RESUMO
BACKGROUND: Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition. AIM: To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia. METHODS: Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL). RESULTS: There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group. CONCLUSION: POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.
Assuntos
Acalasia Esofágica , Esofagite Péptica , Refluxo Gastroesofágico , Laparoscopia , Miotomia , Cirurgia Endoscópica por Orifício Natural , Adulto , Bário , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/etiologia , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Esofagite Péptica/etiologia , Esofagoscopia/efeitos adversos , Esofagoscopia/métodos , Fundoplicatura/efeitos adversos , Fundoplicatura/métodos , Refluxo Gastroesofágico/etiologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Miotomia/efeitos adversos , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Qualidade de Vida , Resultado do TratamentoRESUMO
INTRODUCTION: Peroral endoscopic myotomy (POEM) demonstrated similar efficacy to surgical myotomy in the management of achalasia. However, gastroesophageal reflux disease (GERD) is common after POEM. The aim of this study is to identify factors associated with GERD after POEM. METHOD: After searching electronic databases, randomized trials and observational studies including patients with achalasia or other spastic esophageal disorders, treated by POEM, and providing GERD data were selected. GERD was evaluated by 3 methods: pH monitoring, endoscopic findings, and symptoms. For each method, an analysis was performed comparing the outcomes related to the following independent variables: full-thickness (FT) vs circular myotomy, anterior vs posterior, long myotomy vs short myotomy, naive vs previous treatment failure, previous Heller myotomy (HM) vs non-previous-HM, Type I vs II, Type I vs III, and Type II vs III. RESULTS: 2869 publications were identified, and 25 studies met criteria for inclusion in the qualitative analysis. Of these, 18 were included in the meta-analysis. According to the endoscopic findings, circular and anterior myotomy demonstrated a lower trend of GERD with borderline significance (p = 0.06; p = 0.07, respectively). In the pH monitoring and symptom analyses, circular myotomy, anterior myotomy, treatment naive, and non-HM patients were associated with a lower occurrence of GERD; however, no statistically significant difference was found. When comparing achalasia subtypes, no statistical difference was found in all analyses. CONCLUSION: This systematic review and meta-analysis suggest that a circular anterior approach may limit post-POEM GERD and should be considered in appropriate patients.
Assuntos
Acalasia Esofágica/cirurgia , Refluxo Gastroesofágico/etiologia , Miotomia/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Esofagite Péptica/etiologia , Miotomia de Heller/efeitos adversos , Miotomia de Heller/métodos , Humanos , Masculino , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Resultado do TratamentoRESUMO
Background: Most of the obese patients undergoing an anti-reflux operation experience recurrence of gastroesophageal reflux disease (GERD). Laparoscopic Roux-en-Y gastric bypass (LRNYGB) has been accepted as the bariatric surgery of choice for a previous GERD-operated obese patients. Methods: We present 85 consecutive patients from a single institution, previously submitted to antireflux surgery and then to LRNYGB. Preoperative endoscopy was carried out in all patients; 49 (57.64%) patients had findings of fundoplication failure or signs of persistent GERD, of those 20 (40.81%) with esophagitis. Results: From the bypass, per or postoperative minor to moderate complications occurred in 12 patients (14.11%): 2 (2.35%) conversions to laparotomy, 1 (1.17%) melena, 8 (9.41%) stenosis of gastrojejunostomy, treated by a simple endoscopic dilatation with a balloon, and 1 (1.17%) gastrogastric fistula. A follow-up endoscopy of 79 of 85 (92.9%) patients was carried out after 6 months of LRNYGB. Eight of 79 (10.12%) patients had persistent esophagitis that represented 40% (8 of 20 patients) of persistent reflux esophagitis even after LRNYGB. All of them were men. Conclusion: LRNYGB after laparoscopic fundoplication is a feasible procedure with an excepted higher rate of complications because of the complexity of the procedure. Nevertheless esophagitis still persisted in many of those patients.
Assuntos
Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Refluxo Gastroesofágico/cirurgia , Obesidade/cirurgia , Adulto , Idoso , Conversão para Cirurgia Aberta , Endoscopia Gastrointestinal , Esofagite Péptica/etiologia , Feminino , Fundoplicatura , Refluxo Gastroesofágico/complicações , Humanos , Complicações Intraoperatórias/etiologia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Período Pré-OperatórioRESUMO
Here we report a retrospective cross-sectional study on Esophageal eosinophilia (EsEo) frequency in Brazil, for 2, 425 pediatric patients with symptoms associated with gastroesophageal diseases in 2012. EsEo is defined by ≥15 eosinophils per high power field (400x) and confirmed through histological analyses of esophageal biopsies. Overall, 126 patients had EsEo equating to a frequency of 5.2%. There was a significant difference between the endoscopic features of patients with EsEo, where 10.7% had erosive esophagitis, 3.0% had non-erosive esophagitis and 1% showed normal esophageal mucosa. According to the interaction of the variables in the Classification and Regression Tree Analysis, most patients diagnosed with EsEo were older males with erosive esophagitis. On the other hand, the lowest frequency of EsEo was found among younger females with non-erosive esophagitis/normal mucosa. Environmental conditions, including climate variation and changes, were observed in association with EsEo, supporting a potential role for environmental factors in its pathogenesis. There was an inverse correlation between the number of EsEo, rainfall and humidity. EsEo is a relatively frequent finding in the pediatric population of Brazil with symptoms of gastroesophageal diseases. Both clinical and histological examinations of patients are important for a reliable diagnostic of EsEo cases and to patient care.
Assuntos
Esofagite Eosinofílica/epidemiologia , Eosinófilos , Esofagite Péptica/epidemiologia , Esôfago/citologia , Adolescente , Biópsia , Brasil/epidemiologia , Criança , Pré-Escolar , Clima , Estudos Transversais , Exposição Ambiental/efeitos adversos , Esofagite Eosinofílica/diagnóstico por imagem , Esofagite Eosinofílica/etiologia , Esofagite Eosinofílica/patologia , Esofagite Péptica/diagnóstico por imagem , Esofagite Péptica/etiologia , Esofagite Péptica/patologia , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Contagem de Leucócitos , Masculino , Prevalência , Estudos RetrospectivosRESUMO
OBJECTIVE: To report our experience in POEM vs. LHM, with particular focus on myotomy extension. BACKGROUND: POEM has been adopted worldwide as a treatment for achalasia. While resolution of dysphagia is above 90%, postoperative reflux ranges from 10 to 57%. Myotomy length has been a controversial topic. METHODS: Thirty-five cases of POEM were prospectively analyzed and compared retrospectively to the last 35 patients that underwent LHM, from December 2010 to August 2016. Mean follow-up was 10 months (6/32) for POEM and 20 months (6/68) for LHM. All patients with LHM had a myotomy extension ≥3 cm on the gastric side. In POEM cases, extension was defined by direct vision (Hill type II) and never exceeded 2 cm. RESULTS: Follow-up was completed in 100% of patients. Efficacy (ES ≤ 3) was 33/35 (94.2%) for POEM and 32/35 (91.4%) for LHM in a short-term follow-up (p = 1.000) and 31/35 (88.6%) and 27/35 (77.1%), respectively, in a long-term follow-up (p = 1.000), with average ES drop from 9 to 1.2 (p = 0.0001) in POEM vs. 9.2 to 1.3 (p = 0.0001) in LHM. Major Postoperative complications occurred in 1 patient (leak) for LHM and 1 patient (massive capnothorax) in POEM. Hospital stay was shorter for POEM than for LHM (1.3 vs. 2.1, respectively) (p = 0.0001). Symptomatic reflux cases included 7/35 POEM (20%) vs. 6/35 LHM (17.1%) (p = 0.4620). Esophagitis signs in endoscopy appeared in 1/21 POEM (4.7%) vs. 1/22 LHM (4.5%) (p = 1.000). Patients requiring PPI included 8/35 POEM (22.8%) vs. 7/35 LHM (20%) (p = 0.6642). Further treatment (endoscopic dilation) was performed in 10/35 POEM (28.5%) vs. 8/35 LHM (22.8%). CONCLUSIONS: A shorter myotomy on the gastric side in POEM may contribute to an acceptable reflux rate with comparable relief of dysphagia. Although our follow-up for POEM is shorter than for LHM, the trends are promising and warrant future prospective studies to address this topic.
Assuntos
Endoscopia Gastrointestinal/métodos , Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Afasia/etiologia , Afasia/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Acalasia Esofágica/complicações , Esofagite Péptica/etiologia , Feminino , Miotomia de Heller/efeitos adversos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Nonerosive reflux disease (NERD) is a highly prevalent phenotype of the gastroesophageal reflux disease. In this study, we developed a novel murine model of NERD in mice with microscopic inflammation and impairment in the epithelial esophageal barrier. Female Swiss mice were subjected to the following surgical procedure: the transitional region between the forestomach and the glandular portion of the stomach was ligated, and a nontoxic ring was placed around the duodenum near the pylorus. The control group underwent sham surgery. The animals were euthanized at 1, 3, 7, and 14 days after surgery. Survival and body weight were monitored daily. Esophageal wet weight, macroscopic lesion, histopathological alterations, myeloperoxidase (MPO) activity, cytokine levels, transepithelial electrical resistance (TEER), and mucosal permeability were evaluated. The survival rate was 78% at 14 days, with mild loss in body weight. Surgery did not induce erosive esophagitis but instead induced microscopic inflammation and increased esophageal wet weight, IL-6, keratinocyte-derived cytokine (KC) levels, and MPO activity with maximal peak between 3 and 7 days and resolution at 14 days postsurgery. Epithelial esophageal barrier was evaluated in operated mice at 7 and 14 days postsurgery; a decrease in TEER and increase in the esophageal epithelial permeability were observed compared with the sham-operated group. In addition, the inhibition of acid secretion with omeprazole significantly prevented the esophageal inflammation and impairment of barrier function at 7 days postsurgery. Thus we established a novel experimental model of NERD in mice, which can contribute to understanding the pathophysiological events associated with NERD.NEW & NOTEWORTHY In this study, we standardized an experimental model of nonerosive reflux disease (NERD) in mice. This model involves an acute inflammatory response followed by impaired esophageal mucosal integrity, even in the absence of inflammation. Thus this model can serve for evaluation of pathophysiological aspects of NERD and open new perspectives for therapeutic strategies for patients with this disorder.
Assuntos
Mucosa Esofágica/patologia , Esofagite Péptica/patologia , Refluxo Gastroesofágico/patologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Duodeno/cirurgia , Impedância Elétrica , Mucosa Esofágica/efeitos dos fármacos , Mucosa Esofágica/metabolismo , Mucosa Esofágica/fisiopatologia , Esofagite Péptica/etiologia , Esofagite Péptica/metabolismo , Esofagite Péptica/fisiopatologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/metabolismo , Refluxo Gastroesofágico/fisiopatologia , Mediadores da Inflamação/metabolismo , Ligadura , Camundongos , Tamanho do Órgão , Permeabilidade , Peroxidase/metabolismo , Fenótipo , Inibidores da Bomba de Prótons/farmacologia , Estômago/cirurgia , Fatores de TempoRESUMO
La relación entre índice de masa corporal elevados, la presencia de hernia hiatal y síntomas de reflujo han sido ampliamente asociadas al diagnostico de esofagitis por reflujo. Estudios recientes han demostrado la asociación del sobrepeso con la enfermedad de reflujo. En vista de esto nos propusimos realizar este estudio con el objetivo de demostrar la relación de la esofagitis por reflujo anatomopatologicamente diagnosticada asociada al índice de masa corporal calculado por el índice de Quetelet, los hallazgos endoscópicos de esofagitis según la clasificación de los Ángeles, y síntomas de reflujo referidos por los pacientes de la consulta del servicio de gastroenterología del Hospital Carlos J. Bello de la Cruz Roja Venezolana. Se tomo una muestra de 32 pacientes los cuales el 100% tienen diagnostico anatomopatologico de esofagitis por reflujo en un periodo comprendido entre noviembre 2009 y abril de 2010, de los cuales 26 eran del sexo femenino representando el 81,25% de la muestra y 6 del sexo masculino representando el 18,75% de la muestra. El 78,12% presentaron Hernia hiatal como diagnostico endoscópico y referían síntomas de reflujo gastroesofagico (Regurgitación y Pirosis). En cuanto al hallazgo endoscópico 56,25% presento diagnostico de esofagitis grado A y el 28,12% esofagitis grado B según la Clasificación de los Angeles. En cuanto al índice de masa corporal 32,5% presento IMC< de 24,99 Kg/mt2; el 35,4% presentó IMC>25 kg/mt2 y < de 29,99 Kg/mt2; y el 32,1% presento IMC> 30 kg/mt2. En conclusión el 67,5% de los pacientes presentaban IMC elevados.
The relation between elevated body mass index, and the presence of hiatal hernia and reflux symptoms had been widely associated with the diagnosis of GERD. Most recently lack of studies had demonstrated the association between overweight and GERD. In regard to this matter we proposed to make an study to demonstrate the relation of esophageal reflux disease diagnose by histopalogic finding and elevated body mass index calculated with the Quetelet index, endoscopic findings of esofaghitis clasificated by the Los Angeles classification, and reflux symptoms referred by the patients on the Consult of the Gastroenterology service from the Carlos J. Bello Hospital, Venezuelan Red Cross. It took a sample of 32 patients 100% of them with histopathology findings of reflux esophagitis taken from a time period between November 2009 to April 2010, distributed in 26 female patients (81,25%) and 6 male patients (18,75%). 78,12% had hiatal hernia, and referred gastro esophageal reflux symptoms (Regurgitation and pyrosis). Regard to Endoscopic findings 56.25% presented grade A esofaghitis, 28,12% Grade B esophagitis. Regard to Body mass index 32,5% presented a BMI: <24.99 Kg/ mt2; 35,4% BMI:>25 Kg/mt 2 and <29,99 Kg/mt2; 32,1% presented BMI>30 Kg/mt2. In conclusion 67,5% presented elevated BMI.
Assuntos
Humanos , Índice de Massa Corporal , Esofagite Péptica/diagnóstico , Esofagite Péptica/etiologia , Hérnia Hiatal/patologia , Azia/patologia , Refluxo Laringofaríngeo/patologia , GastroenterologiaRESUMO
BACKGROUND: The effects of vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella) on the esophageal mucosa of patients with histological esophagitis are poorly understood. To evaluate long-term effects, we investigated the persistence, aggravation or disappearance of histological esophagitis in patients with morbid obesity and reflux esophagitis (diagnosed by endoscopic biopsy) after Roux-en-Y gastric bypass. METHODS: Twenty-one patients with morbid obesity and esophagitis (histological diagnosis) were submitted to gastric bypass (Fobi-Capella technique) and underwent upper endoscopy and esophageal biopsy during the late postoperative period. RESULTS: The mean age of the patients was 42.57 +/- 7.49 years (30 to 56). Nineteen (90.48%) patients were women, and two (9.52%) were men. Before surgery, the patients presented a mean weight of 124.26 +/- 19.09 kg and a mean body mass index (BMI) of 48.46 +/- 6.37 kg/m(2). Thirteen (61.90%) patients had endoscopic esophagitis before surgery. The mean weight and BMI were 81.65 +/- 13.16 kg and 31.91 +/- 4.99 kg/m(2), respectively, during the late postoperative period (29.80 +/- 8.91 months). The mean percentage of excess weight loss was 68.7 +/- 14.6%. Among the 21 patients with a preoperative histological diagnosis of reflux esophagitis, five (23.18%) had the same diagnosis after surgery, and four (19.04%) continued to present findings of endoscopic esophagitis. CONCLUSION: Vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella technique) is effective in the treatment of reflux esophagitis. No association was observed between the percentage of excess weight loss and improvement of esophagitis.
Assuntos
Esofagite Péptica/patologia , Derivação Gástrica , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Esofagite Péptica/etiologia , Esofagite Péptica/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Obesidade Mórbida/complicações , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Redução de PesoRESUMO
OBJECTIVE: To evaluate the association between ineffective oesophageal motility and reflux oesophagitis controlling for hiatal hernia, hypotensive lower oesophageal sphincter and male sex in patients with gastro-oesophageal reflux disease. METHODS: A total of 387 patients with reflux disease (mean age, 46 years, 42% men) were consecutively selected from a database. All patients underwent upper endoscopy, oesophageal manometry and 24 h oesophageal pH-metry in accordance with a standardized protocol. Reflux disease was confirmed either by endoscopy (oesophagitis grade I-IV according to Savary-Miller) or by pH-metry (increased acid exposure). Hiatal hernia was diagnosed endoscopically, whereas ineffective oesophageal motility and hypotensive lower oesophageal sphincter were characterized during manometry testing. The association between ineffective oesophageal motility and reflux oesophagitis was assessed by logistic regression analysis. RESULTS: A total of 166 patients with oesophagitis (mean age 45 years, 49% men) and 221 without oesophagitis (mean age 46 years, 37% men) were present. Prevalences of ineffective oesophageal motility, hiatal hernia, hypotensive lower oesophageal sphincter and male sex were significantly higher in patients with oesophagitis compared with those without oesophagitis (P<0.05). Ineffective oesophageal motility was independently associated with oesophagitis after multivariate logistic regression analysis (odds ratio=1.68; 95% confidence interval=1.04-2.70). CONCLUSION: Ineffective oesophageal motility is associated with reflux oesophagitis, independently of hiatal hernia, hypotensive lower oesophageal sphincter and male sex.
Assuntos
Transtornos da Motilidade Esofágica/complicações , Esofagite Péptica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Motilidade Esofágica/diagnóstico , Monitoramento do pH Esofágico , Esofagoscopia , Feminino , Refluxo Gastroesofágico/complicações , Hérnia Hiatal/complicações , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Fatores SexuaisRESUMO
BACKGROUND: In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence. AIM: To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease. PATIENTS AND METHODS: We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH < 4 (%TT) and by % of time of pH < 4 in upright (%UT) and supine (%ST) positions. Patients were classified as non-erosive reflux disease if no erosive esophagitis was found in endoscopy and pH monitoring was abnormal and as erosive reflux disease if they had erosive esophagitis. Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm. RESULTS: A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 +/- 7.1; 13.4 +/- 7.4 and 12.3 +/- 11.5 in small hiatal hernias and 20.2 +/- 12.3; 17.8 +/- 14.1 and 20.7 +/- 14.1 in large hiatal hernias, respectively (P < 0.05 for %TT and %TS). In non-erosive reflux disease patients, %TT, %UT and %ST were 9.6 +/- 4.8; 10.8 +/- 6.8 and 8.6 +/- 7.3 in small hiatal hernias and of 14.6 +/- 13.3; 11.2 +/- 7.5 and 18.1 +/- 21.0 in large hiatal hernias respectively (P < 0.05 for %TT and %TS). CONCLUSION: Large hiatal hernias increase acid exposure time only in supine position in erosive esophagitis patients and in non-erosive patients.
Assuntos
Esofagite Péptica/etiologia , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Esofagite Péptica/fisiopatologia , Esofagoscopia , Feminino , Refluxo Gastroesofágico/fisiopatologia , Hérnia Hiatal/patologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Índice de Gravidade de Doença , Fatores de TempoRESUMO
BACKGROUND: Obesity is an important risk for pathological gastroesophageal reflux. AIM: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. PATIENTS AND METHODS: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. RESULTS: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. CONCLUSIONS: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity.
Assuntos
Esofagite Péptica/cirurgia , Derivação Gástrica , Refluxo Gastroesofágico/cirurgia , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Esofagite Péptica/etiologia , Feminino , Seguimentos , Refluxo Gastroesofágico/complicações , Azia/etiologia , Azia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Estudos Prospectivos , Resultado do TratamentoRESUMO
RACIONAL: Nos últimos anos, estudos têm demonstrado a importância da hérnia hiatal na etiopatogenia da doença do refluxo gastroesofágico, atuando por vários mecanismos, sendo enfatizado que quanto maior a hérnia, maior seria a possibilidade de refluxo e esofagite. OBJETIVOS: Avaliar por parâmetros de pHmetria prolongada, se a presença de hérnias volumosas se correlaciona com maior intensidade do refluxo, em pacientes com a doença do refluxo erosiva e doença do refluxo não-erosiva. PACIENTES E MÉTODOS: Foram revistas as pHmetrias prolongadas anormais consecutivas de pacientes em investigação de doença do refluxo gastroesofágico (pirose como queixa principal) e analisadas as percentagens de tempo total ( por centoTT), em posição ereta ( por centoTE) e posição supina ( por centoTS) com pH <4. Todos haviam realizado previamente endoscopia digestiva alta. Selecionaram-se pacientes com doença do refluxo erosiva (esofagite pela classificação de Savary-Miller) e com doença do refluxo não-erosiva (sem esofagite, com pHmetria prolongada anormal), todos com hérnia hiatal. Considerou-se hérnia hiatal não volumosa aquelas entre 2 e <5 cm e hérnia hiatal volumosa quando de tamanho =/>5 cm. RESULTADOS: Cento e noventa e dois pacientes preencheram os critérios de inclusão, sendo 115 com doença do refluxo erosiva e 77 com doença do refluxo não-erosiva. No primeiro grupo, 94 (81 por cento) pacientes apresentavam hérnias hiatais não-volumosas, enquanto que 21 (19 por cento) apresentavam hérnias hiatais volumosas. No grupo com doença do refluxo não-erosiva, 66 (85 por cento) pacientes apresentavam hérnia hiatal não-volumosa e 11 (15 por cento) hérnia hiatal volumosa. Na doença do refluxo erosiva, as por centoTT, por centoTE e por centoTS foram de 13,1 + 7,1, 13,4 + 7,4 e 12,3 + 11,5 nas hérnias hiatais não-volumosas, aumentando para 20,2 + 12,3, 17,8 + 14,1 e 20,7 + 14,1 nas hérnias hiatais volumosas, respectivamente, sendo este aumento estatisticamente significante nos tempos total e supino. Na doença do refluxo não-erosiva, as por centoTT, por centoTE e por centoTS foram de 9,6 + 4,8, 10,8+ 6,8 e 8,6 + 7,3 nas hérnias hiatais não volumosas e de 14,6 + 13,3, 11,2 + 7,5 18,1 + 21,0 nas hérnias volumosas, respectivamente, com significância semelhante à anterior. CONCLUSAO: As hérnias volumosas aumentam o tempo de exposição ácida esofágica exclusivamente na posição supina nos pacientes com doença do refluxo erosiva e doença do refluxo não-erosiva.
Assuntos
Humanos , Masculino , Feminino , Esofagite Péptica/etiologia , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Esofagoscopia , Esofagite Péptica/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Concentração de Íons de Hidrogênio , Manometria , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Background: Obesity is an important risk for pathological gastroesophageal reflux. Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. Patients and methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esofagite Péptica/cirurgia , Derivação Gástrica , Refluxo Gastroesofágico/cirurgia , Obesidade Mórbida/cirurgia , Índice de Massa Corporal , Esofagite Péptica/etiologia , Seguimentos , Refluxo Gastroesofágico/complicações , Azia/etiologia , Azia/cirurgia , Obesidade Mórbida/complicações , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The protective role of Helicobacter pylori in gastro-oesophageal reflux disease has been widely discussed. AIM: To assess the risk of reflux oesophagitis in patients with functional dyspepsia after treatment for H. pylori infection. METHODS: A randomized, placebo-controlled, investigator-blinded trial was carried out on 157 functional dyspeptic patients. Patients were randomized to receive lansoprazole, amoxicillin and clarithromycin (antibiotic group) or lansoprazole and identical antibiotic placebos (control group). Upper gastrointestinal endoscopy was performed at baseline, 3 and 12 months after randomization. The primary aim was to detect the presence of reflux oesophagitis. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 147 patients (94%) and 133 (85%) completed 3 months and 12 months follow-up, respectively. The eradication rate of H. pylori was 90% in the antibiotic group (74 of 82) and 1% (one of 75) in the control group. At 3 months, reflux oesophagitis was diagnosed in 3.7% (three of 82) in the antibiotic group and 4% (three of 75) in the control group (P > 0.2). At 12 months, diagnosis was established in five new cases within the first group and in four within the second (P > 0.2). No difference was found in heartburn symptoms. CONCLUSIONS: H. pylori eradication does not cause reflux oesophagitis in this western population of functional dyspeptic patients.
Assuntos
Dispepsia/microbiologia , Esofagite Péptica/etiologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Omeprazol/análogos & derivados , 2-Piridinilmetilsulfinilbenzimidazóis , Adolescente , Adulto , Idoso , Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Dispepsia/complicações , Dispepsia/tratamento farmacológico , Esofagite Péptica/microbiologia , Seguimentos , Azia/complicações , Infecções por Helicobacter/complicações , Humanos , Lansoprazol , Pessoa de Meia-Idade , Omeprazol/uso terapêutico , Medição de Risco , Método Simples-CegoRESUMO
OBJECTIVE: Our objective was to determine the relationship between reflux of duodenogastric contents with different degrees of esophagitis, and its levels and activity, with regard to the severity of esophagitis-induced duodenogastroesophageal reflux disease (DGERD). MATERIAL AND METHODS: Our study design was prospective, transversal, descriptive, observational, and open. We took samples of gastric and esophageal juices from patients with a diagnosis of gastroesophageal reflux disease (GERD) and esophagitis during the period from March to August 2002. Sample material was placed in black rubber-covered assay tubes to prevent bilirubin degradation. In our Unit's central laboratory, these samples were centrifuged for 30 min, the dissolved material separated, and a reactive strip was introduced to measure the amount of bile pigment. Endoscopic study reports were provided by this Department on terminating the procedure. Univariate analysis was used to obtain results. RESULTS: In 60% of cases, the esophageal liquid was positive for total bilirubin; 40% presented stage II esophagitis, 27% chronic esophagitis, and 27%, stage I esophagitis. Specific quantifications of total bilirubin at different stages of esophagitis demonstrated in stage II 50% with levels of 0.1-1, 33% with a level of 2-3, in cases of chronic esophagitis 75% with levels of 0.1-1, and with stage I esophagitis, 25% with levels of 2-3 mg/dl. Measurement of gastric pH showed 18 (69%) <3 and esophageal pH of 20 (67%) > 4, with 10 (33%) referring occasional or asymptomatic dyspepsia. We determined presence of duodenal elements in esophagus by means of quantification of total bilirubin in 60% of patients, observing greatest frequency of stage II esophagitis. Low but continuous levels of duodenal, principally biliary, elements continued in patients with DGERD, producing greatest damage in esophageal mucosa.
Assuntos
Refluxo Duodenogástrico/fisiopatologia , Esofagite Péptica/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Adulto , Bilirrubina/análise , Estudos Transversais , Refluxo Duodenogástrico/complicações , Refluxo Duodenogástrico/patologia , Esofagite Péptica/etiologia , Esofagite Péptica/patologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/patologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: The association between Helicobacter pylori (Hp) infection and gastroesophageal reflux disease (GERD) has been extensively studied with controversial results. There is not sufficient information on this relationship in populations with high prevalence of Hp infection. OBJECTIVES: a) To know prevalence of Hp infection in patients with reflux esophagitis, b) to compare this prevalence in subjects with reflux esophagitis and without GERD, and c) to study the relationship between infection and the severity of esophagitis. MATERIALS AND METHODS: Patients with digestive symptoms were studied using a questionnaire, upper-gastrointestinal endoscopy, and rapid urease test. Two groups were conformed: cases (subjects with heartburn, acid regurgitations, and erosive esophagitis or Barrett's esophagus), and controls (subjects with epigastric pain, without heartburn, acid regurgitations, or erosive esophagitis). Prevalence of Hp infection, hiatal hernia and peptic ulcer disease was compared in both groups. The relationship between frequency of Hp infection and severity of esophagitis was analyzed. RESULTS: Five hundred eighty three patients were studied (226 cases, 357 controls). Hp infection was detected in 65% of cases and 66% of controls (p = NS). Hiatal hernia was more frequently detected in patients with esophagitis; however, prevalence of peptic ulcer disease was similar in both groups. Proportion of Hp-infected patients was similar regardless of severity of esophagitis (Los Angeles grade A-B, 64%; grade C-D, 69%) and Barrett's esophagus, 63%; p = NS). CONCLUSIONS: Prevalence of Hp infection in patients with reflux esophagitis is 65% and very similar in patients without GERD. No relationship was founded between Hp infection and severity of esophagitis.
Assuntos
Esofagite Péptica/epidemiologia , Infecções por Helicobacter/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Endoscopia Gastrointestinal , Esofagite Péptica/etiologia , Feminino , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
AIM: To describe the endoscopic findings in adult patients subjected to esophagogastroduodenoscopy (EGD) for the evaluation of heartburn, and establish a relationship between the presence of a hiatal hernia and erosive esophagitis. PATIENTS AND METHODS: We reviewed the endoscopic reports of all the patients older than 16 years old who were evaluated for heartburn in our institution, between December 1998 and December 2001. The statistical analysis to establish the relationship between Hiatal Hernia (HH) and Erosive Esophagitis (EE) was performed calculating the Odds Ratio (OR). RESULTS: A total of 1270 outpatient EGD were performed in the study period, of which 345 (27%) had persistent heartburn as the indication for the procedure. There were 174 females (50.43%) and 171 males (49.57%). Erosive esophagitis was diagnosed in 151 (44%). Fifty-eight (17%) patients had EE in the absence of a HH, 63 (18%) had HH in the absence of EE. Ninety-three patients (27%) had both HH and EE, 20 (6%) of patients had histologically confirmed Barrett's esophagus, 91 (26%) had other nonrelated findings such as antral gastritis and 36 (10%) had normal EGD. Of 156 patients with HH, 93 (59.6%) had also EE, whereas EE was present only in 58 of 189 (30.6%) patients who did not have HH, obtaining an OR of 3.33. CONCLUSIONS: Most of our patients with heartburn didn't have erosive esophagitis. In our series, patients with heartburn and a hiatal hernia have a three-fold risk of having erosive esophagitis compared with patients with heartburn and no hiatal hernia.
Assuntos
Esofagite Péptica/epidemiologia , Hérnia Hiatal/epidemiologia , Adulto , Estudos Transversais , Endoscopia do Sistema Digestório , Esofagite Péptica/diagnóstico , Esofagite Péptica/etiologia , Feminino , Refluxo Gastroesofágico/epidemiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Masculino , Fatores de RiscoRESUMO
Se realizó un estudio descriptivo, retrospectivo de corte transversal, sobre la asociación entre el reflujo gastroesofágico. El universo estuvo constituido por todos los niños con diagnóstico de enfermedad por reflujo gastroesofágico, la muestra correspondió a 64 pacientes que cumplieron los criterios de inclusión. Para obtener la información se realizó revisión de expedientes clínicos de los pacientes en estudioEntre los resultados más importantes se destacan que el 87.5 porciento de los pacientes eran lactantes, la mayoría del sexo masculino 73.4 porciento. El motivo de la consulta más frecuente fue tos 93.7 porciento y 92 porciento acudió por dificultad respiratoria, 71.9 porciento de nuestros pacientes necesitaron 2 ó mas hospitalizaciones, incluyendo 10 pacientes que requirieron más de 5. El diagnóstico de ingreso más frecuente fue neumonía 76.5 porciento (49) seguido del diagnóstico descartar cardiopatía congénita, hiperreactividad bronquial y síndrome emético con 9.4 porciento, 7.8 porciento y 6.3 porciento respectivamente, la dificultad respiratoria fue la manifestación clínica más frecuente 89 porciento y tos 87.5 porciento...
Assuntos
Diagnóstico Clínico , Dissertações Acadêmicas como Assunto , Esofagite Péptica/classificação , Esofagite Péptica/diagnóstico , Esofagite Péptica/etiologia , Refluxo Gastroesofágico , Doenças Respiratórias , Fatores de RiscoRESUMO
Esophageal disease is a common complication in patients infected with human immunodeficiency virus type-1 (HIV-1). Dysphagia, odynophagia and retrosternal pain are the most common symptons associated with the esophageal compromise. Esophageal candidiasis, the most frequent opportunistic infection, may occur in patients with long-standing infection or may be a manifestation of the seroconversion. Cytomegalovirus and Herpes simplex virus are more likely to produce esophageal ulcers or erosions. HIV itself may be responsible for ulcerative esophagitis. Neoplasms as Kaposi's sarcoma, are an infrequent cause of symptomatic disease. Barium esophagography and specially upper endoscopy are the most commonly employed diagnostic modalities for the evaluation of symptomatic patients. Endoscopy may be warranted to make a rapid diagnosis such that specific therapy will not be delayed. The use of a combination of histologic, cytologic, mycologic and virologic studies is necessary to provide an etiologic diagnosis of these lesions.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Esofagite/microbiologia , HIV-1 , Antifúngicos/uso terapêutico , Candidíase/complicações , Candidíase/tratamento farmacológico , Infecções por Citomegalovirus/complicações , Esofagite/classificação , Esofagite/terapia , Esofagite Péptica/etiologia , Herpes Simples/complicações , HumanosRESUMO
Esophageal disease is a common complication in patients infected with human immunodeficiency virus type-1 (HIV-1). Dysphagia, odynophagia and retrosternal pain are the most common symptons associated with the esophageal compromise. Esophageal candidiasis, the most frequent opportunistic infection, may occur in patients with long-standing infection or may be a manifestation of the seroconversion. Cytomegalovirus and Herpes simplex virus are more likely to produce esophageal ulcers or erosions. HIV itself may be responsible for ulcerative esophagitis. Neoplasms as Kaposis sarcoma, are an infrequent cause of symptomatic disease. Barium esophagography and specially upper endoscopy are the most commonly employed diagnostic modalities for the evaluation of symptomatic patients. Endoscopy may be warranted to make a rapid diagnosis such that specific therapy will not be delayed. The use of a combination of histologic, cytologic, mycologic and virologic studies is necessary to provide an etiologic diagnosis of these lesions.(AU)