Effect of the celexoxib in microscopic changes of the esophageal mucosal of rats induced by esofagojejunostomy / Efeito do celecoxibe nas alterações microscópicas da mucosa esofágica de ratos causadas por esofagojejunostomia

OBJECTIVE: To evaluate the protective effect of celecoxib in the esophageal mucosa in rats undergoing esofagojejunostomy. METHODS: Sixty male Wistar rats from the vivarium of the University of Health Sciences of Alagoas were used for the experiment. The animals were divided into four groups: Group I, 15 rats undergoing esofagojejunostomy with the use of celecoxib postoperatively; Group II, 15 rats undergoing esofagojejunostomy without the use of celecoxib; Group III, 15 rats undergoing celiotomy with bowel manipulation; and Group IV, 15 rats without surgery and using celecoxib. The observation period was 90 days. After the death of the animals, the distal segment of the esophagus was resected and sent for microscopic analysis. RESULTS: esofagojejunostomy caused macroscopic and microscopic esophagitis. Esophagitis was equal in both groups I and II. In groups III and IV esophageal lesions were not developed. CONCLUSIONS: celecoxib had neither protective nor inducing effect on esophagitis, but had a protective effect on dysplasia of the animals of group I. .

OBJETIVO: avaliar o efeito do celecoxibe como função protetora na mucosa esofágica, em ratos machos Wistar, submetidos à esofagojejunostomia. MÉTODOS: sessenta animais oriundos do biotério da Universidade de Ciências da Saúde de Alagoas foram utilizados para o experimento. Os animais foram distribuídos em quatro grupos: Grupo I, 15 ratos que foram submetidos à esofagojejustomia e que utilizaram o celecoxibe no pós-operatório, Grupo II, 15 ratos submetidos à esofagojejunostomia sem uso de celecoxibe, Grupo III, 15 ratos submetidos à celiotomia com manipulação de alças, e Grupo IV, 15 ratos sem cirurgia e que utilizaram celecoxibe. O período de observação foi de 90 dias. Após a morte dos animais, o seguimento distal do esôfago foi ressecado e enviado para análise macro e microscópicas. RESULTADOS: a esofagojejunostomia causou esofagite macro e microscópica. A esofagite foi igual tanto no grupo I quanto no II. Nos animais dos grupos III e IV não foram desenvolvidas lesões esofagianas. CONCLUSÕES: o celecoxibe não teve efeito protetor nem indutor nas esofagites, mas obteve efeito protetor nas displasias dos animais do grupo I. .

Acute esophageal necrosis occurring in a patient undergoing percutaneous coronary intervention

Acute esophageal necrosis is uncommon in the literature. Its etiology is unknown, although cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, hypoxemia, hypercoagulable state, infection, and trauma have all been suggested as possible causes. A 67-year-old female underwent a coronary angiography (CAG) for evaluation of chest pain. CAG findings showed coronary three-vessel disease. We planned percutaneous coronary intervention (PCI). Coronary arterial dissection during the PCI led to sudden hypotension. Six hours after the index procedure, the patient experienced a large amount of hematemesis. Emergency gastrofibroscopy was performed and showed mucosal necrosis with a huge adherent blood clot in the esophagus. After conservative treatment for 3 months, the esophageal lesion was completely improved. She was diagnosed with acute esophageal necrosis. We report herein a case of acute esophageal necrosis occurring in a patient undergoing percutaneous coronary intervention.

Endoscopic comparison of alendronate alone and the enteric-coated alendronate with calcitriol combination in postmenopausal Korean females

BACKGROUND/AIMS: This study was performed to compare the mucosal findings after esophagogastroduodenoscopy in two groups before and after the use of alendronate only and following administration of the enteric-coated alendronate (5 mg) and calcitriol (0.5 microg) combined drug (Maxmarvil, Yuyu Co.). METHODS: The study population consisted of 33 postmenopausal healthy female volunteers, aged 50 to 70 years (mean age, 58 +/- 5) without gastrointestinal symptoms and with normal baseline endoscopic findings. Esophagogastroduodenoscopy was performed at baseline and was repeated 2 weeks later after daily intake of Maxmarvil (n = 17 subjects) or alendronate only (n = 16 subjects). Mucosal injury scores were reported by an endoscopist after 2 weeks of treatment with each medication schedule. RESULTS: Esophageal mucosal injuries developed in two of 16 subjects in the alendronate only group and 0 of 17 in the Maxmarvil group. Gastric mucosal injuries developed in eight subjects in the alendronate group and four subjects in the Maxmarvil group; this difference was statistically significant. CONCLUSIONS: The mucosal damage scores for the alendronate group (total score 24) were significantly higher than those for the Maxmarvil group (total score 9) in the esophagus and stomach. Therefore, this study suggested that enteric-coated Maxmarvil is less harmful to gastrointestinal mucosa than alendronate, and may improve the tolerability of osteoporosis medication in clinical practice.

Variation of the intercellular space in the esophageal epithelium in response to hydrochloridric acid infusion in patients with erosive esophagitis

The purpose of this study was to compare esophageal infusion with 0.1 N hydrochloridric acid (HCl) to esophageal infusion with saline in patients presenting with typical gastroesophageal reflux symptoms and erosive esophagitis. METHODS: Upper gastrointestinal endoscopy was performed on 44 prospective subjects, 29 of whom were included in the study. Eighteen patients presented with normal esophagi (Control Group "C"), nine of whom were infused with HCl and nine with saline. Eleven patients presented with erosive esophagitis (Lesion Group "L"), five of whom were infused with HCl and six with saline. Biopsies of the esophageal mucosa were collected before and after infusions. RESULTS: No statistically significant difference was found between the two types of infusions in terms of the dilation of the intercellular space of the esophageal epithelium, regardless of the status of the patient. CONCLUSIONS: Response to HCl infusion cannot be used as a marker for gastroesophageal reflux disease.

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória / Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy

Na punção tráqueo-esofágica(PTE) é realizada miotomia do músculo constritor da faringe, mas sua necessidade é entre 9 por cento a 79 por cento dos pacientes. Sua realização pode aumentar as taxas de fístula salivar no pós-operatório. A aplicação da TB é ambulatorial. OBJETIVO: Análise da eficácia da aplicação de toxina botulínica (TB), na reabilitação do laringectomizado total com voz tráqueo-esofágica(VTE) com espasmo(E) do segmento faringo-esofágico (SFE) sem miotomia. MATERIAL E MÉTODOS: Análise de oito pacientes submetidos à laringectomia total (LT), reabilitados com VTE com prótese fonatória (PF), esforço para emissão de voz devido à E do SFE. Todos submetidos a tratamento dessa alteração motora com injeção de 100 unidades de TB no SFE. A avaliação constituiu-se de análise perceptiva de voz, videofluoroscopia (VF) do SFE, análise acústica de voz e manometria computadorizada (MC) do SFE, todos antes e após aplicação de TB. DESENHO DE ESTUDO: Estudo prospectivo. RESULTADOS: Houve diminuição na pressão à MC do SFE, após a injeção de TB. Análise acústica demonstrou melhora na qualidade de harmônicos após o tratamento. Houve emissão de voz sem esforço e melhora do E após o uso da TB. CONCLUSÃO: Todos os pacientes com E do SFE apresentaram melhora vocal após aplicação da TB neste SFE.

In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79 percent of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. AIM: analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy. MATERIALS AND METHODS: We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. STUDY DESIGN: prospective. Results: There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. CONCLUSION: all patients with PES spasms presented vocal improvement after BT injection in the PES.

Endoscopic abnormalities in the oesophagus after variceal sclerotherapy--a long-term follow up study.

Endoscopic sclerotherapy is a well-established treatment modality for oesophageal varices. Various local, regional and systemic complications occur after sclerotherapy. Altered endoscopic appearances of the oesophagus have been observed on follow-up of patients after sclerotherapy. 171 consecutive patients with extra-hepatic portal venous obstruction on follow up after achieving variceal eradication by sclerotherapy during the period from January 2004 to June 2005 were enrolled in this study. The oesophagus was closely observed for mucosal abnormalities and the endoscopic findings were recorded. Out of 171 patients, 95 (55.5%) patients had no specific endoscopic changes in the oesophagus. The most common finding was mucosal neovascularization which was seen in 56 (32.7%) patients. Oval or oblong depressed areas were seen in 41 (23.9%) patients. Mucosal tags and polypoidal lesions were seen in 37 (21.6%) patients. 25 (15.6%) patients had stenosis of the lower oesophagus and 3 (1.7%) patients had mucosal bridges. On multivariate analysis, these abnormal endoscopic findings in the oesophagus correlated with the total volume of sclerosant injected when compared with those patients without similar findings on endoscopy (p value < 0.001). Endoscopic sclerotherapy leads to various abnormalities at the injection sites like neovascularization, oval or oblong depressed areas, mucosal tags, polypoidal lesions, stenosis and mucosal bridges. Endoscopic abnormalities correlated with the total volume of sclerosant used. The long-term significance of these changes is not known at present and further follow-up studies will be required.

Thoracic sympathetic block reduces respiratory system compliance

CONTEXT AND OBJECTIVE: Thoracic epidural anesthesia (TEA) following thoracic surgery presents known analgesic and respiratory benefits. However, intraoperative thoracic sympathetic block may trigger airway hyperreactivity. This study weighed up these beneficial and undesirable effects on intraoperative respiratory mechanics. DESIGN AND SETTING: Randomized, double-blind clinical study at a tertiary public hospital. METHODS: Nineteen patients scheduled for partial lung resection were distributed using a random number table into groups receiving active TEA (15 ml 0.5 percent bupivacaine, n = 9) or placebo (15 ml 0.9 percent saline, n = 10) solutions that also contained 1:200,000 epinephrine and 2 mg morphine. Under general anesthesia, flows and airway and esophageal pressures were recorded. Pressure-volume curves, lower inflection points (LIP), resistance and compliance at 10 ml/kg tidal volume were established for respiratory system, chest wall and lungs. StudentÆs t test was performed, including confidence intervals (CI). RESULTS: Bupivacaine rose 5 ± 1 dermatomes upwards and 6 ± 1 downwards. LIP was higher in the bupivacaine group (6.2 ± 2.3 versus 3.6 ± 0.6 cmH2O, p = 0.016, CI = -3.4 to -1.8). Respiratory system and lung compliance were higher in the placebo group (respectively 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0.003, CI = 19.1 to 23.7; 127.2 ± 31.7 versus 70.2 ± 23.1 ml/cmH2O, p < 0.001, CI = 61 to 53). Resistance and chest wall compliance showed no difference. CONCLUSION: TEA decreased respiratory system compliance by reducing its lung component. Resistance was unaffected. Under TEA, positive end-expiratory pressure and recruitment maneuvers are advisable.

CONTEXTO E OBJETIVO: Os benefícios pós-operatórios da anestesia peridural torácica (APT) na analgesia e respiração após toracotomias são conhecidos. Contudo, bloqueio simpático torácico pode desencadear hiperreatividade das vias aéreas. Este estudo pesou tais efeitos benéficos e indesejáveis na mecânica respiratória intra-operatória. TIPO DE ESTUDO E LOCAL: Estudo clínico, randomizado, duplo-cego realizado em hospital público terciário. MÉTODOS: Uma tabela de números aleatórios dividiu 19 pacientes submetidos a ressecção pulmonar parcial entre duas soluções administradas na APT: ativa (15 ml 0,5 por cento bupivacaína, n = 9) ou placebo (15 ml 0,9 por cento NaCl, n = 10). Ambas continham epinefrina 1:200,000 e morfina 2 mg. Sob anestesia geral, pressões esofágicas e de vias aéreas foram registradas. Curvas de pressão versus volume, pontos de inflexão inferior (PII), resistências e complacências sob volume corrente de 10 ml.kg-1 foram aferidos para sistema respiratório, parede torácica e pulmões. O teste t de Student foi realizado (p < 0,005), incluindo intervalos de confiança (IC). RESULTADOS: A dispersão cefálica e caudal da bupivacaína foi, respectivamente, de 5 ± 1 e de 6 ± 1 dermátomos. A curva PII foi maior no Grupo Bupivacaína (6,2 ± 2,3 versus 3,6 ± 0,6 cm H2O, p = 0,016, IC = -3,4 a -1,8). Complacências do sistema respiratório e pulmões foram maiores no Grupo Placebo (respectivamente 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0,003, IC = 19,1 a 23,7, e 127,2 ± 31,7 versus 70,2 ± 23,1 ml.cm H2O-1, p < 0,001, IC = 61 a 53). Resistências e complacências da parede torácica não mostraram diferenças. CONCLUSÃO: APT diminui a complacência do sistema respiratório por reduzir seu componente pulmonar. Resistências não são afetadas. Sob APT, pressão positiva expiratória final e manobras de recrutamento são recomendáveis.

Prospective evaluation of medication-induced esophageal injury and its relation to esophageal function.

BACKGROUND: Few prospective studies are available on the incidence of medication-induced esophageal injury (MIEI). AIMS: To prospectively study the occurrence of MIEI with indomethacin and doxycycline and the predictive factors for its development. METHODS: In an operator-blinded study, 51 patients (age 16-65 y) requiring indomethacin (n = 24) or doxycycline (27) underwent symptom evaluation, endoscopy and scintigraphy before and after 7 days of therapy. MIEI was defined as de novo occurrence or worsening of pre-existing esophagitis or development of esophageal ulcer. RESULTS: Pre-therapy endoscopy was normal in 32 patients and revealed esophagitis in 19 (grade I--11, grade II--8). Post-therapy, 16 patients developed esophageal symptoms, which appeared earlier with doxycycline (2.0 [0.8] vs 4.1 [1.7] days, p = 0.016). MIEI developed in 23 patients--de novo esophagitis in 16, worsening of esophagitis in 6; 5 patients developed ulcer. Seven of 12 patients with hiatus hernia developed MIEI. Presence of pre-therapy gastroesophageal reflux disease did not predict MIEI. There was no difference in pre- or post-therapy transit values between patients with and without MIEI; patients who developed ulcers had significantly slower esophageal transit (p < 0.05). There was no difference in esophageal transit or occurrence of MIEI between patients who received indomethacin or doxycycline; however, 5 of 8 patients with hiatus hernia who received doxycycline developed MIEI (p = 0.02; relative risk 3.96 [CI 1.2-12.7]). CONCLUSIONS: 40% of patients receiving doxycycline or indomethacin developed MIEI; 10% developed ulcers. Hiatus hernia increased the risk for MIEI.

Effect of cholinergic agonists on muscular tonus of the lizard small intestine and esophagus

The underlying mechanisms of acetycholine-induced intestinal relaxation in the lizard Liolaemus tenuis tenuis are still unknows. By using a classical model of intestinal recording of isometric contraction and relaxation in conjunction with specific pharmacological tools, this article studies the possible influence of EDRF/NO and nicotinic ganglionar receptors on the Ach-induced relaxation in an effort to elucidate the probable mechanisms involved in ACh effect. It was observed that the relaxation of the lizard intestine elicited by ACh (10(-7) - 4 x 10(-4) M) was not affected by hexametonium (5 x 10(4) M) or tetrodotoxin (10(-6) M). Nicotine (10(-7) to 10(-4) M) induced relaxation was significantly antagonized by hexametonium; however, it was not influenced by tetrodotoxin. These results allow us to discard a neuronal pathway in cholinergic-induced relaxation, suggesting a more direct cholinergic effect on the smooth muscle, perhaps mediated by an unknown substance released by some specialized tissue. N-nitro-L-arginine, used to block NO-synthase and NO production, induced no changes in ACh-induced relaxation. Methylene blue, a soluble guanylate cyclase inhibitor, induced no changes in ACh-induced relaxation. These results allow us to dicard a probable role of EDRF/nitric oxide in the ACh-induced relaxation of lizard small intestine, providing evidence that this mechanism could be different from reported on other species.

Indirect excitatory actions of histamine on isolated chicken oesophagus.

The histamine-induced contraction on chicken oesophagus was antagonised non-competitively by atropine, hexamethonium, cocaine, methysergide, indomethacin, theophylline and verapamil. Physostigmine slightly potentiated the excitatory action of histamine. These results indicate that histamine excreted its excitatory action by involving a number of mechanisms as suggested in guinea pig oesophagus.

Computerized representation of the influence of the lower esophageal sphincter pressure on gastric regurgitation during anaesthesia

The effects of anesthetic gases [N2O/O2 and Halothane of Enflurane] and muscle relaxants [Pancronium or Atracurium] on Lower Esophageal Sphincter Pressure [LESP] were studied in 20 ASA I or II patients, by a perfused 8-channel probe constructing an imaginary 3-dimensional image of the asymmetric lower esophageal sphincter [LES]. The inhalation of N2O/O2 alone or in combination with 2 MAC Halothane or Enflurane resulted in a highly significant pressure drop [P <0.05] at LES. After Pancronium 0.1 mg/kg IV, there was a significant increase in LESP from control values. The findings of this pilot study suggest that pancuronium may be beneficial in induction than atracurium and that silent regurgitation is always a risk during maintenance of anesthesia because of the complex pharmacological actions of N2O/O2, Halothane or Enflurane upon the LESP

distribution of cholinesterase enzyme in the oesophagus and trachea of baladi rabbit as revealed by cholinesterase technique

The distribution patterns of specific cholinesterase enzyme positive nerve fibers were described in both esophagus and trachea of Baladi rabbit. The lining epithelium of the esophagus was found free from cholinergic nerve fibers. While, that of the trachea showed cholinergic intraepithelial nerve fibers. The submucosa of both esophagus and trachea were richly supplied by cholinergic nerve fibers and plexuses surrounded the blood vessels and secretory adenomeres of esophageal and tracheal glandular elements. The intermuscular area of the esophagus was found richly supplied by positive nerve plexuses and fibers

Morphological changes in esophagus following endoscopic sclerotherapy with 3% aqueous phenol.

Autopsy studies have shown that a majority of sclerosants presently used for endoscopic variceal sclerotherapy achieve their end result by a process of necrotizing inflammation of the esophageal wall followed by fibrosis and thrombosis, rather than bland thrombosis of varices. We have been using 3% phenol in water for variceal sclerotherapy and found it to be an effective sclerosant. To study the effect of this sclerosant on varices and the esophageal wall, autopsies were performed in 15 patients who died following sclerotherapy. Histopathological examination of sections from the esophagus showed (a) fresh thrombus in the varices immediately following injection, (b) intimal damage with medial sclerosis and superficial mucosal ulceration after one week, (c) organisation and recanalization with marked medial sclerosis at 3-4 weeks, and (d) complete obliteration of varices after 6-12 weeks. None of the patients was found to have esophageal necrosis, perforation or mediastinitis. Thus, 3% aqueous phenol appears to be an effective and safe sclerosant for variceal sclerotherapy.

Disfunción motora esofagica y radioisotopos: su modificación con un bloqueante calcico / Esophageal motility dysfunction and radioisotopes: its modification with a calcium channel blocker

Se describe el tránsito edofágico radioisotópico (TER) de un bolo líquido a través de cinco áreas de interés fijadas en faringe, tres niveles esofágicos y fundus gástrico, antes y después de la administración de 30 mg de nifedipina sublingual en dos grupos: uno de 8 individuos normales y otro de 13 pacientes afectados de trastorno motores esfágicos conocidos. El total de la muestra fue estudiada previamente por electromanometría (EMM). El tiempo de tránsito total (TTT) normal promedio fue de 11,85 ñ 1,13 segundos. La actividad residual normal (AR) fue de 9,53 ñ 4,64%. El tiempo de inicio de llenado gástrico (LLG) promedio fue de 3,99 ñ 0,65 segundos. El trazado normal configurá un patrón secuencial. La nifedipina mostró evidente efecto sobre la motilidad del cuerpo esofágico en el grupo de normales, lo que se tradujo en el TER por una AR significativamente aumentada (p<0,01), no variando el TTT en forma significativa. El método detectó el 100% de los acalásicos, configurando un patrón adinámico, con TTT que excedió los 40 segundos en todos los casos y LLG retrasado. La nifedipina no produjo modificaciones significativas con respecto a los registros basales. El único caso de acakasia vigorosa estudiado demostró un patrón adinámico con actividad en picos y, sorpresivamente, LLG normal. La nifedipina mejoró drásticamente estas alteraciones. Hubo dos pacientes portadores de "nutcraker". En uno de ellos se obtuvo un trazado de aspecto normal pero fue definido como patológico cuando se analizaron los valores de tiempo al pico (TP) y AR. La sensibilidad global del método en cuestión fue de 100%. La nifedipina parece ser de utilidad para mejorar el tránsito esofágico en pacientes portadores de trastornos motores con actividad en picos. Consideradndo lo no invasivo y la alta sensibilidad del TER, proponemos el empleo de este método como paso previo a la EMM dentro de la metodología de estudio de los trastornos motores esofágicos

Lesión esofágica por drogas / Esophageal lesion by drugs

Se presentan dos casos de daño esofágico producido por drogas de prescripción habitual en la práctica médica. Se realiza una revisión de las diversas drogas asociadas a lesiones esofágicas describiendo los factores predisponentes, la sintomatología, los hallazgos semiológicos, la fisiopatogenia, los exámenes complementarios, las complicaciones, la evolución y las medidas que deben adoptarse para prevenir esta patología

Acción del propel-oxifenil-mandelato de dimetilamino-etano sobre la motilidad esofágica: estudio manométrico en diversas afecciones esofágicas / Action of the dimetyl-ameno-etane propin-oxyphenyl-mandelate on esophageal motility: manometric study in various esophageal lesions

Se estudia la acción del Propin-oxifenil-mandelato de dimetilamino-etano (Sertal [r]) sobre la motilidad del esófago mediante electromanometría intraluminal, demostrando que esta droga no tiene acción sobre la motilidad normal (peristalsis, zona de alta presión del esfínter inferior), pero sí produce reducción en la amplitud y el número de ondas disquinéticas en dosis de 25 mg administradas en forma endovenosa