[Clinical, endoscopic and manometric findings in the gastroesophageal tract of patients with systemic sclerosis]. / Manifestaciones de esclerosis sistémica en el aparato digestivo. Clínicas, endoscópicas y por manometría.

BACKGROUND: In the systemic sclerosis (SSc) gastrointestinal manifestations are present up to 90 % and the esophagus is the most affected organ. The purpose was to investigate clinical, endoscopic and manometric upper gastroesophageal manifestations in patients with SSc. METHODS: We studied 60 patients with SSc, mean age of 48 +/- 11 years and a mean disease evolution of 11 +/- 8 years. An endoscopy of gastro-esophageal tract and esophageal manometry were performed. RESULTS: The clinical manifestations were: dysphagia 80 %, pirosis and regurgitations 78 %. Endoscopic findings were: esophagitis 60 %, hiatal hernia 65 %, loose hiatus 15 % and Barrett's esophagus 18 %. Manometric findings were hypotensive lower esophageal sphincter (LES) 95 %. Aperistalsis (41 %), slight hypomotility (30 %), severe hypomotility (27 %) were found. Gastric manifestations were: early satiety 45 %, abdominal pain 35 %, nausea 20 % and vomiting 10 %, and by endoscopy we observed: Gastric disturbances in 80 %, of these 40 % corresponds to non erosive gastropathy, 30 % to erosive gastropathy and 10 % to nodular gastropathy. CONCLUSIONS: The most frequents endoscopic finding were esophagitis and hiatal hernia, and by manometry were aperistalsis and hypotensive LES. These alterations imply disorders of motility and dysfunction of LES. Barrett's esophagus was always associated with hiatal hernia.

[Obesity, symptoms of gastroesophageal reflux and endoscopic findings in a referral hospital]. / Obesidad, sintomas de reflujo gastroesofágico y hallazgos endoscópicos en un hospital de referencia.

OBJECTIVE: To determine association between obesity, gastroesophageal reflux symptoms, hiatus hernia and erosive esophagitis. METHODS: Consecutive patients who underwent upper endoscopies at our center were studied. Before endoscopy, through a direct interview all subjects were asked to complete the Carlsson-Dent questionnaire. Weight and height of all patients were determined. Body mass index was calculated. At endoscopy it was looked for the presence of hiatus hernia and erosive esofagitis. We excluded patients with some of the following conditions: Pregnancy, ascitis, esophageal varices, esophageal, gastric or duodenal stenosis, and patient who required an emergency or therapeutic endoscopy. We compared prevalence of symptomatic GERD, hiatus hernia and erosive esophagitis between normal weight patients, overweight and obese. RESULTS: A total of 196 patients were included for analysis, 122 women and 74 men, mean age 52.5 years, 40.3% were overweight and 28.1% were obese. There were 124 patients (63.3%) with symptoms of GERD determined by the C-D Questionnaire obtained. Hiatus hernia was observed in 87 patients (44.4%), and erosive esophagitis in 69 patients (35.7%). Prevalence of GERD symptoms in obese or overweight patients were similar to those normal-weight patients (66.4% and 56.5% respectively, p = 0.20) OR 1.52 (IC 95%, 0.82-2.82). Among obese or overweight hiatus hernia was observed in 47% compared to 38.7% of those normal-weight (p = 0.28) OR 1.40 (IC 95%, 0.76-2.59). Prevalence of erosive esofagitis was also similar in both groups 37.3% and 32.3% respectively (p = 0.52) OR 1.25 (IC 95%, 0.66-2.36). CONCLUSIONS: This study didn't show association between symptoms of GERD, hiatus hernia or erosive esofagitis and overweight or obesity.

[Association between symptomatic gastroesophageal reflux and Barrett's esophagus]. / Asociación entre reflujo gastroesofágico sintomático y esófago de Barrett.

BACKGROUND DATA: Barrett esophagus is a proximal displacement of the squamocolumnar junction relative to the gastroesophageal junction with intestinal metaplasia, it has been linked to gastroesophageal reflux disease. However, it has been observed in individuals without gastroesophageal reflux symptoms, with prevalence up to 25% in 50 years older men. OBJECTIVE: Assess the association between symptomatic gastroesophageal reflux and Barrett's esophagus. METHODS: Consecutive patients undergoing endoscopy at our center were studied. Before endoscopy, through a direct interview all subjects were asked to complete the Carlsson-Dent questionnaire for determining 2 groups (patients with and without gastroesophageal reflux symptoms). Those subjects with suggestive image of Barrett's esophagus, biopsy specimens were obtained from the distal esophageal mucosa with the intention of find intestinal metaplasia. We compared prevalence of Barrett's esophagus between groups. RESULTS: One hundred and nine patients were studied. Prevalence of symptomatic gastroesophageal reflux disease was 37.6%. Barrett's esophagus was found in 9.7% of symptomatic gastroesophageal reflux disease patients and in 9.6% of subjects without symptoms of gastroesophageal reflux disease (p = 0.87). Gender and age were similar between groups. Prevalence of hernia hiatal was bigger in patients with Barrett's esophagus (90 vs. 42%) (p = 0.004). CONCLUSION: Our study didn't show association between symptomatic gastroesophageal reflux detected by a questionnaire and Barrett's esophagus.