Impacto da pirose e regurgitação no bem-estar de indivíduos da população geral: um inquérito nacional brasileiro / Impact of heartburn and regurgitation on individuals' well-being in the general population: a brazilian national survey

ABSTRACT BACKGROUND: Heartburn and acid regurgitation are typical symptoms usually associated with gastroesophageal reflux disease (GERD). GERD is one of the gastrointestinal diagnosis with higher prevalence worldwide, significantly impairing patients' quality of life. OBJECTIVE: The objective of this study was to analyze the impact of GERD-related symptoms in the Brazilian urban population. METHODS: National telephone survey with community-dwelling Brazilian individuals. Self-reported prevalence and frequency of symptoms (heartburn / regurgitation) were assessed. Individuals rated the impact of symptoms in their general well-being using a numeric scale from 1 to 10 (1 = no impact; 10 = very intense, preventing the person to eat and perform daily routine activities). Descriptive and bivariate statistical analyses were performed. RESULTS: The final sample was comprised of 1,773 subjects, 935 (52.7%) females, an average of 40 years old. The prevalence of heartburn and regurgitation in the past 6 months was 26.2% (n=466) and 11.0% (n=196), respectively. Women presented higher prevalence (heartburn n=266, 28.5% and regurgitation n=119, 12.7%) than men (n=200, 23.1% and n=78, 8.9%, respectively) (P<0.05). Heartburn in the past week was reported by 175 individuals (9.8%), while regurgitation episodes by 67 (3.8%). Absence of impact of the symptom in the overall well-being was observed for 82 subjects (17.6%) with heartburn and 18 individuals (9.2%) with regurgitation. Very intense impact was reported by 46 subjects (9.8%) with heartburn and 41 (20.9%) with regurgitation. Women's well-being was more affected than men's (mean score 5.45 vs 4.71, P<0.05). CONCLUSION: Heartburn and regurgitation were frequent symptoms, women with higher prevalence. These symptoms led to a substantial impact on individuals' well-being, women being more affected.

RESUMO CONTEXTO: Pirose e regurgitação ácida são sintomas típicos usualmente relacionados à doença do refluxo gastroesofágico (DRGE). A DRGE é um dos diagnósticos gastrointestinais com maior prevalência mundial, afetando significativamente a qualidade de vida dos pacientes. OBJETIVO: Analisar o impacto de sintomas relacionados à DRGE em uma amostra da população brasileira urbana. MÉTODOS: Inquérito nacional via telefone com indivíduos brasileiros em contexto comunitário. O inquérito foi conduzido entre 6 de agosto e 12 de setembro de 2018. A prevalência autorrelatada e a frequência dos sintomas foram avaliadas. Os respondentes classificaram o impacto dos sintomas no seu bem-estar geral utilizando uma escala numérica de 1 a 10 (1 = ausência de impacto; 10 = impacto muito grave, impedindo a pessoa de comer ou realizar atividades da vida diária). Análises estatísticas descritivas e bivariadas foram conduzidas. RESULTADOS: A amostra final foi constituída por 1.773 indivíduos, 935 (52,7%) mulheres, com idade média de 40 anos. A prevalência de pirose e regurgitação nos últimos 6 meses foi de 26,2% (n=466) e 11,0% (n=196), respectivamente. Sexo feminino (pirose n=266, 28,5% e regurgitação n=119, 12,7%) apresentou prevalência mais alta do que o masculino (n=200, 23,1% e n=78, 8,9%, respectivamente) (P<0,05). Pirose na última semana foi relatada por 175 indivíduos (9,8%), enquanto episódios de regurgitação por 67 (3,8%). Ausência de impacto dos sintomas no bem-estar geral dos indivíduos foi observada para 82 respondentes (17,6%) com pirose e 18 (9,2%) daqueles com regurgitação. Impacto muito grave foi reportado por 46 (9,8%) indivíduos com pirose e 41 (20,9%) com regurgitação. Sexo feminino foi mais afetado pelos sintomas do que o masculino. CONCLUSÃO: Pirose e regurgitação foram bastante frequentes sendo o sexo feminino mais afetado. Tais sintomas levaram a impacto no bem-estar dos indivíduos, com maior prejuízo para mulheres.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é considerada uma das afecções mais prevalentes em todo o mundo, podendo comprometer de forma significativa a qualidade de vida dos pacientes. Trata-se de uma afecção crônica que se desenvolve quando o refluxo do conteúdo gástrico causa sintomas incomodativos ou complicações, sendo sintomas incomodativos aqueles definidos pelos pacientes.

Gastric reflux disease (GERD) is considered one of the most prevailing sickness in all over the world that can affect meaningfully patient?s quality of life. It?s a case of chronic sickness which is developed when reflux of gastric contents causes disturbing, that are defined by patients, or complications.

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é uma afecção crônica frequente na prática médica, interferindo negativamente na qualidade de vida dos pacientes. Apresenta um amplo espectro de sintomas, classificados como típicos e atípicos, sendo a pirose a principal manifestação. O tratamento inclui medidas comportamentais farmacológicas e eventualmente cirúrgicas

Gastroesophageal reflux disease (GERD) is a common chronic condition that affects negatively the patient's quality of life. Patients with GERD can exhibit a wide variety of symptoms, both typical and atypical. Heartburn is the main clinical presentation. Treatment consists of supportive and pharmacological measures; surgery may eventually be required

Valor diagnóstico de la inhibición de la secreción de ácido en la enfermedad por reflujo gastroesofágico / Diagnostic value of acid inhibition in gastro-esophageal reflux disease

La enfermedad por reflujo gastroesofágico (ERGE) es unade las más frecuentes tanto en atención primaria comoen atención especializada. En el mundo desarrollado, el2.5% al 10% de los sujetos tienen pirosis diaria y alrededordel 30% al menos una vez al mes. Esta enfermedad puede también manifestarse con síntomas extraesofágicos, como dolor torácico no cardíaco, laringitis,tos crónica y asma. Pacientes con síntomas sugestivosde enfermedad no complicada son con frecuenciatratados empíricamente con medidas higiénico-dietéticasy medicación antisecretora. Los inhibidores de la bombade protones (IBP) son escogidos como primera líneade tratamiento por su mayor eficacia en la ERGE. Por ello, en la práctica clínica muchos médicos consideranque el alivio sintomático rápido después de un tratamiento corto con IBP es un marcador adecuado para diagnosticar ERGE. Es la base para que se desarrollara la llamada“prueba de los IBP”. La endoscopia es la exploración más recomendada y aceptada en la ERGE, pero 50% a 75%de los pacientes con síntomas compatibles tienen una endoscopia normal...

Gastroesophageal reflux disease (GERD) is one of the most common disorders observed by both primary carephysicians and gastroenterologists. In the developed world, between 2.5 and 10% of the adult populationhas heartburn daily and about 30% experience thiscondition at least once monthly. This disorder can alsobe associated with extra-esophageal symptoms, such asnon-cardiac chest pain, laryngitis, cough and asthma. Patients with symptoms suggestive of uncomplicated disease are frequently treated empirically with lifestyle modifications and acid suppressive medications. ProtonPumpInhibitors (PPI) are often used as first-line therapy because they are more effective than other availabletreatments for GERD. In clinical practice, therefore, manyphysicians consider that rapid symptom relief after a shortcourse of PPI therapy is a valuable marker for a diagnosisof GERD This represents the basis for the developmentof so-called “PPI test”. Endoscopy is the most acceptableand recommendable exploratory procedure but resultsare normal in 50-75% of patients whose symptoms are compatible with GERD...

Efecto del bypass en la esofagitis erosiva en pacientes con obesidad mórbida / Effects of gastric bypass on erosive esophagitis in obese subjects

Background: Obesity is an important risk for pathological gastroesophageal reflux. Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. Patients and methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity.

Comprometimento hepático na Paracoccidioidomicose / Hepatic Involvement in Paracoccidioidomycosis

A paracoccidioidomicose compromete o fígado e/ou as vias biliares em número considerável de pacientes na forma disseminada aguda da doença do tipo linfático-abdominal tendo sua traduçäo em processo degenerativo gordo do parênquima hepático, hepatite aguda, hepatite granulomatosa crônica, fibrose portal de pequena intensidade e ocasionalmente necrose acentuada, alteraçöes essas concomitantes com icterícia e fresqüentemente com icterícia obstrutiva extra-hepática que domina o quadro clínico