[Histological criteria of esophagitis in the gastroesophageal reflux disease. Reevaluation of the sensitivity of the esophageal 24-hours pHmetry]. / Critérios histológicos de esofagite na doença do refluxo gastroesofágico. Reavaliação da sensibilidade da pHmetria esofágica de 24 horas.

Little change was observed in the histological criteria of reflux esophagitis since the studies of Ismail-Beiji, Pope (1970) and Weinstein (1975). The 24-hour esophageal pHmetry has been proposed as a high sensitivity method in diagnosis of gastroesophageal reflux disease patients. In this study we selected 35 patients with histological esophagitis and submitted them to 24-hour esophageal pHmetry. We determined histological differences according to reflux pattern, endoscopic esophagitis grades and age. The sensitivity of 24-hour esophageal pHmetry was 60.0% in our patients. There are higher histological alterations in patients with more severe patterns of reflux (supine and combined) and significant difference (P < 0.05) in observed quantitative exocytosis between moderate and severe endoscopic esophagitis. There are no difference between histological esophagitis criteria and age groups.

Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group.

The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD). Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM) criteria and distributed into three age groups: Group A: 14-24 years of age. Group B: 25-54; and Group C: 55-64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05), having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

[The importance of age as determining factor in hiatus hernia and gastroesophageal reflux. Cross-sectional study]. / Importância do fator etário no determinismo da hérnia hiatal por deslizamento e a doença do refluxo gastroesofagiano. Estudo transversal.

This prospective study involve a total of 77 patients distributed according age. The patients were divided in three groups: Group A > or = 14 e < or = 24, Group B > or = 25 e < or = 54, and Group C > or = 55 e < or = 64 years old. Each group of patients had similar alterations in 24 h-pHmetry parameters such as total episodes number, number of episodes with duration more than 5 minutes, the longest episode, Johnson and DeMeester Score, reflux patterns (orthostatic or supine or combined) (P > 0.05 NS). The hiatal hernia was present in 10.00% of the patients between 14 and 24 years old, 43.40% between 25 and 54 years old, and 64.29% between 55 and 64 years old (P < 0.0001). The conclusion is that hiatal hernia do not participate in gastroesophageal reflux disease etiopathogenesis. Although the older age is a risk factor for development of gastroesophageal reflux disease complications, it is speculated if the continuous acid aggression in the distal esophagus in patients with gastroesophageal reflux disease is the only factor responsible for the higher incidence of hiatal hernia in patients with 55 and 64 years old than the younger groups of patients.

[Relationship between 24 h ambulatory esophageal pHmetry and upper digestive endoscopy in reflux esophagitis patients]. / Relação entre pHmetria esofagiana ambulatorial de 24 h e endoscopia digestiva alta em pacientes portadores de esofagite de refluxo.

The reflux gastroesophageal patients can be divided in three patterns, according with ambulatorial esophageal 24 h-pHmetry: orthostatic, which the reflux episodes occur when the patients are upright; supine, which the reflux episodes occur when the patients are sleeping; combined, when the reflux episodes are both observed in upright or lay down position. There are presented 56 patients with endoscopic reflux esophagitis who are divided according to the patterns of reflux by 24 h-pHmetry. The results are similar to those of international reports. Complicated esophagitis is more common in the combined refluxers following by supine refluxers. In the orthostatic refluxers were not observed complicated esophagitis. The 24 h-pHmetry is an useful tool for clinical use and prognosis in the gastroesophageal reflux disease.