RESUMO
BACKGROUND: An association between gastroesophageal reflux (GER) and pulmonary or laryngeal diseases has been recognized, and dual pH monitoring of both distal and proximal esophagus has been proposed to investigate chronic respiratory symptoms of unexplained etiology. However, the degree of acid reflux in the upper esophagus is still uncertain, making it difficult to discriminate between physiological and abnormal GER. AIM: To define normal values for proximal esophageal acid exposure. METHODS: Two-level esophageal pH monitoring was performed in 22 healthy subjects and 26 reflux patients. A dual pH sensor with electrodes spaced 15 cm that were positioned 5 and 20 cm above cardias was used. Two different thresholds of pH 4 and 5 were used to evaluate GER at proximal level. RESULTS: In healthy subjects, at proximal level, the acid exposure time (% time pH < 4) was 0.4%, 0.7% and 0.1% for 24-hrs, upright and recumbent periods, respectively. Using pH 5 as threshold, acid exposure time (% time pH < 5) was 1.5%, 2.3% and 0.3% for 24-hrs, upright and recumbent periods, respectively. Twenty cm above cardias, acid exposure was greater in reflux patients in comparison to controls; however, all reflux values were significantly different between the two groups only when pH 5 was used as threshold. The percentage of distal reflux reaching the proximal site (16.0%, 27.9% and 7.1% in controls for 24-hrs, upright and recumbent periods, respectively) was similar in the two groups. CONCLUSIONS: Acid reflux, to a limited extent, is physiologic in proximal esophagus. The technique of pH recording 20 cm above cardias might be useful in documenting the cephalic extend of GER, allowing to investigate patients with atypical presentations of GER disease. It may be best to use both thresholds 4 and 5 for evaluating proximal acid exposure.
RESUMO
Endoscopy and radiology are usually suggested as the first line investigations in patients with dysphagia. Esophageal manometry is indicated if the above studies are unfruitful. Our aim was to evaluate the role of manometry in diagnosing motor disorders of the esophagus in patients with non-organic dysphagia. We retrospectively evaluated the results of seven years' experience with esophageal manometry performed in 114 patients with difficulty in swallowing not due to esophageal structural lesions or reflux esophagitis, both escluded by endoscopic and/or radiologic studies prior to manometric investigation. A variety of nonspecific esophageal motor disorders were the most common (32%) manometric abnormalities seen in patients with dysphagia. Achalasia was common (23%) too, whereas diffuse esophageal spasm (8%), nutcracker esophagus (6%) and hypertensive LES (1%) accounted for a few motility disorders associated with dysphagia. Low LES pressure was found in 3% of the patients, suggesting gastroesophageal reflux as the cause of their difficulty in swallowing. The study confirms the role of esophageal manometry in diagnosing the cause of a swallowing disorder, identified in 83 out of 114 patients (73%). Achalasia and nonspecific esophageal motor disorders accounted for more than 50% of the motility disorders in patients with dysphagia.
RESUMO
Chronic alcoholic gastritis is a very important social problem in the Health District of Arezzo, which covers an area where wine is an integral part of the diet. The etiology of this disease is related to the alcohol induced rupture of the gastric mucosal barrier. For this reason we wanted to verify the therapeutic effect of a "barrier acting drug" such as pirenzepine. A selected group of 50 randomized patients (46 males and 4 females, mean age 52.6 years) received in a double blind fashion 50 mg b.i.d. of pirenzepine or placebo for consecutive 4 weeks. Endoscopy and histological examinations performed before and after treatment together with the clinical evaluation of the dyspeptic symptoms, showed that pirenzepine was more active than placebo. In addition our results suggest that pirenzepine stimulates defence mechanisms of the gastric mucosa.
