Comparação do refluxo supino diurno e noturno na pHmetria ambulatorial prolongada de indivíduos com suspeita clínica de doença do refluxo gastroesofágico
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Data
2024-03-13
Autores
Almeida, Filipe de Pádua Brito de Figueiredo [UNIFESP]
Orientadores
Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivo: Comparar características pHmétricas do refluxo supino diurno com o noturno. Métodos: Estudamos 500 indivíduos consecutivos com suspeita clínica para a doença do refluxo gastroesofágico (DRGE), que foram submetidos aos testes de função esofágica: manometria esofágica de alta resolução e pHmetria ambulatorial prolongada. O índice de DeMeester (IDM) foi calculado em todos os doentes. Valores do IDM acima de 14,7 foram considerados patológicos, caracterizando o paciente como portador da DRGE. Os pacientes foram considerados com o padrão supino da DRGE quando a porcentagem do tempo de refluxo ácido na posição supina foi maior ou igual a 2,2%. Dados sobre o refluxo ácido na posição supina, durante a recumbência diurna e noturna, foram coletados e analisados: (i) tempo de exposição ácida; (ii) número de episódios de refluxo; (iii) episódio de refluxo mais longo; (iv) intervalo entre a última refeição e a posição supina; (v) intervalo entre a posição supina e o primeiro episódio de refluxo ácido; e (vi) os sintomas referidos. Resultados: Dos 500 pacientes avaliados, 238 (48%) eram refluidores patológicos. Dentre estes, padrão supino foi constatado em 134 (56%) dos pacientes, 53 (23%) misto, e 51 (21%) ortostático. Nos pacientes com recumbência diurna, 112 (51% dos 217) eram refluidores patológicos, com DeMeester médio de 45 ± 26. O tempo de exposição ácida total (p=0,8) e o Índice de Sintomas (p=0,2) reportados não diferiram a depender do período, se diurno ou noturno. Enquanto que todos os outros parâmetros, foram menores durante o período de recumbência diurna. Conclusões: O refluxo supino diurno possui tempo de exposição ácida e correlação temporal entre sintomas e episódios de refluxo semelhantes ao refluxo supino noturno. Demais parâmetros pHmétricos são menores para o refluxo supino diurno.
Objective: To compare pHmetric characteristics of diurnal and nocturnal supine reflux. Methods: We studied 500 consecutive individuals with clinical suspicion of gastroesophageal reflux disease (GERD) who underwent esophageal high-resolution manometry and prolonged ambulatory pH monitoring. The DeMeester score (DMS) was calculated for all patients, with values above 14.7 considered pathological, characterizing the patient as having GERD. Patients were classified with supine GERD pattern when the percentage of acid reflux time in the supine position was equal to or greater than 2.2%. Data on acid reflux in the supine position during daytime and nighttime recumbency were collected and analyzed: (i) acid exposure time; (ii) number of reflux episodes; (iii) longest reflux episode; (iv) interval between the last meal and the supine position; (v) interval between the supine position and the first acid reflux episode; and (vi) reported symptoms. Results: Of the 500 evaluated patients, 238 (48%) had GERD. Among these, supine pattern was observed in 134 (56%) patients, bipositional in 53 (23%), and orthostatic in 51 (21%). In patients with daytime recumbency, 112 (51% of 217) were pathological refluxers, with a mean DMS of 45 ± 26. Total acid exposure time (p=0.8) and reported Symptom Index (p=0.2) did not differ depending on the period, whether diurnal or nocturnal. However, all other pHmetric parameters were lower during daytime recumbency. Conclusions: Diurnal supine reflux has similar acid exposure time and temporal correlation between symptoms and reflux episodes as nocturnal supine reflux. Other pHmetric parameters are lower for diurnal supine reflux.
Objective: To compare pHmetric characteristics of diurnal and nocturnal supine reflux. Methods: We studied 500 consecutive individuals with clinical suspicion of gastroesophageal reflux disease (GERD) who underwent esophageal high-resolution manometry and prolonged ambulatory pH monitoring. The DeMeester score (DMS) was calculated for all patients, with values above 14.7 considered pathological, characterizing the patient as having GERD. Patients were classified with supine GERD pattern when the percentage of acid reflux time in the supine position was equal to or greater than 2.2%. Data on acid reflux in the supine position during daytime and nighttime recumbency were collected and analyzed: (i) acid exposure time; (ii) number of reflux episodes; (iii) longest reflux episode; (iv) interval between the last meal and the supine position; (v) interval between the supine position and the first acid reflux episode; and (vi) reported symptoms. Results: Of the 500 evaluated patients, 238 (48%) had GERD. Among these, supine pattern was observed in 134 (56%) patients, bipositional in 53 (23%), and orthostatic in 51 (21%). In patients with daytime recumbency, 112 (51% of 217) were pathological refluxers, with a mean DMS of 45 ± 26. Total acid exposure time (p=0.8) and reported Symptom Index (p=0.2) did not differ depending on the period, whether diurnal or nocturnal. However, all other pHmetric parameters were lower during daytime recumbency. Conclusions: Diurnal supine reflux has similar acid exposure time and temporal correlation between symptoms and reflux episodes as nocturnal supine reflux. Other pHmetric parameters are lower for diurnal supine reflux.
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Citação
ALMEIDA, Filipe de Pádua. Comparação do refluxo supino diurno e noturno na pHmetria ambulatorial prolongada de indivíduos com suspeita clínica de doença do refluxo gastroesofágico. 2024. 67 f. Dissertação (Mestrado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina. Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.