ABSTRACT
OBJECTIVES: Angico gum (AG) (Anadenanthera colubrina var. Cebil [Griseb.] Altschul) is utilized by some Brazilian communities to alleviate symptoms from gastroesophageal reflux disease. Here, we aimed to investigate the "in vitro" topical protective capacity of AG on human esophageal mucosa. METHODS: Biopsies of the distal esophageal mucosa were collected from 35 patients with heartburn (24 non-erosive and 11 with erosive oesophagitis (EE)) and mounted in Üssing chambers. AG was applied topically, followed by exposure with acid solution (pH 2.0 or pH 1.0), where transepithelial electrical resistance (TER) and The transepithelial permeability for fluorescein was assessed. The incubation of the AG labeled with FITC in the esophageal mucosa was localized by fluorescence microscopy. KEY FINDINGS: Pretreatment with AG prevented the drop in TER induced by acid solution, as well as significantly decreases the fluorescein permeability in non-erosive patients. The protective effect of AG was sustained for up to 120 min both in biopsies of non-erosive and erosive esophagitis. Confocal microscope images showed mucosal luminal adherence of FITC-labeled AG. CONCLUSION: AG had a prolonged topical protective effect against acid solution in mucosal biopsies of patients with non-erosive and erosive esophagitis.
Subject(s)
Esophageal Mucosa , Gastroesophageal Reflux , Humans , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/prevention & control , Esophageal Mucosa/drug effects , Esophageal Mucosa/pathology , Esophageal Mucosa/metabolism , Male , Female , Middle Aged , Adult , Permeability , Electric Impedance , Administration, Topical , Biopolymers , Aged , Fluorescein/administration & dosage , Esophagus/drug effects , Esophagus/pathology , Esophagus/metabolism , Heartburn/drug therapy , Heartburn/prevention & control , Clinical RelevanceABSTRACT
BACKGROUND: Gastroesophageal reflux (GER) is more frequent in premature infants. Metoclopramide was introduced routinely in premature babies followed in ambulatory care by the Colombian Kangaroo Mother Care program (KMCP), based on a 2004 Cochrane review. AIM: Because of the recent controversy on the use of metoclopramide in children, this study was conducted to evaluate the effectiveness and safety of metoclopramide given as GER disease (GERD) prophylaxis. METHODS: A randomized clinical trial was conducted between April 2017 and January 2019 in 466 premature infants discharged home and followed at a KMCP. Double-blind allocation to metoclopramide versus placebo was performed, 0.2 mg/kg three times daily, administered 15 min before feeding, up to term. Exclusion criteria were oxygen dependency, any perinatal neurological problem or parent's participation refusal. The incidence of GERD symptoms and adverse events that could be associated with the use of metoclopramide were recorded by parents weekly (e.g., emesis, cyanosis or apnea, post-prandial crying episodes, extrapyramidal symptoms, tremor, and drowsiness). RESULTS: A total of 466 subjects were recruited, most of them late preterm. The groups' baseline characteristics were similar. Median duration of the intervention was approximately 3 weeks, at which time most patients were at term. In the longitudinal mixed effects analysis, we did not find clinically significant differences in GERD-related symptoms between groups, either in minor or severe side effects. CONCLUSION: Results show absence of effectiveness in the systematic use of metoclopramide as prophylaxis of GERD symptoms in premature infants. Additionally, no adverse effects attributable to the drug were found. ClinicalTrials.gov: NCT02907632; September 20, 2016. Retrospectively registered.
Subject(s)
Gastroesophageal Reflux , Infant, Premature, Diseases , Kangaroo-Mother Care Method , Child , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/prevention & control , Humans , Infant , Infant, Newborn , Infant, Premature , Metoclopramide/adverse effectsABSTRACT
OBJECTIVE: To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. STUDY DESIGN: We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan-Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. RESULTS: In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. CONCLUSIONS: Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.
Subject(s)
Anti-Ulcer Agents/administration & dosage , Deglutition Disorders/therapy , Gastroesophageal Reflux/prevention & control , Laryngomalacia/complications , Anti-Ulcer Agents/adverse effects , Deglutition Disorders/etiology , Female , Gastroesophageal Reflux/etiology , Glottis/surgery , Hospitalization , Humans , Infant , Laryngomalacia/surgery , Laryngomalacia/therapy , Male , Retrospective Studies , Severity of Illness Index , Treatment OutcomeSubject(s)
Humans , Infant , Gastroesophageal Reflux/prevention & control , Child Health , Infant WelfareABSTRACT
OBJECTIVE: Saliva is the most important biological factor to protect against erosive tooth wear (ETW). Gastroesophageal reflux disease (GERD) patients have an increased risk of ETW due to the frequent presence of intrinsic acids in the oral cavity. Remarkably, not all GERD patients suffer from ETW, which might be due to differences in the composition of the saliva. METHODS: This study compared the proteomic profile of saliva in patients (1) with GERD and ETW (basic erosive wear examination, BEWE, score ≥9; GE group) and (2) with GERD without ETW (BEWE = 0; GNE group) using shotgun label-free quantitative proteomic analysis nLC-ESI-MS/MS. The ability of hemoglobin (Hb) to protect against initial enamel erosion caused by a daily 10-s immersion of enamel specimens in 0.01 M HCl (pH 2.3) for 3 days was evaluated in vitro for proof of concept. Surface hardness change was used as response variable. RESULTS: The differential expression of Hb subunits was significantly increased in the GNE group versus the GE group, in particular the Hb α-subunit that showed a >22-fold increase. Expressions of serum albumin (4.5-fold) and isoforms of cytoskeletal keratin type II (>3-fold) were also increased in the GNE group. Proteinase inhibitors, such as α1-antitrypsin and α2-macroglobulin, were only identified in the GNE group. In vitro, Hb (1.0 and 4.0 mg/mL) significantly reduced initial enamel erosion compared to a negative control after 3 days. CONCLUSIONS: Our results indicate that many proteins, with special emphasis on Hb, may be involved in the resistance of GERD patients to the occurrence of ETW. These proteins may be candidates for inclusion in dental products to protect against ETW.
Subject(s)
Gastroesophageal Reflux , Tooth Erosion , Tooth Wear , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/prevention & control , Hemoglobins , Humans , Prevalence , Proteomics , Tandem Mass Spectrometry , Tooth Erosion/etiology , Tooth Erosion/prevention & controlABSTRACT
Achalasia is a primary esophageal motility disorder characterized by lack of esophageal peristalsis and partial or absent relaxation of the lower esophageal sphincter in response to swallowing. Available treatment modalities are not curative but rather intend to relieve patient' symptoms. A laparoscopic Heller myotomy with Dor fundoplication is associated with high clinical success rates and low incidence of postoperative reflux. A properly executed operation following critical surgical steps is key for the success of the operation.
Subject(s)
Esophageal Achalasia/surgery , Fundoplication/methods , Heller Myotomy/methods , Laparoscopy/methods , Esophageal Sphincter, Lower/surgery , Esophagoplasty/adverse effects , Gastroesophageal Reflux/prevention & control , Humans , Postoperative Period , Treatment OutcomeABSTRACT
BACKGROUND: The clinical impact of head-of-bed elevation in patients with gastro-oesophageal reflux disease is unclear, because of inconsistency and methodological limitations of previous studies. PATIENTS AND METHODS: A randomised single-blind single-centre controlled clinical trial with a 2x2 cross-over design, in 39 pharmacologically treated patients with gastro-oesophageal reflux disease. Active intervention was to use a head-of-bed-elevation of 20cm for 6 weeks and then to sleep without inclination for 6 additional weeks, with a wash-out of 2 weeks between periods. The primary outcome was a change ≥10% in RDQ score and secondary outcomes were a change ≥10% in SF-36 score, patient preference and frequency of adverse events. RESULTS: 27 (69.2%) patients who used the intervention reached the primary outcome vs 13 (33.3%) patients in the control group (RR: 2.08; 95 CI%: 1.19 - 3.61). No effect was found in SF-36 score (RR: 1.11; 95% CI: 0.47 - 2.60). Preference favouring the intervention was 77.1% and adverse event proportion was 54.0%. CONCLUSION: Head-of-bed elevation improved reflux symptoms but there was no effect on quality of life. The finding of a non-optimal risk-benefit ratio warrants additional studies before this intervention can be recommended (IBELGA, ClinicalTrials.gov identifier NCT02706938).
Subject(s)
Gastroesophageal Reflux/drug therapy , Posture , Adult , Aged , Beds , Cross-Over Studies , Female , Gastroesophageal Reflux/prevention & control , Humans , Male , Middle Aged , Single-Blind Method , SleepABSTRACT
RESUMEN El reflujo gastroesofágico presenta variaciones en cuanto a su definición, pero continúa causando una elevada morbilidad y mortalidad, a pesar que las estadísticas no recogen cifras exactas, su manejo sigue siendo controversial. En la práctica médica, se podría decir que el reflujo gastroesofágico fisiológico, no patológico, usualmente se acompaña de regurgitación, y que en esta enfermedad el síntoma principal de presentación en los niños, es el vómito. Cuando el reflujo gastroesofágico es mantenido, persistente, a pesar de la medidas posturales y dietéticas indicadas, provocando sintomatología digestiva y extradigestiva, se considera patológico, capaz de provocar una enfermedad por reflujo gastroesofágico. En neumología, no todo niño que tiene sibilancias es un asmático, en gastroenterología no todo niño que vomita o regurgita tiene un reflujo gastroesofágico. Actualmente, se conocen ciertas patologías y condiciones de tórpida evolución que por su historia natural y morbimortalidad, se catalogan como reflujo gastroesofágico refractario, cuyo pronóstico implica una diferente orientación terapéutica. El niño con reflujo gastroesofágico incluye las medidas antirreflujo, tratamiento medicamentoso y quirúrgico (AU).
ABSTRACT The Gastroesophageal Reflux presents variations as for its definition, but it continues causing a high morbility and mortality, to weigh that the statistics don't pick up exact report, its handling continues being controversial. In the medical practice, one could say that the reflux physiologic gastroesophageal, not pathological, usually accompanies of regurgitation, and that in this illness the main symptom of presentation in the children, is the vomit. When RGE is maintained, persistent, in spite of the measures posturales and dietary suitable, provoking digestive symptoms and extradigestive, it is considered pathological, able to provoke an illness for reflux gastroesophageal . In Neumology, not all boy that has lung sonority is an asthmatic one, in Gastroenterology not all boy that vomits or it regurgitation he has a reflux gastroesophageal. At the moment, certain pathologies and conditions of torpid evolution are known that for their natural history and morbimortality, they are classified as reflux refractory gastroesophageal whose presage implies a therapeutic different orientation. The boy with reflux gastroesophageal includes the measures antirreflux, treatment prescribes and surgical (AU).
Subject(s)
Humans , Infant , Child , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/prevention & control , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/diagnostic imaging , Risk Factors , Health PromotionABSTRACT
Resumen Introducción: La técnica de elección para la reconstrucción del tránsito intestinal después de una gastrectomía total es la esófago-yeyuno anastomosis en Y de Roux, la cual evita el reflujo de jugo digestivo alcalino. El objetivo del presente estudio es el de analizar la motilidad del esófago y del asa de yeyuno en pacientes operados con gastrectomía total por cáncer gástrico. Pacientes y método: Se estudió prospectivamente una muestra de 17 pacientes intervenidos mediante gastrectomía total 5 años atrás. En todos ellos se realizaron manometrías esofágicas de alta resolución incluyendo los primeros 7 cm del asa de yeyuno. Resultados: Los resultados de la manometría demostraron motilidad esofágica normal a excepción de la presión máxima intrabolo, la cual se encontraba aumentada en todos los pacientes. La motilidad del asa de yeyuno fue desordenada e inefectiva. Conclusiones: La motilidad del cuerpo esofágico es normal 5 años después de la gastrectomía total. Sin embargo, la presión intrabolo máxima se encuentra aumentada; la causa más probable de este hecho estaría constituida por el asa de yeyuno, que ejerce resistencia al paso del bolo debido a que presenta una actividad motora desordenada y poco propulsiva. El impacto clínico de este hecho es, sin embargo, poco importante.
Abstract Introduction: The most preferred technique to reconstruct the intestinal transit after total gastrectomy for gastric cancer is the Roux-en-Y esophagus-gastrostomy which prevents the reflux of alkaline intestinal juice. The purpose of this study was to analyze the esophageal motility and the motility of the jejunal loop in patients subjected to total gastrectomy. Patients and method: A prospective sample of 17 total gastrectomy patients operated on 5 years before was studied using high resolution esophageal manometry including the first 7 cm of the jejunal loop. Results: Manometry results showed normal esophageal body motility with the exception of the maximum intrabolus pressure that was elevated in all patients. The jejunal loop motility was disordered and ineffective. Conclusions: Esophageal body motility was normal 5 years after the surgical procedure. However, maximum intrabolus pressure was elevated and the most plausible reason would be the jejunal loop that exerts resistance to the bolus passage due to its ineffective motility. However, this fact does not have a significant clinical impact.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anastomosis, Roux-en-Y/methods , Esophagus/physiology , Gastrectomy/methods , Jejunum/physiology , Manometry/methods , Postoperative Period , Stomach Neoplasms/surgery , Anastomosis, Roux-en-Y/adverse effects , Gastroesophageal Reflux/prevention & control , Prospective Studies , Treatment Outcome , Gastrectomy/adverse effectsABSTRACT
BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients have a high incidence of gastroesophageal reflux disease (GERD) whose pathophysiology seems to be linked to an increased trans-diaphragmatic pressure gradient and not to a defective esophagogastric barrier. Inhaled beta agonist bronchodilators are a common therapy used by patients with COPD. This drug knowingly not only leads to a decrease in the lower esophageal sphincter (LES) resting pressure, favoring GERD, but also may improve ventilatory parameters, therefore preventing GERD. AIMS: This study aims to evaluate the effect of inhaled beta agonist bronchodilators on the trans-diaphragmatic pressure gradient and the esophagogastric barrier. METHODS: We studied 21 patients (mean age 67 years, 57 % males) with COPD and GERD. All patients underwent high-resolution manometry and esophageal pH monitoring. Abdominal and thoracic pressure, trans-diaphragmatic pressure gradient (abdominal-thoracic pressure), and the LES retention pressure (LES basal pressure-transdiaphragmatic gradient) were measured before and 5 min after inhaling beta agonist bronchodilators. RESULTS: The administration of inhaled beta agonist bronchodilators leads to the following: (a) a simultaneous increase in abdominal and thoracic pressure not affecting the trans-diaphragmatic pressure gradient and (b) a decrease in the LES resting pressure with a reduction of the LES retention pressure. CONCLUSION: In conclusion, inhaled beta agonist bronchodilators not only increase the thoracic pressure but also lead to an increased abdominal pressure favoring GERD by affecting the esophagogastric barrier.
Subject(s)
Bronchodilator Agents/therapeutic use , Esophageal Sphincter, Lower/drug effects , Esophageal Sphincter, Lower/physiopathology , Gastroesophageal Reflux/physiopathology , Pulmonary Disease, Chronic Obstructive/drug therapy , Aged , Diaphragm/physiopathology , Esophageal pH Monitoring , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/prevention & control , Humans , Male , Manometry , Middle Aged , Pressure , Pulmonary Disease, Chronic Obstructive/complicationsABSTRACT
BACKGROUND: Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence . AIM: To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. METHODS: This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. RESULTS: Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). CONCLUSION: There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group.
Subject(s)
Esophageal Atresia/surgery , Esophagus/surgery , Tracheoesophageal Fistula/surgery , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Anastomotic Leak/epidemiology , Anastomotic Leak/etiology , Anastomotic Leak/prevention & control , Esophageal Stenosis/epidemiology , Esophageal Stenosis/etiology , Esophageal Stenosis/prevention & control , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/prevention & control , Humans , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & controlABSTRACT
Background: Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence . Aim: To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. Methods: This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. Results: Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). Conclusion: There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group.
Racional: Deiscência de anastomose esofágica é frequente e ainda existem controvérsias qual tipo de anastomose é preferível para diminuir sua incidência. Objetivo : Comparar a anastomose terminoterminal versus a lateroterminal em termos de deiscência de anastomose, estenose de esôfago, e sintoma de refluxo gastroesofágico. Métodos : Este estudo foi realizado por dois anos a partir de 2012. Anastomoses terminoterminal e terminolateral foram comparadas em termos de deiscência de anastomose, estenose de esôfago, sintoma do refluxo gastroesofágico, duração da operação e transfusão. Resultados : Na comparação das anastomoses terminoterminal e terminolateral, respectivamente, a duração em minutos das operações foi de 127.63±13.393 e 130.29±10.727 (p=0,353); estenose esofágica foi observada em dois (5,9%) e oito (21,1%) casos (p=0,09); doença do refluxo gastroesofágico foi detectada em seis (15,8%) e três (8,8%) casos (p=0,485); deiscência de anastomose foi encontrada em cinco (13,2%) e um (2,9%) caso (p=0,203); duração do internamento na UTI neonatal foi significativamente menor na terminoterminal (11,05±2,438 dias) em comparação com terminolateral (13,88±2,306 dias, p<0,0001). Conclusão : Não houve diferença significativa entre as anastomoses terminoterminal e terminolateral, exceto para UTI neonatal que foi significativamente menor no grupo de anastomose terminoterminal.
Subject(s)
Humans , Tracheoesophageal Fistula/surgery , Esophageal Atresia/surgery , Esophagus/surgery , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/prevention & control , Gastroesophageal Reflux/epidemiology , Esophageal Atresia/epidemiology , Esophageal Stenosis/etiology , Esophageal Stenosis/prevention & control , Anastomotic Leak/etiology , Anastomotic Leak/prevention & control , Anastomotic Leak/epidemiologyABSTRACT
BACKGROUND: Stent palliation is the gold standard for gastric/duodenal cancer outlet obstruction. When stenting is impossible, feeding may be achieved through a gastrojejunostomy (PEG-J), but displacement of jejunal tube is frequent due to manipulation for feeding and drainage. Gastric outlet obstruction results on increased gastroesophageal reflux or extra-tube leakage. In order to reduce the jejunostomy tube manipulation and the gastric residuum, we created a second gastrostomy (PEG) dedicated to gastric drainage, reducing the PEG-J handling. OBJECTIVE: Our aim was evaluating of the usefulness of an added second gastrostomy in a PEG-J patient, for: 1. controlling symptomatic reflux and extra-tube leakage; 2. preventing jejunal tube dislocation. Methods We retrospectively evaluated patients were stent palliation of gastric/duodenal cancer outlet obstruction was not achieved, who were referred and underwent PEG-J. We selected four of these patients who needed a second PEG dedicated to gastric drainage, which was performed a few centimetres apart from the gastrojejunostomy. In order to achieve an efficient gastric drainage and provide the maximum comfort to the patient, the drainage PEG tube could be linked to an ileostomy bag. RESULTS: The four PEG-J cancer patients with longer survival developed symptoms associated with an important gastric residuum. After the drainage gastrostomy, symptoms subsided or vanished and there were no jejunal tube dislocations. CONCLUSIONS: When stenting is not possible in patients with gastric/duodenal outlet obstruction due to cancer growing, feeding PEG-J plus drainage PEG may be an alternative, allowing duodenal/jejunal feeding and gastric drainage with minimal manipulation of the jejunal tube.
Subject(s)
Duodenal Neoplasms/complications , Enteral Nutrition/methods , Gastric Outlet Obstruction/surgery , Gastrointestinal Neoplasms/complications , Gastrostomy/methods , Intubation, Gastrointestinal/methods , Gastric Bypass , Gastric Outlet Obstruction/etiology , Gastroesophageal Reflux/prevention & control , Humans , Intubation, Gastrointestinal/adverse effects , Jejunostomy , Palliative Care/methods , Retrospective StudiesABSTRACT
AIM: To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers. METHODS: Eight SSc volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A high-resolution manometry/impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak pressures during forced inhalation under 12 and 24 cmH2O loads). Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM. RESULTS: SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7±2.8 mmHg vs 32.2±2.7 mmHg, P=0.007). Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls (142.6±9.4 mmHg vs 104.6±13.8 mmHg, P=0.019). Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls (83.8±13.4 mmHg vs 37.5±6.9 mmHg, P=0.005). Threshold maneuver pressures normalized to IDL were also greater in SSc patients than in controls (TM 12 cmH2O: 85.1±16.4 mmHg vs 43.9±6.3 mmHg, P=0.039; TM 24 cmH2O: 85.2±16.4 mmHg vs 46.2±6.6 mmHg, P=0.065). Inspiratory diaphragm lowering in SSc patients was less than in controls (2.1±0.3 cm vs 3±0.2 cm, P=0.011). CONCLUSION: SSc patients had increased inspiratory EGJ pressure. This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.
Subject(s)
Diaphragm/physiopathology , Esophageal Motility Disorders/etiology , Esophagogastric Junction/physiopathology , Gastroesophageal Reflux/prevention & control , Inhalation , Scleroderma, Systemic/complications , Adult , Breathing Exercises , Case-Control Studies , Deglutition , Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/physiopathology , Esophageal Sphincter, Lower/physiopathology , Female , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/physiopathology , Humans , Male , Manometry , Pressure , Scleroderma, Systemic/diagnosis , Scleroderma, Systemic/physiopathology , Severity of Illness IndexABSTRACT
INTRODUCTION: Postoperative reflux remains to be a challenge for patients with achalasia undergoing Heller myotomy. Similarly, per-oral endoscopic myotomy (POEM) is gaining rapid acceptance but the impossibility of adding a fundoplication is questioned as the main pitfall to control reflux. Electrical stimulation of the lower esophageal sphincter (LES) has emerged as a new alternative for the treatment of reflux disease. The objective of this study was to evaluate the potential benefits of combining electrical stimulation with endoscopic esophageal myotomy to prevent post procedural reflux. METHODS: Five pigs were subjected to POEM. After myotomy was completed, two electrical leads were implanted at the LES level and electrical stimulation was applied with the Endostim system with a regimen of 215 µs (5 mA amplitude), at 20 Hz for 25 min. LES pressures were recorded with manometry at pre and post-myotomy and after LES stimulation. RESULTS: Myotomy was completed successfully in all cases. Mean pre-myotomy LES pressure was 35.99 ± 8.08 mmHg. After myotomy, the LES pressure significantly dropped to 10.60 ± 3.24 mmHg (p = 0.03). Subsequent to LES-EST, LES pressure significantly increased to 21.74 ± 4.65 mmHg (p = 0.01). CONCLUSIONS: The findings of this study show that LES-EST in healthy animals increases LES pressure after POEM procedure, and could be useful tool to minimize gastroesophageal reflux.
Subject(s)
Electric Stimulation Therapy , Esophageal Achalasia/surgery , Esophageal Sphincter, Lower , Gastroesophageal Reflux/prevention & control , Natural Orifice Endoscopic Surgery , Postoperative Complications/prevention & control , Animals , Female , Fundoplication/methods , Gastroesophageal Reflux/etiology , Manometry , Sus scrofa , Treatment OutcomeABSTRACT
Antecedentes: Hemos creado la guía de práctica clínica de las intervenciones de enfermería para el cuidado del paciente pediátrico con enfermedad de reflujo gastroesofágico.Métodos: Esta guía de intervención de la práctica clínica de Enfermería forma parte de los guías que integran el Catálogo General de la Práctica Clínica, la cual se instrumentó a través del programa de acción específico: Guías de desarrollo de la práctica clínica, de acuerdo con las estrategias y líneas de acción que considera el Programa Nacional de Salud. 2013-2018 Esta guía de práctica clínica guiará al profesional de la salud para que otorgue cuidados especiales a este tipo de pacientes, al mismo tiempo que se basa en el conocimiento actualizado y estandarizado que fundamenta la evidencia y la toma de decisiones que favorecen la calidad de vida del paciente con la enfermedad de reflujo gastroesofágico, disminuyendo así las complicaciones y la mortalidad súbita. Y al mismo tiempo aumentar la eficiencia del proceso de atención en la enfermería propiciando un cuidado seguro y libre de riesgos.Resultados: Se favorecerá la mejora de la eficiencia, seguridad y calidad de la atención que contribuye, por la presente, para el bienestar de la gente y de las comunidades, que es el objetivo central y la razón de ser de los servicios de salud.Conclusión: el propósito de este catálogo es establecer un estandar nacional para orientar las decisiones clínicas de guía basadas en las recomendaciones sufridas en la mejor evidencia disponible y que tiene las intervenciones dirigidas a la identificación oportuna de los signos y síntomas y complicaciones, así como intervenciones de colaboración para el tratamiento y medidas de seguridad.
Background: We created the guide of clinical practice of interventions of infirmary for the care of pediatric patient with disease of gastroesophageal reflux. Methods: This guide of clinical practice intervention of infirmary forms a part of the guides who integrate the Guides' Main Catalogue of Clinical Practice, which is orchestrated across the Specific Program of Action: Guides' Development of Clinical Practice, according to the strategies and lines of action that considers 2013-2018 National Health program. This guide of clinical practice will guide the professional of health provider to taken care this type of patients, rely on updated and standardized knowledge based on the evidence and to take decisions that affect favorably the quality of life of the patient with gastroesophageal reflux disease as well as to diminish complications, sudden mortality, increase the efficiency of the process of care in infirmary and to propitiate a sure and free care of risks.Results: it will favor the improvement of the efficiency, safety and quality of the care contributing, hereby, to the wellbeing of the people and of the communities, which it is the central aim and the reason to be of health services. Conclusion: the purpose of this catalog is to establish national modal to orientate the guide clinical decisions based on recommendations sustained in the best available evidence and having interventions directed to the opportune identification of signs and symptoms and complications as well as collaborative interventions for the treatment and safety measures.
Antecedentes: Criamos o guia da prática clínica de intervenções de enfermaria para o atendimento de pacientes pediátricos com a doença do refluxo gastroesofágico.Métodos: Este guia de intervenção prática clínica da enfermaria faz parte dos guias que integram 'principal Catalogue of Clinical Practice, que é orquestrada em todo o programa de acção específicos: Guias' as Guias de Desenvolvimento da prática clínica, de acordo com as estratégias e linhas de ação que considera 2013-2018 programa Nacional de Saúde. Este guia da prática clínica vai orientar o profissional de prestador de cuidados este tipo de pacientes, dependem de conhecimento atualizado e padronizado com base nas provas e tomar decisões que afectam favoravelmente a qualidade de vida do paciente com doença do refluxo gastroesofágico, bem de modo a diminuir as complicações, a mortalidade súbita, aumentar a eficiência do processo de atendimento em enfermaria e propiciar um atendimento seguro e livre de riscos. Resultado: ele vai favorecer a melhoria da eficiência, segurança e qualidade do contribuinte cuidado, por este meio, para o bem-estar das pessoas e das comunidades, que é o objetivo central e a razão de ser dos serviços de saúde.Conclusão: o objectivo deste catálogo é estabelecer modal nacional para orientar as decisões clínicas de orientação com base nas recomendações sustentadas na melhor evidência disponível e com intervenções dirigidas à identificação oportuna de sinais e sintomas e complicações, bem como intervenções de colaboração para o tratamento e medidas de segurança.
Subject(s)
Child , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/nursing , Gastroesophageal Reflux/prevention & control , ChildABSTRACT
OBJECTIVE: Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. METHODS: Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. RESULTS: In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. CONCLUSION: The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.
Subject(s)
Gastrectomy/methods , Gastroesophageal Reflux/surgery , Obesity/surgery , Adult , Body Mass Index , Female , Follow-Up Studies , Gastroesophageal Reflux/prevention & control , Gastrointestinal Tract/diagnostic imaging , Gastrointestinal Transit , Humans , Laparoscopy/methods , Male , Medical Illustration , Middle Aged , Radiography , Time Factors , Treatment Outcome , Weight Loss , Young AdultABSTRACT
Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. .
Objetivo A gastrectomia vertical é o procedimento cirúrgico para tratamento da obesidade que mais cresce em indicações. No entanto, esse procedimento pode causar ou agravar a doença do refluxo gastresofágico. Este artigo buscou descrever originalmente a adição de procedimentos antirrefluxo (remoção de coxins gordurosos do hiato, hiatoplastia, pequena plicatura e fixação do remanescente na posição anatômica), além de relatar seus resultados precoces e tardios. Métodos Foram submetidos à gastrectomia vertical com medidas antirrefluxo 88 oito pacientes obesos com sintomas de doença do refluxo gastresofágico. Dentre esses pacientes, 50 foram submetidos também à bipartição do trânsito. A perda de peso destes foi comparada àquela ocorrida em 360 pacientes consecutivos submetidos à gastrectomia vertical usual e à de 1.140 pacientes submetidos à gastrectomia vertical + bipartição do trânsito. Os sintomas do refluxo gastresofágico foram investigados por meio de questionário em todos os submetidos à gastrectomia vertical com medidas antirrefluxo e comparados com os resultados obtidos em 50 pacientes submetidos à gastrectomia vertical usual e a 60 submetidos à gastrectomia vertical + bipartição do trânsito, também com sintomas prévios de doença do refluxo gastresofágico. Resultados O percentual de perda do excesso de índice de massa corporal após gastrectomia vertical antirefluxo não foi inferior a gastrectomia vertical usual. Além disso, a gastrectomia vertical antirefluxo + bipartição do trânsito não foi inferior a gastrectomia vertical + bipartição do trânsito. Não houve aumento da morbidade na gastrectomia vertical antirefluxo, porém notou-se redução ...
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Gastrectomy/methods , Gastroesophageal Reflux/surgery , Obesity/surgery , Body Mass Index , Follow-Up Studies , Gastrointestinal Transit , Gastroesophageal Reflux/prevention & control , Gastrointestinal Tract , Laparoscopy/methods , Medical Illustration , Time Factors , Treatment Outcome , Weight LossABSTRACT
AIM: To investigate the effects of beeswax alcohols (D-002) on the esophageal damage induced by gastroesophageal reflux (GER) in rats. METHODS: Sixty male rats were randomized into six groups (10 rats/group): a negative control and five groups with experimentally induced GER: a positive vehicle control, three treated with D-002 (25, 100 and 200 mg/kg, respectively), and one with omeprazole 10 mg/kg. All treatments were given by gastric gavage. One hour after dosing, GER was produced by simultaneous ligation of the pyloric end and the forestomach. Esophageal lesions index (ELI), gastric secretion volume and acidity, and esophageal malondialdehyde (MDA) and sulfhydryl (SH) group concentrations were measured. Statistical significance was considered at P < 0.05. RESULTS: As compared to the negative control, the positive control group exhibited increased ELI (5.2 ± 0.33 vs 0 ± 0, P = 0.0003), gastric secretion volume (2.69 ± 0.09 vs 0.1 ± 0.0, P = 0.0003) and acidity (238 ± 19.37 vs 120.0 ± 5.77, P = 0.001), and esophageal concentrations of MDA (2.56 ± 0.1 vs 1.76 ± 0.28, P = 0.001) and SH groups (1.02 ± 0.05 vs 0.56 ± 0.08, P = 0.0003). D-002 (25, 100 and 200 mg/kg) reduced ELI (3.36 ± 0.31, 2.90 ± 0.46 and 2.8 ± 0.23, respectively) vs the positive control (5.2 ± 0.33) (P = 0.004; P = 0.002; P = 0.001, respectively). There were no significant changes in acidity with D-002 treatment, and only the highest dose reduced the volume of the gastric secretion (1.92 ± 0.25) vs the positive control (2.69 ± 0.09, P = 0.013). D-002 (25, 100 and 200 mg/kg) lowered the esophageal MDA (2.05 ± 0.16, 1.98 ± 0.22 and 1.93 ± 0.22, respectively) (P = 0.01; P = 0.03; P = 0.03, respectively) and SH group concentration (0.87 ± 0.06, 0.79 ± 0.08 and 0.77 ± 0.06, respectively) (P = 0.04; P = 0.04; P = 0.02) vs the positive control (2.56 ± 0.10 and 1.02 ± 0.05, respectively). Omeprazole decreased ELI (2.54 ± 0.47), gastric secretion volume (1.97 ± 0.14) and acidity (158.5 ± 22.79), esophageal MDA (1.87 ± 0.13) and SH group (0.72 ± 0.05) concentrations vs the positive control (P = 0.002; P = 0.001; P = 0.02; P = 0.003; P = 0.002, respectively). CONCLUSION: Acute oral administration of D-002 decreased macroscopic esophageal lesions and oxidative stress in rats with experimentally induced GER, without modifying gastric secretion acidity.