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1.
Orv Hetil ; 163(17): 677-687, 2022 Apr 24.
Artigo em Húngaro | MEDLINE | ID: mdl-35462353

RESUMO

Introduction: In the treatment of symptomatic Zenker's diverticulum, the flexible endoscopic myotomy of the cricopharyngeal muscle is considered to be a safe and effective technique. Objective and method: We retrospectively analyzed our experiences with conventional flexible endoscopic myotomy. Results and discussion: 38 patients with symptomatic Zenker's diverticulum were treated with flexible endoscopic myotomy and 47 myotomies were performed from September 2012 until February 2020. Most of our patients were male (23/38), with an average age of 71.5 (40-88) years. The mean size of diverticula was 3.94 (2-10) cm. In most cases, we used diverticuloscope, while free-hand technique was needed in 8 cases. We assessed our patients' symptoms by applying DRC (dysphagia, regurgitation, complication) score before the treatment and during follow-up. The overall rate of significant complications was 4.2% (2/47), and there was no procedure-related mortality. We observed pneumomediastinum in one patient that was treated conservatively. Intraprocedural bleeding occurred in several (8/47) cases, in all of them the bleeding was successfully stopped during intervention. In one of them, early recurrent massive bleeding required urgent surgery. All 38 patients were followed (mean 34.7 months). Clinical success at 1.5 months was 91.9% among endoscopically treated patients (34/37). 3 patients remained symptomatic, 2 of them were treated with re-myotomy, 1 of them needed surgery later on, another patient underwent percutan endo-scopic gastrostomy at 18 months. Over long-term period, complete success (DRC<2) was 78.4% (29/37), while clinical success (DRC: 0/1/2) reached in 89.2% (33/37). Conclusion: Our experiences confirmed that conventional method of flexible endoscopic myotomy is safe and effec-tive for the treatment of Zenker's diverticulum symptoms.


Assuntos
Transtornos de Deglutição , Enfisema Mediastínico , Divertículo de Zenker , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Divertículo de Zenker/cirurgia
2.
Pancreatology ; 21(1): 59-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33309622

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic modality in acute biliary pancreatitis (ABP) cases with cholangitis or ongoing common bile duct obstruction. Theoretically, inflammation of the surrounding tissues would result in a more difficult procedure. No previous studies examined this hypothesis. OBJECTIVES: ABP and acute cholangitis (AC) without ABP cases were compared to assess difficulty of ERCP. METHODS: The rate of successful biliary access, advanced cannulation method, adverse events, cannulation and fluoroscopy time were compared in 240 ABP cases and 250 AC cases without ABP. Previous papillotomy, altered gastroduodenal anatomy, and cases with biliary stricture were excluded. RESULTS: Significantly more pancreatic guidewire manipulation (adjusted odds ratio (aOR) 1.921 [1.241-2.974]) and prophylactic pancreatic stent use (aOR 4.687 [2.415-9.098]) were seen in the ABP than in AC group. Average cannulation time in the ABP patients (248 vs. 185 s; p = 0.043) were longer than in AC cases. No difference was found between biliary cannulation and adverse events rates. CONCLUSION: ERCP in ABP cases seem to be more challenging than in AC. Difficult biliary access is more frequent in the ABP cases which warrants the involvement of an experienced endoscopist.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangite/terapia , Colestase/terapia , Pancreatite/terapia , Idoso , Idoso de 80 Anos ou mais , Colangite/complicações , Colestase/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Sistema de Registros
3.
Dig Dis ; 38(2): 104-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31846972

RESUMO

Less than 2 centuries have elapsed since the identification of hydrochloric acid in the stomach. The clarification of the molecular mechanisms allowed the effective therapeutic suppression of gastric acid secretion. The spectacular advances in the treatment of acid-related disorders represent a synthesis of the contributions of several brilliant pharmacologists, basic scientists, and clinical physicians. Effective gastric acid suppressive therapy has dramatically improved the therapy and outcome of acid-related disorders. The introduction of proton pump inhibitors (PPIs) in clinical practice has significantly changed the medical management of upper gastrointestinal disorders. PPIs represent the "gold-standard" therapy in acid-related disorders. However, some challenges persist in the therapy of acid related diseases, including management of patients who respond inadequately to PPI therapy, more effective gastroprotection, or more powerful antisecretory treatment for the eradication of Helicobacter pylori infection. New antisecretory drugs are currently being developed and investigated to further provide a more effective and profound gastric acid secretion inhibition. The major advance has been the development of acid pump -antagonists, the potassium channel acid blocking drugs (-P-CABs). Long-term studies comparing P-CABs with PPIs will help to define the exact place and safety profile of this class of drug in the management of acid-related disorders.


Assuntos
Ácido Gástrico/metabolismo , Fármacos Gastrointestinais/farmacologia , Desenvolvimento de Medicamentos , Fármacos Gastrointestinais/uso terapêutico , Antagonistas dos Receptores Histamínicos/farmacologia , Humanos , Bloqueadores dos Canais de Potássio/farmacologia , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico
4.
Orv Hetil ; 150(41): 1883-7, 2009 Oct 11.
Artigo em Húngaro | MEDLINE | ID: mdl-19801354

RESUMO

UNLABELLED: In addition to lower esophageal sphincter (LES) relaxations and decreased LES tone, increased intra-abdominal pressure can also play role in the pathogenesis of gastroesophageal reflux disease (GERD),. AIM: To analyze the correlation between occupation-related increased intra-abdominal pressure or straining (experienced for years) and the prevalence of GERD symptoms. METHODS: Reflux symptoms were analyzed through a questionnaire among professional singers, wind players and glassblowers in comparison with controls. RESULTS: Heartburn, regurgitation and hoarseness were significantly more frequent among professional singers than in controls (P<0.001). Among wind players heartburn (P<0.05) and regurgitation (P<0.01), among glassblowers regurgitation (P<0.01) were significantly more frequent in comparison with control subjects. Reflux symptoms correlated significantly with the duration of professional activity (P<0.05). CONCLUSIONS: Results suggest that reflux symptoms are more frequent among subjects with occupation-related increased intra-abdominal pressure. GERD seems to be a work-related disease in this aspect.


Assuntos
Esfíncter Esofágico Inferior/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Estômago/fisiopatologia , Adulto , Feminino , Refluxo Gastroesofágico/terapia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Música , Doenças Profissionais/fisiopatologia , Pressão , Inquéritos e Questionários
5.
Dig Dis ; 27(1): 38-44, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19439959

RESUMO

BACKGROUND: An occupation-related susceptibility of professional singers to experience gastroesophageal reflux has been suggested. AIMS: To investigate the prevalence of gastroesophageal reflux symptoms in a series of professional opera choristers, wind players, glassblowers and water polo players in comparison with a sample of general population. SUBJECTS AND METHODS: A total of 202 professional opera choristers from well-known choirs in different Hungarian regions, 71 professional wind players, 43 glassblowers, 54 water polo players were identified and 115 control subjects were compared prospectively. Reflux symptoms together with selected individual characteristics and lifestyle habits were investigated in study groups through a reflux questionnaire. RESULTS: Professional opera choristers reported a statistically significantly higher prevalence of heartburn, regurgitation and hoarseness than control subjects (p < 0.001). Among professional wind players, heartburn and regurgitation were significantly more frequent compared with controls (p < 0.05 and p < 0.01, respectively). Glassblowers reported a significantly higher prevalence of acid regurgitation in comparison with controls (p < 0.01). The prevalence of reflux symptoms in water polo players was similar to that of controls. In opera choristers, wind players and glassblowers, reflux symptoms appeared to be significantly correlated with the cumulative lifetime duration of professional singing, playing and working activity, respectively (p < 0.05). CONCLUSIONS: Our results demonstrate that professional opera choristers, professional wind players and glassblowers have a higher prevalence of reflux symptoms compared with control subjects. Gastroesophageal reflux in these professions should be considered as a work-related disorder that may have an impact on quality of life and may negatively interfere with professional performance.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Doenças Profissionais/epidemiologia , Qualidade de Vida , Estudos de Casos e Controles , Tosse/epidemiologia , Tosse/etiologia , Diafragma/fisiopatologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/fisiopatologia , Azia/epidemiologia , Azia/etiologia , Rouquidão/epidemiologia , Rouquidão/etiologia , Humanos , Hungria/epidemiologia , Estilo de Vida , Masculino , Análise Multivariada , Doenças Profissionais/etiologia , Doenças Profissionais/fisiopatologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
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