RESUMO
Chest pain is common in medical consultations. One of the most frequent and serious causes is acute ischemic heart disease, which must be ruled out. The gold standard is coronary angiography. Noncardiac recurrent chest pain has a favorable prognosis. The most frequent cause is esophageal disease, with a prevalence of between 20% and 50%. The most frequent form is gastroesophageal reflux disease followed by esophageal motor disorders. Empirical treatment with high-dose proton pump inhibitors should be considered as a diagnostic-therapeutic test before performing exhaustive complementary investigations of esophageal function. Among complementary tests, manometry combined with 24-hour pH-metry has the highest diagnostic yield. Antidepressants are an acceptable therapeutic option in patients with esophageal visceral hyperalgesia.
Assuntos
Dor no Peito/etiologia , Doenças do Esôfago/complicações , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Doenças do Esôfago/diagnóstico , HumanosRESUMO
El dolor torácico es un síntoma muy frecuente de consulta médica. La cardiopatía isquémica aguda es una de las causas más frecuentes y de mayor trascendencia, por lo que es prioritario descartarla; para ello, el método de referencia es la coronariografía. El dolor torácico recurrente de etiología no cardíaca tiene un pronóstico muy favorable. Las causas más frecuentes son las enfermedades esofágicas, con una prevalencia de entre el 20 y el 50%, y entre ellas, la más frecuente es la enfermedad por reflujo gastroesofágico, seguida de los trastornos motores del esófago. Un tratamiento empírico con inhibidores de la bomba de protones en dosis altas debería considerarse como prueba diagnosticoterapéutica antes de iniciar un estudio exhaustivo de la función esofágica con exploraciones complementarias, entre las cuales la que mejor rendimiento diagnóstico tiene es la manometría combinada con la pH-metría de 24 h. Los antidepresivos son una aceptable opción terapéutica en pacientes con hiperalgesia visceral esofágica
Chest pain is common in medical consultations. One of the most frequent and serious causes is acute ischemic heart disease, which must be ruled out. The gold standard is coronary angiography. Noncardiac recurrent chest pain has a favorable prognosis. The most frequent cause is esophageal disease, with a prevalence of between 20% and 50%. The most frequent form is gastroesophageal reflux disease followed by esophageal motor disorders. Empirical treatment with high-dose proton pump inhibitors should be considered as a diagnostic-therapeutic test before performing exhaustive complementary investigations of esophageal function. Among complementary tests, manometry combined with 24-hour pH-metry has the highest diagnostic yield. Antidepressants are an acceptable therapeutic option in patients with esophageal visceral hyperalgesia
Assuntos
Humanos , Dor no Peito/etiologia , Doenças do Esôfago/complicações , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Doenças do Esôfago/diagnósticoAssuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Hedeoma/efeitos adversos , Mentha pulegium/efeitos adversos , Bebidas/efeitos adversos , Bebidas/análise , Biotransformação , Humanos , Óleos de Plantas/efeitos adversos , Óleos de Plantas/química , SolubilidadeRESUMO
No disponible
Assuntos
Humanos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Plantas Medicinais/toxicidade , Óleos Voláteis/toxicidadeRESUMO
No disponible
Assuntos
Humanos , Síndrome do Intestino Irritável , Antidepressivos , Antidiarreicos , Loperamida , Serviços de Saúde , PrevisõesAssuntos
Tosse , Adulto , Algoritmos , Asma/complicações , Asma/tratamento farmacológico , Bronquiectasia/complicações , Bronquiectasia/tratamento farmacológico , Bronquite/complicações , Bronquite/tratamento farmacológico , Carcinoma Broncogênico/complicações , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Tosse/psicologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/fisiopatologia , Arterite de Células Gigantes/complicações , Humanos , Neoplasias Pulmonares/complicações , Pólipos Nasais/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológicoRESUMO
No disponible
Assuntos
Adulto , Humanos , Tosse , Arterite de Células Gigantes , Pólipos Nasais , Doença Pulmonar Obstrutiva Crônica , Asma , Bronquite , Bronquiectasia , Carcinoma Broncogênico , Doença Crônica , Algoritmos , Refluxo Gastroesofágico , Neoplasias PulmonaresRESUMO
OBJECTIVE: To evaluate if the clinical presentation and the response to pneumatic dilation is different in patients with achalasia with an apparent normal lower esophageal sphincter relaxation. DESIGN: Prospective study to compare clinical, radiographic and manometric characteristics and the response to pneumatic dilation according to the ability of the lower esophageal sphincter to relax normally. PATIENTS: One hundred and fifty seven consecutive patients with achalasia were included. Relaxation of the lower esophageal sphincter was abnormal in 130 patients and apparently normal in 27. The response to pneumatic dilation was evaluated in 116 patients, 94 with abnormal function of the lower esophageal sphincter and 22 with normal function. RESULTS: Clinical findings, esophageal diameter and basal pressure of the lower esophageal sphincter were similar in both groups. The efficacy of the dilation, the number of dilations and the rate of complications were also similar. CONCLUSIONS: Patients with achalasia and an apparent normal lower esophageal sphincter relaxation are not different from patients with typical achalasia and present a similar response to pneumatic dilation.
Assuntos
Cateterismo , Acalasia Esofágica/fisiopatologia , Junção Esofagogástrica/fisiologia , Relaxamento Muscular , Adulto , Acalasia Esofágica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The aim of this study was to analyze whether the vigorous character of esophageal contraction conditions differences in the clinical characteristics or in response to pneumatic dilatation treatment in patients with achalasia. To do so, a prospective protocol study was designed in which the clinical, radiological, and manometric characteristics of the patients and the response to pneumatic dilatation were compared on the basis of the presence or absence of severe contraction of the esophageal body. One hundred fifty-seven consecutive patients diagnosed with achalasia were included on presentation of a compatible clinical picture and absence of peristalsis in the esophageal body. Out of these patients, 120 presented a manometric pattern of typical achalasia and 37 had vigorous achalasia. Response to pneumatic dilatation was analyzed in 116 patients, 90 with typical achalasia and 26 with vigorous achalasia. Significant differences were only found between the two groups with respect to the greater response tone of the lower esophageal sphincter observed in the patients with vigorous achalasia. There were no differences in the remaining clinical, radiologic or manometric variables compared. Neither were any differences observed in regard to therapeutic response to pneumatic dilatation in the two groups of patients. It may be concluded that differentiation between typical and vigorous achalasia has no clinical or therapeutic significance.
Assuntos
Dilatação , Acalasia Esofágica/classificação , Acalasia Esofágica/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Acalasia Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The prognosis of 189 patients with upper gastrointestinal bleeding was studied with the assistance of a computer. The safety of the prognosis given by the doctor was partially improved with the computer. However, when both judgements were simultaneously considered, the best results were obtained. A scoring-system constructed with simple clinical data proved useful to obtain prognostic judgements with high sensitivity and specificity. It is concluded that the reliability of the prognosis given in patients with upper gastrointestinal bleeding can be improved with objective methods. The improvement is maximal if objective information is evaluated together with clinical information.
Assuntos
Diagnóstico por Computador , Hemorragia Gastrointestinal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Recidiva , Sensibilidade e EspecificidadeRESUMO
In peptic ulcer disease, antacids present a therapeutic effect by neutralizing gastric acid and reducing acid delivery to the duodenum. Furthermore, they reduce the activity of pepsin and have the capacity to bind bile acids. Despite the opinion of most clinicians, the effect of antacids relieving pain in patients with peptic ulcer has not been definitely demonstrated. Furthermore, antacids do not seem to improve the healing rate of gastric ulcer. Earlier studies showed that antacids could hasten the healing of duodenal ulcer when administered at a very high dose. However, recent papers demonstrate that this therapeutic effect is also achieved with a dose with very low neutralizing capacity. Severe side effects are rare, although they can occur in high-risk patients. However, minor problems, such as changes in bowel habits, are more frequent.
Assuntos
Antiácidos/uso terapêutico , Úlcera Péptica/tratamento farmacológico , Antiácidos/farmacologia , HumanosRESUMO
To assess the additional prognostic value of endoscopic stigmata of recent haemorrhage (SRH) in addition to clinical data, a pilot study was conducted on 207 duodenal ulcer patients from the OMGE survey. The incidence of SRH was compared in 145 patients who settled and 62 who re-bled. Only active bleeding emerged as significantly commoner in the latter group. Two computer-assisted predictions of further bleeding (before and after addition of the stigmata to a clinical database) were compared with the final outcome. Little improvement, in terms of prognosis for further bleeding, was obtained when SRH data were added. Similar findings were observed in a smaller series from Marburg, FRG.