RESUMO
BACKGROUND: The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. METHODS: Consecutive morbidly obese (BMI ≥ 35 kg/m2) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively. RESULTS: Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. CONCLUSIONS: The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.
Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Esôfago/fisiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Manometria , Obesidade Mórbida/complicações , Adulto , Técnicas de Diagnóstico do Sistema Digestório/história , Técnicas de Diagnóstico do Sistema Digestório/tendências , Transtornos da Motilidade Esofágica/epidemiologia , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/fisiopatologia , História do Século XXI , Humanos , Masculino , Manometria/história , Manometria/métodos , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Prevalência , Sensibilidade e EspecificidadeRESUMO
This article presents a short account of theories, methods, and experimental data formulated and carried out 120 years ago, by Ruggero Oddi, then a 4th-year student in medicine, about the identification of the common bile duct sphincter. A historical picture emerges which leads us to think that Oddi not only discovered the bile duct sphincter, but also described bile duct dilation after cholecystectomy and performed biliary manometry for the first time. The role of serendipity and the almost unknown contribution of Arturo Marcacci, Oddi's "maestro" are also mentioned.
Assuntos
Doenças dos Ductos Biliares/história , Esfíncter da Ampola Hepatopancreática/anatomia & histologia , Animais , Epônimos , História do Século XIX , História do Século XX , Humanos , Itália , Manometria/históriaRESUMO
PURPOSE: The origin and the development of the cystometrogram are described. MATERIALS AND METHODS: We reviewed and analyzed the published literature on cystometrography. RESULTS: The cystometrogram originated in the latter half of the nineteenth century, an age of intense clinimetric investigation. Early investigators studied fundamental aspects of bladder function with meticulous techniques using relatively crude equipment. The first clinical cystometer was designed by Dalton K. Rose in 1927. He was followed by Nesbit, McLellan, Muschat and Munro, who brought the cystometrogram to its current key role in modern urology. CONCLUSIONS: Numerous investigators have advanced the knowledge of bladder function using the cystometrogram, a key urological tool.
