[Study in oral cavity alterations in patients with gastroesophageal reflux disease]. / Estudo de alterações na cavidade oral em pacientes com doença do refluxo gastroesofágico.

BACKGROUND: The gastroesophageal reflux disease, which has become highly and increasingly incident, may be manifested by typical (pyrosis and regurgitation) and atypical (pulmonary, otorhinolaryngological and buccal) symptoms. AIM: To analyze alterations in the oral cavity patients with gastroesophageal reflux disease. METHODS: One hundred patients were studied being 50 gastroesophageal reflux disease patients (group 1) and 50 controls (group 2). All patients were submitted to an oral clinical exam and specific survey. Patients in group 1 were submitted to upper endoscopy, manometry and esophageal pH monitoring. RESULTS: The upper endoscopy revealed esophagitis in all patients, 20 erosive esophagitis, 30 no-erosive esophagitis and 38 hiatal hernia. Average pressure of the lower esophageal sphincter was 11 +/- 4,8 mm Hg and of the upper esophageal sphincter 75 +/- 26,5 mm Hg. In 42 patients of group 1 (84%) pathological gastroesophageal reflux was observed. Clinical exams revealed: dental erosions in group 1: 273 faces and in group 2: 5 tooth decays in group 1: 23 and 115 in group 2; abrasion in group 1: 58 and in group 2: 95; attrition wear: 408 in group 1 and 224 in group 2. The most damages was the palatine face. In group 1, 21 patients complained about frequent episodes of canker sores, 35 of tooth sensibility, 26 of burning mouth and 42 of sour taste in the mouth. In group 2 the complaints were observed in lower number of patients. CONCLUSIONS: Patients with gastroesophageal reflux disease present higher incidence of dental erosion, canker sores, mouth burning sensation, sensitivity and sour taste than controls. Patients with gastroesophageal reflux disease show lower incidence of tooth decays as compared to controls.

Morphological and functional evaluation of distal esophagus of rabbits submitted to esophageal infusion with caustic soda.

UNLABELLED: The ingestion of caustic substances is an important emergency situation, because of its serious consequences. PURPOSE: To study morphological and functional alterations of the esophagus in rabbits submitted to esophageal infusion of caustic soda (NaOH). METHODS: The 88 rabbits studied were divided into 4 groups: G1 (n=22) were submitted to esophageal infusion with distilled water. G2, G3, and G4 were submitted to esophageal infusion of 2%, 4% and 6% NaOH respectively. Morphological alterations were studied in 12 animals from each group and manometric alterations in the remaining 10. An analysis was made of lower esophageal sphincter (LES) pressure, number and amplitude of contractions in the distal third of the esophagus. These studies were performed before (moment M1) and at 30 minutes, 6 hours, and 24 hours after (moments M2, M3, and M4, respectively) esophageal infusion. RESULTS: Morphological evaluation: G1 - no alterations; G2 - edema, hyperemia, and ecdysis; G3 - enlarged calibre of esophagus, ulcers, ecdysis of mucosa; G4 - lesions similar to G3, but more intense, areas of extensive hemorrhage at M3 and M4. Functional evaluation: LES was higher at M2; the number of distal third lower esophageal contractions in G3, and G4 was lower; and the contraction amplitude was lower in G4. CONCLUSIONS: 1) Esophageal infusion with caustic soda in rabbits is a good experimental model for studying caustic esophagites. 2) Esophageal infusion with NaOH caused lesions in the esophageal wall, with gravity proportional to solution concentration; 3) Infusion caused LES spasm at M2, and reduced both contraction number and amplitude in the distal third of the esophagus.

[Esophageal cancer in patient with chagasic megaesophagus]. / Câncer do esôfago em paciente com megaesôfago chagásico.

BACKGROUND: Megaesophagus constitutes a public health problem in our country since it affects individuals in the most productive phase of their lives. During the development of the disease, people suffering from it may present association with esophageal cancer. AIM: To analyze the clinical and epidemiological aspects of patients with megaesophagus and esophageal cancer. METHODS: Twenty patients with megaesophagus and cancer (group 1) and 20 patients with esophageal cancer (group 2) were retrospectively analyzed. Demographic data, habits (alcoholism and smoking), tumor histological type, lesion location, cellular differentiation, staging, treatment and survival were assessed. RESULTS: No difference was observed between the groups in relation to age, sex, lesion location, tumor histological type, cellular differentiation, staging or survival. As regards habits, the association of alcoholism with smoking was observed in a larger number of patients with esophageal cancer without the megaesophagus antecedent. CONCLUSION: The clinical characteristics of patients with megaesophagus and cancer do not differ from those of patients with malignant esophageal neoplasia, particularly as regards the unfavorable prognosis with the instituted treatment. Patients with megaesophagus may present esophageal tumor at any part of the organ.

The Glasgow Prognostic Score. An useful tool to predict survival in patients with advanced esophageal squamous cell carcinoma.

PURPOSE: To evaluate the usefulness of the Glasgow Prognostic Score (GPS) in patients with esophageal carcinoma (EC). METHODS: A total of 50 patients with EC were analyzed for GPS, nutritional and clinicopathologic parameters. Patients with CRP ≤ 1.0mg/L and albumin ≥ 3.5mg/L were considered as GPS = 0. Patients with only CRP increased or albumin decreased were classified as GPS = 1 and patients with CRP > 1.0mg/L and albumin < 3.5mg/L were considered as GPS = 2. RESULTS: GPS of 0, 1 and 2 were observed in seven, 23 and 20 patients, respectively. A significant inverse relationship was observed between GPS scores and the survival rate. The survival rate was greatest in patients with GPS = 0 and significantly higher than those from patients with GPS = 1 and GPS = 2. Minimum 12-month survival was observed in 71% patients with GPS = 0 and in 30% patients with GPS = 1. None of the patients with GPS = 2 survived for 12 months. A significant relationship between CRP or albumin individually and the survival rate was observed. No significant relationship among nutritional, clinic pathological parameters and survival was found. CONCLUSION: Glasgow Prognostic Score is an useful tool to predict survival in patients with esophageal carcinoma.

[Manometric evaluation of distal esophagus of rabbits submitted to open and laparoscopic fundoplication]. / Avaliação manométrica do esôfago distal de coelhos submetidos a fundoplicatura total laparotômica e laparoscópica.

BACKGROUND: Total fundoplication used in gastroesophageal reflux treatment, may be performed according to two techniques: laparotomy and laparoscopy. AIM: To study the lower esophageal sphincter in rabbits submitted to open and laparoscopic fundoplication. MATERIAL AND METHODS: Electromanometry studies of esophagus were carried out in 40 male rabbits, through the pull trough technique and infusion of the catheters with distilled water. The pressure width (mm Hg) and the length (cm) of the lower esophageal sphincter were measured in basal conditions (moment 1). The 40 animals were divided into four groups of 10 animals, according to the following surgical procedure: group 1: open total fundoplication; group 2: median laparotomy and dissection of gastroesophageal junction; group 3: laparoscopy total fundoplication; group 4: pneumoperitonium and dissection of the gastroesophageal junction. In moment 2 (1 week after the surgery) the manometry of the esophagus was performed in every animals. RESULTS: In groups 1 (open fundoplication) and 3, an increase of pressure width and length of the lower esophageal sphincter was observed. In groups 2 and 4, the pressure width and length of the lower esophageal sphincter presented no significant alteration. CONCLUSIONS: The fundoplication affects the antireflux gastroesophagic barrier and it becomes more efficient, because the pressure and the length of the lower esophageal sphincter increased after the pos-operated step of the surgery. This effect was observed in the two studied techniques, the laparotomy and the laparoscopy.

Diagnosis and management of gastroesophageal reflux disease.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma.

PURPOSE: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus.

Pharyngoesophageal diverticulum: evaluation of treatment results.

OBJECTIVE: To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments. METHODS: We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler. RESULTS: Operative mortality was zero in both groups. Early complications: group 1 - two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2. CONCLUSION: Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study.

PURPOSE: To analyze the clinicopathological features and outcome of patients with pathologically proven superficial squamous cell carcinoma of the esophagus. METHODS: A total of 234 consecutive cases of esophageal carcinoma in a 15-year period were reviewed. RESULTS: Superficial esophageal cancer was found in five patients (2.1%). They were four men and one woman and the mean age was 52.5 years. Smoking and alcohol were the main risk factors. Achalasia due to Chagas disease occurred in one patient and a second primary tumor developed in the larynx in another patient. Four patients underwent esophagectomy and one patient received chemoradiotherapy. The histopathologic diagnosis was of squamous cell carcinoma in all cases. Intramucosal tumor (Tis) was identified in three cases and superficially invasive carcinoma in two cases. Four patients are free of disease with survival times of two, four, six and nine years. The patient who developed laryngeal cancer died six years after esophagectomy. CONCLUSION: Long-term survival in patients with esophageal cancer is related to early diagnosis. Therefore, a less aggressive surgical approach, such as endoscopic resection, may be a good option for these patients, if depth of tumor invasion can be accurately predicted by the new imaging tools.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke.

PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.

Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease.

CONTEXT: In the gastroesophageal reflux disease (GERD), a highly prevalent digestive disorder, gastric content may return to the esophagus and reach the mouth, thus leading to a small number of carious lesions and high incidence of dental erosion. Since saliva plays a major role in oral homeostasis, evaluating salivary parameters is necessary in attempting to explain such outcome. OBJECTIVES: This study aimed at analyzing salivary parameters (salivary flow, pH and buffering capacity), bacterial count, caries index and dental erosion in patients with GERD. MATERIALS: Sixty patients were studied, and of these, 30 had GERD (group 1), and 30 were controls (group 2). Gastroesophageal reflux disease diagnosis confirmation was achieved by means of endoscopy, manometry and pH metric esophageal monitoring. The above mentioned salivary parameters were evaluated in patients from groups 1 and 2. RESULTS: The number of erosions in patients with GERD (group 1) was larger than in controls (P<0.001). The number of carious teeth was smaller in group 1 than in group 2 (P<0.001). Salivary flow (non-stimulated and stimulated) and pH did not show differences between the 2 groups (P = 0.49; P = 0.80 and P = 0.85, respectively). Salivary buffering capacity in patients with GERD showed lower values in controls (P = 0.018). The number of bacteria (Lactobacilli and Streptococci) was smaller in patients with gastroesophageal reflux disease than in controls (P = 0.0067 and P = 0.0017, respectively). CONCLUSION: It was concluded that the large number of erosions must be a result of GERD patients reduced salivary buffering capacity. The reduced number of caries of patients in group 1 can be explained by the low prevalence of bacteria (Lactobacilli and Streptococci), observed in the saliva of patients with chronic reflux.

Grade of esophageal cancer and nutritional status impact on postsurgery outcomes.

CONTEXT: Undernutrition is a well known underlying cause in both disease onset and outcome. OBJECTIVE: To associate disease severity with pre surgical nutritional status, the main postsurgical complications, and mortality in esophagus cancer patients. METHOD: Retrospective data from 100 patients (38-81 years old, 85% males) who had undergone esophagectomy (G1/n = 25) or gastro/jejunostomy (G2/n = 75) between 1995 and 2004. Data included clinical, endoscopic, histological (TNM-UICC), dietary, anthropometric, blood chemistry, and postsurgical (>30 days) complications and mortality. Surgical groups were compared by Student's test and existing associations between variables by either c² or Fisher exact tests with P = 0.05. RESULTS: The studied sample was predominantly male (85%), white (80%), smokers and alcoholics (95%), dysphagics (95%) mostly presenting body weight loss before cancer diagnosis (78%). TNM III and IV predominated over I and II, associated (P≤0.005) with higher body mass index and hypoalbuminemia (<3.5 mg/dL) frequency. Esophagic obstructions (n = 77) were associated (P = 0.002) with lower body mass index (kg/m²). Postsurgical complications were more common in G1 (69.2%) than G2, predominantly with infections in G2 (80%) and pleura-pulmonary in G1 (61%). Body mass index and lower lymphocyte counts were associated with early infections and postsurgical complications in G2. Plasma albumin levels were lower in this group than G1, and were associated with postsurgical complications and mortality whereas lower lymphocyte counts was associated with mortality in G1. CONCLUSIONS: Disease severity (or late diagnosis) is associated with poor nutritional status and palliative surgery which lead to more complicated postsurgery outcome and mortality. Early diagnosis and nutritional intervention are the recommended actions.

The Glasgow Prognostic Score. An useful tool to predict survival in patients with advanced esophageal squamous cell carcinoma

PURPOSE: To evaluate the usefulness of the Glasgow Prognostic Score (GPS) in patients with esophageal carcinoma (EC).METHODS: A total of 50 patients with EC were analyzed for GPS, nutritional and clinicopathologic parameters. Patients with CRP ≤ 1.0mg/L and albumin ≥ 3.5mg/L were considered as GPS=0. Patients with only CRP increased or albumin decreased were classified as GPS=1 and patients with CRP > 1.0mg/L and albumin < 3.5mg/L were considered as GPS=2.RESULTS: GPS of 0, 1 and 2 were observed in seven, 23 and 20 patients, respectively. A significant inverse relationship was observed between GPS scores and the survival rate. The survival rate was greatest in patients with GPS= 0 and significantly higher than those from patients with GPS=1 and GPS=2. Minimum 12-month survival was observed in 71% patients with GPS=0 and in 30% patients with GPS=1. None of the patients with GPS=2 survived for 12 months. A significant relationship between CRP or albumin individually and the survival rate was observed. No significant relationship among nutritional, clinic pathological parameters and survival was found.CONCLUSION:Glasgow Prognostic Score is an useful tool to predict survival in patients with esophageal carcinoma.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke.

CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22 degrees C) and cold (8 degrees C) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. CONCLUSION: Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.

Diagnosis and management of gastroesophageal reflux disease / Diagnóstico e tratamento da doença do refluxo gastroesofágico

INTRODUCTION: Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact ...

INTRODUÇÃO: A doença do refluxo gastroesofágico (DRGE) é, provavelmente, uma das doenças mais prevalentes no mundo que compromete significativamente a qualidade de vida. Sua incidência no Brasil é de 12%, o que corresponde a 20 milhões de indivíduos. OBJETIVO: Atualizar o manuseio da DRGE e as novas tendências no diagnóstico e tratamento, revendo as experiências internacional e brasileira sobre o tema. MÉTODO: Foi realizada revisão da literatura baseada em artigos publicados no Medline/Pubmed, SciELO, Lilacs, Embase e Cochrane cruzando os seguintes descritores: doença do refluxo gastroesofágico, diagnóstico, tratamento clínico, cirurgia, fundoplicatura. RESULTADOS: Vários fatores estão envolvidos na fisiopatologia da DRGE, sendo o mais importante o relaxamento transitório do esfíncter inferior do esôfago. As manifestações clínicas são azia, regurgitação (sintomas típicos), tosse, dor torácica, asma, rouquidão e pigarro (sintomas atípicos), que podem ser seguidos ou não de sintomas típicos. Pacientes com DRGE podem apresentar complicações como estenose péptica, hemorragia e esôfago de Barrett, que é o fator predisponente mais importante para adenocarcinoma. O diagnóstico deve ser baseado na anamnese e os sintomas devem ser avaliados em termos de duração, intensidade, frequência, fatores precipitantes e relevância, padrão de evolução e impacto na qualidade de vida do paciente. O diagnóstico exige confirmação com exames diferentes. O objetivo do tratamento clínico é aliviar os sintomas e o tratamento cirúrgico é indicado para os que necessitam de uso contínuo de drogas, com intolerância ao tratamento clínico prolongado e com complica...

[Preoperative and postoperative nutritional evaluation in patients with non-advanced megaesophagus]. / Avaliação nutricional pré e pós-operatória em pacientes com megaesôfago não-avançado.

UNLABELLED: Megaesophagus, an affection characterized by the aperistalsis of the esophageal body and deficient relaxation of the lower esophageal sphincter presents dysphagia as the most frequent complaint. The goal of this study was to evaluate the nutritional status of patients with non-advanced megaesophagus in pre and postoperative periods of laparoscopic cardiomyotomy. Ten patients were studied in five moments (pre operative and at 1, 3, 6 and 12 months after surgery). The anthropometric, hematimetric and biochemical parameters were studied in five moments. CONCLUSIONS: 1) most patients with non-advanced megaesophagus were eutrophic; 2) surgical treatment led to improvement in nutritional status and increase of HDL cholesterol fraction.

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

PURPOSE: To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS: Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus. .

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study

PURPOSE: To analyze the clinicopathological features and outcome of patients with pathologically proven superficial squamous cell carcinoma of the esophagus. METHODS: A total of 234 consecutive cases of esophageal carcinoma in a 15-year period were reviewed. RESULTS: Superficial esophageal cancer was found in five patients (2.1%). They were four men and one woman and the mean age was 52.5 years. Smoking and alcohol were the main risk factors. Achalasia due to Chagas disease occurred in one patient and a second primary tumor developed in the larynx in another patient. Four patients underwent esophagectomy and one patient received chemoradiotherapy. The histopathologic diagnosis was of squamous cell carcinoma in all cases. Intramucosal tumor (Tis) was identified in three cases and superficially invasive carcinoma in two cases. Four patients are free of disease with survival times of two, four, six and nine years. The patient who developed laryngeal cancer died six years after esophagectomy. CONCLUSION: Long-term survival in patients with esophageal cancer is related to early diagnosis. Therefore, a less aggressive surgical approach, such as endoscopic resection, may be a good option for these patients, if depth of tumor invasion can be accurately predicted by the new imaging tools.

Divertículo faringoesofagiano: avaliação dos resultados do tratamento / Pharyngoesophageal diverticulum: evaluation of treatment results

OBJETIVO: Avaliar a evolução pós-operatória de pacientes com divertículo faringoesofagiano submetidos aos tratamentos cirúrgico e endoscópico. MÉTODOS: Foram analisados de maneira retrospectiva 36 pacientes com divertículo faringo-esofagiano atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. Os pacientes foram distribuídos em dois grupos, na dependência do tratamento: grupo 1 (n=24) - diverticulectomia associada á miotomia do cricofaríngeo, através de cervicotomia esquerda; grupo 2 (n=12) - diverticulostomia endoscópica usando grampeador linear. RESULTADOS: A mortalidade operatória foi nula em ambos os grupos. Complicações precoces: grupo 1 - dois pacientes desenvolveram fistula cervical e outros dois, rouquidão; grupo 2 - sem complicações. Complicações tardias: grupo 1 - sem complicações: grupo 2: recidiva da disfagia em quatro pacientes (p=0,01). O seguimento médio foi 33 meses para o grupo 1 e 28 meses para o grupo 2. CONCLUSÃO: Os dois procedimentos foram eficazes na remissão da disfagia. O tratamento cirúrgico apresentou superioridade em relação ao endoscópico, com resolução da disfagia com um único procedimento. O tratamento endoscópico deve ser reservado para os mais idosos e portadores de comorbidades.

OBJECTIVE: To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments. METHODS: We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler. RESULTS: Operative mortality was zero in both groups. Early complications: group 1- two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2. CONCLUSION: Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.