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- ItemAcesso aberto (Open Access)Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis(Biomed Central Ltd, 2015-05-09) Kuranishi, Lilian Tiemi [UNIFESP]; Leslie, Kevin O.; Ferreira, Rimarcs Gomes [UNIFESP]; Coletta, Ester Aparecida Ney [UNIFESP]; Storrer, Karin Mueller [UNIFESP]; Soares, Maria Raquel [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Mayo ClinBackground: Airway-centered Interstitial Fibrosis (ACIF) is a common pathologic pattern observed in our practice.Objectives: the objectives of this study are to describe the causes associated with ACIF in a large sample of patients and its effect on survival.Methods: A retrospective study in three centers of interstitial lung disease in São Paulo, between January of 1995 and December of 2012. the surgical lung biopsy specimens were reviewed by three pathologists. the clinical, functional and tomographic findings were analyzed by a standardized protocol.Results: There were 68 cases of ACIF, most of them women. the mean age was 57 +/- 12 yr. Dyspnea, cough, restrictive pattern at spirometry and oxygen desaturation at exercise were common. A reticular pattern with peribronchovascular infiltrates was found in 79% of the cases. the etiologies of ACIF were hypersensitivity pneumonitis in 29 (42.6%), gastroesophageal reflux disease in 17 (25.0%), collagen vascular disease in 4 (5.9%), a combination of them in 15 cases and idiopathic in 3 (4.4%). the median survival was 116 months (95% CI = 58.5 - 173.5). Lower values of oxygen saturation at rest, presence of cough and some histological findings - organizing tissue in the airways, fibroblastic foci and microscopic honeycombing - were predictors of worse survival.Conclusions: ACIF is an interstitial lung disease with a better survival when compared with IPF. the main etiologies are HP and GERD. the oxygen saturation at rest, the presence of cough and some histological findings are predictors of survival.
- ItemAcesso aberto (Open Access)Análise da compliância e gradiente timpanométrico em lactentes com refluxo(Sociedade Brasileira de Fonoaudiologia, 2012-06-01) Camboim, Elizângela Dias [UNIFESP]; Scharlach, Renata Coelho [UNIFESP]; Almeida, Maiara Cristine Oliveira De; Vasconcelos, Dênis; Azevedo, Marisa Frasson de [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyze and compare the tympanometric gradient and the compliance obtained in probe tones of 226 and 1 kHz between groups of infants with and without gastroesophageal reflux (GER). METHODS: Participants were 118 full-term and preterm infants, from newborns to 6-month-olds - 63 with clinical diagnosis of physiological GER performed by pediatricians or gastroenterologists, and 55 without GER -, who were submitted to tympanometry with probe tones of 226 and 1 kHz. RESULTS: Higher compliance values were found with 1 kHz in both groups. Comparing the average compliance between groups, we observed that the group without reflux showed higher values. The mean value of the tympanometric gradient was higher in the group without reflux, when compared to the one with reflux. CONCLUSION: The 1 kHz probe tone has higher compliance in infants with and without GER, when compared to the 226 Hz probe tone. Infants with reflux have compliance within normal limits, although they present lower compliance than infants without reflux. Regarding the gradient, infants with GER have altered values and/or within normality limits in both ears.
- ItemAcesso aberto (Open Access)Avaliação entre Refluxo Proximal e Refluxo Distal com o emprego de pHmetria em voluntários sadios e sua relação com pacientes portadores da Doença do Refluxo Gastroesofágico(Universidade Federal de São Paulo (UNIFESP), 2013) Pannocchia Neto, Sebastiao Carlos [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/6731826031291522; Universidade Federal de São Paulo (UNIFESP)Introdução: O limiar para o refluxo acido patologico proximal e um tema controverso no tratamento de pacientes com a DRGE. Apesar de varios estudos anteriores terem tentado estudar o limite normal para o refluxo proximal em voluntarios saudaveis, nenhum valor e universalmente aceito. A maioria dos valores se baseia em numeros absolutos. Consideramos a hipotese de que um valor relativo representando a relacao quantitativa entre a quantidade de refluxo acido que atinge niveis proximais e a quantidade de refluxo distal poderia ser um parametro mais adequado para definir refluxo proximal. Metodo: Foram estudados tres grupos. Grupo 1: 20 voluntarios saudaveis (idade mediana de 30 (27-40) anos, 70% mulheres), sem DRGE; Grupo 2: 50 pacientes (idade mediana de 51 (37-68) anos, 60% mulheres) com sintomas esofagicos da DRGE (regurgitacao, azia), e Grupo 3: 50 pacientes (idade mediana de 49 (40-56) anos, 60% mulheres) com sintomas extraesofagicos da DRGE. Todos os individuos foram submetidos a manometria e pHmetria com duplo sensor. DRGE foi definida como uma pontuacao DeMeester >14,7. A razao entre refluxo proximal /distal foi calculada para todos os 6 parametros que constituem o indice de DeMeester. Resultados: Numeros absolutos para o refluxo proximal nao foram diferentes quando os 3 grupos foram comparados com excecao do numero de episodios de refluxo que foi maior para os pacientes com DRGE e sintomas esofagicos 3,5 (1-15), em comparacao com pacientes com DRGE e sintomas extraesofagicos 1 (0-4) (p=0,007). Quanto a relacao proximal / distal os tres grupos mostraram resultados semelhantes, com excecao para a relacao entre o numero de episodios de refluxo que foi maior para os voluntarios 0,2 (0,0-1,0) em comparacao a pacientes com DRGE e sintomas extraesofagicos 0 (0-0,1) (p=0,003) e maior para os pacientes com DRGE e sintomas esofagicos 0,08 (0,02-0,2) comparado aos com sintomas extraesofagicos (p=0,02). Conclusao: Estes resultados podem sugerir que a sensibilidade esofagica e nao exposicao acida esofagica pode ser a responsavel por sintomas extraesofagicos
- ItemAcesso aberto (Open Access)Avaliaçãoobjetiva da doença do refluxo gastroesofágico em portadores de fibrilação atrial paroxística(Universidade Federal de São Paulo (UNIFESP), 2018-11-26) Coutinho, Enia Lucia [UNIFESP]; Paola, Angelo Amato Vincenzo de [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/6259836166380719; http://lattes.cnpq.br/2009601020813967; Universidade Federal de São Paulo (UNIFESP)Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Some evidence shows that gastroesophageal reflux disease (GERD) may be a trigger for paroxysmal AF (PAF). Most of the previous studies that correlated GERD and AF used questionnaires to diagnose GERD, not an objective evaluation. This study aims to evaluate in patients with PAF: (a) accuracy of symptoms to diagnose GERD; (b) prevalence of GERD; and (c) temporal correlation between cardiac arrhythmia and reflux. Methods: Twentytwo patients (59% females, mean age 68 years) with PAF underwent esophageal manometry followed by ambulatory pH monitoring and concurrent Holter. Eight (36%) patients had GERD symptoms. Patients were grouped as GERD+ or GERDbased on the DeMeester score. Temporal correlation between arrhythmia and reflux was recorded. Results: Six (27%) patients were GERD+. Symptoms had sensitivity and specificity of 50 and 70%, respectively, for the diagnosis of GERD. Episodic AF occurred in one patient only (GERD). There were 23 episodes of AF during the test with 14% correlation with reflux. Persistent AF during the period of the test was found in five patients (60% GERD?). Conclusions: Our results show: (a) Symptoms have a low accuracy for the diagnosis of GERD; (b) the prevalence of GERD in patients with PAF is low; and (c) temporal correlation between episodes of reflux and cardiac arrhythmia is low. Key Words: Gastroesophageal reflux – paroxistic atrial fibrillation – esophageal pH monitoring – gastroesophageal reflux disease.
- ItemAcesso aberto (Open Access)Doença do refluxo gastroesofágico na literatura cirúrgica versus literatura clínica: clínicos não leem revistas cirúrgicas(Colégio Brasileiro de Cirurgia Digestiva, 2010-12-01) Herbella, Fernando A M [UNIFESP]; Szor, Daniel [UNIFESP]; Takassi, Guilherme F [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Patti, Marco G; Universidade Federal de São Paulo (UNIFESP); University of Chicago Department of SurgeryBACKGROUND: Several diseases may be treated either medically or surgically; however, clinical and surgical therapies are often not treated as different options for the same patient but rather as different medical philosophies. AIM: To assess whether the main surgical and medical journals make references to their counterparts, with gastroesophageal reflux as a model of clinical/surgical disease. METHOD: It was reviewed the leading medical journals in order to verify if surgeons and clinicians make references to their counterparts on their work using gastroesophageal reflux disease as a model of a clinical/surgical disease. It was reviewed the five top-ranked journals in the field of gastroenterology, general surgery and general medicine and a neutral journal. The issues of the year 2008 of the selected journals were searched for papers dealing with gastroesophageal reflux disease. RESULTS: The search in the selected journals retrieved 49 papers, 36 (74%) in clinical journals, 5 (10%) in surgical journals, 2 (4%) in general medicine journals, and 6 (12%) in the neutral journal. Thirty one (63%) had a clinical origin, 13 (26%) a surgical origin, and 5 (10%) a neutral origin. Surgical journals published only surgical papers and general medicine journals published only clinical papers. Clinical journals and general medicine journals showed a higher proportion of clinical/surgical references compared to surgical journals (p<0.001) and the neutral journal (p<0.001). There was no differences in the proportion of clinical/surgical references when surgical and the neutral journal were compared (p=0.06). Clinical journals and general medicine journals showed a similar proportion of clinical/surgical references (p=0.06). CONCLUSION: Clinicians make significantly less references to surgical journals than surgeons do to clinical journals.
- ItemAcesso aberto (Open Access)Eletromanometria esofágica e pHmetria de 24 horas na avaliação pós-operatória da hiatoplastia e válvula anti-refluxo total laparoscópica(Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2006-06-01) Pastore, Ricardo; Crema, Eduardo; Silveira, Mariana De Carvalho; Presoto, Adriana Ferreira; Herbella, Fernando Augusto Mardiros [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Faculdade de Medicina do Triângulo Mineiro; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The electromanometry and 24-hour esophageal pHmetry has been proposed as objective method in postoperative evaluation of antireflux surgery. AIM: Prospective evaluation of the results of cruroplasty and total fundoplication in the treatment of non-complicated gastroesophageal reflux disease based on comparative results of pre and post operative manometry and pHmetry findings. METHODS: Fifty-nine consecutive individuals with typical symptoms of gastroesophageal reflux disease were prospectively studied. All patients were submitted to a laparoscopic short floppy Nissen fundoplication between March, 2002 and August, 2003. All patients were submitted pre and postoperatively (3 months) to upper digestive endoscopy, manometry and pHmetry 24 hours. RESULTS: Eighteen (30.5%) patients were male and 41 (69.5%) female, their average age was 43.8 years. There were differences comparing the pre and post operative period in the manometrical findings in the following items: localization of the lower esophageal sphincter (41.2 cm and 42.3 cm). Extension o f the lower esophageal sphincter preoperative (2.0 cm and 2.5 cm), resting pressure of the lower esophageal sphincter (15.0 mm Hg and 21.5 mm Hg), and pressure of the esophageal body (78.0 mm Hg and 70.0 mm Hg). There were differences comparing the pre and post operative period in the pHmetrical findings in the following items: total number of acid refluxes (68.0 and 3.0), total number of acid refluxes more than 5 minutes (2.0 and 0.0), acid reflux more than 5 minutes in supine position (1.0 and 0.0), acid reflux more than 5 minutes in upright position (0.0 and 0.0), acidification period (5.5 and 0.1 min), DeMeester score (33.0 and 0.8). CONCLUSIONS: The esophageal manometry and pHmetry findings were improved in the post operative period with statistical significance when compared to the pre operative period. The exams were considered efficient in the evaluation of the surgical procedure.
- ItemAcesso aberto (Open Access)Emissões otoacústicas e medidas de imitância acústica com sonda de 226 e 1000Hz em lactentes com refluxo gastroesofágico(Universidade Federal de São Paulo (UNIFESP), 2010-09-29) Camboim, Elizângela Dias [UNIFESP]; Azevedo, Marisa Frasson de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To examine and compare the otoacoustic emissions results evoked by transient stimulus and the acoustic immittance measures in infants with and without gastroesophageal reflux, and associate the otoscopic results with the tympanometric results in 226 and 1000Hz probes. Method: it was carried out an otorhinolaringology evaluation, otoacoustic emission evoked by transient stimulus, tympanometry with 226 and 1000 Hz probe and ipsilateral acoustic reflex in 118 infants, being 63 with gastroesophageal reflux and 55 without referred by pediatricians or Gastroenterology pediatricians, with clinical diagnosis. It was used the masking technique (double blind), in which the evaluator did not know the results of other evaluations Results: There was a higher incidence of failure in TEOAE in infants with bilaterally gastroesophageal reflux. There was also a higher incidence of tympanometric change in the group with reflux gastroesogágico with two types of probe. There was a lower incidence of ipsilateral reflex ( 226 probe) in the group with reflux. Tympanometry with 1000 Hz probe showed higher correlation with the results of otoacoustic emissions and otoscopy. Conclusions: Infants with gastroesophageal reflux showed higher occurrence of acoustic immittance change in both types of probes and failed OAET more than the infants without reflux. There was even greater association between the results of otoscopy with tympanometry 1000Hz probe.
- ItemAcesso aberto (Open Access)Estudo dos testes de função esofágica em pacientes com doença pulmonar obstrutiva crônica(Universidade Federal de São Paulo (UNIFESP), 2015-11-27) Del Grande, Leonardo de Mello [UNIFESP]; Herbella Fernandes, Fernando Augusto Mardiros [UNIFESP]; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/4592434276111339; Universidade Federal de São Paulo (UNIFESP)Introdução: A associação entre doença do refluxo gastroesofágico (DRGE) e doenças pulmonares é bastante conhecida. O estudo da prevalência da DRGE, da motilidade esofágica através da manometria e a monitorização ambulatorial do pH podem ser bastante úteis na investigação da fisiopatologia da associação entre DRGE e a doença pulmonar obstrutiva crônica (DPOC). Este estudo tem como objetivo avaliar em pacientes com DPOC: (1) a prevalência de DRGE, (2) a acurácia do diagnóstico de DRGE pelos sintomas, (3) a motilidade esofágica e (4) o gradiente de pressão transdiafragmático. Métodos: Foram estudados 48 pacientes (56% do sexo feminino). Todos os pacientes foram submetidos à manometria de alta resolução (MAR) e pHmetria. Os pacientes foram divididos de acordo com a presença de DRGE (grupos A e B). Para o estudo da pressão transdiafragmático utilizou-se também manometria de 31 voluntários saudáveis para comparação de valores. Resultados: O grupo A (DRGE+) compreendeu 21 (44%) dos pacientes (43% sexo feminino com idade média de 67 anos). O grupo B (DRGE-) compreendeu 27 (56%) pacientes (sendo 67% do sexo feminino, com idade média de 65 anos). Não houve diferença entre os grupos em relação aos sintomas, gênero (p=0,1), idade (p=0,5), índice de massa corpórea (p=0,8) e gravidade da DPOC (p=0,9). Observamos diferença em relação a pressão do esfíncter superior do esôfago (p=0,018). Não foram observadas diferenças entre os parâmetros do esfíncter inferior do esôfago. Em relação ao corpo esofágico, não houve diferença significativa, exceto que o grupo A apresentou maior hipocontratilidade distal (p=0,008) e porcentagem maior de contrações inefetivas distais (p= 0,036). O grupo A apresentou pressão torácica menor e gradiente transdiafragmático maior que os grupos B e C. O grupo B, por sua vez, não apresentou diferenças em relação ao grupo C. Conclusões: Nossos resultados mostram que: (1) quase metade dos pacientes com DPOC tem DRGE, (2) A motilidade esofágica não é significantemente diferente nos pacientes com DPOC e DRGE do que nos pacientes com DPOC sem DRGE. Os pacientes com DPOC tem elevada prevalência de DRGE e a fisiopatologia está ligada ao gradiente de pressão transdiafrgmático e não a um defeito de barreira esfincteriana.
- ItemAcesso aberto (Open Access)Estudo pHmétrico esofágico de oito horas em pacientes pediátricos com suspeita de refluxo gastroesofágico(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2005-04-01) Carneluti, Ricardo [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Cury, Edson Khodor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To study the pH monitoring over eight hours, analyzing variables such symptomatology and esophagogastroduodenoscopy, as well as the following pH monitoring parameters: number of reflux episodes, number of episodes longer than five minutes, length of reflux time during the eight hours, and the episode of longest duration, for the diagnosis of gastroesophageal reflux. METHODS: A prospective study. Continuous measurement of esophageal pH was performed over eight hours on 35 patients whose ages ranged from four months to 11 years. The DPS-100 Diagnosis pH meter System was utilized, programmed in accordance with the methodology suggested by Vandenplas. The pH monitoring results were divided into positive and negative and compared with all the variables and parameters of the examination. RESULTS: We obtained statistically significant differences in all the pH monitoring parameters analyzed, with the reflux index being the most effective for identifying the pathological reflux, independent of age. None of the qualitative variables of age, symptomatology and esophagogastroduodenoscopy showed statistically significant differences when compared to the pH monitoring results. CONCLUSION: The esophageal pH monitoring of eight hours has its pH monitoring parameters validated for the diagnosis of gastroesophageal reflux.
- ItemAcesso aberto (Open Access)Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children(Korean Soc Pediatric Gastroenterology & Nutrition, 2016) Machado, Rodrigo Strehl [UNIFESP]; Woodley, Frederick W.; Skaggs, Beth; Di Lorenzo, Carlo; Eneli, Ihuoma; Splaingard, Mark; Mousa, HayatPurpose: This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children. Methods: Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals. Results: Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux. Conclusion: The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.
- ItemAcesso aberto (Open Access)Gastroesophageal reflux disease: exaggerations, evidence and clinical practice(Soc Brasil Pediatria, 2014-03-01) Ferreira, Cristina Targa; Carvalho, Elisa de; Sdepanian, Vera Lucia [UNIFESP]; Morais, Mauro Batista de [UNIFESP]; Vieira, Mario Cesar; Silva, Luciana Rodrigues; Hosp Crianca Santo Antonio; Univ Fed Ciencias Saade Porto Alegre; Dept Gastroenterol; Hosp Base Distrito Fed; Hosp Crianca Brasilia; Universidade de Brasília (UnB); Dept Pediat Gastroenterol; Universidade Federal de São Paulo (UNIFESP); Hosp Israelita Albert Einstein; Pontificia Univ Catolica Parana; Hosp Pequeno Principe; Universidade Federal da Bahia (UFBA); Acad Brasileira PediatObjective: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. the association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children.Data source: a search was conducted in the MEDLINE, Pub Med, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013.Data synthesis: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects.Conclusions: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. for these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected. (C) 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
- ItemAcesso aberto (Open Access)Impacto adicional de práticas não farmacológicas associadas ao tratamento medicamentoso nos sintomas do refluxo laringofaríngeo(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Moreira, Marinalva Aparecida [UNIFESP]; Biase, Noemi Grigoletto De [UNIFESP]; http://lattes.cnpq.br/3156326658988323; http://lattes.cnpq.br/3886612683861842; Universidade Federal de São Paulo (UNIFESP)Gastroesophageal reflux (GER) is a spontaneous movement of the gastric contents of the stomach into the esophagus, considered physiological. When the reflux product reaches the supraesophageal regions - pharynx and larynx - symptoms of laryngopharyngeal reflux (LPR) occur, characterized by dysfunction in the upper esophageal sphincter (UES). The most frequent symptoms of LPR are: pharyngeal globus, throat clearing, halitosis, dysphonia, odynophagia, dysphagia, regurgitation, cough, among others; having as characteristic signs subglottic edema, ventricular obliteration, erythema/hyperemia, vocal fold edema, diffuse laryngeal edema, interaritenoid hypertrophy, granuloma/granulation tissue, thick endolaryngeal mucus, among others. LPR is a disease with a negative impact on quality of life. Objective: To evaluate the additional contribution of non-pharmacological measures simultaneous to drug treatment in the symptoms of laryngopharyngeal reflux. Method: This is a randomized clinical study, performed at the Unifesp - Escola Paulista de Medicina, in the Laryngology and Voice Ambulatory, which is part of the Department of Otorhinolaryngology and Head and Neck Surgery. The sample consisted of 32 patients, divided by lot in two groups, A and B, and both groups underwent pharmacological treatment. Only group A performed simultaneous treatment with the behavioral measures. The treatment lasted for 90 days, divided into three visits, the first one for the diagnosis through videolaryngoscopy and application of the scale of symptoms, the second to reinforce the adherence to the treatment, and the third to finish the study, with a new scale application of symptoms. For diagnosis of the patients, two otorhinolaryngologists, who filled out the Reflux Finding Score (RFS) scale, analyzed the videolaryngoscopy images. The reliability analysis of the total score of the RFS (signal scale) was done with the total sample, using the intraclass correlation coefficient (ICC). To assess the additional contribution of pharmacological measures concurrent to drug treatment in RLF symptoms, the groups A (medication + orientation) and B (medication) were compared in the initial moment in relation to age and signs and symptoms; after 15 days in relation to the adhesion and, after three months, in relation to the improvement of the symptoms. For all statistical tests used in these comparisons, the level of significance was set at 5%. Results:The sample consisted of 62% female, 69% workers, mean age 49.3 years (26 to 83 years). According to the scale of signs observed in videolaryngoscopy for LPR diagnosis, the value of the intraclass correlation coefficient referring to the concordance of the total Reflux Finding Score - RFS, in the study performed by two observers with 32 subjects were 0.560 (95% IC: 0.267 – 0.758), indicating moderate / satisfactory reliability. According to the assessment at baseline, the groups were similar in age; total score scale (mean=9.8 and standard deviation=2.57) and total symptom scale score (mean=15.1 and standard deviation=8.84). The RLF diagnosis was considered positive when the IHR criterion was> = 13 and or RFS > = 7, the symptoms presented approximately 18/32 (56.3%) and the signs were positive in 27/32 (84.4%). Patients in both groups were similar about adherence to treatment: 93.8% of patients took the medication regularly, 84.4% did not feel discomfort with medication and 81.3% stated that they were easily able to perform behavioral measures. In the whole sample there was an improvement in the intensity of the symptoms (total score), from the pre-post treatment moment in the whole sample (p=0.001). The reduction of the total score scale was statistically significant in Group A (p=0.031) and in Group B (p=0.008). When analyzing in which of the groups the patients improved, no statistically significant difference was found (p=0.659). Conclusion: There was similar improvement in symptoms in the two groups of patients, those receiving exclusive pharmacological treatment and those receiving concomitant non-pharmacological guidance, however, no additional impact of behavioral measures was observed in this group of patients with symptoms of laryngopharyngeal reflux.
- ItemSomente MetadadadosIncrease of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux(Wiley-Blackwell, 2013-07-01) Silva, Rafael Corrêa Vieira da; Sá, Cláudia Cristina de; Pascual-Vaca, Ángel Oliva; Fontes, Luiz Henrique de Souza; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; Dib, Ricardo Anuar; Blanco, Cleofás Rodriguez; Queiroz, Rogerio Augusto; Navarro-Rodriguez, Tomas; Escuela Osteopatia Madrid; Univ Seville; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)The treatment of gastroesophageal reflux disease may be clinical or surgical. the clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. the objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease - 16 submitted to sham technique and 22 submitted osteopathic technique - were randomly selected. the average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann-Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. the MEP had no statistical difference (P= 0.146). the values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.
- ItemAcesso aberto (Open Access)Nova técnica de alimentação enteral em fístulas esôfago-jejunais(Colégio Brasileiro de Cirurgiões, 2004-02-01) Marks, Guido; Fagundes, Djalma José [UNIFESP]; Cevalos, Francisco A; Universidade Federal de Mato Grosso do Sul Depto. de Clínica Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Serviço de EndoscopiaBACKGROUND: A new procedure for the treatment of esophageal fistula, mainly associated to the ebb esophagojejunal in patients submitted to the total gastrectomy and reconstruction with loop jejunal Rouxen-Y anastomosis is present. METHODS: The method is based in the use of probe standard enteral prolongated with drain to laminate adapted in extremity, which results in advanced positioning inside the jejunum, making the administration of enteral nutrition possible and impeding ebb esophagojejunal. RESULTS: The authors discuss the theoretical advantages of the procedure and they suggest that the treatment of esofagic fistula with probe prolonged enteral would be suitable in the treatment of the fistula esophagojejunal by preventing the ebb esophagojejunal, which would result in smaller period of duration of the fistula esophagojejunal and it would prevent the high mortality rate. CONCLUSIONS: Preliminary studies demonstrated that this is a technically easy, low cost procedure through the endoscopic use. A prospective evaluation for morbility and mortality related to the method is needed.
- ItemSomente MetadadadosPathophysiology of Gastroesophageal Reflux in Patients with Chronic Pulmonary Obstructive Disease Is Linked to an Increased Transdiaphragmatic Pressure Gradient and not to a Defective Esophagogastric Barrier(Springer, 2016) Del Grande, Leonardo M. [UNIFESP]; Herbella, Fernando A. M. [UNIFESP]; Bigatao, Amilcar M. [UNIFESP]; Abrao, Henrique [UNIFESP]; Jardim, Jose R. [UNIFESP]; Patti, Marco G.
- ItemSomente MetadadadosPathophysiology of Gastroesophageal Reflux in Patients with Chronic Pulmonary Obstructive Disease Is Linked to an Increased Transdiaphragmatic Pressure Gradient and not to a Defective Esophagogastric Barrier(Springer, 2016) Del Grande, Leonardo M. [UNIFESP]; Herbella, Fernando A. M. [UNIFESP]; Bigatao, Amilcar M. [UNIFESP]; Abrao, Henrique [UNIFESP]; Jardim, Jose R. [UNIFESP]; Patti, Marco G.
- ItemAcesso aberto (Open Access)pH nasofaríngeo e refluxo gastroesofágico em crianças com doença respiratória crônica(Sociedade Brasileira de Pediatria, 2007-06-01) Junqueira, José Cesar da Fonseca; Penna, Francisco José [UNIFESP]; Universidade Federal do Rio de Janeiro; Instituto de Puericultura e Pediatria Martagão Gesteira Serviço de Gastroenterologia Pediátrica; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Minas GeraisOBJECTIVES: The aim of this case-control study was to evaluate the nasopharyngeal pH (NasopH) in children with normal or abnormal pH-metry in two groups of patients: 1) children presenting gastroenterological symptoms; and 2) children with chronic respiratory symptoms. METHODS: From February 2004 to January 2005, all consecutive patients referred for 24-hour pH-metry and in whom gastroesophageal reflux disease was suspected were enrolled in a prospective study. They were assigned to four groups: gastroenterological symptoms with normal (A) or abnormal (B) pH-metries (GG), and chronic respiratory symptoms with normal (C) or abnormal (D) pH-metries (RG). NasopH was measured for 5 minutes, before the 24-hour test was performed. RESULTS: Thirty-eight pH-metry tests were included (20 in the RG and 18 in the GG). Abnormal pH-metry results were observed in 11 patients in the GG and in 12 in the RG. NasopH means were 6.3273 and 5.6917, respectively (p < 0.0001). Average nasopharyngeal pH was 5.6917 among the 12 RG patients with abnormal pH-metry results and 6.5000 among the remaining eight patients with normal test results (p = 0.0006). Analysis of the RG with a receiver operating characteristic (ROC) curve showed pH of 5.8 as cutoff point (sensitivity of 91.7% and specificity of 87.5%). The area below the ROC curve was 0.870. CONCLUSIONS: Nasopharyngeal pH is significantly lower among patients in the RG presenting abnormal pH-metry results. A 5.8 NasopH has good sensitivity and specificity and can be used as a screening test in patients with chronic respiratory diseases to select those for whom conventional 24-hour pH-metry is indicated.
- ItemSomente MetadadadosPostprandial proximal gastric acid pocket in patients after laparoscopic Nissen fundoplication(Springer, 2011-10-01) Herbella, Fernando A. M. [UNIFESP]; Vicentine, Fernando P. P. [UNIFESP]; Del Grande, Jose C. [UNIFESP]; Patti, Marco G.; Universidade Federal de São Paulo (UNIFESP); Univ ChicagoBackground An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). the role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether change in the PPGAP may contribute to GERD control. This study aims to analyze the presence of PPGAP in patients submitted to Nissen fundoplication.Methods Fifteen patients who had a laparoscopic Nissen fundoplication (mean age = 61 years, 13 females, mean time from operation 1 year) were studied. All patients were free of foregut symptoms. Patients underwent high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES).Station pull-through pH monitoring was performed from 5 cm below the LBLES to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal.ResultsFour patterns of gastric acidity were found: (1) acid was not detected in the studied area of the stomach in 8 (53%) patients; (2) constant acidity (stomach is not alkalinized after meal), i.e., a buffered layer was not found in 3 (20%) patients; (3) PPGAP was not detected, i.e., the whole stomach is alkalinized, in 1 (7%) patient; and (4) PPGAP was noted in 3 (20%) patients with extensions of 2, 2, and 5 cm.Conclusion PPGAP is present in a minority of patients after Nissen fundoplication. This finding may explain part of the GERD control and that the gastric fundus may play a role in the genesis of the PPGAP.
- ItemSomente MetadadadosPostprandial Proximal Gastric Acid Pocket in Patients after Roux-En-Y Gastric Bypass(Springer, 2010-11-01) Herbella, Fernando A. M. [UNIFESP]; Vicentine, Fernando P. P. [UNIFESP]; Del Grande, Jose C. [UNIFESP]; Patti, Marco G.; Arasaki, Carlos H. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ ChicagoAn unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). the role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether operations that control GERD, such as Roux-en-Y gastric bypass (RYGB) and Nissen fundoplication, change the PPGAP.This study aims to analyze the presence of PPGAP in patients submitted to RYGB.Fifteen patients who had a RYGB for morbid obesity (mean age 53 years, 14 females, mean time from operation 3 years) were studied. All patients were free of foregut symptoms. Patients underwent a high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES). A station pull-through pH monitoring was performed from 5 cm below the LBLES to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal (40 g of chocolate, 50% fat).Acidity was not detected in the stomach of four patients before meal. After meal, PPGAP was not found in eight patients. in three patients, a PPGAP was noted with an extension of 1 to 3 cm.PPGAP is present in a minority of patients after RYGB; this finding may explain part of the GERD control after RYGB and that the gastric fundus may play a role in the genesis of the PPGAP.
- ItemAcesso aberto (Open Access)A qualidade de vida na doença do refluxo gastroesofágico: comparação entre os grupos não erosivo e erosivo(Universidade Federal de São Paulo (UNIFESP), 2011-06-29) Maciel, Paulo Roméro [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The gastroesophageal reflux disease is one of the most common disorders in medical practice, disease grouping under the same designation, clinical presentations as diverse as the occasional pyrosis, the chronic cough and the refractory asthma, besides the typical symptoms such as the pyrosis, regurgitation, epigastric pain and retrosternal pain. The symptoms are not related with disease severity and affect significantly the quality of people’s life. Objectives: To compare the quality of life in gastroesophageal reflux disease, among the group non-erosive and the erosive one, observing exist in four presentations of the disease: erosive disease without hiatal hernia, erosive disease with hiatal hernia, non-erosive disease with hiatal hernia and non-erosive disease without hiatal hernia. Method: The present study was conducted from a sample of 400 individuals, treated at a clinic specializing in gastroenterology and digestive endoscopy, in the city of Caruaru, in Pernambuco. Were included in the study the patients aged 14 to 82 years old, suffering from gastroesophageal reflux disease. All patients were evaluated clinically, underwent to high digestive endoscopy and to a therapeutic trial with proton pump inhibitors and prokinetics. The questionnaires of quality of life SF-36 and the questionnaire of gastroesophageal reflux symptoms QS-DRGE, both validated for Brazil, evaluated the quality of life. The sample was obtained by inviting the patients already diagnosed and not treated by medication with proton pump inhibitors or prokinetics. Results: The sample of patients with gastroesophageal reflux disease in the statistical tests with the analysis of the questionnaires showed no statistical differences in symptoms and therapeutic results in the four presentations of gastroesophageal reflux disease. Conclusions: The quality of life was similar in patients with and without esophageal lesions, regardless of their nature: erosive disease without hiatal hernia, erosive disease with hiatal hernia, non-erosive disease with hiatal hernia and non-erosive disease without hiatal hernia.