The Repercussions of Spinal Cord Injury on the Action of the Diaphragmatic Crura for Gastroesophageal Reflux Containment

The Repercussions of Spinal Cord Injury on the Action of the Diaphragmatic Crura for Gastroesophageal Reflux Containment

Autor Silva, Cleuza B. Autor UNIFESP Google Scholar
Martinez, Julio C. Autor UNIFESP Google Scholar
Yanagita, Edison T. Autor UNIFESP Google Scholar
Morais, Jose F. Autor UNIFESP Google Scholar
Carvalho, Luciane B. Autor UNIFESP Google Scholar
Herani Filho, Benedito Autor UNIFESP Google Scholar
Moraes, Daniel G. Autor UNIFESP Google Scholar
Vianna, Patricia C. Autor UNIFESP Google Scholar
Prado, Gilmar F. Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo Study Design. Cross-sectional and nonexperimental.Objective. To detect and compare functional abnormalities in the esophagus and esophagogastric junction in 2 groups with chronic spinal injuries, 1 with injuries at the phrenic innervation level and the other at upper thoracic levels, and to relate these to gastroesophageal reflux containment.Summary of Background Data. There are no studies on esophageal manometry with pH metering among spinal cord injury patients. Worldwide statistics reveal that the prevalence of gastroesophageal reflux disease among spinal cord injury patients is greater than among the general population, at around 22% to 27%. the diaphragmatic crura has been recognized as an important antire-flux barrier and should functionally be considered to be a muscle separated from the costal diaphragm. However, doubts remain regarding whether this difference relates to its innervation.Methods. This was a cross-sectional study on 29 patients with complete spinal cord injuries: 14 quadriplegics (level C(4)) and 15 paraplegics (levels T(1)-T(7)). Functional abnormalities of the esophagogastric junction, esophagus, and diaphragm were investigated using esophageal manometry and diaphragmatic video fluoroscopy. Presence of gastroesophageal reflux was investigated subjectively (pyrosis and regurgitation) and objectively (pH metering and endoscopy).Results. the incidence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crural pressures were compared (quadriplegics: 37.5 +/- 17.8; paraplegics: 26.6 +/- 7.2; P = 0.048). It was also significant in relation to the prevalence of at least one of the objective and/or subjective reflux findings and/or esophageal peristaltism (quadriplegics: 85.7%; paraplegics: 40.0%; P = 0.011).Conclusion. Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics toward greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crural contractility among the quadriplegics.
Palavra-chave spinal cord injury
diaphragmatic crura
phrenic innervation
reflux gastroesophageal
esophagogastric junction
esophageal manometry
pH metering
Idioma Inglês
Data de publicação 2008-12-15
Publicado em Spine. Philadelphia: Lippincott Williams & Wilkins, v. 33, n. 26, p. 2892-2897, 2008.
ISSN 0362-2436 (Sherpa/Romeo, fator de impacto)
Publicador Lippincott Williams & Wilkins
Extensão 2892-2897
Fonte http://dx.doi.org/10.1097/BRS.0b013e31818a2c59
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000263260800009
Endereço permanente http://repositorio.unifesp.br/handle/11600/31100

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