Esofagitis necrotizante aguda / Acute necrotizing esophagitis / Esofagite necrotizante aguda

La esofagitis necrotizante aguda es un trastorno poco común que puede ser causa de hemorragia digestiva alta. Predomina en el sexo masculino en la sexta década de la vida. El diagnóstico es endoscópico y muestra una mucosa esofágica de apariencia negra que afecta al esófago distal en toda su circunferencia y se detiene abruptamente en la unión gastroesofágica. Clínicamente suele presentarse con hematemesis y melenas, shock hipovolémico por sangrado masivo, siendo otras manifestaciones el dolor epigástrico, molestia retroesternal y disfagia. Se vincula a pacientes con antecedentes de enfermedad cardiovascular, alcoholismo, diabetes mellitus, desnutrición, hernia hiatal, estenosis gastroduodenal, cáncer, así como pacientes en shock, traumatizados, sometidos a cirugía mayor e inmunosuprimidos. El tratamiento se basa en fluidoterapia, inhibidores de la bomba de protones y suspensión de la vía oral, siendo controvertido el uso de antibioticoterapia. Su pronóstico es malo y dependerá de la gravedad de la enfermedad esofágica y del terreno del paciente, con una mortalidad de hasta el 36 %. Presentamos el caso clínico de un paciente de 81 años, hipertenso, que presenta hematemesis, confirmándose en la endoscopía una esofagitis necrotizante aguda, que evoluciona favorablemente con tratamiento médico.

Acute necrotizing esophagitis is a rare disorder that can cause upper gastrointestinal bleeding. It predominates in males in the sixth decade of life. The diagnosis is endoscopic and shows a black-appearing esophageal mucosa that affects the entire circumference of the distal esophagus and stops abruptly at the gastroesophageal junction. Usually, patients present with hematemesis and melena, with other manifestations such as epigastric pain, retrosternal discomfort, dysphagia, and hypovolemic shock. Almost all patients reported comorbidities: cardiovascular disease, alcoholism, diabetes mellitus, malnutrition, hiatal hernia, gastroduodenal stenosis, and malignant neoplasia; is related as well to patients with shock, trauma, undergoing major surgery, and immunosuppression. The treatment is based on fluid reposition, proton pump inhibitors and suspension of the oral route, the use of antibiotic therapy being controversial. Its prognosis is poor and will depend on the severity of the esophageal disease and the patient comorbidities, with a mortality rate up to 36 %. Case: A 81-year-old male patient with hypertension, who presented hematemesis, confirmed by endoscopy as acute necrotizing esophagitis, whose evolution was favorable with medical treatment.

A esofagite necrosante aguda é uma doença rara que pode causar hemorragia digestiva alta. Predomina no sexo masculino na sexta década de vida. O diagnóstico é endoscópico e mostra uma mucosa esofágica circunferencial difusa com aspecto preto que envolve quase universalmente o esôfago distal e para abruptamente na junção gastroesofágica. Clinicamente, geralmente se apresenta com hematêmese e melena, com outras manifestações sendo dor epigástrica, desconforto retroesternal, disfagia e choque hipovolêmico. Está relacionado a pacientes com histórico de doenças cardiovasculares, alcoolismo, diabetes mellitus, desnutrição, hérnia hiatal, estenose gastroduodenal e neoplasia maligna, bem como pacientes em choque, trauma, cirurgia de grande porte e imunossupressão. O tratamento é a medicação dietética higiênica baseada em fluidoterapia, inibidores da bomba de prótons e suspensão da via oral, sendo o uso de antibioticoterapia controverso. Seu prognóstico é ruim e dependerá da gravidade da doença esofágica e do terreno do paciente, com mortalidade de até 36 %. Apresentamos o caso clínico de um paciente hipertenso de 81 anos que apresentou hematêmese, confirmada por endoscopia como esofagite necrosante aguda, que evoluiu favoravelmente com tratamento higiênico-dietético e medicamentoso.

Estenose esofágica em duas cadelas após ovário-histerectomia: relato de caso / Esophageal stricture in two female dogs after ovariohysterectomy: case report

A estenose esofágica benigna é uma afecção rara em pequenos animais, comumente secundária a esofagites ulcerativas. O refluxo gastroesofágico, frequente durante procedimentos anestésicos, é a principal causa de esofagite grave, com consequente formação de cicatriz esofágica. O presente trabalho tem por objetivo descrever dois casos de estenose esofágica ocorrentes após ovário-histerectomia, com destaque para os procedimentos diagnósticos realizados. Em ambos os casos, a combinação dos sinais clínicos sugestivos e os achados de esofagograma e esofagoscopia foram determinantes. No primeiro caso, devido ao tempo avançado de desenvolvimento dos sinais clínicos, o paciente veio a óbito antes mesmo que a intervenção direta da região de estenose fosse realizada. Já no segundo, o procedimento de gastrostomia para melhor manejo alimentar, associado à dilatação esofágica via esofagoscopia e à terapia com medicamentos antiácidos, resultou em melhora clínica.(AU)

Benign esophageal stricture is a rare affection in small animals, usually secondary to ulcerative esophagitis. Gastroesophageal reflux, frequent during anesthetic procedures, is the main cause of severe esophagitis with consequent formation of esophageal cicatrix. The objective of this work is to describe two cases of esophageal stricture occurring after ovariohysterectomy, highlighting the diagnostic procedures performed. In both cases, the combination of the suggestive clinical signs and findings from an esophagram and an esophagoscopy were determinants. In the first case, due to the advanced stage of the clinical signs, the patient died before direct interventions on the stenosis region were performed. But in the second case, the gastrostomy procedures for better feed management associated with esophageal dilatation by esophagoscopy and therapy with antacids resulted in clinical improvement.(AU)

What is the rea impairment on esophageal motilty in patients with gastroesophhageal reflux disease?

Context Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD) as reduced lower esophageal sphincter (LES) basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Objective Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. Methods The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. Results The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (<30 mm Hg); this same group showed higher percentage of esophageal motility disorders. Conclusions The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility. .

Contexto Alteração no peristaltismo esofágico assim como diminuição do tônus basal do esfíncter inferior do esôfago são um achado comum em pacientes com doença do refluxo gastroesofágico. A presença de hipotonia acentuada do esfíncter inferior do esôfago pode facilitar a ocorrência de refluxo gastroesofágico mais intenso e a presença de alteração no peristaltismo esofágico pode contribuir para uma deficiente depuração esofágica. Objetivo Avaliar a função motora do esfíncter inferior do esôfago e do corpo esofágico nas várias formas da doença do refluxo gastroesofágico. Métodos Avaliaram-se os prontuários de 268 pacientes, que realizaram manometria esofágica como parte da investigação diagnóstica da doença do refluxo gastroesofágico. Os pacientes foram distribuidos em quatro grupos: 33 pacientes que não tinham esofagite, 92 pacientes que tinham esofagite erosiva; 101 pacientes que tinham esôfago de Barrett curto e 42 pacientes que tinham esôfago de Barrett longo (grupo EBL). Resultados O grupo dos que tinham EBL, apresentou menor média de pressão do esfíncter inferior do esôfago e maior percentual de hipotonia acentuada do esfíncter inferior do esôfago; no segmento distal do corpo do esôfago, este grupo apresentou maior percentual de hipocontratilidade acentuada (< 30 mm Hg). O grupo dos que tinham EBL apresentou maior porcentagem de distúrbios da motilidade esofágica. Conclusões As alterações mais intensas na motilidade esofágica e no esfíncter inferior do esôfago foram observadas no grupo com EBL. Aqueles com esofagite de refluxo e esôfago de Barrett curto ...

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47 percent, for NERD in 48 percent, and for EE patients in 48 percent of cases. Esophagitis was present in 42 percent of patients with IBS and in 45 percent of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95 percent CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS), dispepsia, doença do refluxo não-erosiva (NERD) e esofagite erosiva (EE). Os pacientes com IBS preencheram os critérios para dispepsia em 47 por cento, para NERD em 48 por cento, e para pacientes EE em 48 por cento dos casos. Esofagite estava presente em 42 por cento dos pacientes com IBS e em 45 por cento dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais frequentemente sintomas como muco nas fezes, distensão abdominal, náuseas e gastrite, enquanto que as mulheres mais frequentemente relataram esofagite e duodenite. Os pacientes com NERD (OR 2,54, IC 95 por cento 1,08-5,99, p = 0,04), apresentaram tenesmo e saciedade precoce, e os homens tiveram um risco aumentado relacionado a fezes endurecidas ou fragmentadas. Em conclusão, quase metade dos pacientes mexicanos com NERD, EE e dispepsia preenchem os critérios para a IBS. Um grande número de sintomas foi correlacionado com a endoscopia, esta correlação pode ser utilizada para aumentar a indicação da endoscopia e sua aplicação em estudos clínicos.

Acute Diffuse Phlegmonous Esophagogastritis: A Case Report

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Esófago negro secundario a esofagitis necrotizante aguda: reporte de un caso clínico / Black esophagus due to acute necrotizing esophagitis: report of one case

Acute esophageal necrosis, which presents as a black esophagus on endoscope, is an uncommon occurrence. It is defined as a dark pigmentation of the esophagus associated with histological mucosal necrosis. We report a 75-year-old man who developed black esophagus due to acute esophageal necrosis caused by septicemia. The patient had a favorable evolution.

Esofagite eosinofílica em 29 pacientes pediátricos / Eosinophilic esophagitis in 29 pediatric patients

RACIONAL: A esofagite eosinofílica é uma entidade recentemente descrita, caracterizada por sintomas esofágicos, semelhantes aos da doença por refluxo gastroesofágico e importante eosinofilia esofágica. OBJETIVO: Apresentação de 29 pacientes com esofagite eosinofílica, discutindo as características clínicas, diagnóstico, tratamento e evolução. MÉTODOS: Foram identificados 29 pacientes (22 do sexo masculino) com idade entre 1 e 18 anos, nos quais as biopsias de esôfago demonstraram contagem de 20 ou mais eosinófilos/campo de grande aumento, sem infiltração eosinofílica em antro e/ou duodeno. Avaliaram-se as manifestações clínicas, achados endoscópicos e histológicos, tratamento e evolução. RESULTADOS: Os sintomas mais freqüentes foram vômitos em 15 pacientes (52 por cento) e dor abdominal em 11 (38 por cento). Os pacientes com idade inferior a 4 anos apresentavam recusa alimentar e baixo peso. Os com idades entre 5 e 8 anos apresentavam predominantemente dor abdominal e/ou pirose e/ou vômitos. Os pacientes com mais de 8 anos apresentavam dor abdominal, disfagia e/ou impactação alimentar eventual. Os achados endoscópicos incluíram estrias verticais em 14 pacientes (48 por cento), pontilhado branco em 12 (41 por cento), anéis circulares em 2 (7 por cento) e esofagite erosiva em 3 (10 por cento). Em sete pacientes a endoscopia foi normal (24 por cento). O tratamento incluiu fluticasona tópica em 19 pacientes e restrição dietética em 7. Os pacientes acompanhados apresentaram resposta favorável ao tratamento, com melhora ou remissão dos sintomas. Onze pacientes que foram submetidos a endoscopia de controle pós-tratamento apresentaram diminuição significativa do número de eosinófilos no esôfago. CONCLUSÕES: A esofagite eosinofílica deve ser considerada quando há sintomas de refluxo, que não respondem ao tratamento habitual. Os exames endoscópicos devem ser acompanhados de biopsias com análise detalhada do número de eosinófilos.

BACKGROUND: Eosinophilic esophagitis is a recently described entity with esophageal symptoms like gastroesophageal reflux disease and significant esophageal eosinophilic infiltration. AIM: To present our clinical series of 29 children with eosinophilic esophagitis, describing the clinical and diagnostic features, treatment and outcome. METHODS: We describe 29 patients (22 boys), 1-18 years-old, with 20 eosinophils per high-power field in esophageal biopsy specimens and absence of eosinophilic inflammation in the stomach and duodenum. Evaluation of the clinical, endoscopic and histologic findings, treatment and outcome was undertaken. RESULTS: The most common presenting symptoms included vomiting in 15 patients (52 percent) and abdominal pain in 11 patients (38 percent). Children under the age of 4 years presented with feeding disorder and failure to thrive. Patients between 5 and 8 years of age presented commonly with abdominal pain or symptoms that may be associated with reflux (heartburn and/or vomiting). Patients over the age of 8 presented most often with abdominal pain, dysphagia and occasional food impaction. Endoscopic features included vertical furrowing in 14 patients (48 percent), whitish papules in 12 (41 percent), corrugated rings in 2 patients (7 percent) and esophageal erosions in 3 patients (10 percent). In seven patients endoscopy was normal (24 percent). Treatment included swallowed fluticasone propionate in 19 patients and restriction diet in 7 patients. Patients who returned for follow-up had either improvement or remission of symptoms. After treatment, endoscopic biopsies were repeated in 11 patients, and a significant decrease in esophageal eosinophil counts was observed. CONCLUSIONS: The diagnosis of eosinophilic esophagitis must be considered when symptoms of reflux do not respond to conventional treatment. Upper gastrointestinal endoscopy must be complemented by a detailed analysis of histologic findings and eosinophil...

[Prenatal gastrointestinal bleeding caused by oesophagitis]

Upper gastrointestinal tract bleeding in the neonate is usually related to gastritis and esophagitis. Fewer cases of prenatal gastrointestinal tract bleeding diagnosis are reported, showing that gastric peptic lesions can occur in the prenatal period. We report a case of a prenatal oesophagitis revealed at 35 weeks of gestation by the presence of bloody amniotic fluid that was confirmed by endoscopy at birth

Severe corrosive oesophagitis: are high doses of methyl prednisolone efficient to prevent oesophageal caustic stricture in children?

Corrosive oesophagitis stricture is the long term complication of severe corrosive oesophagitis. The aim of our study was to evaluate the effect of a high doses of steroids on incidence and quality of oesophageal stricture. We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 December 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone [1000mg/l,73/m2 SC]. The frequency of stricture was 12/26 [46%]. Ten children required a mean of 6,7 [5,74] dilatation range [1 - 17].One patient required an oesocoloplasty. The frequency of stricture in the group treated early before the 24th hour and after the 24th hours was [9/21] [47,4%] versus [3/7] [42,9%]. This difference was not significant [P = 1]. The frequency of stricture in the group treated less than 21 days and more than 21 days was 6/17 [40%] versus 6/9 [66,7%]. This difference was not significant [P = 0,400]. High doses of methyl prednisolone seems to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated less than 21 days and those more than 21 days

Presença de refluxo em pacientes com sintomas típicos de doença do refluxo gastroesofágico / Factors related to the presence of reflux in patients with typical symptoms of gastroesophageal reflux disease (GERD)

OBJETIVO: Analisar os aspectos clínicos, ultra-sonográficos, endoscópicos, manométricos e os dados de pHmetria prolongada do esôfago nos pacientes com sintomas típicos de doença do refluxo gastroesofágico (DRGE). MÉTODOS: Foram estudados, em 251 pacientes com sintomas típicos da doença do refluxo gastroesofágico, os aspectos clínicos, o IMC, os dados ultra-sonográficos, endoscópicos, manométricos e de pHmetria do esôfago. RESULTADOS: Eram mulheres 172 pacientes (68,5 por cento). A média de idade foi de 51,8 anos. A ultra-sonografia diagnosticou colelitíase em 23 doentes e colecistectomia prévia em 21 pacientes. A hérnia hiatal (HH) estava presente em 177 pacientes (71 por cento), com tamanho médio de 3 cm. A esofagite erosiva foi encontrada em 168 pacientes (66,9 por cento) e o esôfago de Barrett em 23 casos (9,2 por cento). A associação de HH com EE foi observada em 131 pacientes (52,3 por cento). Apenas 37 pacientes (14,7 por cento) não apresentavam HH ou EE. Quanto à manometria, o valor médio da extensão do esfíncter inferior do esôfago (EIE) foi 2,6 cm, sendo que 132 pacientes (52,6 por cento) apresentaram EIE curto. A pressão média do EIE foi 18,9 mmHg e 46 doentes (18,3 por cento) apresentaram pressão abaixo de 14 mmHg. A pHmetria prolongada do esôfago, a média do número de refluxos foi 42,9 e a porcentagem de tempo ácido total média foi 8,4 por cento. Em 175 pacientes (69,7 por cento), o índice de DeMeester mostrou-se elevado. CONCLUSÃO: Nos pacientes com sintomas típicos da DRGE, os fatores que influenciaram a presença do refluxo patológico, comprovada pela pHmetria do esôfago, foram: a idade mais avançada, a presença de hérnia hiatal com esofagite erosiva; a extensão menor, a pressão basal diminuída e o menor vetor volume do EIE.

OBJECTIVE: To analyze clinical, abdominal ultrasound, upper digestive endoscopic, esophageal manometric and prolonged esophageal pH-monitoring findings in patients with typical symptoms of GERD. METHODS: The study included a total of 251 patients with typical GERD symptoms. Clinical data, Body Mass Index, abdominal ultrasound aspects and upper digestive endoscopic data are reported. Manometry and esophageal pH-monitoring were performed. RESULTS: One-hundred-and-seventy-two patients were female (68.5 percent). Mean age of the total was 51.8 years. Ultrasound examination revealed colelithiasis in 23 patients and PC in 21 patients. Hiatal hernia was diagnosed in 177 patients (71 percent), with an average size of 3.0cm. Erosive esophagitis was found in 168 patients (66.9 percent) and Barrett's esophagus in 23 patients (9.2 percent). A combination of hiatal hernia and esophagitis was diagnosed in 131 patients (52.3 percent) while only 37 patients (14.7 percent) did not present either. The mean extension of the lower esophageal sphincter (LES) was 2.6 cm, whereas in 132 patients (52.6 percent) the LES was shorter. The mean pressure of the LES was 18.9 mmHg; 46 patients (18.3 percent) had pressures below 14 mmHg. The mean number of reflux episodes on prolonged esophageal monitoring was 42.9; the mean number of prolonged episodes of reflux was 4.6, and the mean percentage of total acid time was 8.4 percent. DeMeester scores were high in 175 patients (69.7 percent). CONCLUSION: In patients with typical GERD symptoms, factors influencing the presence of pathological reflux as confirmed by prolonged esophageal pH-monitoring were: age, hiatal hernia associated to erosive esophagitis, a smaller extension, low baseline pressure and smaller volume vector of the LES.

Analysis on the causes for refractory GERD / 华中科技大学学报（医学）（英德文版）

To analyze the causes of failure in conventional treatment to refractory gastroesophageal reflux diseases (GERD) patients, 16 refractory GERD patients (group R) and 16 cases of GERD primarily diagnosed (group P) were studied. Endoscopy, pathologic examination and 14C urea breath test were conducted in every patient. 24 h ambulatory pH and bilirubin monitoring were performed with Digitrapper MK III and Synetics Bilitec 2000. It was found that esophagitis in group R was more severe than in group P. The rate of Helicobacter pylori infection in group R was significantly lower than in group P. Fraction time pH below 4.00 was not longer while the bile reflux represented by fraction time abs above 0.14 was greater for patients in the group R as compared with those in the group P. The mixed refluxes and pure bile refluxes between the two groups had significant difference. The reflux episodes in the group R mainly occurred during nights. These results indicated that severe esophagitis, especially Barrett's esophagus with complications makes it difficult to control GERD. Severe duodenogastroesophageal refluxes (DGER) are often accompanied by refractory GERD. Mixed refluxes aggravate the esophageal injuries. Pure bile refluxes and nocturnal refluxes may cause failure of administration of proton pump inhibitors (PPI) in the morning. Helicobacter pylori infection and acid refluxes may not be the direct cause of refractoriness. Individual refractory GERD patient without abnormal results on pH or bile reflux recently should be diagnosed again.

Reflujo gastroesofágico: una complicación tardía en la esofagitis cáustica en niños / Gastroesophagics reflux: a esophagitis late complications in the casustic in children

La ingestión de agentes cáusticos, puede desencadenar una lesión progresiva y desvastadora del esófago. De los niños que ingieren cáusticos, sólo un tercio desarrolla quemaduras esofágicas, principalmente relacionadas con álcalis más que con ácidos. Las complicaciones tempranas ocurren antes de las 48 horas posteriores a la ingesta, y la estenosis esofágica ocurre más tardiamente, siendo la complicación más común. El propósito del siguiente estudio es demostrar que el reflujo gastroesofágico severo. Se estudiaron 19 pacientes con diagnóstico de ingesta de cáustico, a quienes se les realizó endoscopia digestiva superior entre 24-48 horas después de la ingesta y 3-6 meses más tarde endoscopia control más biopsia, radiología esofágica, manometría y pH metría. En un 52,63 por ciento de los pacientes se evidencio reflujo gastroesofágico por pH metría de los cuales 6 ingirieron hidroxido de sodio y 2 ácido hidroclórico, desarrollando esofágitis severa, presentando en su mayoría complicaciones tardías como estenosis y alteraciones motoras. En conclusión, este estudio pone en evidencia, que el reflujo gastroesofágico se produce como una complicación tardía en la quemadura esofágica severa, por acortamiento de la longitud esofágica y en algunos casos alteración de la presión del esfinter esofágico inferior, los que en condiciones normales son las barreras que se oponen al reflujo

Estudio de casos y controles de manifestaciones atípicas en la enfermedad por reflujo gastroesofágico / A cases-control study of atypifical manifestations of gastroesophageal reflux disease

Objetivo. Determinar la prevalencia de manifestaciones atípicas (MA) de la enfermedad por reflujo gastroesofágico (ERGE) en pacientes con esofagitis péptica comparada con la de sujetos controles. Métodos. Se estudiaron pacientes consecutivos que acudieron a nuestro instituto de enero a agosto de 1997 para endoscopia de tubo digestivo proximal. Se clasificaron en dos grupos: a) casos, enfermos con diagnóstico endoscópico de esofagitis péptica; y b) controles, enfermos sin síntomas típicos de ERGE ni evidencia de esofagitis en la endoscopia. Se les aplicó un cuestionario para evaluar la presencia intergrupos significativas en género (p= 0.2), edad (p= 0.4=, antecedentes de tabaquismo (p = 0.7= ni antecedentes de atopia (p = 0.6=. Las MA de la ERGE fueron más frecuentes en los casos (66 por ciento) que en los controles (42 por ciento), con diferencia estadísticamante significativa (RM = 2.7, IC 1.2-6, p = 0.02). La MA con mayor frecuencia en los casos fueron disfonía (RM = 9.3, IC = 1.1-77), dolor torácico (4.9, 1.8-14) y globus (2.8, 0.9-9). El desarrollo de las MA no se asoció a grado de esofagitis (p= 0.7), presencia o intensidad de manifestaciones típicas (p= 0.2), género (p= 0.4) ni edad de los pacientes (p= 0.2). Conclusiones. Los enfermos con esofagitis por reflujo mostraron mayor riesgo de desarrollar manifestacione sextraesofágicas que involucraron farínge, larínge y pulmones

Estudio prospectivo endoscópico y biópsico de la prevalencia de metaplasia intestinal en la unión gastro-esofágica en controles y en pacientes con reflujo gastroesofágico / Endoscopic assessment of the prevalence of gastro esophageal junction intestinal metaplasia in gastroesophageal reflux

Background: The Classic diagnosis of Barret esophagus is based on the finding of three or more cm of distal esophagus covered by specialized columnar epithelium. However, at the present time, it is based on the presence of intestinal metaplasia in the jucntion of aquamous-columnar mucosae. Aim: To assess the prevalence of Barret esophagus using endoscopic and pathological criteria in healthy subjects and in individuals with gastroesophageal reflux. Patients and methods: One hundred thirty nine controls and 372 patients with symptoms of gastroesophageal reflux subjects to an upper gastrointestinal endoscopy were studied. Patients with Barret esophagus was classified as being a "mini Barret" wben the pathological presence of intestinal metaplasia was the only finding. A "short Barret esophagus" was diagnoses when less than 3 cm were covered with fingerings of mucosal substitutions and "extensive Barret esophagus" when more than 13 cm of esophageal mucosa were substituted. Results: Two percent of controls, 12.4 percent of patients with gastroesophageal reflux without esophagitis and l1,7 percent of such patients with esophagitis had intestinal metaplasia in the gastresophageal junction. Patients with Barret esophagus were older than the rest of patients. "Short Barret esophagus" is six times more frequent than "extensive Barret esophagus". Esophageal erosions, peptic ulcer and stenosis were more frequent in patients with extensive Barret esophagus. The prevalence of dysplasia was similar in all types of Barret esophagus. Conclusions: Intestinal metaplasia was very infrequent in control patients. In subjects with gastroesophageal reflux, classic endoscopic diagnosis may miss up to 80 percent of patients with Barret esophagus. Thus, gastroesophageal junction biopsies must be obtained in all patients with symptoms of gastroesophageal reflux

Tratamento da candidíase oro-esofagiana em pacientes portadores de HIV / Therapeutic management of oral-esophageal candidiasis in HIV patients

Os autores revisam a literatura sobre a candidíase oroesofagiana em pacientes portadores do vírus da imunodeficiência adquirida. Apresentam aspectos da fisiopatogenia, quadro clínico, diagnóstico e, em especial, do manejo terapêutico