Navegando por Palavras-chave "gastroesophageal reflux"

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    Achalasia 2016: Treatment Alternatives
    (Mary Ann Liebert, Inc, 2017) Herbella, Fernando Augusto Mardiros [UNIFESP]; Moura, Eduardo G. H.; Patti, Marco G.
    The treatment for achalasia changed dramatically after the introduction of minimally invasive surgery. Since 1991, laparoscopic Heller myotomy (LHM) has replaced pneumatic dilatation (PD) as the primary form of treatment in many centers. Over time, PD became safer, and eventually endoscopic experts were able to perform an endoscopic myotomy via a per oral endoscopic myotomy (POEM). This article reviews the advantages and disadvantages of each technique. Ultimately, the best outcomes are obtained by a multidisciplinary team that can tailor a specific treatment to each individual patient.
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    Aplicações da cirurgia videolaparoscópica em crianças
    (Sociedade Brasileira de Pediatria, 2001-10-01) Esteves, Edward [UNIFESP]; O. Neto, Miguel; C. Neto, Eriberto; Terêncio Jr., Osmar; Carvalho, Bernardina B.; Pereira, Ruy E.; Universidade Federal de São Paulo (UNIFESP); UFG; Instituto Ortopédico de Goiânia e no Hospital Amparo
    OBJECTIVES: to present the videolaparoscopies performed by the Children's Surgery Service, and study the main indications for pediatric laparoscopic surgeries, considering advantages and disadvantages over conventional open procedures. METHODS: retrospective analysis of 612 videolaparoscopies in children aged between 8 days and 17 years treated from November/95 to 2000. Basic principles of videolaparoscopy and the postoperative management of several pediatric diseases are described. The results, advantages, and complications were analyzed after a 5-year follow-up period. RESULTS:laparoscopic surgery allowed for a wide series of abdominal procedures conventionally carried out through open surgery, mainly for the treatment of gastroesophageal reflux disease, inflammatory acute abdomen, adhesive intestinal obstruction, biliary lithiasis, tumors, cryptorchidism, ovarian diseases, splenectomies, aganglionosis, trauma and others. Morbidity was low (1%), and mortality due to laparoscopy was nonexistent. Conversion to laparotomy occurred in only 14 cases (2.3%), mainly because of trauma. The principal advantages included minimal surgical trauma, pain and reflex ileum, short hospital stay, almost no incisional hernias and better cosmetic scars. CONCLUSIONS: videolaparoscopy seems to be a great advance in modern pediatric surgery, allowing safer and less invasive treatment of a wide series of abdominal diseases at all pediatric ages.
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    Estudo da relação entre doença pulmonar obstrutiva crônica e exacerbações e doença do refluxo gastroesofágico, diagnosticada por phmetria
    (Universidade Federal de São Paulo (UNIFESP), 2014-10-31) Bigatao, Amilcar Marcelo [UNIFESP]; Jardim, Jose Roberto de Brito Jardim [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The gastroesophageal reflux disease (GERD) has a great association with respiratory diseases. Based on symptoms, GERD seems to be very prevalent in chronic obstructive pulmonary disease (COPD) patients and is associated with COPD exacerbations. However, GERD has not been extensively studied with pH monitoring in these patients, correlating with their exacerbations. This study aims to: (1) evaluate the prevalence of GERD diagnosed by ambulatory pH monitoring in COPD patients, (2) correlate GERD with COPD exacerbations and (3) compare GERD symptoms with pH monitoring. Methods: Transversal study to evaluate stable COPD outpatients. COPD exacerbations in the last 12 months were recorded. Patients were questioned regarding the presence and frequency of pulmonary and GERD symptoms in the last year. High resolution esophageal manometry and pH monitoring were performed in all patients. Results: We evaluated 50 patients (56% females, mean age 66 years) with COPD. The prevalence of GERD was 44% and a higher number of COPD exacerbations were noticed in the group with GERD. There was no correlation between GERD and symptoms. Heartburn and regurgitation combined had a sensitivity and specificity of 48%. Almost half of the patients with GERD had no symptoms reported. Conclusion: There is a high prevalence of GERD in COPD patients, and patients with COPD and GERD have more exacerbations than those without GERD. Symptoms are unreliable for predict GERD diagnosis. We believe GERD must be objectively tested in these patients since the outcomes of the treatment for GERD in these individuals is still elusive.
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    Evaluation of health-related quality of life in gastroesophageal reflux disease patients before and after treatment with pantoprazole
    (Blackwell Publishing, 2006-01-01) Cury, MDS; Ferrari, Angelo Paulo [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Moraes, JPP; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Gastrooesophageal reflux disease (GERD) is highly prevalent in the Western world but its true population prevalence is difficult to estimate without a validated instrument to detect it. The evaluation of health-related quality of life (HRQoL) is an useful tool in this assessment. The aims of this study are to translate and validate a GERD specific HRQoL questionnaire and evaluate HRQoL in a Brazilian population before and after GERD treatment. GERD patients with typical symptoms and Los Angeles Classes A to C esophagitis were included in the study. Two HRQoL questionnaires and upper digestive endoscopy were performed before and after 6 weeks treatment with pantoprazole 40 mg/day followed by 80 mg/day for another 8 weeks if healing did not occur. A generic (SF-36) and one disease-specific questionnaire (GERD score) were used. The latter was translated and validated for Brazilian Portuguese. From January 2002 to December 2003, 100 patients were enrolled. Of these, 78 patients were evaluated in a per protocol analysis (35 men, mean age: 40 years). The translated questionnaire (Brazilian GERD Score, BGERDS) demonstrated adequate psychometric properties (validity, responsiveness and reliability). SF-36 and BGERDS domains significantly improved after treatment (P < 0.01 and P < 0.001 respectively). The BGERDS was shown to be valid and reliable. Patients with esophagitis showed an impaired HRQoL that improved or normalized after treatment with pantoprazole.
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    Expiratory Flow Increase Technique and Acid Esophageal Exposure in Infants Born Preterm With Bronchopulmonary Dysplasia
    (Lippincott Williams & Wilkins, 2011-12-01) Serrou Camy, Lia Franco; Mezzacappa, Maria Aparecida; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)
    Objective: To determine if an expiratory flow increase technique (EFIT) is associated with acid reflux episodes in infants born preterm with bronchopulmonary dysplasia (BPD). Methods: A crossover study was carried out. Eighteen subjects divided into 2 groups were randomly assigned to receive 2 EFIT sessions at 2 postprandial time points. Group 1 started 2 hours after feeding and group 2 started 3 hours after feeding. Esophageal acid exposure was assessed by the reflux index (RI) during EFIT and 20 minutes before EFIT by esophageal pH monitoring. Results: A significant reduction in the RI was observed in group 1 with EFIT performed 2 hours after feeding. Group 2 showed no significant differences in RI values before and during EFIT in both postprandial periods. Conclusion: When EFIT is performed 2 and 3 hours after feeding, it is not associated with an increase in acid reflux episodes in infants born preterm with BPD. (Pediatr Phys Ther 2011; 23: 328-334)
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    From sponges to capsules. the history of esophageal pH monitoring
    (Wiley-Blackwell, 2009-04-01) Herbella, Fernando A. M. [UNIFESP]; Nipominick, Ian [UNIFESP]; Patti, Marco G.; Universidade Federal de São Paulo (UNIFESP); Univ Chicago
    The understanding of digestive physiology, gastric acid production, and gastroesophageal reflux disease has been evolving since the 16th century. During this time, several methods to detect gastric refluxate were ingeniously developed. Ambulatory esophageal pH monitoring is still the current gold standard test for the diagnosis of gastroesophageal reflux disease. State-of-the-art technologies use catheter-free wireless pH sensors, an idea first conceived in the 1950s. the authors reviewed the history of esophageal pH monitoring.
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    Gastroesophageal reflux episodes in asthmatic patients and their temporal relation with sleep architecture
    (Assoc Bras Divulg Cientifica, 2008-02-01) Mello-Fujita, Luciane [UNIFESP]; Roizenblatt, Suely [UNIFESP]; Frison, Claudio Ricardo [UNIFESP]; Rodrigues, L. [UNIFESP]; Garbuio, Silvério Aparecido [UNIFESP]; Tufik, Sergio [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Gastroesophageal reflux (GER) is common in asthma patients and can contribute to sleep disruption. The aim of the present study was to determine the time-related distribution of GER events together with their impact on sleep in asthmatic subjects with GER disease symptoms. The inclusion criteria were: 18-65 years, controlled moderate to severe asthma and GER-compatible clinical evidence. The exclusion criteria were: chronic obstructive lung disease, smoking, infections of the upper airways, use of oral corticosteroids, other co-morbidities, pregnancy, sleep-related disorders, night-time shift work, and the use of substances with impact on sleep. Asthmatic patients with nocturnal symptoms were excluded. All-night polysomnography and esophageal pH monitoring were recorded simultaneously. Of the 147 subjects selected, 31 patients and 31 controls were included. Seventeen patients were classified as DeMeester positive and 14 as DeMeester negative. Both groups displayed similar outcomes when general variables were considered. Sleep stage modification one minute prior to GER was observed in the DeMeester-positive group. Awakening was the most frequent occurrence at GER onset and during the 1-min period preceding 38% of the nocturnal GER. Sleep stage 2 was also prevalent and preceded 36% of GER events. In the DeMeester-negative group, awakening was the most frequent response before and during GER. Modifications in sleep stages, arousals or awakenings were associated with 75% of the total GER events analyzed during the period of one minute before and after the fall of esophageal pH below 4 in the DeMeester-positive group. These data provide evidence that sleep modifications precede the GER events in asthmatic patients.
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    Hiatal Mesh Repair-Current Status
    (Lippincott Williams & Wilkins, 2011-04-01) Herbella, Fernando A. M. [UNIFESP]; Patti, Marco G.; Del Grande, Jose C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Chicago
    Most surgeons believe that cruroplasty (hiatoplasty) is an essential part of antireflux operations. One of the main causes of failure after antireflux operation is gastric (wrap) herniation through the hiatus that may be attributed to breakdown of the hiatal closure or a faulty repair. Surgeons are at present faced with the dilemma of choosing between a risk of recurrence and the fear of complications of prosthetic hiatal reinforcement. We reviewed the literature to evaluate the current status of hiatal mesh repair (HMR). Indication, technique, complications, and results are shown. Available data show a small number of mesh-related complications compared with the number of patients submitted to the procedure, and better results of HMR compared with simple hiatal closure. We support the use of HMR when performed by skilled foregut surgeons, as complications described occurred more frequently in the earliest cases of the series. in addition, HMR should be probably used selectively. However, studies to identify the patients at risk of hernia recurrence or mesh-related complications are still elusive. the ideal type of mesh and the ideal technique for mesh implantation are yet to be established.
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    Lower esophageal sphincter reacts against intraabdominal pressure in children with symptoms of gastroesophageal reflux
    (Kluwer Academic/plenum Publ, 2002-11-01) Goldani, HAS; Fernandes, MIM; Vicente, YAMVA; Dantas, R. O.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Studies of the effect of increased intraabdominal pressure on the lower esophageal sphincter (LES) are controversial. This study aimed to verify the LES competence against extrinsic abdominal compression in children with and without symptoms of gastroesophageal reflux (GER). Eighteen children ages 6-20 months were evaluated, 11 of them with symptoms of GER (group I) and 7 without symptoms of GER (group II). Manometry of the esophagus, LES, and stomach was performed in all children who underwent extrinsic abdominal compressions of 20, 40, 60, and 80 mm Hg. the pressure gradients in the esophagus, LES, and stomach were measured. the pressure gradient showed a significant difference only in the esophagus after extrinsic abdominal compressions of 60 mm Hg [group I median (range): 7.6mm Hg (2.7-20.0) vs group II: 2.8 mm Hg (1.4-9.6), P < 0.05], and 80 mm Hg [group I median (range): 7.7 mm Hg (3.7-28.9) vs group II: 3.8 mm Hg (1.2-21.1), P < 0.05]. It was concluded that the competence of LES to contain increased intraabdominal pressure might be an important factor in the pathophysiology of GER in children.
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    Nível de resposta das emissões otoacústicas evocadas por estímulo transiente em lactentes com refluxo gastroesofágico
    (Fundação Otorrinolaringologia, 2011-09-01) Camboim, Elizângela Dias [UNIFESP]; Scharlach, Renata Coelho [UNIFESP]; Farias, Kelvânio Vitório De; Oliveira, Lívia Karla Gadêlha De; Vasconcelos, Dênis; Azevedo, Marisa Frasson de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Ciências da Saúde de Alagoas Faculdade de Fonoaudiologia de Alagoas
    INTRODUCTION: The transient-evoked otoacoustic emissions (TEOAE) have been the most widespread technique to perform neonatal hearing screening. Scrutinizing their measures by way of an association with other alterations that may impair the infant's auditory system is important. OBJECTIVE: Analyze the incidence and the response levels of the transient-evoked otoacoustic emissions on infants having a physiological gastroesophageal reflux disease (GERD). METHOD: A prospective study was performed at Santa Juliana Hospital's Otorhinolaryngology Department. 118 prematurely-born and timely-born babies, from newly-born to 6 months old, who were sent by pediatricians and gastropediatricians, participated in the study and they were divided into two groups: Study Group: 63 infants clinically diagnosed of a physiological gastroesophageal reflux disease, and Control Group: 55 infants without a physiological gastroesophageal reflux. The peripheral hearing function was evaluated by both transient-evoked otoacoustic emissions and otoscopy examinations performed by an otorhinolaryngologist. RESULTS: The average response levels of the transient-evoked otoacoustic emissions were higher in the non-reflux group for frequency bands of 2kHz, 2. 5kHz, 3kHz, 3. 5kHz and 4. 5kHz bilaterally, with a statistically significant difference, achieving the average values of 7. 71dB and 7dB in the right ear found in the frequency bands of 2 and 4kHz, respectively. CONCLUSION: There was a lower incidence and a lower response level of the transient-evoked otoacoustic emissions in physiological gastroesophageal reflux children in comparison with children having no reflux.
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    Nutritional management of regurgitation in infants
    (Amer College Nutrition, 1998-08-01) Vandenplas, Yvan; Lifshitz, Jere Ziffer; Orenstein, Susan; Lifschitz, Carlos H.; Shepherd, Ross W.; Casaubon, Pablo R.; Muinos, William I.; Fagundes-Neto, Ulysses [UNIFESP]; Aranda, José A Garcia; Gentles, Myrna; Santiago, José D.; Vanderhoof, Jon; Yeung, Chap Yung; Moran, J Roberto; Lifshitz, Fima; Universidade de São Paulo (USP)
    Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development.
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    Postprandial proximal gastric acid pocket and gastroesophageal reflux disease
    (Wiley-Blackwell, 2012-09-01) Herbella, F. A. M. [UNIFESP]; Vicentine, F. P. P. [UNIFESP]; Silva, L. C. [UNIFESP]; Patti, M. G.; Universidade Federal de São Paulo (UNIFESP); Univ Chicago
    An unbuffered layer of acidity that escapes neutralization by food has been demonstrated in volunteers and gastroesophageal reflux disease patients. This postprandial proximal gastric acid pocket (PPGAP) is manometrically defined by the presence of acid reading (pH < 4) in a segment of the proximal stomach between nonacid segments distally (food) and proximally (lower esophageal sphincter or distal esophagus). the PPGAP may have important clinical implications; however, it is still poorly understood. Gastric anatomy and physiology seem to be important elements for PPGAP genesis. Gastric operations and acid suppression medications may decrease distal proximal intragastric acid reflux and help control gastroesophageal reflux.
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    Postprandial proximal gastric acid pocket in patients after distal gastrectomy
    (Wiley-Blackwell, 2011-12-01) Herbella, F. A. M. [UNIFESP]; Vicentine, F. P. P. [UNIFESP]; Silva, L. C. [UNIFESP]; Patti, M. G.; Universidade Federal de São Paulo (UNIFESP); Univ Chicago
    Background An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in the majority of normal individuals and patients with gastroesophageal reflux disease. the role of gastric anatomy, specifically the antrum, in the physiology of the PPGAP is not yet fully elucidated. This study aims to analyze the presence of PPGAP in patients submitted to distal gastrectomy. Methods A total of 15 patients who had a distal gastrectomy plus DII lymphadenectomy and Roux-en-Y reconstruction for gastric adenocarcinoma (mean age 64.3 +/- 8.4 years, 12 females) were studied. All patients were free of foregut symptoms after the operation. Patients underwent a high-resolution manometry. A station pull-through pH monitoring was performed from 5 cm below the lower border of the lower esophageal sphincter (LBLES) to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal. Postprandial proximal gastric acid pocket was defined by the presence of acid reading (pH<4) in a segment of the proximal stomach between non-acid segments distally (food) and proximally (LBLES). the PPGAP extent was recorded. the protocol was approved by local ethics committee. Key Results Acidity was not detected in the stomach of nine patients before meal. After meal, PPGAP was not found in three patients. in three patients (20%), a PPGAP was noted with an extension of 1, 1 and 3 cm. Conclusions & Inferences in conclusion, PPGAP is present in a minority of patients after distal gastrectomy; this finding may suggest that the gastric antrum may play a role in the genesis of the PPGAP.
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    Refluxo gastroesofágico em pacientes portadores de papilomatose recorrente de laringe
    (ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-04-01) Pignatari, Shirley Shizue Nagata [UNIFESP]; Liriano, Raquel Ysabel Guzmán [UNIFESP]; Avelino, Melissa Ameloti Gomes [UNIFESP]; Testa, Jose Ricardo Gurgel [UNIFESP]; Fujita, Reginaldo Raimundo [UNIFESP]; De Marco, Eduardo Kutchell; Universidade Federal de São Paulo (UNIFESP); real e Benemérita Sociedade Portuguesa de Beneficência de São Paulo Hospital São Joaquim Diretor da Unidade de Fisiologia e Motilidade
    Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM: the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS: ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS: fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION: the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.
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    Revisão sistemática e metanálise do uso de procinéticos no refluxo gastroesofágico e na doença do refluxo gastroesofágico em Pediatria
    (Sociedade de Pediatria de São Paulo, 2009-09-01) Magalhães, Pedro Vieira S.; Bastos, Telma Regina P. D.; Appolinário, José Carlos B.; Bacaltchuk, Josué [UNIFESP]; Mota Neto, Joaquim Ignácio S.; UFPel Centro de Medicina Baseada em Evidências; Hospital de Clínicas de Porto Alegre Instituto Nacional de Ciência e Tecnologia Translacional em Medicina; UFRJ Instituto de Psiquiatria; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate, by systematic review and meta-analysis, randomized studies comparing the prokinetics (domperidone, bromopride, metoclopramide and bethanechol) to placebo in the treatment of gastroesophagic reflux (GER) and gastroesophagic reflux disease (GERD) in children. METHODS: Bibliographic search for randomized clinical trials (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). The primary outcome was the modification of reflux symptoms. Other outcomes were: GER-related complications, alterations in control exams, life quality, adverse events and abandon of treatment. RESULTS: The metanalysis included four studies on domperidone, two on metoclopramide, and one on bethanechol. No study of bromopride was retrieved. The risk of non-response to the treatment was significantly smaller in children that received prokinetics in comparison to placebo (RR 0.35, 95%CI 0.14-0.88). Individual therapeutic advantage regarding placebo was related to domperidone (n=126; RR 0.27; 95%CI 0.14-0.52, NNT 3; I2 0%) and bethanechol (n=44; RR 0.19; 95%CI 0.05-0.55; NNT 2), but not to metoclopramide (n=71; RR 0.63; 95%CI 0.07-5.71; I2 92.2%). CONCLUSIONS: The evidence for prokinetic use in GER and GERD in children is limited because the few studies report preliminary trials that evaluate short-term responses and show methodological limitations.
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    Upper esophageal sphincter motility in gastroesophageal reflux disease in the light of the high-resolution manometry
    (Oxford Univ Press Inc, 2017) Nadaleto, B. F. [UNIFESP]; Herbella, F. A. M. [UNIFESP]; Pinna, B. R.; Patti, M. G.
    This study aims to evaluate the upper esophageal sphincter (UES) motility in patients with gastroesophageal reflux disease (GERD) as compared to healthy volunteers. We retrospectively studied the HRM tests of 44 patients (median age: 61 years, 54% females) under evaluation for GERD. The manometric UES parameters of these patients were compared to 40 healthy volunteers (median age: 27 years, 50% females). Almost half of the patients had a short and hypotonic UES. Patients with extraesophageal symptoms had a higher proportion of hypotonic UES as compared to patients with esophageal symptoms. Reflux pattern did not influence manometric parameters. Proximal reflux (any number of episodes) was present in 37(84%) patients (median number of proximal episodes = 6). Manometric parameters are similar in the presence or absence of proximal reflux. There is not a correlation between the UES length and UES basal pressure. In conclusion, our results show that: (1) the manometric profile of the UES in patients with GERD is characterized by a short and hypotonic UES in half of the patients