Comparación entre el aspecto endoscópico del cardias, hallazgos manométricos y pHmetría de 24 horas en pacientes con síntomas de reflujo gastroesofágico crónico / Comparison of the endoscopic aspect of the cardia, manometry and 24 hours pH measurement in patients with chronic gastroesophageal reflux

Background: The endoscopic view of the gastric cardia could be related with the manometric competence of the lower esophageal sphincter (LES) and with pathological gastroesophageal reflux. Aim: To compare the endoscopic aspect of the cardia with the results from esophageal manometry and 24 h esophageal pH monitoring. Materials and Methods: The cardia of a group of 150 patients (aged 19 to 72 years, 89 women) with gastroesophageal reflux symptoms was classified as normal or open, during upper gastrointestinal endoscopy. All subjects were subjected to a manometric study to measure LES pressure and determine LES incompetence and to a 24 h esophageal pH measurement. Results: LES pressure was 14.7±6.2 and 8.7±4.2 mmHg in patients with normal and open cardia, respectvively (p <0.001). Likewise, 43 and 79% of patients with normal and open cardia had an incompetent LES, respectively (p <0.001). Pathological acid reflux was present in 43 and 71% of patients with normal or open cardia, respectively (p <0.001). Conclusions: The endoscopic appearance of the cardia can identify patients with pathological gastroesophageal reflux.

Motilidades espontânea e estimulada por acetilcolina, de segmentos isolados da cárdia do estômago de cäes, in vitro / Spontaneous and acetylcholine stimulated motility of cardia isolated strips of the stomach of dogs, in vitro

Verificou-se o comportamento motor, espontâneo e estimulado por acetilcolina, de segmentos isolados da cárdia do estômago de caes, "in vitro", utilizando-se banho fisiológico para estudo de órgäos isolados. O estudo teve como objetivo a melhor compreensäo dos fenômenos motores desta regiäo. Para tanto foram utilizados trinta cäes mestiços. Do estômago de cada animal foram retirados segmentos das paredes anterior e posterior, pequena e grande curvaturas. Os tipos de contraçöes encontradas foram: onda I, onda II, onda III, tônicas simples, tônicas segmentares e ondinhas. Foram estudados a amplitude, duraçäo, freqüência e proporçäo de traçados positivos, para cada tipo e regiäo, nos padröes espontâneo e estimulado. Os resultados encontrados mostraram uma proporçäo significante de traçados para as ondas do tipo II no padräo estimulado, em todas as regiöes estudadas. A amplitude das contraçöes tônicas simples diferiram, significantemente, quanto as médias de amplitude na motilidade espontânea, nas quatro regiöes estudadas, sendo que na parede anterior observou-se a maior amplitude média e na parede posterior, a menor. Quanto ao estudo da duraçäo e freqüência, nenhuma diferença significante foi observada. Em conclusäo, a motilidade da cárdia se caracterizou por contraçöes tônicas e peristálticas, representadas, respectivamente, pelas contraçöes tônicas simples e pelas ondas do tipo II.

Endoscopic appearances of the gastro-esophageal valve and competence of the cardia

The endoscopic appearances of the gastro-oesophegal valve, viewed by the retroflexed gastroscope have been studied in 51 patients with and without reflux oesophagitis. Oesphagitis was graded according to its severity and the yield pressure [YP] was measured in all patients and to assess the competence of the cardia. There was a close relationship between the YP and the grades of the gastro-oesophageal valve. Yield prerssure was significantly lower in patients with endoscopic oesophagitis than in patients with no evidence of reflux oesophagitis [p< 0.0001]. An increased abnormality of the gastro-oesophageal valve was associated with all grades of oesophagitis and with a low YP. The valve mechanism at the cardia has an important role in determining its competence. YP is possibly a measure of the flap valve component of the gastro-oesphageal junction