Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis

OBJETIVOS: o objetivo do presente estudo é estudar a hemodinâmica portal em pacientes com hipertensão portal secundária a forma hepatoesplênica da esquistossomose e avaliar a contribuição do hiperfluxo esplênico na sua fisiopatologia CASUISTICA E MÉTODOS: Foram estudados prospectivamente 16 pacientes portadores de hipertensão portal secundária à forma hepatoesplênica da esquistossomose mansônica com indicação de tratamento cirúrgico. Todos foram submetidos a avaliação hemodinâmica portal com cateter de termodiluição 4F antes e após a realização de desvascularização esofago-gástrica com esplenectomia. RESULTADOS: Na avaliação intra-operatória inicial observou-se pressão (28,5 + 4,5 mmHg ) e fluxo (1750,59 ± 668,14 ml/min) portais iniciais bem acima dos valores considerados normais. Houve queda significante de 25 por cento na pressão (21,65 ± 5,55 mmHg ) e de 42 por cento no fluxo (1011,18 ± 332,73 ml/min) ao término da cirurgia. Quatorze pacientes (87.5 por cento) apresentavam fluxo portal superior a 1200 ml/min e, em 5 casos, valores superiores a 2000 ml/min foram observados. CONCLUSÕES: A pressão e o fluxo portais estão aumentados na hipertensão portal esquistossomótica. A desvascularização esofago-gástrica com esplenectomia reduz significativamente tanto a pressão quanto o fluxo portais. Estes dados favorecem a hipótese do hiperfluxo esplâncnico (esplênico e mesentérico) na fisiopatologia da hipertensão portal na esquistossomose forma hepatoesplênica.

The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy

BACKGROUND: Many of the currently used Helicobacter pylori eradication regimens fail to cure the infection due to either antimicrobial resistance or poor patient compliance. Those patients will remain at risk of developing potentially severe complications of peptic ulcer disease. AIM: We studied the impact of the antimicrobial resistance on the efficacy of a short course pantoprazole based triple therapy in a single-center pilot study. METHODS: Forty previously untreated adult patients (age range 20 to 75 years, 14 males) infected with Helicobacter pylori and with inactive or healing duodenal ulcer disease were assigned in this open cohort study to 1 week twice daily treatment with pantoprazole 40 mg, plus clarithromycin 250 mg and metronidazole 400 mg. Helicobacter pylori was assessed at entry and 50 ± 3 days after the end of treatment by rapid urease test, culture and histology of gastric biopsies. The criteria for eradication was a negative result in the tests. Susceptibility of Helicobacter pylori to clarithromycin and metronidazole was determined before treatment with the disk diffusion test. RESULTS: One week treatment and follow up were complete in all patients. Eradication of Helicobacter pylori was achieved in 35/40 patients (87.5 percent) and was higher in patients with nitroimidazole-susceptible strains [susceptible: 20/20 (100 percent), resistant: 10/15 (67 percent)]. There were six (15 percent) mild adverse events reports. CONCLUSIONS: A short course of pantoprazole-based triple therapy is well tolerated and effective in eradicating Helicobacter pylori. The baseline metronidazole resistance may be a significant limiting factor in treatment success.

Cholestasis in a murine experimental model: lesions include hepatocyte ischemic necrosis

OBJECTIVE: To establish a murine experimental model of bile duct obstruction that would enable controlled observations of the acute and subacute phases of cholestasis. METHODOLOGY: Adult male isogenic BALB/c mice underwent a bile duct ligation (22 animals) or a sham operation (10 animals). Fifteen days after surgery, or immediately after the animal's death, macroscopic findings were noted and histological study of the liver, biliary tree, and pancreas was performed (hematoxylin-eosin and Masson trichromic staining). RESULTS: Beginning 24 hours after surgery, all animals from the bile duct ligation group presented progressive generalized malaise. All animals presented jaundice in the parietal and visceral peritoneum, turgid and enlarged liver, and accentuated dilatation of gallbladder and common bile duct. Microscopic findings included marked dilatation and proliferation of bile ducts with accentuated collagen deposits, frequent areas of ischemic necrosis, hepatic microabscesses, and purulent cholangitis. Animals from the sham operation group presented no alterations. CONCLUSION: We established a murine experimental model of induced cholestasis, which made it possible to study acute and subacute tissue lesions. Our data suggests that in cholestasis, hepatic functional ischemia plays an important role in inducing hepatic lesions, and it also suggests that the infectious process is an important factor in morbidity and mortality

Therapeutic efficacy of ranitidine bismuth citrate with clarithromycin for seven days in the eradication of Helicobacter pylori in Brazilian peptic ulcer patients

CONTEXT: The curative treatment of peptic ulcer is made available nowadays through the eradication of the bacterium Helicobacter pylori, which is associated with it, but the best therapeutic regimen is yet to be determined. OBJECTIVE: To assess the efficacy of a therapeutic regimen with 400 mg ranitidine bismuth citrate associated with 500 mg clarithromycin given twice a day for seven days in a cohort of Brazilian patients with peptic ulcer. TYPE OF STUDY: Cross-sectional study. SETTING: Tertiary-care hospital. PATIENTS: One hundred and twenty nine outpatients, with active or healed peptic ulcers infected by Helicobacter pylori, diagnosed via endoscopy with confirmation via the urease test and histological examination, who had never undergone a regimen for the eradication of the bacterium. PROCEDURE: Administration of 400 mg ranitidine-bismuth and 500 mg clarithromycin twice a day, for seven days. MAIN MEASUREMENTS: Efficacy of the treatment, with a check on the cure done via another endoscopy eight weeks after drug administration. The eradication of the bacterium was determined via the urease test and histological examination. Patients who were negative for both were considered to be cured. RESULTS: Eight patients failed to complete the study. The eradication rate according to intention to treat was 81 percent (104/129) and per protocol was 86 percent (104/121). CONCLUSION: The bismuth ranitidine compound associated with clarithromycin used for one week was shown to be a simple, effective and well-tolerated therapeutic regimen for the eradication of Helicobacter pylori

Historico do Departamento de Gastroenterologia da FMUSP / The history of the Department of Gastroenterology of FMUSP

O Departamento de Gastroenterologia da FMUSP reune tres disciplinas : Gastroenterologia Clinica, Coloproctologia e Cirurgia do Aparelho Digestivo. A atividade de ensino, pesquisa e assistencia medica do Departamento de gastroenterologia se prende, portanto, a tudo que se refere ao ...

Treatment by splenectomy of a portal vein aneurysm in hepatosplenic schistosomiasis

Portal vein aneurysm is a rare medical entity that can be caused by chronic hepatic diseases with portal hypertension. We describe a 45-year-old man with variceal bleeding from hepatosplenic schistosomiasis and an incidentally found intrahepatic aneurysm. Diagnosis was confirmed with non-invasive imaging exams, arteriography and liver biopsy. Following splenectomy, the aneurysm diameter decreased substantially

Omeprazole, Furazolidone, and Tetracycline: an eradication treatment for resistant H. pylori in Brazilian patients with peptic ulcer disease

OBJECTIVES: To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori) using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS: Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT) and histological examination, untreated and previously unsuccessfully treated by macrolides and nitroimidazole, were medicated with omeprazole 20 mg daily dose and tetracycline 500 mg and furazolidone 200 mg given 3 times a day for 7 days. Another endoscopy or a breath test was performed 12 weeks after the end of treatment. Patients were considered cured of the infection if a RUT and histologic examination proved negative or a breath test was negative for the bacterium. RESULTS: Sixty-four patients were included in the study. The women were the predominant sex (58 percent); the mean age was 46 years. Thirty-three percent of the patients were tobacco users, and duodenal ulcer was identified in 80 percent of patients. For the 59 patients that underwent follow-up examinations, eradication was verified in 44 (75 percent). The eradication rate for the intention-to-treat group was 69 percent. The incidence of severe adverse effects was 15 percent. CONCLUSION: The treatment provides good efficacy for H. pylori eradication in patients who were previously treated without success, but it causes severe adverse effects that prevented adequate use of the medications in 15 percent of the patients

Preoperative serum levels of ca 72-4, cea, ca 19-9, and Alpha-fetoprotein in patients with gastric cancer

INTRODUCTION: The clinical importance of preoperative serum levels of CA 72-4, carcinoembryonic antigen (CEA), CA 19-9, and alpha-fetoprotein (AFP) was prospectively evaluated in 44 patients with gastric cancer. METHOD: The serum tumor marker levels were determined by commercial radioimmunoassay kits. Positivity for CA 72-4 (>4 U/mL), CEA (>5 ng/mL), CA 19-9 (>37 U/mL), and AFP (>10 ng/mL) were correlated according to the stage, histology, and lymph node metastasis. RESULTS AND DISCUSSION: CA 72-4 showed a higher positivity rate for gastric cancer (47.7 percent) than CEA (25 percent), CA 19-9 (25 percent), and AFP (0 percent). The combination of CA 72-4 with CEA and CA 19-9 increased the sensitivity to 61.4 percent. The positivity rates of CA 72-4 in patients at stages I and II (initial disease) and in patients at stages III and IV (advanced disease) were 9 percent and 60.6 percent, respectively (P < 0.005). No correlation was found between CEA and CA 19-9 levels and the stage of gastric cancer. There was a tendency of positivity for CA 72-4 to suggest lymph node involvement, but it was not significant (P = 0.075). Serum levels of tumor markers did not show a correlation with the histological types of gastric cancer. CONCLUSION: Preoperative serum levels of CA 72-4 provided a predictive value in indicating advanced gastric cancer

Papel do pantoprazol em baixa dose no tratamento ambulatorial da dispepsia funcional, das gastrites e da esofagite de refluxo leve / Role of low-dose pantoprazole in outpatient treatment of functional dyspepsia, gastritis, and mild gastroesophageal reflux disease

Sintomas dispépticos säo queixas comuns na prática clínica diária. Apenas uma minoria destes pacientes tem alguma alteraçäo estrutural que explique os sintomas. A maioria nlo apresenta lesöes estruturais, sendo, portanto, rotulada como portadora de dispepsia funcional ou DRGE sem esofagite. Muitos säo inadequadamente rotulados como portadores de gastrite A inibiçäo da secreçäo ácida é um elo comum na abordagem terapêutica destas afecçöes. O objetivo do presente estudo foi a avaliaçäo do papel do pantoprazol 20 mg no alívio sintomático da dispepsia funcional, das gastrites e no tratamento da doença do refluxo gastroesofágico sem esofagite ou da esofagite de refluxo leve. Num estudo aberto e multicêntrico foram incluídos 5.105 pacientes ambulatoriais, divididos em quatro grupos: Grupo 1:DRGE com 641 pacientes (12,6 porcento), Grupo 2:DF com 1709 pacientes(33,5 porcento), Grupo 3:gastrites com 2.105 pacientes(41,2 porcento), Grupo 4: outros(diagnósticos mistos: DRGE e DF, DRGE e gastrites, DF e gastrites) com 650 pacientes (12,7 porcento). Todos os sintomas gastrointestinais avaliados apresentaram melhora estatísticamente significante no pós-tratamento quanto comparados ao quadro inicial. Com o término do tratamento, a ausencia dos sintomas foi observada em cerca de 80 porcento a 95 porcento dos pacientes. Reaçöes adversas foram descritas em 1 porcento dos pacientes durante o tratamento com pantoprazol, sendo as mais observadas cefaléias, constipaçlo intestinal e diarréia. O presente estudo demonstrou uma eficácia significativa näo apenas em relaçäo a remissäo dos sintomas da dispepsia do tipo úlcera, mas também de sintomas característicamente descritos como motores, como a sensaçäo de plenitude gástrica ou empachamento, saciedade precoce, retardo do esvaziamento gástrico, náuseas e vômitos com o uso diário de 20 mg de pantoprazol durante uma média de três semanas. O alívio sintomático da dispepsia funcional, das gastrites e no tratamento da doença de refluxo gastroesofágico sem esofagite ou da esofagite de refluxo leve foi significativo com excelente tolerabilidade e segurança.

Low efficacy of an ultra-short term, once-daily dose triple therapy with omeprazole, azithromycin, and secnidazole for Helicobacter pylori eradication in peptic ulcer

PURPOSE: To determine the eradication rate of an ultra-short treatment schedule for Helicobacter pylori infection in a population with peptic ulcers, using omeprazole, secnidazole, and azithromycin in a once-daily dose for 3 days. METHODS: Thirty patients with peptic ulcer diagnosed by upper endoscopy and for Helicobacter pylori infection by rapid urease test and histologic examination received omeprazole 40 mg, secnidazole 1000 mg, and azithromycin 500 mg, administered once daily for 3 days. A follow-up exam was performed 12 weeks after the end of the treatment. Patients who were negative for Helicobacter pylori infection by rapid urease test and histologic examination were considered cured. RESULTS: Patients were predominantly female, and the mean age was 50 years. Duodenal peptic ulcer was found in 73 percent of the patients. Eradication was achieved in 9 of the 28 (32 percent) patients as determined from the follow-up endoscopic exam. The eradication rate by intention to treat was 30 percent. Side effects were present in 3 percent of the patients, and compliance to treatment was total. CONCLUSIONS: In spite of the low rate of side effects and good compliance, the eradication index was low. A possible drawback of this therapy is that it reduces the efficacy of macrolide and nitroimidazole compounds in subsequent treatments

Pancreatic involvement in co-infection visceral leishmaniasis and HIV: histological and ultrastructural aspects

The involvement of the gastrointestinal tract in the co-infection of HIV and Leishmania is rarely reported. We report the case of an HIV-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. Light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for HIV p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or HIV infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the HIV infection. Further studies are needed to elucidate these issues

Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor, tinidazole and clarithromycin, in brazilian patients with peptic ulcer

Triple therapy is accepted as the treatment of choice for H. pylori eradication. In industrialized countries, a proton pump inhibitor plus clarithromycin and amoxicillin or nitroimidazole have shown the best results. Our aims were: 1. To study the eradication rate of the association of a proton pump inhibitor plus tinidazole and clarithromycin on H. pylori infection in our population. 2. To determine if previous treatments, gender, age, tobacco, alcohol use, and non-steroidal anti-inflammatory drugs (NSAIDs) change the response to therapy. METHODS: Two hundred patients with peptic ulcer (upper endoscopy) and H. pylori infection (histology and rapid urease test - RUT) were included. A proton pump inhibitor (lansoprazole 30 mg or omeprazole 20 mg), tinidazole 500 mg, and clarithromycin 250 mg were dispensed twice a day for a seven-day period. Eradication was assessed after 10 to 12 weeks of treatment through histology and RUT. RESULTS: The eradication rate of H. pylori per protocol was 65 percent (128/196 patients). This rate was 53 percent for previously treated patients, rising to 76 percent for not previously treated patients, with a statistical difference p<0.01. No significant difference was observed regarding sex, tobacco use, alcohol consumption, and NSAID use, but for elderly patients the difference was p = 0.05. Adherence to treatment was good, and side effects were mild. CONCLUSIONS: A proton pump inhibitor, tinidazole, and clarithromycin bid for seven days resulted in H. pylori eradication in 65 percent of the patients. Previous treatments were the main cause of treatment failure

Ursodeoxycholic acid does not interfere with in vivo Helicobacter pylori colonization

A low frequency of Helicobacter pylori in the gastric mucosa of patients with alkaline gastritis has been reported. At the same time, it can be noted that the growth of bacteria can be inhibited by bile acids. We studied 40 patients with chronic gastritis related to Helicobacter pylori in order to determine the effect of ursodeoxycholic acid on this infection. Diagnoses of the infection and the inflammatory process were obtained by histologic study of gastric biopsies collected during endoscopy. Two groups were studied: group I received ursodeoxycholic acid - 300 mg/day, and group II received the placebo, twice a day, both for 28 days. The colonization by Helicobacter pylori and the intensity of the mononuclear and polymorphonuclear inflammatory infiltrate were determined before (time 1) and after (time 2) treatment. Ursodeoxycholic acid had no effect on the Helicobacter pylori infection. A significant reduction in the intensity of the mononuclear inflammatory infiltrate of the gastric antrum mucosa was observed in patients from group I, when we compared not only times 1 and 2 but also groups I and II. However, this was not the case with the body mucosa. We concluded that ursodeoxycholic acid had no action on the colonization by Helicobacter pylori or on the polymorphonuclear inflammatory infiltrate, but it caused a significant reduction in the intensity of the mononuclear inflammatory infiltrate of the gastric antrum

Helicobacter pylori genotyping from positive clotests in patients with duodenal ulcer

Even though the seroprevalence of H. pylori may be high in the normal population, a minority develops peptic ulcer. Colonization of the gastric mucosa by more pathogenic vacA strains of H. pylori seems to be associated with enhanced gastric inflammation and duodenal ulcer. H. pylori genotyping from positive CLOtests was developed to determine the vacA genotypes and cagA status in 40 duodenal ulcer patients and for routine use. The pathogenic s1b/ m1/ cagA genotype was the most frequently occurring strain (17/42.5 per cent); only two (5 per cent) patients presented the s2/ m2 genotype, the less virulent strain. Multiple strains were also detected in 17 (42.5 per cent) patients. Multiple strains of H. pylori colonizing the human stomach have been underestimated, because genotyping has been performed from cultures of H. pylori. We concluded that genotyping of H. pylori from a positive CLOtest had the advantages of reducing the number of biopsies taken during endoscopy, eliminating the step of culturing H. pylori, and assuring the presence of H. pylori in the specimen being processed.

Manifestaçöes radiológicas da doença de Crohn do intestino grosso em 33 pacientes

Resumo: Avaliamos se as manifestaçöes radiógicas da doença de Crohn do colón em pacientes do Brasil têm comportamento diferente das observadas em países onde ela é mais freqüênte. Avaliamos alteraçöes no colón em enemas e trânsitos de 33 pacientes com colite ou ileocolite da doença de Crohn. Identificamos as següintes manifestaçöes: alteraçöes mucosas difusas 22,5 (por cento), úlceras profundas 72,5 (por cento), úlceras lineares 55,0 (por cento), úlceras aftóides 25,0 (por cento), úlceras rasas 32,5 (por cento), saculaçöes 20,0 (por cento), estenoses 75,0 (por cento), formaçöes polipiformes 32,5 (por cento), deformidades cecais de natureza extrínseca 40,0 (por cento), haustraçöes convergentes para a válvula iileocecal 11,5 (por cento) e ainda a distribuiçäo das lesöes. Observamos fístulas em 39,4 (por cento) dos pacientes. Pregas mucosas convergentes para úlceras foram identificadas em 22,5 (por cento) dos exames, em 54,5 (por cento)deles convergindo para úlceras rasa agrupadas. Concluindo, os dados obtidos näo indicam comportamento diferente da doença de Crohn do cólon em nosso meio

Efeito do tratamento da depressão sobre o esvaziamento gástrico / Treatment of depression effect on the gastric emptying

O esvaziamento gástrico foi medido por meio de refeição sólida marcada com 99mTc em 11 pacientes que atendiam os critérios de "depressão maior" do DSM-III-R antes e após o tratamento com fluoxetina (20 a 40 mg por dia) durante nove semanas. Após o tratamento não se observou redução no tempo para o esvaziamento gástrico de metade da refeição de prova (T1/2) em relação a antes do tratamento. Pode-se, no entanto, separar os pacientes em dois grupos: 1) Os que exibiram resposta ao antidepressivo (redução do escore da Escala de Depressão de Hamilton > 50 por cento) e apresentaram redução significativa do T1/2 (p<0,001) e 2) Os pacientes que, sem resposta ao tratamento (redução do escore da Escala de Depressão de Hamilton 50 por cento), não apresentaram redução do T 1/2 (p>0,10). Concluímos que a alteração da velocidade do esvaziamento gástrico pode estar correlacionada à resposta ao tratamento antidepressivo e que sua redução ou aumento não pode ser atribuída à ação farmacológica da fluoxetina sobre o estômago, mas antes ao efeito da melhoria da depressão sobre a motilidade gástrica.

Validation of 14-C-urea breath test for diagnosis of Helicobacter pylori

The aim of this study was to validate the 14C-urea breath test for use in diagnosis of Helicobacter pylori infection. Thirty H. pylori positive patients, based on histologic test and thirty H. pylori negative patients by histology and anti-H. pylori IgG entered the study. Fasting patients drank 5 uCi of 14C-urea in 20 ml of water. Breath samples were collected at 0, 5, 10, 15, 20 and 30 min. The difference of cpm values between the two groups was significant at all the time intervals, besides time 0 (p<0.0001). At 20 min, the test gave 100 percent sensitivity and specificity with a cut-off value of 562 cpm. Females were higher expirers than males (p=0.005). 14C-urea breath test is highly accurate for Helicobacter pylori diagnosis. It is fast, simple and should be the non-invasive test used after treating Helicobacter pylori infection.

Estado hiperdinamico sistemico na forma hepatoesplenica da esquistossomose mansonica / Hyperdynamic circulation in manson's hepatoesplenic schistosomiasis

Foram estudados prospectivamente 22 pacientes portadores de hipertensao portal a forma hepatoesplenica da esquistossomose mansonica com indicacao para tratamento cirurgico. Todos os pacientes foram submetidos a monitorizacao hemodinamica invasiva com cateter de arteria pulmonar. Os resultados mostraram alteracoes hemodinamicas caracterizadas por aumento do indice cardiaco (4,50 + ou - 0,96 L/min/m2) associado a reducao no indice de resistencia vascular sistemica (1638,60 + ou - 441,86 dynas.seg/cm5.m2). O indice sistolico (55,51 + ou - 12,43 mL/bat/m2) e os indices de trabalho cardiaco esquerdo (5,75 + ou - 1,39 Kg.m/m2) e direito (1,09 + ou - 0,70 Kg.m/m2) estavam tambem aumentados. A pressao media de arteria pulmonar estava aumentada (17,23 + ou - 8,63 mmHg) e o indice de resistencia vascular diminuido (147,95 + ou - 126,21 dinas.seg/cm5.m2). Conclui-se que a forma hepatoesplenica da esquistossomose determina um estado hiperdinamico sistemico, provavelmente secundario a circulacao colateral porto-sistemica, com discreta hipertensao pulmonar

Complicaçöes das pancreatites crônicas em Säo Paulo / Complications of chronic pancreatitis in Sao Paulo (Brasil)

As pancreatites cronicas (PC) apresentam caracteristicas peculiares em diferentes areas geograficas. Com o intuito de avaliar as caracteristicas clinicas, em particular a frequencia e a etiopatogenia das complicacoes das PC em Sao Paulo comparativamente a outros centros, foram analisados, retrospectivamente, 545 portadores desta afeccao. Destes, 493 (90,5 por cento) eram do sexo masculino e 52 (9,5 por cento) do feminino, com idades variando entre 8 e 88 anos (38,2 + ou - 9,3 anos). Os principais fatores etiologicos foram apresentados por: alcoolismo cronico em 509 dos 545 pacientes (93,4 por cento), hereditariedade em quatro (0,7 por cento), desnutricao em tres (0,5 por cento), alteracoes metabolicas em tres (0,5 por cento), alteracoes metabolicas em tres (0,5 por cento) e obstrucao ao fluxo pancreatico em dois pacientes (0,3 por cento)...

The screening sensitivity of endoscopy, acid perfusion test and 24-hour pH-monitoring to evaluate esophagitis in patients with heartburn and histological esophagitis

The sensitivity of endoscopic examinations, acid perfusion test and 24-hour esophageal pH-monitoring, were studied in patients with hearburn. Thirty six adult patients with histological esophagitis were included in this prospective study. Endoscopy showed esophageal lesion in 18/36 (sensitivity of 50 percent): esophagitis grade I in 10 (55.6 percent) and, grade II in eight (44.4 percent). Acid perfusion test was positive in 10/25 (sensitivity of 40 percent) of the patients submitted to the test. Twenty-four-hour pH-monitoring was positive in 17/29 patients (sensitivity of 58.6 percent): eight (61.5 percent) did not have esophageal lesion at endoscopy, two (25 percent) had esophagitis grade I and seven (87.5 percent) had esophagitis grade II. In the patients submitted to 24-hour pH-monitoring, a greater number or reflux episodes in orthostatic position than in supine position (P<0.0001) was observed. The total number of reflux episodes, the most prolonged reflux and the total pH time < 4 were statistically higher in post-prandial period than during meals (P = 0.05).