RESUMO
BACKGROUNDS AND AIMS: New mucosal resective and ablative endoscopic procedures based on gastric cardiac remodeling to prevent reflux have appeared. We aimed to evaluate the feasibility of a new ablative technique named antireflux ablation therapy (ARAT) for control of GERD in patients without hiatal hernia. METHODS: Patients with proton pump inhibitor (PPI)-refractory GERD without hiatal hernia underwent ARAT between January 2016 and October 2019. Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL), upper endoscopy, 24-hour pH monitoring, and PPI use were documented at 3, 6, 12, 24, and 36 months after ARAT. RESULTS: One hundred eight patients were included (61 men [56.5%]; median age, 36.5 years; range, 18-78 years). ARAT was performed on all patients. At the 36-month evaluation, 84 patients had completed the protocol. Median ARAT time was 35.5 minutes (range, 22-51 minutes), and median circumference ablation was 300° (range, 270°-320°). No major adverse events occurred, and 14 of 108 patients (12.9%) presented with stenosis that was responsive to balloon dilation (<5 sessions). At the 3-month evaluation, the acid exposure time (AET), DeMeester score, and GERD-HRQL score had decreased from 18.8% to 2.8% (P = .001), 42.5 to 9.1 (P = .001), and 36.5 to 10 (P = .02), respectively, and these values were maintained up to 36 months. Success (AET <4%) was achieved in 89% and 72.2% at 3 and 36 months, respectively. Related factors at 36 months were as follows: pre-ARAT Hill type II (odds ratio [OR], 3.212; 95% confidence interval [CI], 1.431-5.951; P = .033), post-ARAT 3-month Hill type I (OR, 4.101; 95% CI, 1.812-9.121; P = .042), and AET <4% at 3 months (OR, 5.512; 95% CI, 1.451-7.621; P = .021). CONCLUSIONS: ARAT is a feasible, safe, and effective therapy for early and mid-term treatment of GERD in patients without a sliding hiatal hernia. However, longer follow-up evaluations and randomized comparative studies are needed to clarify its real role. (Clinical trial registration number: NCT03548298.).
Assuntos
Técnicas de Ablação , Fundoplicatura , Refluxo Gastroesofágico , Hérnia Hiatal , Técnicas de Ablação/métodos , Adolescente , Adulto , Idoso , Endoscopia Gastrointestinal , Monitoramento do pH Esofágico , Estudos de Viabilidade , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/tratamento farmacológico , Hérnia Hiatal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Resultado do Tratamento , Adulto JovemAssuntos
Humanos , Masculino , Feminino , Hérnia Hiatal/tratamento farmacológico , Metoclopramida/uso terapêutico , Piperidinas/uso terapêutico , Adolescente , Adulto , Intervalos de Confiança , Avaliação de Medicamentos , Resumo em Inglês , Hérnia Hiatal/epidemiologia , Hérnia Hiatal/fisiopatologia , Pessoa de Meia-Idade , Metoclopramida/efeitos adversos , Estudos Prospectivos , Piperidinas/efeitos adversosRESUMO
Comparative study of the therapeutical effects of cisapride and metoclopramide in 50 patients with symptomatic hiatal hernia was performed. Behaviour of media before and after treatment, of resting pressure and relaxation lower esophageal sphincter, pressure of the primary wave and the number of reflux episodes with pH < 4. The group of patients treated with cisapride had a considerably higher beneficial effect (p < 0.01) than the metoclopramide-treated group. A total of 4 patients were dropped-off the study because of undesirable side effects (diarrhea 2, headache 1, and somnolence 1).
Assuntos
Hérnia Hiatal/tratamento farmacológico , Metoclopramida/uso terapêutico , Piperidinas/uso terapêutico , Adolescente , Adulto , Cisaprida , Intervalos de Confiança , Avaliação de Medicamentos , Feminino , Hérnia Hiatal/epidemiologia , Hérnia Hiatal/fisiopatologia , Humanos , Masculino , Metoclopramida/efeitos adversos , Pessoa de Meia-Idade , Piperidinas/efeitos adversos , Estudos ProspectivosRESUMO
It is presented a case of spontaneous rupture of the union cardioesophageal consecutive on ingestion of bicarbonate in an old patient with strangulated hiatal hernia. It is analyzed the phisiopathological factors of such complication and the surgical treatment employed.
Assuntos
Bicarbonatos/efeitos adversos , Junção Esofagogástrica/lesões , Animais , Bicarbonatos/uso terapêutico , Gatos , Hérnia Hiatal/tratamento farmacológico , Humanos , Ruptura EspontâneaRESUMO
In 10 patients with esophageal hiatus hernia the effect of metoclopramide bromide and metoclopramide chloride compared with placebo, was studied by the double blind method. Both drugs produced an increase of the lower esophageal sphincter pressure and of the peristalsis of the lower third of the esophagus, only being statistically significative the action of metoclopramide chloride on the perstalsis. No significative side-effects were noted.
Assuntos
Junção Esofagogástrica/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Metoclopramida/farmacologia , Peristaltismo/efeitos dos fármacos , Adulto , Idoso , Brometos/farmacologia , Cloretos/farmacologia , Método Duplo-Cego , Junção Esofagogástrica/fisiopatologia , Feminino , Hérnia Hiatal/tratamento farmacológico , Hérnia Hiatal/fisiopatologia , Humanos , Masculino , Metoclopramida/administração & dosagem , Metoclopramida/uso terapêutico , Pessoa de Meia-Idade , PlacebosRESUMO
A brief review of the role of gastrin on gastric secretion and its influence in the genesis of peptic ulcer is made. A report is made of the pharmacological studies of Proglumida and its antigastrin action and the interest its association with Hioscin Butil-Bromuro may represent in the antiulcer therapy. A study is made of 26 patients submitted to a general treatment for peptic ulcer this drug together with a bland diet and psychotherapy. The results were: 19 (73%) cases cured; 6 (23%) cases improved; no results in 1 (4%) case. No secondary side effects appear and the symptomatic response appears 8 days after the treatment is initiated. The dosis used is of 2 tablets before the 3 main meals. Each tablet contains 250 mg of Proglumide and 10 mg of Hioscin Butil-Bromuro. It is considered useful in the antiulcer therapy to have available a drug which can control the physiological effects of gastrin and from this point of view its action is different from that of the antiacids and anticolinergics.