, la cual fue subsecuentemente analizada con estadística descriptiva. RESULTADOS: Se incluyó información de cuatro estudios. Dos estudios compararon la eficacia de omeprazol y bicarbonato de sodio versus omeprazol, y un estudio comparó la eficacia de la dosis diaria matutina con la nocturna. El otro estudio comparó omeprazol más bicarbonato de sodio y alginato versus omeprazol. No hubo diferencia entre omeprazol con bicarbonato de sodio y omeprazol. Sin embargo, hubo una tendencia hacia una respuesta más sostenida y una mayor proporción de alivio total sostenido por 30 minutos con omeprazol y bicarbonato de sodio. CONCLUSIÓN: La terapia con omeprazol y bicarbonato de sodio no es más efectiva que el omeprazol en el tratamiento de la enfermedad por reflujo gastroesofágico. Sin embargo, la información sugiere que puede tener una respuesta más sostenida y un alivio total de mayor duración.
Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Omeprazol/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Bicarbonato de Sódio/administração & dosagem , Esquema de Medicação , Combinação de Medicamentos , Humanos , Resultado do TratamentoRESUMO
ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.
RESUMO CONTEXTO: Disfagia é uma queixa presente em 32% dos pacientes com laringite. OBJETIVO: O objetivo desta investigação foi avaliar o trânsito oral e faríngeo de pacientes com laringite, com a hipótese de que a alteração no trânsito do bolo pela boca e faringe pode estar envolvida com a queixa de disfagia. MÉTODOS: A avaliação videofluoroscópica da deglutição de bolos líquido, pastoso e sólido foi realizada em 21 pacientes com laringite, 10 deles com disfagia e 21 voluntários normais da mesma idade e sexo. Duas deglutições de 5 mL de bolo líquido, duas deglutições de bolo pastoso e duas deglutições de bolo sólido foram avaliadas em sequência casual definida por sorteio. Bolo líquido foi sulfato de bário 100%, e o bolo pastoso foi preparado com 50 mL de bário líquido e 4 g de espessante alimentar (amido e maltodextrina). O bolo sólido foi 2,2 g de uma bolacha macia embebida em bário líquido. A duração da preparação oral, trânsito oral, trânsito faríngeo, depuração da faringe, abertura do esfíncter superior do esôfago, movimento do hióide e do trânsito oral-faríngeo foram medidas. Precedendo a videofluoroscopia todos pacientes realizaram exame de pHmetria de 24 horas. RESULTADOS: O registro do pH intraesofágico distal revelou resultado anormal em 10 pacientes. Pacientes com laringite apresentaram maior duração da preparação oral para bolo pastoso e um tempo de trânsito oral mais rápido para bolo sólido. Os pacientes com laringite e disfagia tiveram uma preparação oral mais longa para bolo pastoso e sólido e tempo de trânsito oral menor com bolos líquido, pastoso e sólido. CONCLUSÃO: Preparação oral mais longa para bolos pastoso e sólido e trânsito mais rápido através da boca são situações associadas com a presença de disfagia em pacientes com laringite.