Esophageal Hypocontractile Disorders and Hiatal Hernia Size Are Predictors for Long Segment Barrett's Esophagus.

Background/Aims: Presently, there is paucity of information about clinical predictors, especially esophageal motor abnormalities, for long segment Barrett's esophagus (LSBE) as compared with short segment Barrett's esophagus (SSBE). The aims of this study are to compare the frequency of esophageal function abnormalities between patients with LSBE and those with SSBE and to determine their clinical predictors. Methods: This was a multicenter cohort study that included all patients with a diagnosis of BE who underwent high-resolution esophageal manometry. Motility disorders were categorized as hypercontractile disorders or hypocontractile disorders and their frequency was compared between patients with LSBE and those with SSBE. Multivariable logistic regression modeling was used to calculate the odds of being diagnosed with LSBE relative to SSBE for demographics, comorbidities, medication use, endoscopic findings, and the type of motility disorders. Results: A total of 148 patients with BE were identified, of which 89 (60.1%) had SSBE and 59 (39.9%) LSBE. Patients with LSBE had a significantly larger hiatal hernia and higher likelihood of erosive esophagitis than patients with SSBE (P = 0.002). Patients with LSBE had a significantly lower mean LES resting pressure, distal contractile integral, distal latency, and significantly higher failed swallows and hypocontractile motility disorders than those with SSBE (P < 0.05). Hiatal hernia and hypocontractile motility disorder increased the odds of LSBE by 38.0% and 242.0%, as opposed to SSBE. Conclusions: The presence of a hypocontractile motility disorder increased the risk for LSBE. Furthermore, the risk for LSBE was directly associated with the length of the hiatal hernia.

Esophageal Function Abnormalities in Patients With Barrett's Esophagus.

Various esophageal functional abnormalities have been described in patients with Barrett's esophagus (BE). A significantly higher esophageal acid exposure especially in the supine position has been documented in BE, as compared with the other gastroesophageal reflux disease phenotypes. In addition, weakly acidic reflux and duodenogastroesophageal reflux are more common in BE patients. The presence of Barrett's mucosa reduces esophageal mucosal impedance, occasionally to a level that prevents detection of reflux episodes. Reduced amplitude contractions and lower esophageal sphincter basal pressure are more common in BE patients as compared with the other gastroesophageal reflux disease groups. Ineffective esophageal motility is the most commonly defined motor disorder in BE. Reduced chemoreceptor and mechanoreceptor sensitivity to acid and balloon distention, respectively, have been suggested to explain lack or significantly less reports of reflux-related symptoms by BE patients.

Etiologia de los derrames pleuropulmonares en niños hospitalizados / Etiology of pleuropulmonar effusion in childreen hospitalized

El derrame paraneumónico nos permite obtener una muestra adecuada y confiable para determinar al agente causal de una neumonía. El objetivo del presente estudio fue determinar la etiología de los derrames paraneumónicos, en niños hospitalizados, por medio del cultivo del derrame pleural y hemocultivo para bacterias aerobias y anaerobias en un período de nueve meses (de agosto de 1986 a abril de 1987). Se incluyeron 15 pacientes, 12 hombres y tres mujeres cuya edad media era de un año ocho meses. La duración de la enfermedad previo a la hospitalización fue de tres a 30 días, con un promedio de 11.8 días. Trece pacientes (86.6%) habían recibido antibióticos anterior a toracocentesis. La localización del derrame fue izquierdo en el 60%, derecho en 33% y bilateral en 6%. Sólo un hemocultivo fue positivo, (H. Influenzae 6.6%). El cultivo del derrame pleural fue positivo en 40% (6/15), siendo las bacterias aisladas H. influenzae (3/6), S. pneumoniae, Pseudomonas sp y E. coli. No se aislaron bacterias anaerobicas. El fracaso para aislar algún microrganismo en el 60% de los casos se debe en parte a los antimicrobianos administrados en forma previa a la toracocentesis y además a la falta de búsqueda de otros microganismos como virus, Mycoplasma y parásitos