Obese patients have stronger peristalsis and increased acid exposure in the esophagus.

BACKGROUND: Obesity is a risk factor for GERD and a potential modulator of esophageal motility. AIM: To assess whether obese patients differ from non-obese patients in terms of esophageal motility and reflux. METHODS: Patients (n = 332) were categorized in GERD and controls after clinical assessment, esophageal manometry, and pH monitoring. Non-obese (BMI 16-29.9) and obese (BMI 30-68) were compared in regard of distal esophageal amplitude (DEA), LES pressure (LESP), manometric diagnosis, and esophageal acid exposure (EAE). RESULTS: Obese showed higher DEA in both controls (122 ± 53 vs. 97 ± 36 mmHg, p = 0.041) and GERD patients (109 ± 38 vs. 94 ± 46 mmHg, p < 0.001), higher LESP in GERD patients (20.5 ± 10.6 vs. 18.2 ± 10.6 mmHg, p = 0.049), higher frequency of nutcracker esophagus in controls (30 vs. 0%, p = 0.001), lower frequency of ineffective motility in GERD patients (6 vs. 20%, p = 0.001), and higher EAE in both controls [total EAE: 1.6% (0.7-5.1) vs. 0.9% (0.2-2.4), p = 0.027] and GERD patients [upright EAE: 6.5% (3.8-11.1) vs. 5.2% (1.5-10.6), p = 0.048]. Multiple linear regression showed that BMI was associated either with EAE (p < 0.001), DEA (p = 0.006), or LESP (in men, p = 0.007). CONCLUSIONS: Obese patients differed from non-obese in terms of esophageal motility and reflux, regardless of the presence of GERD. Obese patients showed stronger peristalsis and increased acid exposure in the esophagus.

[Symptom's questionnaire for gastroesophageal reflux disease]. / Questionário de sintomas na doença do refluxo gastroesofágico.

BACKGROUND: Structured questionnaires are valuable instruments to measure the impact of specific diseases in patient's quality of life through a score and they are available such abroad as in Brazil. Nevertheless, questionnaires based on gastroesophageal reflux disease symptoms are not available in Portuguese. AIM: To develop and validate in Portuguese a specific questionnaire for gastroesophageal reflux disease symptoms. PATIENTS AND METHODS: Velanovich's original questionnaire was translated, one question about "regurgitation" symptom was included and the vocabulary was adjusted to be understood to the scholarity level of the analyzed population. The "face validity" to each question was evaluated by the members of a multidisciplinary panel and a symptom's questionnaire for gastroesophageal reflux disease was developed. The questionnaire was applied to patients with gastroesophageal reflux disease symptoms confirmed by prolonged pH esophageal monitoring. The reproducibility, the comprehension, the time spent to fill out the questionnaire and the correlation coefficient to Johnson-DeMeester's score were measured. RESULTS: The "face validity" was considered satisfactory by the panel and the questionnaire was applied to 124 patients, consecutively. The comprehension of the questionnaire and the time less than 5 minutes to fill out them were observed in all patients (100%). Reproducibility for 10 patients in two different occasions showed a high intra-class correlation coefficient of 0,833. The correlation to the Johnson-DeMeester's score was null. CONCLUSION: This study showed that the symptom's questionnaire for gastroesophageal reflux disease has "face validity", excellent reproducibility, easy comprehension and was quickly answered by patients. The correlation with Johnson-DeMeester's score was null.

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle.

BACKGROUND: Transjugular liver biopsy is an alternative procedure for patients who present contraindications to standard percutaneous procedure. AIM: To compare the rate of histological diagnosis obtained on transjugular liver biopsy with an automated trucut needle and with a modified Ross needle. PATIENTS / METHOD: Eighty-five patients with suspicion of chronic liver diseases and presenting contraindications for percutaneous liver biopsy (coagulopathy, massive ascites, morbid obesity, or chronic renal problems) were submitted to 89 transjugular liver biopsies between March 1994 and April 2001 at "Hospital São José, Irmandade da Santa Casa de Misercórdia", Porto Alegre, RS, Brazil. Thirty-five patients underwent 36 biopsies with an automated trucut needle, and 50 patients underwent 53 biopsies with a modified Ross needle. RESULTS: Histological diagnosis was reached in 32/35 subjects submitted to transjugular liver biopsy with the trucut needle (91%) and in 35/50 (70%) submitted to biopsy with the modified Ross needle. Specimens obtained with the trucut needle were significantly larger and less fragmented than those obtained with the Ross needle. CONCLUSION: Transjugular liver biopsy with the automated trucut needle allowed a higher rate of histological diagnosis when compared to the modified Ross needle in patients with suspicion of chronic liver diseases.