Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding.

OBJECTIVES: To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients. METHODS: Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up. RESULTS: Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up. CONCLUSION: Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.

Normal values in ambulatory oesophageal pH monitoring at two levels in Spain.

AIM: Upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification. METHODS: 155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS. RESULTS: 130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases. CONCLUSION: This is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

Absence of cardiovascular autonomic dysfunction and vagal pancreatic impairment in idiopathic achalasia of the oesophagus.

Extra-oesophageal autonomic dysfunction in idiopathic achalasia is not well documented, due to contradictory results reported. We aimed to study the cardiovascular and pancreatic autonomic function in patients with idiopathic achalasia. Thirty patients with idiopathic achalasia (16M/14F; 34.5 +/- 10.8 years) and 30 healthy volunteers (13M/17F; 34.8 +/- 10.7 years) were prospectively studied. Age >60 years and conditions affecting results of autonomic evaluation were excluded. Both groups underwent the sham feeding test and plasmatic levels of pancreatic polypeptide (PP) were determined by radioimmunoassay (basal, at 5, 10, 20 and 30 min). Cardiovascular parasympathetic (deep breathing, standing, Valsalva) and sympathetic function (postural decrease of systolic blood pressure, Handgrip test) were assessed. Statistical comparison of basal and increase levels of PP and parasympathetic/sympathetic cardiovascular parameters was performed between groups. Basal levels of PP were similar in controls and patients and maximum increase of PP during sham feeding test. A similar rate of abnormal cardiovascular tests was found between groups (P > 0.05). E/I ratio was the mostly impaired parameter (patients: 36.7% vs controls: 20%, P = 0.15, chi-squared test). Autonomic cardiovascular tests and pancreatic response to vagal stimulus are not impaired in patients with primary achalasia of the oesophagus.

Oesophageal motility disorders in type 1 diabetes mellitus and their relation to cardiovascular autonomic neuropathy.

The relationship between cardiovascular autonomic neuropathy (CVAN) and oesophageal dysfunction in diabetes mellitus has not been well established because reports are contradictory. The aim of this study was to assess oesophageal function and its correlation with CVAN in type 1 diabetic patients without oesophageal symptoms. Forty-six type 1 diabetic patients without oesophageal symptoms (DG) and 34 healthy volunteers (CG) were studied. Both groups underwent CVAN tests and oesophageal manometry and pH-metry. Differences between groups regarding results of cardiovascular autonomic tests and oesophageal studies were statistically analysed. Compared with the CG, the DG group showed insufficient lower oesophageal sphincter (LOS) relaxation and a higher percentage of simultaneous waves (P < 0.01). Patients with CVAN (n = 22) showed a higher prevalence of pathological simultaneous contractions (>10%), and the prevalence of simultaneous waves related to the degree of autonomic neuropathy was: 9% of patients without CVAN, 7% of those suspected to have it and 50% of patients with CVAN (P < 0.001). Factors associated with the presence of pathological simultaneous waves (>10%) were the presence of CVAN and duration of diabetes (P < 0.05, logistic regression analysis). Increase in simultaneous waves and impaired relaxation of LOS are more frequent in diabetic patients with CVAN.

Prevalence of silent fecal and urinary incontinence in women from the town of Teruel.

OBJECTIVES: To study the prevalence of fecal (FI) and urinary incontinence (UI) in women from Teruel (Spain), as well as the clinical conditions associated with these disorders. METHODS: We studied prospectively women with an age range of 20-64 years who were randomly selected from the population seen in a primary care center because of medical disorders not related to incontinence. Patients with functional or cognitive impairment were excluded. Medical and obstetric antecedents, as well as the type and frequency of incontinence symptoms were collected in a questionnaire. RESULTS: Out of 115 women, 103 completed the study (mean age: 41+/-12 years range 20-64). UI was present in 34.9% (stress 33%, urge 14%, mixed 47%), FI in 14 (13.6%) (flatus 57%, liquid stools 43%), and 10 (9.7%) displayed both disorders. Age > 42 years and body mass index more or equal of 25 were associated with FI and UI; pregnancy was only associated with UI, but the group of women with more or equal of 2 vaginal deliveries showed a higher frequency of FI (p < 0.05, Chi squared test). In the multivariate analysis, only the presence of UI was associated with FI (OR 6.0; CI 95% 1.7-21). Association of FI and UI was more frequent in women older than 42 years (OR 16.7, CI 95% 1.9-141). No statistical differences were found when smoking, exercise, and type of childbirth were compared between the presence/absence of FI or UI. CONCLUSIONS: Urinary and fecal incontinence are frequent in women, and the coexistence of both disorders is not uncommon. Age, overweight and parity are associated with the presence of fecal and/or urinary incontinence.

Pre- and postoperative manometric studies in diffuse esophageal spasm.

Since January, 1972, the authors have operated upon 4 patients with idiopathic diffuse exophageal spasm. Clinical details and barium studies are included. Extramucosal myotomy extending from the gastric fundus to the aortic arch was done in each case. Pre- and postoperative manometric studies were carried out in all. After operation in each patient the dysphagia and substernal pain disappeared and in 3 patients radiological patterns changed. The myotomy was associated with marked fall of contractile wave pressures in the body of esophagus. The basal pressures of the esophageal body elevated, in 2 cases fell after the myotomy; in 2 with normal preoperative pressure it remained unchanged. At the lower esophageal sphincter the resting and yield pressures remained similar to the preoperative readings but the myotomy produced a disappearance of the relaxation and contraction pressure. The authors conclude that with myotomy they cannot correct the nature of the functional disorder but, by reducing the amplitude of the waves and lowering the resting pressure if elevated, they can relieve the patient's symptoms.

Motor activity after colon replacement of esophagus. Manometric evaluation.

Motor activity of the colon transplant for esophageal reconstruction is a point of controversy. In this paper we present manometric studies carried out in 15 patients subjected to isoperistaltic colon interposition. Manometric studies were carried out with two polyvinyl water-filled catheters inserted through pressure transducers. Basal colonic activity and motor activity following several stimuli and "dry swallows" were registered. The type of waves after stimuli were classified as (1) synchronous, (2) sequential or progressive, and (3) segmental. Details of the basal colonic waves and colon contractions after stimuli are given: i.e., rate, duration, amplitude, interval from the stimulus, and percentage of motor activity. The data reported here indicate the good motor response of the isoperistaltic colon to intraluminal injection of water or 0. 1 N hydrochloric acid and to chachet swallowing. Only two free-symptoms patients did not have motor activity. One of them was submitted to manometric studies too soon after the operation. We conclude that the presence of sequential waves in the interposed segment likely can help to propel the contents of the colon into the stomach and to clear gastric juice if reflux from the stomach should occur.

Lesser curvature tubular gastroplasty with partial plication for gastroesophageal reflux: manometric and pH-metric postoperative studies.

Thirty-four patients with sliding hiatal hernia, gastroesophageal reflux, or both were treated by lesser curvature gastroplasty with partial gastric plication, using a surgical stapler. Before operation, esophageal manometric studies were performed in 33 patients and during the early postoperative period (1 to 3 months), in 34. The esophageal pH test was performed before operation in 22 patients, shortly after discharge in 27, and later in 30 patients. The clinical results were considered satisfactory in 30 patients (88%) after follow-up ranging from 18 to 33 months (average, 23 months). Before the procedure, the abdominal compression test was positive in 25 of 30 patients (83%). In early postoperative studies it was positive in 1 out of 34 patients (3%), but in the second series of postoperative studies it was positive in 9 out of 32 (28%). After instillation of hydrochloric acid into the stomach, the esophageal pH test was considered positive in 17 out of 22 patients in preoperative studies (77%). In early postoperative studies the test was positive in 3 out of 27 patients (11%) and one year later, in 7 out of 30 (23%). The later postoperative studies showed a higher number of positive reflux tests than the early studies, 28 and 23% positive in manometric and pH tests, respectively.

Gastroplasty with partial or total plication for gastroesophageal reflux: manometric and pH-metric postoperative studies.

From January, 1975, to December, 1980, 83 patients with sliding hiatal hernia, gastroesophageal reflux, or both were treated using a modified Collis gastroplasty associated with either partial or total gastric application. When partial plication was used, the five-year clinical results were considered satisfactory in 27 out of 35 patients (77%). When total plication was used, the results were satisfactory in 41 out of 46 patients (89%) after follow-up ranging from 12 to 60 months (average, 36 months), but no symptoms of gastroesophageal reflux reappeared in any patient. In patients undergoing partial plication, the mean preoperative high-pressure zone of 11.20 +/- 8.19 mm Hg increased after operation to 17.31 +/- 10.50 mm Hg, but in the second postoperative studies the value decreased to 13.69 +/- 7.24 mm Hg. When 360 degrees plication was used, the preoperative value of the high-pressure zone--9.36 +/- 4.80 mm Hg--increased after operation to 17.70 +/- 7.53 mm Hg but did not decrease significantly in the second postoperative studies: 16.46 +/- 7.99 mm Hg. When partial plication was used, the positivity of the abdominal compression test was 9 and 28% in the early and late postoperative studies, respectively. Using total plication, the percentage of positivity in the early and late postoperative periods was 0 and 2%, respectively. Concerning the acid reflux test, when partial plication was used, the test was positive in 3 out of 27 patients (11%) in the early postoperative studies and in 7 out of 30 (23%) one year later. For the total plication procedure, the percentage of positive tests was null in the first control and 3% in the second postoperative studies.

Total fundoplication with or without gastroplasty for gastroesophageal reflux: comparative study.

The results of clinical, radiographic, manometric, and pH-metric studies of two groups of patients with reflux esophagitis treated by total (Nissen) fundoplication with or without a Collis esophagus-lengthening gastroplasty were compared. On postoperative follow-up, clinical recurrence of gastrophageal reflux was found in 5 of the 76 patients in the Nissen group, whereas none of the 46 patients in the Collis-Nissen group had reflux. A dramatic reduction in the clinical score was observed for all patients, and postoperative clinical morbidity was similar in both groups. Postoperative radiographic recurrence of hiatal hernia was found in 11 of 60 patients in the Nissen group, but not in any of the patients in the Collis-Nissen group. The lower esophageal sphincter pressure was significantly increased after operation in both groups (p less than 0.05). The postoperative "common cavity test" and acid reflux test were positive in 9% of the patients having Nissen fundoplication alone and 11% of those having the Collis-Nissen procedure; in the latter group, both tests were positive in only 1 asymptomatic patient. These results demonstrate that the standard Nissen repair is a good surgical technique for management of uncomplicated reflux esophagitis and that the Collis-Nissen procedure is the most effective method of surgical repair for almost all patients with complicated reflux esophagitis.

Motor activity of esophageal substitute (stomach, jejunal, and colon segments).

Manometric studies were performed to evaluate motor activity of several types of esophageal substitutes: total stomach (5 patients), isoperistaltic gastric tube (5 patients), jejunal Roux-en-Y loops (4 patients), and isoperistaltic left colon (15 patients). Motor behavior of substitutes was assessed following dry swallows and following several stimuli: intraluminar injection of 30 ml of water or 0.1N hydrochloric acid and swallowing pills. Following dry swallows, there was no response with either stomach or isoperistaltic gastric tube, jejunum showed a variable response, and a response was infrequent in patients with colon transplants. After dry swallows, transmission of the pressure wave through the anastomosis was not observed in any patient. Total stomach and isoperistaltic gastric tube did not respond to any stimulus. Jejunum responded with progressive waves after water and solid stimuli, and had a hyperkinetic response after acid injection. Colon had a constant (80 to 90%) and homogeneous response with progressive waves after all stimuli. After wet swallows, there was transmission through the anastomosis in 2 patients with colon transplants. Our data indicate that stomach and isoperistaltic gastric tubes do not contribute actively to the onward transmission of food in the digestive tract. Jejunum may contribute actively in digestive transit, but its responses are variable. Having steady and homogeneous responses, colon segments take an active part in transit.

Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography diagnostic algorithm.

BACKGROUND: Magnetic resonance cholangiopancreatography is an accurate technique that can replace invasive diagnostic methods of the biliary and pancreatic duct. AIMS: Our aim was to assess sensitivity and specificity of magnetic resonance cholangiopancreatography and ultrasonography using the results of endoscopic retrograde cholangiopancreatography as reference, and to establish a diagnostic algorithm under which circumstances magnetic resonance cholangiopancreatography can replace endoscopic retrograde cholangiopancreatography. PATIENTS: Eighty-three patients with suspicion of biliary disease based on clinical, biochemical and ultrasonography findings were studied. METHODS: Ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed, comparing the results of the techniques for the determination of their sensitivity and specificity. RESULTS: Sensitivity and specificity results obtained by magnetic resonance cholangiopancreatography were: 100 and 92.8% when dilated ducts were detected (n=61); 97.4 and 97.2% in the diagnosis of choledocholithiasis (n=38); 100 and 96.7% in malignant lesions (n=14) and 81.8 and 98.4% when biliary ducts were normal. The percentage of images of diagnostic quality was 97.6%. Sensitivity and specificity achieved by ultrasonography was: 100 and 57.1% in detection of dilatation, 71 and 97.2% in choledocholithiasis, 92.8 and 96.7% in malignancy and 66.6 and 96.8% in normal ducts. CONCLUSIONS: Magnetic resonance cholangiopancreatography is a technique with high sensitivity and specificity in the evaluation of biliary ducts. Thus, magnetic resonance cholangiopancreatography may replace diagnostic endoscopic retrograde cholangiopancreatography for purely diagnostic purposes, following an initial clinical and ultrasonographic exam.

Dental and periodontal lesions in patients with gastro-oesophageal reflux disease.

OBJECTIVE: Dental erosion has been considered an extraesophageal manifestation of gastro-oesophageal reflux disease, but few reports have studied the relationship between this disease and other periodontal or dental lesions. The aim of this study was to investigate the prevalence of dental and periodontal lesions in patients with gastro-oesophageal reflux disease. PATIENTS AND METHODS: A total of 253 subjects were prospectively studied between April 1998 and May 2000. Two study groups were established: 181 patients with gastro-oesophageal reflux disease and 72 healthy volunteers. Clinical assessment, including body mass index and consumption of tobacco and alcohol, was performed in all subjects, as well as a dental and periodontal examination performed by a dentist physician, blind as to the diagnosis of subjects. Parameters evaluated were: (a) presence and number of dental erosion, location and severity, according to the Eccles and Jenkins index [Prosthet Dent 1979;42:649-53], modified by Hattab [Int J Prosthes 2000;13:101-71; (b) assessment of dental condition by means of the CAO index; and (c) periodontal status analysed by the plaque index, the haemorrhage index, and gingival recessions. RESULTS: Clinical parameters were similar in both groups (p > 0.05). Age was statistically associated with the CAO index, presence of dental erosion, and gingival recession (p < 0.001, Student's t-test). Compared with the control group, the percentage of dental erosion was significantly higher in the gastro-oesophageal reflux disease group (12.5 vs. 47.5%, p < 0.001, chi2-test), as was the number and severity of dental erosions (p < 0.001, Student's t-test). Location of dental erosion was significantly different between groups. Age was not statistically related to either the amount or severity of dental erosion. CAO and periodontal indices were similarly distributed between groups. CONCLUSIONS: Dental erosion may even be considered as an extraesophageal manifestation of gastro-oesophageal reflux disease. The fact that the prevalence of caries and periodontal lesions is similar in patients with gastro-oesophageal reflux disease and in healthy volunteers suggests a lack of relationship with gastro-oesophageal reflux disease.

The colon as oesophageal substitute in non-malignant disease. Long-term clinical results and functional studies.

Between 1974 and 1987, we performed 18 left colonic interpositions for benign oesophageal disease: caustic lesions in 6 patients, undilatable reflux stenosis in 5, reoperative peptic strictures in 5, penetrating wound in 1 and iatrogenic stricture following oesophagogastric transection for bleeding in 1. Four patients were women. The mean age was 40 +/- 19 years. In 10 patients a left thoracotomy was used; in the other 8 a cervico-abdominal approach was employed. One patient died postoperatively from liver failure. The mean follow-up was 11 +/- 4 years. Clinical results were excellent or good in 12 of the remaining 17 patients (71%). These results varied according to the length of colon interposition; in patients with long colonic interposition, poorer results were achieved. The motor activity of the colonic transplant was evaluated by manometric studies. After intraluminal injection of 30 ml of liquid, the colon responded uniformly with sequential peristaltic waves. Transmission of the oesophageal waves through the oesophagocolic anastomosis was studied in 2 patients. After wet swallows, the oesophageal contractile waves were followed by colonic waves. Solid radionuclide colonic transit studies were carried out in 18 control subjects and in 18 patients with colon interposition. In subjects with a normal oesophagus, the general pattern was rapid emptying of the bolus through the oesophagus. Findings in patients with a short transplant were similar to those observed in normal oesophagi. In most patients with long transplants the transit was abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)

[Colonic transit time (segmental and total) in healthy subjects and patients with chronic idiopathic constipation]. / Estudio del tiempo de tránsito colónico (segmentario y total) en sujetos sanos y pacientes con estreñimiento crónico idiopático.

BACKGROUND: The efficacy of the treatment of patients with chronic idiopathic constipation not responding to normal therapeutic measures depends on correct functional diagnosis. The study of the segmentary and total colonic transit time with radioopaque markers is the most economic technique in everyday clinic ambience for functionally evaluating these patients. METHODS: Segmental and total colonic transit time was calculated with the use of radioopaque markers in 23 healthy subjects (12 men and 11 women) and in 13 women with severe idiopathic constipation. Twenty markers were administered daily for three consecutive days and simple x-rays of the abdomen were made on the fourth, seventh and in some cases on the tenth day. In addition, the symptomatology of 9 patients was collected by means of a 30 day diary. RESULTS: The maximum values of transit time (mean + 2SD) obtained in the healthy subjects were 17, 25, 26, and 49 hours for the right colon, left colon, rectosigmoid and the whole colon, respectively. The time of left colon transit was significantly lower in the women. The transit time in constipated patients permitted the differentiation of three functional patients: a) slowing of the right and left colon possibly associated to rectosigmoid slowing in 5 patients; b) isolated slowing in the left colon in 4 patients and c) isolated rectosigmoid slowing in 4 patients. Group a) was characterized by long total colonic transit times while these were normal in 2 patients of group b) and in one patient of group c). No differences were seen in the symptomatology of the groups. CONCLUSIONS: The calculation of segmentary and total colonic transit time with radioopaque markers is a simple technique which permits the detection of different subgroups of patients with chronic idiopathic constipation refractory to normal treatment. The exact typification of the functional anomaly is an important basis for the individualization of treatment.

[Outpatient care of upper gastrointestinal hemorrhage not related to portal hypertension]. / Seguridad del control ambulatorio de la hemorragia digestiva alta no relacionada con hipertensión portal.

BACKGROUND: The handling of upper gastrointestinal hemorrhage (UGH) usually includes the hospitalization of all patients, regardless of severity and prognosis. The aim of this paper is to assess the security of the outpatient control of some UGH, after their assessment in the hospital emergency room. PATIENTS AND METHODS: Prospective cohort of 533 patients who attended over 1994 and 1995 hospital emergency room for an episode of UGH not linked to portal hypertension. After clinical and endoscopical assessment in the emergency department, 422 cases (79%) were admitted and 111 (21%) discharged for outpatient care. An analysis is presented of the characteristics of both groups, their clinical outcomes and a multivariate analysis to assess the factors associated with the decision to admit the patient. RESULTS: Outpatients were young, with less comorbidity and better haemodynamic status than hospitalized patients. Most of outpatient cases UGH was due to gastroduodenitis, oesophagitis and Mallory-Weiss syndrome, as opposed to the greater importance of peptic ulcer in those admitted. All outpatients presented clean lesions or haematic remains. 25 (5.9%) hospitalized patients presented rebleeding, vs. only 1 (0.9%) outpatient (p < 0.05). When more severity cases were excluded from hospital group, the differences were not significant. All cases with active bleeding, severe haemodynamic repercussion or without endoscopy were admitted. For the remainder, the decision to admit was associated with the presence of bleeding stigmata, haemodynamic repercussion, some causes of hemorrhage, older age, and urea levels. CONCLUSIONS: Although the scarce sample do not permit definitive conclusions, results guide towards that a substantial part of UGH not linked to portal hypertension may be monitored without hospitalizing the patient, thereby minimizing care costs and increasing the productive capacity of the hospital, without increasing risks for the patient.

[Pressure of the anal canal in patients with hemorrhoids or with anal fissure. Effect of the topical application of an anesthetic gel]. / Estudio presivo del canal anal en pacientes con hemorroides o con fisura anal. Efecto de la aplicación tópica de un gel anestésico.

The pressure measurements and clinical sensation of 11 patients with hemorrhoids and 8 patients with posterior and fissure were analyzed before and after the topical administration of an anesthetic gel containing tetracaine in the anal canal. A significant increase of the maximal basal pressure (p less than 0.01) was observed in comparison with a control group of the same age and sex. No differences in the maximal pressure of voluntary contractions. The anesthetic gel produced a significant decrease of the maximal basal pressure in subjects with hemorrhoids, as well as a lessening of pain in 37% of patients with anal fissure and in 55% of those with hemorrhoids. This symptomatic improvement was not correlated with changes in pressure. Therefore we conclude that the hypertonicity of the anal canal is not secondary to pain and must be evaluated as a disturbance related to the subjacent lesion.

[Continuous monitoring of the upper esophageal sphincter with the Dent device, during acid perfusion or distension with balloon of the esophageal body]. / Monitorización contínua del EES mediante el dispositivo de DENT, durante la perfusión de ácido o la distensión con balón del cuerpo esofágico.

The aim of the present study was to evaluate pressure changes of the UES under conditions that simulate the effects of gastroesophageal reflux (GER), that are, balloon esophageal distension and acid perfusion 0.1 N. Studies were performed in eight healthy subjects and fourteen patients with reflux esophagitis (RE), divided in two groups according to symptoms, 6 patients with heartburn and 8 patients with heartburn and regurgitation. We have employed the Dent sleeve to monitor UES pressure. The catheter was located with the help of a side-hole manometric catheter placed in the opposite side of the Dent sleeve; thereafter, it was anchorated. Perfusion of acid at 5 and 10 cm below the UES induces a pressure increase statistically significant, (paired data). This pressure increase is shown when mean values of the 5 minutes are considered as well for every minute. On the after hand, esophageal balloon distension did not produce pressure increases in any of the groups.

[Response of the upper esophageal sphincter to various esophageal stimuli in patients with reflux esophagitis]. / Respuesta del esfínter esofágico superior a diferentes estímulos esofágicos en pacientes con esofagitis por reflujo (EPR).

The clinical symptoms, including oropharingeal dysphagia and bronchial symptoms, have been analyzed in 18 normal controls and in 48 patients with reflux esophagitis. Patients with reflux and pyrosis and regurgitation usually have a disease of longer duration, more bronchial symptoms, greater severity of endoscopic lesions and less pressure in the U.E.S. area than those who only have heartburn. In 10 normals as well as in 28 patients (15 with pyrosis and 13 with both pyrosis and regurgitation) the pressure behavior of the superior esophageal sphincter has been studied with a specially designed instrument after different stimuli: acid perfusion at 5 and 10 cm of the U.E.S. during 5 minutes and esophageal balloon distention at 10 cm. In normal individuals none of the stimuli modified the pressure at rest of the U.E.S., while in patients with reflux esophagitis only HCl perfusion at 5 cm was able to significantly increase pressure. This finding was independent of the clinical symptoms of the patients.