Navegando por Palavras-chave "Esophageal manometry"
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- ItemSomente MetadadadosEsophageal Motility after Laparoscopic Roux-en-Y Gastric Bypass: the Manometry Should Be Preoperative Examination Routine?(Springer, 2012-07-01) Valezi, Antonio Carlos; Mardiros Herbella, Fernando Augusto [UNIFESP]; Mali Junior, Jorge; Menezes, Mariano de Almeida; Universidade Estadual de Londrina (UEL); Universidade Federal de São Paulo (UNIFESP)Our goal was to identify the changes of esophageal motility, lower esophageal sphincter (LES) function, and eating adaptation before and after Roux-en-Y gastric bypass (RYGBP) and whether manometry should be a routine examination in patients who undergo this procedure.A total of 81 patients underwent manometry before surgery and 1 year after surgery. the control group consisted of 10 nonobese volunteers. Patients were classified as presenting with vomiting and without vomiting 1 year after surgery. Manometric variables were compared before and after surgery. Statistical analysis was performed using Wilcoxon and Mann-Whitney test.The patients (45.6%) had preoperative manometric findings, 29.8% had LES hypertonia, 18.9% LES hypotonia, 43.2% increase in wave amplitude of contraction, and three 8.1% abnormal peristalsis. One year after surgery manometry was abnormal in 62.9% of patients, 11.7% with hypertonia and 15.7% with hypotonia of the LES, 53% with changes in amplitude contraction and 19.6% with abnormal peristalsis. the control group showed no manometric abnormalities. Chronic vomiting was noted in 21% of patients. When comparing all variables between the pre and postoperative periods, there was no significant difference for all of them except for peristalsis. Comparing the results of manometric findings between the vomiting and non-vomiting groups, no significant changes were found in the variables studied.There was an association between RYGBP and motor abnormalities in the esophagus but no differences in postoperative feeding adaptation. Thus, we conclude that esophageal manometry is not necessary as a routine preoperative examination.
- 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.
- ItemSomente MetadadadosImportance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study(Springer, 2016) Herbella, Fernando Augusto Mardiros [UNIFESP]; Andolfi, Ciro; Vigneswaran, Yalini; Patti, Marco G.; Pinna, Bruno de Rezende [UNIFESP]Patients with otorhinolaryngologic (ear, nose, and throat-ENT) symptoms attributed to gastroesophageal reflux disease (GERD) are usually treated with medication based on the findings of nasal endoscopy and laryngoscopy only. This study aims to determine sensitivity and specificity of symptoms, nasal endoscopy, and laryngoscopy for the diagnosis of GERD as compared to pH monitoring. We studied 79 patients (mean age 53 years, 38 % males) in whom ENT symptoms were assumed to be secondary to GERD. All patients underwent a transnasal laryngoscopy by the ENT team and upper endoscopy and esophageal function tests by the surgical team. GERD was defined by a pathological pH monitoring. Pathologic reflux by pH monitoring was documented in 36 of the 79 patients (46 %), with a mean DeMeester score of 44. In 25 of the 36 patients (69 %), distal and proximal reflux was present. Among patients with negative pH monitoring, one patient was diagnosed with achalasia. ENT symptom sensitivity for globus, hoarseness and throat clearing was respectively 11, 58, and 33 %
- ItemAcesso aberto (Open Access)As repercussões da lesão medular sobre a ação da crura diafragmática e na contenção do refluxo gastroesofágico: um estudo transversal, não experimental(Universidade Federal de São Paulo (UNIFESP), 2009-09-30) Silva, Cleuza Braga da [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Study design: Cross-sectional and non-experimental. Objective: To detect and compare functional abnormalities in the esophagus and esophagogastric junction in two groups with chronic spinal injuries, one 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 antireflux 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 C4) and 15 paraplegics (levels T1 to T7). 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 prevalence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crura 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%; p=0.011). Conclusions: Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics towards greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crura contractility among the quadriplegics.