ABSTRACT
BACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate. AIM: We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE. METHODS: Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies. RESULTS: Among the 103 studied patients, 79 (76.7 percent) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5 percent of patients, and erosive esophagitis was found in 12.6 percent. Only one patient presented lesions suggestive of EoE. Histological examination revealed >20 eo/HPF in this patient. CONCLUSION: Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Eosinophilic Esophagitis/complications , Gastroesophageal Reflux/complications , Diagnosis, Differential , Eosinophilic Esophagitis/epidemiology , Eosinophilic Esophagitis/pathology , Gastroesophageal Reflux/drug therapy , Gastroesophageal Reflux/pathology , Omeprazole/therapeutic use , Prevalence , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Treatment FailureABSTRACT
BACKGROUND: Patients with gastroesophageal reflux disease may or may not have endoscopic esophagitis; there are few studies comparing these groups among themselves. OBJECTIVES: This study was designed in order to evaluate differences between patients with gastroesophageal reflux disease with and without esophagitis. PATIENTS/METHODS: A hundred and twenty-two patients with gastroesophageal reflux disease characterized by esophageal endoscopy and pHmetry were included, 90 with and 32 without esophagitis. Assessment involved an anamnesis, including the following data: age, sex, heartburn, dysphasia, non-cardiac chest pain and respiratory symptoms. Heartburn was analyzed in more detail, its duration, intensity and periodicity being determined. RESULTS: No statistical significant difference was observed between the groups, regarding age, sex or presence of symptoms. However, in the group with esophagitis, heartburn classified as severe or very severe was more frequent. CONCLUSIONS: 1. The groups of patients with or without esophagitis analyzed were very similar concerning age, gender and presence of symptoms. However, regarding the heartburn's intensity, it was more intense in the group with esophagitis. 2. Among patients with gastroesophageal reflux disease, there is a large number of cases without esophagitis (26.2%) and that prolonged pH-monitoring is fundamental in its identification; 3. A better definition of reflux disease, esophagitis and pathological reflux is needed, in order to allow better diagnostic accuracy and comparisons in different studies on this subject.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Esophagitis, Peptic , Gastroesophageal Reflux , Chi-Square Distribution , Deglutition Disorders , Esophagitis, Peptic , Heartburn , Hydrogen-Ion Concentration , Retrospective Studies , Severity of Illness Index , Statistics, NonparametricABSTRACT
Apresenta-se artigo de revisao sobre dor toracica nao-cardiaca. Destaca-se que e elevado o numero de pacientes que apresentam tal manifestacao algica e que as principais afeccoes digestivas que podem determina-la sao a doenca do refluxo gastroesofagico e os disturbios motores esofagicos. Descrevem-se os metodos propedeuticos utilizados para o diagnostico. A pequena divulgacao do tema em questao, especialmente em nosso meio, deve-se a baixa disponibilidade dos metodos propedeuticos adequados e, fundamentalmente, ao baixo indice de suspeicao clinica por parte dos medicos. O objetivo principal deste texto e a disseminacao do conhecimento acumulado sobre o tema