Presença de refluxo em pacientes com sintomas típicos de doença do refluxo gastroesofágico

Abstract

OBJECTIVE: To analyze clinical, abdominal ultrasound, upper digestive endoscopic, esophageal manometric and prolonged esophageal pH-monitoring findings in patients with typical symptoms of GERD. METHODS: The study included a total of 251 patients with typical GERD symptoms. Clinical data, Body Mass Index, abdominal ultrasound aspects and upper digestive endoscopic data are reported. Manometry and esophageal pH-monitoring were performed. RESULTS: One-hundred-and-seventy-two patients were female (68.5{%}). Mean age of the total was 51.8 years. Ultrasound examination revealed colelithiasis in 23 patients and PC in 21 patients. Hiatal hernia was diagnosed in 177 patients (71{%}), with an average size of 3.0cm. Erosive esophagitis was found in 168 patients (66.9{%}) and Barrett{&}{#}039;s esophagus in 23 patients (9.2{%}). A combination of hiatal hernia and esophagitis was diagnosed in 131 patients (52.3{%}) while only 37 patients (14.7{%}) did not present either. The mean extension of the lower esophageal sphincter (LES) was 2.6 cm, whereas in 132 patients (52.6{%}) the LES was shorter. The mean pressure of the LES was 18.9 mmHg; 46 patients (18.3{%}) had pressures below 14 mmHg. The mean number of reflux episodes on prolonged esophageal monitoring was 42.9; the mean number of prolonged episodes of reflux was 4.6, and the mean percentage of total acid time was 8.4{%}. DeMeester scores were high in 175 patients (69.7{%}). CONCLUSION: In patients with typical GERD symptoms, factors influencing the presence of pathological reflux as confirmed by prolonged esophageal pH-monitoring were: age, hiatal hernia associated to erosive esophagitis, a smaller extension, low baseline pressure and smaller volume vector of the LES. OBJETIVO: Analisar os aspectos cl{í}nicos, ultra-sonogr{á}ficos, endosc{ó}picos, manom{é}tricos e os dados de pHmetria prolongada do es{ô}fago nos pacientes com sintomas t{í}picos de doen{ç}a do refluxo gastroesof{á}gico (DRGE). M{É}TODOS: Foram estudados, em 251 pacientes com sintomas t{í}picos da doen{ç}a do refluxo gastroesof{á}gico, os aspectos cl{í}nicos, o IMC, os dados ultra-sonogr{á}ficos, endosc{ó}picos, manom{é}tricos e de pHmetria do es{ô}fago. RESULTADOS: Eram mulheres 172 pacientes (68,5{%}). A m{é}dia de idade foi de 51,8 anos. A ultra-sonografia diagnosticou colelit{í}ase em 23 doentes e colecistectomia pr{é}via em 21 pacientes. A h{é}rnia hiatal (HH) estava presente em 177 pacientes (71{%}), com tamanho m{é}dio de 3 cm. A esofagite erosiva foi encontrada em 168 pacientes (66,9{%}) e o es{ô}fago de Barrett em 23 casos (9,2{%}). A associa{ç}{ã}o de HH com EE foi observada em 131 pacientes (52,3{%}). Apenas 37 pacientes (14,7{%}) n{ã}o apresentavam HH ou EE. Quanto {à} manometria, o valor m{é}dio da extens{ã}o do esf{í}ncter inferior do es{ô}fago (EIE) foi 2,6 cm, sendo que 132 pacientes (52,6{%}) apresentaram EIE curto. A press{ã}o m{é}dia do EIE foi 18,9 mmHg e 46 doentes (18,3{%}) apresentaram press{ã}o abaixo de 14 mmHg. {À} pHmetria prolongada do es{ô}fago, a m{é}dia do n{ú}mero de refluxos foi 42,9 e a porcentagem de tempo {á}cido total m{é}dia foi 8,4{%}. Em 175 pacientes (69,7{%}), o {í}ndice de DeMeester mostrou-se elevado. CONCLUS{Ã}O: Nos pacientes com sintomas t{í}picos da DRGE, os fatores que influenciaram a presen{ç}a do refluxo patol{ó}gico, comprovada pela pHmetria do es{ô}fago, foram: a idade mais avan{ç}ada, a presen{ç}a de h{é}rnia hiatal com esofagite erosiva; a extens{ã}o menor, a press{ã}o basal diminu{í}da e o menor vetor volume do EIE.