Comparación del efecto de omeprazol como monoterapia y su combinación con bicarbonato de sodio en el tratamiento de la pirosis moderada a severa: ensayo clínico controlado, aleatorizado y doble ciego / Comparison of the effect of omeprazole monotherapy and its combination with sodium bicarbonate in the treatment of moderate to severe heartburn: a double-blind, randomized controlled clinical trial

Heartburn occurs in 75% of patients with digestive discomfort of any origin and is one of the main symptoms of gastroesophageal reflux disease. Treatment focuses on lifestyle modification and symptomatology management with various drugs; when heartburn is moderate to severe, a proton pump inhibitor is more suitable. Omeprazole (OMZ) combined with sodium bicarbonate (BC) has demonstrated significant and sustained suppression of acid secretion. The objective was to compare the effect of sequential OMZ/BC therapy compared to OMZ monotherapy for the improvement of heartburn in Mexican individuals. The study was a double-blind, randomized, controlled, multicenter clinical study including 277 subjects with moderate to severe heartburn. Patients received 7 days of OMZ/BC and 7 days of OMZ (OMZ/BC7) or 14 days of OMZ (OMZ14). The primary endpoint was defined as the change in the number of days a week that the patient has heartburn, it was evaluated at 14 days. Both treatments reduced time (days) with heartburn by less than 4 days (OMZ14 3.9 vs. 4.2 days OMZ/BC7), as well as duration, number of events and intensity of heartburn. The treatments improved the quality of life, and the control of the symptoms. The proportion of adverse events was lower with OMZ/BC. The non-inferiority of OMZ/BC7 with respect to OMZ14 was verified.

La pirosis se presenta en el 75% de los pacientes con molestias digestivas de cualquier origen y es uno de los principales síntomas de la enfermedad por reflujo gastroesofágico. El tratamiento se enfoca en la modificación del estilo de vida y el manejo de la sintomatología con diversos fármacos; cuando la pirosis es moderada a severa, un inhibidor de la bomba de protones es más adecuado. El omeprazol (OMZ) combinado con bicarbonato de sodio (BC) ha demostrado supresión significativa y sostenida de la secreción ácida. El objetivo fue comparar el efecto de la terapia secuencial de OMZ/BC en comparación con el tratamiento continuo de OMZ para la mejoría de la pirosis en individuos mexicanos. Estudio clínico multicéntrico, doble ciego, controlado, aleatorizado que incluyó 277 sujetos con pirosis moderada a severa. Los pacientes recibieron 7 días de OMZ/BC y 7 días de OMZ (OMZ/BC7) o 14 días de OMZ (OMZ14). La variable primaria fue definida como el cambio del número de días a la semana que el paciente presenta pirosis, se evaluó a los 14 días. Ambos tratamientos redujeron los días con pirosis en menos 4 días (OMZ14 3,9 vs. 4,2 días OMZ/BC7), así como la duración, el número de eventos e intensidad de la pirosis. Los tratamientos mejoraron los indicadores de calidad de vida, y el control del padecimiento. La proporción de eventos adversos fue menor con OMZ/BC. Se comprobó la no-inferioridad de OMZ/BC7 respecto OMZ14.

Distúrbios funcionais esofágicos na avaliação pré-operatória de cirurgia bariátrica / Esophageal functional disorders in the pre-operatory evaluation of bariatric surgery

ABSTRACT BACKGROUND: Obesity is an independent risk factor for esophageal symptoms, gastroesophageal reflux disease (GERD), and motor abnormalities. When contemplating bariatric surgery, patients with obesity type III undergo esophagogastroduodenoscopy (EGD) and also esophageal manometry (EMN), and prolonged pHmetry (PHM) as part of their pre-operative evaluation. OBJECTIVE: Description of endoscopy, manometry and pHmetry findings in patients with obesity type III preparing for bariatric surgery, and correlation of these findings with the presence of typical GERD symptoms. METHODS: Retrospective study in which clinical symptoms of GERD were assessed, focusing on the presence of heartburn and regurgitation. All patients underwent EMN, PHM and most of them EGD. RESULTS: 114 patients (93 females-81%), average age 36 years old, average BMI of 45.3, were studied. Typical GERD symptoms were referred by 43 (38%) patients while 71 (62%) were asymptomatic. Eighty two patients (72% of total) underwent EGD and 36 (42%) evidenced esophageal abnormalities. Among the abnormal findings, hiatal hernia was seen in 36%, erosive esophagitis (EE) in 36%, and HH+EE in 28%. An abnormal EMN was recorded in 51/114 patients (45%). The main abnormality was a hypotensive lower esophageal sphincter (LES) in 32%, followed by ineffective esophageal motility in 25%, nutcracker esophagus in 19%, IEM + hypotensive LES in 10%, intra-thoracic LES (6%), hypertensive LES (4%), aperistalsis (2%) and achalasia (2%). Among the 43 symptomatic patients, 23 (53%) had abnormal EMN and 31/71 asymptomatic cases (44%) also presented this finding (P=0.30). PHM showed abnormal reflux in 60/114 patients (53%), with a predominance of bi-positional reflux (42%), followed by supine reflux (33%) and upright reflux (25%). Abnormal PHM was found in 26/43 symptomatic cases (60%) and also among 34/71 asymptomatic cases (48%) (P=0.19). CONCLUSION: Manometric abnormalities were common in obesity type III patients, the most frequent being hypotensive LES, followed by IEM. Most patients were asymptomatic. There was no correlation between the finding of motor abnormalities and the presence of symptoms. More than half the patients had abnormal reflux at PHM. We found no significant correlation between abnormal reflux and the presence of symptoms.

RESUMO CONTEXTO: A obesidade é fator de risco independente para sintomas esofagianos, doença do refluxo gastroesofágico (DRGE) e alterações motoras. Pacientes com obesidade tipo III, candidatos à cirurgia bariátrica foram submetidos a endoscopia digestiva alta (EDA) e também realizaram esofagomanometria (EMN) e pHmetria prolongada (PHM) como parte da avaliação pré-operatória. OBJETIVO: Em um grupo de pacientes com obesidade tipo III em pré-operatório de cirurgia bariátrica, descrever os achados endoscópicos, manométricos e pHmétricos, correlacionando-os com a presença de sintomas típicos de DRGE. MÉTODOS: Estudo retrospectivo, de pacientes com obesidade tipo III, candidatos a cirurgia bariátrica. A avaliação clínica focalizou a presença de sintomas típicos de DRGE (pirose/regurgitação); todos foram submetidos a EMN, PHM e a maior parte à EDA, realizada previamente. RESULTADOS: Foram incluídos 114 pacientes, 93 (81%) do sexo feminino, média de idade de 36 anos e IMC médio de 45,3. Sintomas típicos de refluxo foram referidos por 43 (38%) pacientes e 71 (62%) eram assintomáticos. EDA foi realizada por 82 (72%) pacientes, havendo anormalidades esofagianas em 36 (42%). Entre os anormais, havia hérnia hiatal (HH) em 36%, esofagite erosiva (EE) em 36% e HH + EE em 28%. A EMN foi anormal em 51/114 (45%). Entre os anormais, predominou o esfíncter esofagiano inferior (EEI) hipotenso em 32%, seguido por motilidade esofagiana ineficaz (MEI) em 25%, esôfago em quebra-nozes (19%), EEI hipotenso + MEI (10%), EEI intra-torácico (6%), EEI hipertenso (4%), aperistalse (2%) e acalasia (2%). Dentre os 43 sintomáticos, 23 (53%) apresentavam EMN anormal, sendo que em 31 dos 71 (44%) assintomáticos a EMN também era anormal (P=0,30). A PHM revelou refluxo anormal em 60 (53%) pacientes. Predominou o refluxo anormal biposicional (42%) seguido do refluxo supino (33%) e refluxo ereto (25%). Dentre os 43 pacientes sintomáticos, 26 (60%) apresentavam PHM anormal, sendo que em 34 dos 71 assintomáticos a PHM também era anormal (48%) - P=0,19. CONCLUSÃO: Alterações manométricas foram comuns em obesidade tipo III, sendo as mais frequentes o EEI hipotenso, seguida de motilidade ineficaz. A maioria dos pacientes era assintomática. Mais da metade dos pacientes apresentou refluxo anormal à PHM. Não houve diferença significativa entre o achado de refluxo anormal e a presença de sintomas. Não houve relação entre o achado de alterações motoras e a presença de sintomas.

Impacto da pirose e regurgitação no bem-estar de indivíduos da população geral: um inquérito nacional brasileiro / Impact of heartburn and regurgitation on individuals' well-being in the general population: a brazilian national survey

ABSTRACT BACKGROUND: Heartburn and acid regurgitation are typical symptoms usually associated with gastroesophageal reflux disease (GERD). GERD is one of the gastrointestinal diagnosis with higher prevalence worldwide, significantly impairing patients' quality of life. OBJECTIVE: The objective of this study was to analyze the impact of GERD-related symptoms in the Brazilian urban population. METHODS: National telephone survey with community-dwelling Brazilian individuals. Self-reported prevalence and frequency of symptoms (heartburn / regurgitation) were assessed. Individuals rated the impact of symptoms in their general well-being using a numeric scale from 1 to 10 (1 = no impact; 10 = very intense, preventing the person to eat and perform daily routine activities). Descriptive and bivariate statistical analyses were performed. RESULTS: The final sample was comprised of 1,773 subjects, 935 (52.7%) females, an average of 40 years old. The prevalence of heartburn and regurgitation in the past 6 months was 26.2% (n=466) and 11.0% (n=196), respectively. Women presented higher prevalence (heartburn n=266, 28.5% and regurgitation n=119, 12.7%) than men (n=200, 23.1% and n=78, 8.9%, respectively) (P<0.05). Heartburn in the past week was reported by 175 individuals (9.8%), while regurgitation episodes by 67 (3.8%). Absence of impact of the symptom in the overall well-being was observed for 82 subjects (17.6%) with heartburn and 18 individuals (9.2%) with regurgitation. Very intense impact was reported by 46 subjects (9.8%) with heartburn and 41 (20.9%) with regurgitation. Women's well-being was more affected than men's (mean score 5.45 vs 4.71, P<0.05). CONCLUSION: Heartburn and regurgitation were frequent symptoms, women with higher prevalence. These symptoms led to a substantial impact on individuals' well-being, women being more affected.

RESUMO CONTEXTO: Pirose e regurgitação ácida são sintomas típicos usualmente relacionados à doença do refluxo gastroesofágico (DRGE). A DRGE é um dos diagnósticos gastrointestinais com maior prevalência mundial, afetando significativamente a qualidade de vida dos pacientes. OBJETIVO: Analisar o impacto de sintomas relacionados à DRGE em uma amostra da população brasileira urbana. MÉTODOS: Inquérito nacional via telefone com indivíduos brasileiros em contexto comunitário. O inquérito foi conduzido entre 6 de agosto e 12 de setembro de 2018. A prevalência autorrelatada e a frequência dos sintomas foram avaliadas. Os respondentes classificaram o impacto dos sintomas no seu bem-estar geral utilizando uma escala numérica de 1 a 10 (1 = ausência de impacto; 10 = impacto muito grave, impedindo a pessoa de comer ou realizar atividades da vida diária). Análises estatísticas descritivas e bivariadas foram conduzidas. RESULTADOS: A amostra final foi constituída por 1.773 indivíduos, 935 (52,7%) mulheres, com idade média de 40 anos. A prevalência de pirose e regurgitação nos últimos 6 meses foi de 26,2% (n=466) e 11,0% (n=196), respectivamente. Sexo feminino (pirose n=266, 28,5% e regurgitação n=119, 12,7%) apresentou prevalência mais alta do que o masculino (n=200, 23,1% e n=78, 8,9%, respectivamente) (P<0,05). Pirose na última semana foi relatada por 175 indivíduos (9,8%), enquanto episódios de regurgitação por 67 (3,8%). Ausência de impacto dos sintomas no bem-estar geral dos indivíduos foi observada para 82 respondentes (17,6%) com pirose e 18 (9,2%) daqueles com regurgitação. Impacto muito grave foi reportado por 46 (9,8%) indivíduos com pirose e 41 (20,9%) com regurgitação. Sexo feminino foi mais afetado pelos sintomas do que o masculino. CONCLUSÃO: Pirose e regurgitação foram bastante frequentes sendo o sexo feminino mais afetado. Tais sintomas levaram a impacto no bem-estar dos indivíduos, com maior prejuízo para mulheres.

Trânsitos oral e faríngeo na pirose funcional / Oral and pharyngeal transit in functional heartburn

ABSTRACT BACKGROUND: Gastroesophageal reflux disease is associated with slower transit of the bolus through the pharynx and upper esophageal sphincter. Functional heartburn has similar symptoms to gastroesophageal reflux disease, however, the symptoms are not caused by reflux. OBJECTIVE: The aim of this investigation was to evaluate oral and pharyngeal transit in patients with functional heartburn, with the hypothesis that, similar to patients with gastroesophageal reflux disease, they have changes in pharyngeal and upper esophageal sphincter transit time. METHODS: Oral and pharyngeal transit was evaluated by videofluoroscopy in eight women with functional heartburn, five with mild dysphagia for solid foods, and 12 female controls. Controls and patients swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses. RESULTS: No difference in the oral or pharyngeal transit time was found between patients and controls. No aspiration of bolus into the airways was detected in any individual. Pharyngeal residues were detected in the same proportion of swallows, in patients (12.5%) and controls (15.0%), after swallows of 10 mL paste bolus. CONCLUSION: Oral, pharyngeal and upper esophageal sphincter transit time are similar in patients with functional heartburn to healthy controls.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico está associada ao trânsito mais lento do bolo deglutido pela faringe e esfíncter superior do esôfago. Pirose funcional tem sintomas similares aos de doença do refluxo gastroesofágico, entretanto eles não são consequência de refluxo. OBJETIVO: Como na pirose funcional os sintomas são semelhantes aos da doença do refluxo gastroesofágico, o objetivo desta investigação foi avaliar a duração do trânsito do bolo deglutido pela boca, faringe e esfíncter superior do esôfago em pacientes com pirose funcional, com a hipótese de que esses pacientes também apresentem alteração no trânsito. MÉTODOS: Pelo método videofluoroscópico foi avaliado o trânsito oral e faríngeo de oito pacientes do sexo feminino com pirose funcional, cinco com disfagia leve para alimentos sólidos, e 12 indivíduos controles do sexo feminino. Controles e pacientes deglutiram em duplicata 5 mL e 10 mL de bolos com a consistências líquida e pastosa. RESULTADOS: Com bolo líquido e pastoso não houve diferença na duração do trânsito oral, faríngeo e pelo esfíncter superior do esôfago entre controles e pacientes. Não houve aspiração do bolo para as vias aéreas em nenhum indivíduo. Os resíduos faríngeos foram observados na mesma proporção das deglutições em pacientes (12,5%) e controles (15%), com a deglutição de 10 mL de bolo pastoso. CONCLUSÃO: A duração do trânsito oral, faríngeo e pelo esfíncter superior do esôfago foi semelhante nos pacientes com pirose funcional e controles.

Prevalence of non-obstructive dysphagia in patients with heartburn and regurgitation

OBJECTIVE: Heartburn and regurgitation are the most common gastroesophageal reflux symptoms, and dysphagia could be a possible symptom. This investigation aimed to evaluate the prevalence of non-obstructive dysphagia in patients with heartburn and regurgitation. METHODS: A total of 147 patients (age, 20-70 years; women, 72%) complaining of heartburn and regurgitation, without esophageal stricture, previous esophageal surgery, or other diseases, were evaluated. Twenty-seven patients had esophagitis. The Eating Assessment Tool (EAT-10) was employed to screen for dysphagia; EAT-10 is composed of 10 items, and the patients rate each item from 0 to 4 (0, no problems; 4, most severe symptom). Results of the 147 patients were compared with those of 417 healthy volunteers (women, 62%; control group) aged 20-68 years. RESULTS: In the control group, only two (0.5%) had an EAT-10 score ≥5, which was chosen as the threshold to define dysphagia. EAT-10 scores ≥5 were found in 71 (48.3%) patients and in 55% of the patients with esophagitis and 47% of the patients without esophagitis. This finding indicates a relatively higher prevalence of perceived dysphagia in patients with heartburn and regurgitation and in patients with esophagitis. We also found a positive correlation between EAT-10 scores and the severity of gastroesophageal reflux symptoms based on the Velanovich scale. CONCLUSION: In patients with heartburn and regurgitation symptoms, the prevalence of dysphagia was at least 48%, and has a positive correlation with the overall symptoms of gastroesophageal reflux.

Erradicación de Helicobacter pylori en pacientes con dispepsia funcional / Helicobacter pylori eradication in patients with functional dyspepsia

La dispepsia constituye un motivo de consulta frecuente en atención primaria. A propósito de un paciente con diagnóstico de dispepsia funcional, la autora se plantea si el tratamiento de erradicación del Helicobacter pylori podría mejorar los síntomas. Luego de una búsqueda rápida se encontró evidencia que señala que el tratamiento de la infección por este germen podría ser beneficiosa para aliviar los síntomas de la dispepsia funcional a largo plazo, aunque con mayor riesgo de efectos adversos, por lo que otros tratamientos alternativos continúan siendo ser una opción válida en el manejo de los pacientes con este problema de salud. (AU)

Eficacia diagnóstica de la impedancia basal nocturna media, un nuevo parámetro para el estudio de la enfermedad por reflujo gastroesofágico / Diagnostic efficacy of mean nocturnal basal impedance, a new parameter for the study of gastroesophageal reflux disease

Resumen Introducción y objetivos: el análisis de la impedancia basal nocturna media (IBNM) se ha propuesto para incrementar la precisión diagnóstica de enfermedad por reflujo erosiva (ERGE). Nuestro objetivo fue evaluar el rendimiento diagnóstico de esta prueba en un grupo de pacientes con ERGE conocida. Materiales y métodos: incluimos 123 individuos (58 con ERGE y 65 controles sanos) a quienes se les realizó pH-impedanciometría (pH-IMM) consecutiva entre enero de 2015 y junio de 2017. Todos los pacientes tenían endoscopia tomada en los 6 meses previos. El tiempo de exposición ácida (TEA) anormal (>4,2%) y la presencia de pirosis y/o regurgitación en los 6 meses previos fueron los criterios para el diagnóstico de ERGE. Se encontraron 58 pacientes con ERGE, 24 con enfermedad por reflujo erosiva (ERE) y 34 con enfermedad por reflujo no erosiva (ERNE). Los 65 restantes fueron controles sanos (CS) asintomáticos con EGD y pH-IMM normales. Todos los trazos de pH-IMM se reanalizaron para medir la IBNM por un segundo observador que desconocía los datos previos. El análisis estadístico incluyó pruebas múltiples de Bonferroni para comparar los grupos; regresión lineal para variables continuas; y análisis de curva ROC para buscar valor IBNM con mayor rendimiento. Para los diferentes parámetros de precisión diagnóstica se utilizó el punto de corte de la IBNM. Se usó significancia estadística con valor de p <0,01 e intervalos de confianza de 95% (IC 95%) para todos los cálculos. Resultados: los pacientes con ERE y ERNE presentaron valores de IBNM significativamente más bajos que el grupo control (p <0,01). Se observó una correlación negativa entre los valores de la IBNM y TEA (r = 0,59; p = <0,001), y también entre la IBNM y número de eventos de reflujo (r = 0,37; p = <0,001). En el análisis de curva ROC, el área bajo la curva de la IBNM fue de 0,941 (IC 95%: 0,894-0,987) y el punto de corte con mayor eficiencia 1102 ohms (sensibilidad 98,5%; especificidad 84,5%). Usando este valor (<1,102), la IBNM tuvo una sensibilidad para detectar ERGE de 91% (ERNE 86% y ERE 100%) y una especificidad de 98%. Conclusión: la IBNM tiene alta sensibilidad y especificidad para el diagnóstico de la ERGE. Adicionar esta prueba al análisis convencional de la pH-impedancia y a los métodos actuales de estudio de la ERGE puede mejorar significativamente nuestra capacidad para diagnosticar la enfermedad.

Abstract Introduction and Objectives: Analysis of nocturnal basal impedance (IBNM) has been proposed as a way to increase accuracy of GERD diagnosis. Our objective was to evaluate the diagnostic performance of this test in a group of patients known to have GERD. Materials and methods: We included 123 individuals: 58 with GERD and 65 healthy controls. They underwent consecutive pH-impedance monitoring between January 2015 and June 2017. All had undergone endoscopy in the 6 months prior to testing. Criteria used for diagnosis of GERD were abnormal acid exposure time (AET > 4.2%), pyrosis and/or regurgitation in the previous 6 months. We found 58 patients with GERD of whom 24 had erosive reflux disease (ERE) and 34 had non-erosive reflux disease (NERD). The remaining 65 were asymptomatic healthy controls with normal endoscopic results and pH impedance monitoring. A second observer who did not know the previous data measurements analyzed all pH impedance monitoring traces for IBMN. Statistical analysis included multiple Bonferroni tests for comparison between groups, linear regression for continuous variables, and receiver operating characteristic (ROC) curve analysis to find high performance IBNM values. The IBNM cutoff point was used for diagnostic precision parameters. Statistical significance was set at p <0.01, and 95% confidence intervals were used for all calculations. Results: IBNM measures were significantly lower for patients with ERE and NERD than for the control group (p <0.01). A negative correlation was observed between IBNM and acid exposure time values ​​(r = 0.59, p = <0.001) and also between IBNM and number of reflux events (r = 0.37, p = <0.001). ROC curve analysis found that the area under the curve for IBNM was 0.941 (95% CI: 0.894-0.987), and the cutoff point with the highest efficiency was 1,102 ohms (sensitivity 98.5%, specificity 84.5%). Using this value (<1.102), the IBNM had a sensitivity for detecting GERD of 91% (NERD 86% and ERE 100%) and a specificity of 98%. Conclusion: IBNM has high sensitivity and specificity for diagnosis of GERD. Addition of this test to conventional pH-impedance analysis and current methods for studying GERD can significantly improve our ability to diagnose this disease.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Erradicación de Helicobacter pylori con terapia triple estándar de primera línea / Helicobacter pylori eradication with standard first-line triple therapy

La infección por Helicobacter pylori es una de las infecciones crónicas más comunes a nivel mundial y causa importante de enfermedad péptica y cáncer gástrico. Infecta al 50% de la población adulta con mayor prevalencia en América Central/Sur y Asia y al menos dos veces mayor en poblaciones con alta incidencia de cáncer gástrico. Los objetivos de esta investigación fueron identificar la tasa de erradicación de H. pylori con terapia triple estándar y las posibles características asociadas a su erradicación. Se estudió a 119 pacientes con diagnóstico de infección por H. pylori, seleccionados en forma consecutiva de la consulta externa de Gastroenterología del Hospital General San Juan de Dios. Se realizó endoscopia diagnóstica y toma de biopsia gástrica. Se dio terapia triple estándar con lansoprazol, amoxicilina y claritromicina durante 10 días, seguido de 30 días con lansoprazol. Seis semanas después de completado el tratamiento se evaluó el antígeno de H. pylori en heces para determinar si hubo erradicación. La edad promedio de los participantes fue 49.0 años, 81.5% mujeres, 85.7% de área urbana, el síntoma más común fue dispepsia en 86.6%. En el examen post tratamiento el 89.9%, IC 95% [83.0, 94.7] presentó antígeno en heces negativo. No se encontró asociación entre las características de los pacientes con la respuesta al tratamiento. En conclusión, la respuesta a la terapia triple de primera línea se encuentra dentro del rango aceptable para continuar con ese esquema, pero debe mantenerse una evaluación constante por la presencia de posible resistencia.

Infection by Helicobacter pylori is one of the most common chronic infections worldwide and an important cause of peptic disease and gastric cancer. It infects 50% of the adult population with the highest prevalence in Central / South America and Asia and at least twice as high in populations with a high incidence of gastric cancer. The objectives of this research were to identify the eradication rate of H. pylori after first line standard triple therapy and the possible characteristics associated with its eradication. It was studied 119 patients with a diagnosis of H. pylori infection, selected consecutively from the outpatient department of Gastroenterology of the San Juan de Dios General Hospital. Diagnostic endoscopy and gastric biopsy was performed. Standard triple therapy was given with lansoprazole, amoxicillin and clarithromycin for 10 days, followed by 30 days with lansoprazole. Six weeks after the treatment was completed, the H. pylori antigen in feces was evaluated to determine if there was eradication. The average age of the participants was 49.0 years, 81.5% women, 85.7% of urban area, the most common symptom was dyspepsia in 86.6%. In the post-treatment examination 89.9%, 95% CI [83.0, 94.7] presented negative antigen in feces. No association was found between the characteristics of the patients with the response to treatment. In conclusion, the response to first line triple therapy is within the acceptable range to continue with this scheme, but a constant evaluation must be maintained due to the presence of possible resistance.

Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil / Prevalência de sintomas dispépticos e de pirose em uma população de adultos em Belo Horizonte, Brasil

ABSTRACT BACKGROUND Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

RESUMO CONTEXTO Tem sido relatado que cerca de 15% a 40% da população geral apresenta alguma queixa dispéptica e/ou pirose. Os sintomas dispépticos podem surgir em qualquer idade e são mais prevalentes no sexo feminino. OBJETIVO Investigar a prevalência de sintomas dispépticos e pirose em indivíduos com idade superior a 18 anos. MÉTODOS Foram selecionados aleatoriamente indivíduos com idade superior a 18 anos, entrevistados em praças públicas de Belo Horizonte/MG, por meio de um questionário que abordou características sócio-demográficas, questões relacionadas aos hábitos alimentares, sintomas digestivos, consultas médicas, medicamentos, exames, antecedentes cirúrgicos, comorbidades e questionário específico para diagnóstico de dispepsia funcional (Roma III). RESULTADOS Foram entrevistados 548 participantes. Destes, 58,4% eram mulheres, 59,3% da raça branca, 56% solteiros e a idade média foi de 36 anos. Neste grupo, 376 indivíduos (68,6%) declararam ter algum sintoma e/ou utilizar algum medicamento para aliviar sintomas dispépticos. Para esses indivíduos, foi utilizado o questionário Roma III para o diagnóstico de dispepsia sendo sintoma de plenitude pós-prandial (6,7%), saciedade precoce (3,5%) e a dor ou queimação no estômago (azia) presente em 10,6%. A sobreposição desses sintomas foi muito frequente. A prevalência de dispepsia funcional foi de 10,6% (síndrome de desconforto pós-prandial (8,2%), síndrome da dor epigástrica (2,4%)). Dentre os participantes, 52,5% relatavam pirose, sendo que desses 11,1% apresentavam este sintoma, no mínimo, uma vez por semana. O medicamento mais utilizado foi o Omeprazol. CONCLUSÃO A prevalência dos sintomas dispépticos e pirose na população urbana adulta brasileira é semelhante a descrita em outros países.

Reduced quality of life in patients with non-erosive gastroesophageal reflux disease

Introduction: Gastroesophageal reflux disease (GERD) is a highly prevalent condition in the Western world. It is a frequent cause of medical appointments and has a high impact on quality of life (QOL). This study aimed to assess health-related quality of life (HQ-QOL) of patients with non-erosive gastroesophageal disease (NERD) and compare their scores with the scores of patients with GERD symptoms and non-pathological acid reflux (non-NERD). Methods: We studied 42 patients with GERD symptoms­21 with positive pHmetry for acid reflux (NERD group) and 21 with negative pHmetry for acid reflux (non-NERD group). We enrolled patients matched by age and gender. Patient inclusion criteria were based on clinical and endoscopic findings and pHmetry. All other major diseases having an impact on QOL were excluded as well as patients in regular use of proton pump inhibitors, prokinetics, histamine-2 receptor antagonists and anti-depressants. All subjects were asked to fill in a validated translation of the SF-36 questionnaire. We described scores trough median and interquartile range (IQR) and assessed the significance of the comparisons through Mann-Whitney test and chi-square test or Student's t-test when appropriate. Results: We found no significant differences in the eight domains of SF-36 between the two groups. Conclusion: QOL of patients with GERD symptoms was equivalent, regardless of acid reflux at pHmetry (AU)

Impacto de las medidas generales en el tratamiento del reflujo gastroesofágico: una revisión basada en la evidencia / Evidence Based Review of the Impact of Treatments of Gastroesophageal Reflux Disease

Contexto: la enfermedad por reflujo gastroesofágico (ERGE) es una patología muy prevalente en adultos que altera la calidad de vida. Se han investigado múltiples tratamientos, algunos de ellos son cambios en el estilo de vida, dado que se han descrito algunos factores de riesgo asociados. El cambio en el estilo de vida es recomendado, sin embargo la evidencia que la soporta es controvertida y escasa. Objetivo: estimar el impacto que tienen los cambios en el estilo de vida en los pacientes con ERGE. Metodología: se realizó un búsqueda sistemática de la literatura en 3 bases de datos (PubMed, ScienceDirect y Embase) y se utilizaron las palabras claves "gastroesophagueal reflux", "heartburn", "bed head elevation", "Carbonated Beverages", "mint", "cacao", "citrus", "alcohol drinking", "caffeine", "coffee", "late-evening meal", "spicy food", "fatty foods", "obesity", "weight loss", "exercise" y "Smoking Cessation". Se incluyeron ensayos clínicos controlados y estudios de cohortes prospectivos que hayan estudiado una intervención en el estilo de vida sobre y evaluado su efecto sobre la ERGE. Resultados: se encontraron 2731 artículos, de los cuales 15 fueron incluidos para ser analizados. Suspender algunos alimentos o bebidas como la menta, el chocolate, cítricos, bebidas carbonatadas, comidas grasas y picantes para mejorar la clínica de la ERGE carece de evidencia. Tomar café descafeinado podría disminuir la cantidad de reflujo. Dejar de fumar se asoció con mejoría de la sintomatología. El horario de la comida en la noche puede alterar algunos parámetros de la pH-metría pero no modificó los síntomas. Algunos ejercicios, principalmente respiratorios podrían mejorar la sintomatología. La elevación de la cabecera de la cama y disminuir de peso en pacientes en sobrepeso/obesos tienen evidencia a favor de la mejoría de los síntomas, sin embargo cuentan con evidencia en contra y limitaciones metodológicas. Conclusión: los cambios en el estilo de vida para mejorar la ERGE no cuentan con evidencia adecuada, existen principalmente ensayos clínicos no controlados o estudios observacionales. Se necesitan más ensayos clínicos y de mejor calidad para definir el impacto de estas medidas en la ERGE.

Background: Gastroesophageal reflux disease (GERD) is a very prevalent disease among adults that alters the quality of life. Many treatments have been investigated, some of which require changes in lifestyle related to associated risk factors. Although changes in lifestyle are recommended, the evidence that supports these recommendations is controversial and scarce. Objective: The objective of this study is to estimate the impact of lifestyle changes on patients with GERD. Methodology: A systematic search of the literature in PubMed, Science Direct and Embase was conducted using the following keywords: gastroesophagueal (sic) reflux, heartburn, bed head elevation, Carbonated Beverages, mint, cocoa, citrus, Drinking Alcohol, caffeine, coffee, late-evening meal, spicy food, fatty foods, obesity, weight loss, exercise and Smoking Cessation. Controlled clinical trials and prospective cohort studies that studied lifestyle changes and their effects on GERD were included in the study. Results: Of the 2,731 articles found, fifteen were included in our analysis. There is little evidence that suspending consumption of food or drink items such as peppermint, chocolate, citrus, carbonated beverages, fatty foods and spicy foods clinically improves GERD. Decaffeinated coffee may decrease the amount of reflux, and quitting smoking is associated with improvement in symptoms. Meal times at night can change some parameters of pH monitoring but did not alter symptoms. Some exercises, mainly respiratory, may improve symptoms. There is evidence that elevating the head while in the bed and weight loss (in cases of overweight or obese patients) improve symptoms, but there is also evidence against these methods and studies of them have methodological limitations. Conclusion: Adequate evidence does not exist that changes in lifestyle improve GERD symptoms. Most studies are uncontrolled clinical trials or observational studies. Additional clinical trials with better quality are needed to define the impact of these measures on GERD.

Health-related uuality of life of pregnant women with heartburn and regurgitation / Qualidade de vida em gestantes com pirose e regurgitação

Background Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. Objective To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. Results Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. Conclusion Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women .

Contexto A pirose e a regurgitação ocorrem com frequência no terceiro trimestre de gestação, mas o seu impacto na qualidade de vida não foi completamente investigado. Objetivo Avaliar a qualidade da vida de gestantes do terceiro trimestre com pirose e regurgitação. Métodos Os dados sobre a história obstétrica, frequência, intensidade e história de pirose e regurgitação, bem como a qualidade de vida foram coletados de 82 mulheres do terceiro trimestre de gestação. Resultados Sessenta e duas (76%) mulheres tinham pirose e, 58 (71%), regurgitação; 20 eram assintomáticas. A idade gestacional média foi de 33,8 ± 3,7 semanas; 35 (43%) mulheres tinham história familiar de pirose e/ou regurgitação e 57 (70%) eram assintomáticos antes da gestação. Os seguintes domínios de qualidade de vida estavam significativamente reduzidos: limitação física e aspectos sociais pela pirose; limitação física e aspectos emocionais pela regurgitação. Houve concordância entre pirose nas gestações atuais e prévias. Conclusão A pirose e/ou regurgitação afetam a qualidade de vida de gestantes de terceiro trimestre. .

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é considerada uma das afecções mais prevalentes em todo o mundo, podendo comprometer de forma significativa a qualidade de vida dos pacientes. Trata-se de uma afecção crônica que se desenvolve quando o refluxo do conteúdo gástrico causa sintomas incomodativos ou complicações, sendo sintomas incomodativos aqueles definidos pelos pacientes.

Gastric reflux disease (GERD) is considered one of the most prevailing sickness in all over the world that can affect meaningfully patient?s quality of life. It?s a case of chronic sickness which is developed when reflux of gastric contents causes disturbing, that are defined by patients, or complications.

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil / Pesquisa de doença celíaca em pacientes com doença autoimune de tireoide do sul do Brasil

Objective: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. Subjects and methods: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave’s disease was diagnosed in 143 (56.3%) and Hashimoto’s thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. Results: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto’s thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. Conclusion: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves’ disease and one was male, all three patients with confirmed CD were female and had Hashimoto’s thyroiditis. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Objetivo: O objetivo do presente estudo foi determinar a prevalência de doença celíaca (DC) em adultos com doenças autoimunes de tireoide (DAT) que foram atendidos em um serviço de endocrinologia de um hospital universitário do sul do Brasil. Sujeitos e métodos: Entre os anos de 2007 a 2011, 254 pacientes com DAT foram consecutivamente incluídos, sendo 143 (56,3%) desses diagnosticados com doença de Graves e 111 (43,7%) com doença de Hashimoto. Todos os pacientes responderam a um questionário relatando sintomas que poderiam ser associados com DC, e amostras de soro para a pesquisa de anticorpo antiendomisial (EmA-IgA) foram coletadas. Os pacientes com sorologia positiva foram encaminhados para endoscopia gastrointestinal com biópsia duodenal. Resultados: No total, 254 pacientes foram incluídos, sendo 222 (87,4%) mulheres com média de idade 45,4 ± 13,43 anos (18 a 79 anos). EmA-IgA foi positivo em sete (2,7%) pacientes e cinco fizeram endoscopia com biópsia. Desses, três (1,2%) tiveram o diagnóstico de DC confirmada. Todos os três pacientes com DC apresentaram altos títulos de EmA-IgA, eram mulheres e tinham doença de Hashimoto. Assim como outras pacientes com DAT, os pacientes celíacos tinham sintomas gastrointestinais inespecíficos, como queimação e distensão gástrica. Em nosso estudo, um em cada 85 pacientes com DAT tiveram o diagnóstico de DC confirmado. Conclusão: Em nosso estudo, foi observada prevalência de 1,2% (1:85) de DC confirmada entre os pacientes com DAT, sendo todas mulheres e com doença de Hashimoto. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Presencia de síntomas digestivos en el Día Mundial de la Salud Digestiva / Presence of digestive symptoms in the World Digestive Health Day

Introduction: Gastrointestinal symptoms such as heartburn, indigestion/dyspepsia, constipation and bloating are very common in every community. Our group applied a questionnaire in order to identify the presence of gastrointestinal symptoms. Methodology: In 2012, during the World Digestive Health Day a survey of 13 questions given by the World Gastroenterology Organization (WGO) was administered to a group of people (E) at the Clinical Hospital of the University of Chile (HCUCH); the questions were based on the presence and frequency of digestive symptoms. The results were compared with two other groups, one rural (R) and another comprised of people that were accompanying the patients attending HCUCH (group A) for examinations. A χ2 test was used to compare variables by group. Results: Total E = 270, A = 100, R = 69. Women: E = 212 (79 percent), A = 66 (66 percent), R = 43 (62.4 percent). Age E = 48, A = 44, R = 53 (p = 0.0003). Digestive discomfort: E = 94.8 percent (256), A = 81 percent (81), R = 85.5 percent (59) p = 0.000. Distension/bloating E = 94.44 percent (255), A = 84 percent (84), R = 81.2 percent (56) p = NS. Abdominal pain/discomfort E = 89.6 percent (242), A = 75 percent (75), R = 82.6 percent (57) p = 0.000. Constipation: E = 80 percent (216), A = 71 percent (71), R = 63.7 percent (44) p = 0.01, with significant differences in sensation of incomplete evacuation in the 3 groups p = 0.001. Heartburn E = 75.2 percent (203), A = 67 percent(67), R = 68.1 percent (47) p = NS. Reflux E = 74 percent (200), A = 69 percent (69), R = 68.1 percent (47) p = NS. Interference with sleep: E = 62.2 percent (168), A = 45 percent (45), R = 56.5 percent (39) p = 0.012. Problems with soft/mushy/liquid stools = 65.92 percent (178), A = 61 percent (61), R = 68.11 percent (47) p = NS. Conclusions: Over 80 percent of respondents provided an upset stomach. The control group had the highest prevalence of digestive symptoms...

Introducción: Síntomas digestivos como pirosis, indigestión/dispepsia, constipación y distensión son muy frecuentes en cada comunidad. Nuestro grupo aplicó un cuestionario con el objetivo de identificar la presencia de sintomatología digestiva. Metodología: En el año 2012, durante el día mundial de la salud digestiva (DMSD) se realizó en el Hospital Clínico de la Universidad de Chile (HCUCH), una encuesta propuesta por la Organización Mundial de Gastroenterología (OMGE) que incluía 13 preguntas basadas en la presencia y frecuencia de síntomas digestivos. La encuesta se hizo a un grupo de personas (E). Los resultados fueron comparados con otros dos grupos, uno rural (R) y otro conformado por acompañantes (A) de pacientes que acudieron a exámenes al HCUCH. Se realizó una prueba χ² para comparar variables por grupo. Resultados: Total E = 270; A = 100; R = 69. Mujeres: E = 212 (79 por ciento), A = 66 (66 por ciento), R = 43 (62,4 por ciento). Edad E = 48, A = 44, R = 53 (p = 0,0003). Molestias digestivas: E = 94,8 por ciento (256), A = 81 por ciento (81); R = 85,5 por ciento (59) p = 0,000. Distensión/hinchazón E = 94,44 por ciento (255), A = 84 por ciento (84), R = 81,2 por ciento (56) p = NS. Dolor/molestia abdominal E = 89,6 por ciento (242), A = 75 por ciento (75), R = 82,6 por ciento (57) p = 0,000. Constipación: E = 80 por ciento (216), A = 71 por ciento (71), R = 63,7 por ciento (44) p = 0,01, existiendo diferencias significativas en sensación de evacuación incompleta en los 3 grupos p = 0,001. Pirosis E = 75,2 por ciento (203), A = 67 por ciento (67), R = 68,1 por ciento (47) p = NS. Reflujo E = 74 por ciento (200), A = 69 por ciento (69), R = 68,1 por ciento (47) p = NS. Interferencia con el sueño: E = 62,2 por ciento (168), A = 45 por ciento(45), R = 56,5 por ciento (39) p = 0,012. Problemas de heces blandas/ pastosas/líquidas E = 65,92 por ciento (178), A = 61 por ciento (61), R = 68,11 por ciento (47) p = NS...

Doença do refluxo gastroesofágico na gravidez / Gastroesophageal reflux disease during pregnancy

A prevalência de pirose e doença do refluxo gastroesofágico durante a gravidez é elevada e o diagnóstico é geralmente clínico. O tratamento deve ser, além de eficiente, seguro para a mãe e para a criança. A principal manifestação clínica é a pirose, seguida pela regurgitação. Ocasionalmente sintomas atípicos (dor torácica não cardíaca, disfagia, tosse etc.) podem ser referidos.O único exame a ser eventualmente realizado é a endoscopia digestiva alta, mas a manometria esofágica, pHmetria prolongada e impedância-pHmetria, embora poucas vezes sejam necessárias, podem ser realizadas quando houver indicação.O tratamento se baseia em medidas comportamentais e terapêutica farmacológica. As medidas comportamentais incluem: perda de peso, elevação da cabeceira da cama, evitar alimentação noturna dentro de duas a três horas antes de deitar e evitar determinados alimentos, conforme seja observada relação entre sua ingestão e a ocorrência de sintomas. As medicações utilizadas no tratamento da DRGE da gravidez incluem: antiácidos, bloqueadores dos receptores H2 da histamina, protetor da mucosa (sucralfato), inibidores da bomba protônica, supressor de refluxo (alginato)...

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é uma afecção crônica frequente na prática médica, interferindo negativamente na qualidade de vida dos pacientes. Apresenta um amplo espectro de sintomas, classificados como típicos e atípicos, sendo a pirose a principal manifestação. O tratamento inclui medidas comportamentais farmacológicas e eventualmente cirúrgicas

Gastroesophageal reflux disease (GERD) is a common chronic condition that affects negatively the patient's quality of life. Patients with GERD can exhibit a wide variety of symptoms, both typical and atypical. Heartburn is the main clinical presentation. Treatment consists of supportive and pharmacological measures; surgery may eventually be required

Esofagitis por reflujo diagnostico histológico y su relación con variables clínicas y endoscópicas / Reflux esophagitis histologic diagnous and it`s relation with clinical and endoscopic variables

La relación entre índice de masa corporal elevados, la presencia de hernia hiatal y síntomas de reflujo han sido ampliamente asociadas al diagnostico de esofagitis por reflujo. Estudios recientes han demostrado la asociación del sobrepeso con la enfermedad de reflujo. En vista de esto nos propusimos realizar este estudio con el objetivo de demostrar la relación de la esofagitis por reflujo anatomopatologicamente diagnosticada asociada al índice de masa corporal calculado por el índice de Quetelet, los hallazgos endoscópicos de esofagitis según la clasificación de los Ángeles, y síntomas de reflujo referidos por los pacientes de la consulta del servicio de gastroenterología del Hospital “Carlos J. Bello” de la Cruz Roja Venezolana. Se tomo una muestra de 32 pacientes los cuales el 100% tienen diagnostico anatomopatologico de esofagitis por reflujo en un periodo comprendido entre noviembre 2009 y abril de 2010, de los cuales 26 eran del sexo femenino representando el 81,25% de la muestra y 6 del sexo masculino representando el 18,75% de la muestra. El 78,12% presentaron Hernia hiatal como diagnostico endoscópico y referían síntomas de reflujo gastroesofagico (Regurgitación y Pirosis). En cuanto al hallazgo endoscópico 56,25% presento diagnostico de esofagitis grado A y el 28,12% esofagitis grado B según la Clasificación de los Angeles. En cuanto al índice de masa corporal 32,5% presento IMC< de 24,99 Kg/mt2; el 35,4% presentó IMC>25 kg/mt2 y < de 29,99 Kg/mt2; y el 32,1% presento IMC> 30 kg/mt2. En conclusión el 67,5% de los pacientes presentaban IMC elevados.

The relation between elevated body mass index, and the presence of hiatal hernia and reflux symptoms had been widely associated with the diagnosis of GERD. Most recently lack of studies had demonstrated the association between overweight and GERD. In regard to this matter we proposed to make an study to demonstrate the relation of esophageal reflux disease diagnose by histopalogic finding and elevated body mass index calculated with the Quetelet index, endoscopic findings of esofaghitis clasificated by the Los Angeles classification, and reflux symptoms referred by the patients on the Consult of the Gastroenterology service from the Carlos J. Bello Hospital, Venezuelan Red Cross. It took a sample of 32 patients 100% of them with histopathology findings of reflux esophagitis taken from a time period between November 2009 to April 2010, distributed in 26 female patients (81,25%) and 6 male patients (18,75%). 78,12% had hiatal hernia, and referred gastro esophageal reflux symptoms (Regurgitation and pyrosis). Regard to Endoscopic findings 56.25% presented grade A esofaghitis, 28,12% Grade B esophagitis. Regard to Body mass index 32,5% presented a BMI: <24.99 Kg/ mt2; 35,4% BMI:>25 Kg/mt 2 and <29,99 Kg/mt2; 32,1% presented BMI>30 Kg/mt2. In conclusion 67,5% presented elevated BMI.