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).

Dispepsia näo-ulcerosa / Non ulcer dyspepsia

Non ulcer dyspepsia is defined as the presence of pain and/or discomfort localized to the upper abdomen, episodic or persistent, with a duration superior of 4 weeks, in the absecence of any organic lesion or sistemic disease. In order to facilitate its management, non ulcer dyspepsia is classified in five typres: 1) gastroesophageal reflux disease; 2) ulcer-like disease; 3) motility disorders; 4) aerophagia; 5) diopatic. The main clinic and pathophysiologic characteristics of each type are discussed. The diagnosis is basead in the clinical picture and in the negative results of some exams (endoscopy, ultrasound) and sugestive results of others (manometry, contrast X-ray, 24 hour pHmetry and gastric emptying time). The treatment may be divided in general (diet, behaviour, phychologic measures) and pharmacological approach (antiacids, H2blockers, procinetic agents). Each case should be individualized in terms of the presence of its main symptoms. Emphasis is put on the psychologic features and their adequate approach by the physician