RESUMO
BACKGROUND: Chagas disease causes digestive anatomic and functional changes, including the loss of the myenteric plexus and abnormal esophageal radiologic and manometric findings. OBJECTIVE: To evaluate the association of abnormal esophageal radiologic findings, cardiac changes, distal esophageal contractions, and complaints of dysphagia and constipation in upper (UES) and lower (LES) esophageal sphincter basal pressure in Chagas disease patients. METHODS: The study evaluated 99 patients with Chagas disease and 40 asymptomatic normal volunteers. The patients had normal esophageal radiologic examination (n=61) or esophageal retention without an increase in esophageal diameter (n=38). UES and LES pressure was measured with the rapid pull-through method in a 4-channel water-perfused round catheter. Before manometry, the patients were asked about dysphagia and constipation and submitted to electrocardiography and chest radiography. RESULTS: The amplitude of esophageal distal contraction decreased from controls to chagasic patients with esophageal retention. The proportion of failed and simultaneous contractions increased in patients with abnormal radiologic examination (P<0.01). There were no significant differences in UES and LES pressure between the groups. UES pressure was similar between Chagas disease patients with cardiomegaly (n=27, 126.5±62.7 mmHg) and those without it (n=72, 144.2±51.6 mmHg, P=0.26). Patients with constipation had lower LES pressure (n=23, 34.7±20.3 mmHg) than those without it (n=76, 42.9±20.5 mmHg, P<0.03). CONCLUSION: Chagas disease patients with absent or mild esophageal radiologic involvement had no significant changes in UES and LES basal pressure. Constipation complaints are associated with decreased LES basal pressure.
Assuntos
Doença de Chagas , Transtornos da Motilidade Esofágica , Esfíncter Esofágico Inferior , Manometria , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença de Chagas/fisiopatologia , Doença de Chagas/complicações , Esfíncter Esofágico Inferior/fisiopatologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Estudos de Casos e Controles , Transtornos da Motilidade Esofágica/fisiopatologia , Transtornos da Motilidade Esofágica/complicações , Adulto , Esfíncter Esofágico Superior/fisiopatologia , Esfíncter Esofágico Superior/diagnóstico por imagem , Constipação Intestinal/fisiopatologia , Constipação Intestinal/etiologia , Constipação Intestinal/diagnóstico por imagem , Idoso , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/diagnóstico por imagem , PressãoRESUMO
Introducción: La manometría de alta resolución es la prueba de referencia para el estudio de los trastornos motores esofágicos. Objetivo: Determinar la factibilidad de la manometría de alta resolución para el estudio de las características de los trastornos motores esofágicos. Métodos: Se realizó una investigación descriptiva, transversal, en el Centro Nacional de Cirugía de Mínimo Acceso, entre septiembre de 2018 y diciembre de 2019, en 56 pacientes cubanos con diagnóstico de trastorno motor esofágico por manometría de alta resolución, con edades entre 18 y 80 años, que dieron su consentimiento para participar en el estudio. Se excluyeron pacientes con acalasia esofágica y los trastornos menores de la peristalsis. Las variables incluidas fueron: edad, sexo, diagnósticos manométricos y sus características, síntomas, tipos de unión esofagogástrica, diagnósticos imagenológicos o endoscópicos. Para el análisis de los resultados se empleó el porcentaje, medidas de tendencia central y ji cuadrado de Pearson de homogeneidad, con un nivel de significación p 8804; 0,05 y 95 por ciento de confiabilidad. Resultados: Predominó la contractilidad ausente (39,28 por ciento), el sexo femenino (58,9 por ciento) y la disfagia (66,07 por ciento). A la obstrucción al flujo de la unión esofagogástrica correspondió la media de presión de reposo del esfínter esofágico inferior más alta (43,28 mmHg) y la media de la presión de relación integrada por encima de 15 mmHg (38,88 mmHg). El esófago hipercontráctil presentó media de contractilidad distal integrada elevada (5564,25 mmHg/s/cm). Se comprobó la existencia de contracciones rápidas en el espasmo esofágico distal (media de 21,4 cm/ s). Conclusiones: La manometría de alta resolución es factible de ser empleada para el diagnóstico de los trastornos motores esofágicos(AU)
Introduction: High-resolution manometry is the gold standard for the study of esophageal motor disorders. Objective: A descriptive, cross-sectional research was carried out in el Centro Nacional de Cirugía de Mínimo Acceso, between September 2018 and December 2019, in 56 patients, diagnosed with esophageal motor disorder by high-resolution manometry, aged between 18 and 20 years, who gave their consent to participate in the study. Esophageal achalasia and minor peristalsis disorders were excluded. The variables included were: age, sex, manometric diagnoses and their characteristics, symptoms, types of esophagogastric junction, imaging or endoscopic diagnoses. For the analysis of the results, the percentage, measures of central tendency and Pearson's chi square of homogeneity were used, with a level of statistical significance 8804; 0.05 and 95 percent reliability. Development: Absent contractility (39,28 percent), female sex (58,9 percent) and dysphagia (66,07 percent) predominated. The obstruction to the flow of the esophagogastric junction corresponded to the highest mean resting pressure of the lower esophageal sphincter (43,28 mmHg) and the mean integrated pressure ratio above 15 mmHg (38,88 mmHg). The hypercontractile esophagus presented mean high integrated distal contractility (5564,25 mmHg/s/cm). Rapid contractions were found in distal esophageal spasm (mean 21,4 cm/s). Conclusions: High resolution manometry was feasible to be used for the diagnosis of major esophageal motor disorders(AU)
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Espasmo Esofágico Difuso/diagnóstico por imagem , Transtornos de Deglutição , Esfíncter Esofágico Inferior/diagnóstico por imagem , Doenças do Esôfago/diagnóstico , Transtornos da Motilidade Esofágica/diagnóstico , Epidemiologia Descritiva , Estudos Transversais , Junção EsofagogástricaRESUMO
Achalasia is a primary motility disorder of the esophagus, and while there are several treatment options, there is no consensus regarding them. When therapeutic intervention for achalasia fails, a careful evaluation of the cause of the persistent or recurrent symptoms using upper endoscopy, esophageal manometry, and contrast radiologic studies is required to understand the cause of therapy failure and guide plans for subsequent treatment. Options for reintervention are the same as for primary intervention and include pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy, or redo esophageal myotomy. When reintervention fails or if the esophagus is not amenable to intervention and the disease is considered end-stage, esophagectomy is the last option to manage recurrent achalasia.
Assuntos
Acalasia Esofágica , Esfíncter Esofágico Inferior , Esofagectomia , Esofagoscopia , Miotomia de Heller/efeitos adversos , Acalasia Esofágica/diagnóstico por imagem , Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Esfíncter Esofágico Inferior/fisiopatologia , Esfíncter Esofágico Inferior/cirurgia , Humanos , ManometriaRESUMO
We report a case of Plummer-Vinson syndrome (PVS) and lower esophageal ring with a small sliding hiatal hernia. PVS is a rare entity formed by the combination of dysphagia, cervical esophageal web and iron deficiency anemia. It occurs mainly in middle-aged women1,2,3. A lower esophageal ring and a small sliding hiatal hernia were also observed in this case. We documented clinical manifestations of iron deficiency anemia through images and esophageal abnormalities through barium esophagogram. (AU)
Assuntos
Humanos , Feminino , Adulto , Síndrome de Plummer-Vinson/sangue , Síndrome de Plummer-Vinson/diagnóstico por imagem , Esfíncter Esofágico Inferior/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Anemia Ferropriva/sangueAssuntos
Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/terapia , Esfíncter Esofágico Inferior/fisiopatologia , Fundoplicatura , Miotomia de Heller , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Inibidores da Liberação da Acetilcolina/uso terapêutico , Sulfato de Bário , Toxinas Botulínicas Tipo A/uso terapêutico , Meios de Contraste , Acalasia Esofágica/diagnóstico por imagem , Esfíncter Esofágico Inferior/diagnóstico por imagem , Esfíncter Esofágico Inferior/patologia , Esofagoscopia , Humanos , Manometria , Guias de Prática Clínica como Assunto , Radiografia , Resultado do TratamentoRESUMO
Achalasia may present in a non-advanced or an advanced (end stage) stage based on the degree of esophageal dilatation. Manometric parameters and esophageal caliber may be prognostic for the outcome of treatment. The correlation between manometry and disease stage has not been yet fully studied. This study aims to describe high-resolution manometry findings in patients with achalasia and massive dilated megaesophagus. Eighteen patients (mean age 61 years, 55% females) with achalasia and massive dilated megaesophagus, as defined by a maximum esophageal dilatation >10 cm at the barium esophagram, were studied. Achalasia was considered secondary to Chagas' disease in 14 (78%) of the patients and idiopathic in the remaining. All patients underwent high-resolution manometry. Upper esophageal sphincter was hypotonic and had impaired relaxation in the majority of patients. Aperistalsis was seen in all patients with an equal distribution of Chicago type I and type II. No type III was noticed. Lower esophageal sphincter did not have a characteristic manometric pattern. In 50% of the cases, the manometry catheter was not able to reach the stomach. Our results did not show a manometric pattern in patients with achalasia and massive dilated esophagus.
Assuntos
Acalasia Esofágica/patologia , Esôfago/patologia , Manometria/métodos , Doença de Chagas/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Acalasia Esofágica/diagnóstico por imagem , Acalasia Esofágica/etiologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Esfíncter Esofágico Inferior/patologia , Esfíncter Esofágico Superior/diagnóstico por imagem , Esfíncter Esofágico Superior/patologia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia/métodos , Estudos RetrospectivosRESUMO
The complete manifestation of esophageal Chagas' disease includes nonperistaltic contractions in the esophageal body, absent lower esophageal sphincter (LES) relaxation, and dilatation of the organ. However, some patients have a minor degree of esophageal denervation and esophageal motility that does not imply a diagnosis of achalasia. Our objective was to evaluate the evolution of esophageal involvement by Chagas' disease in 28 patients with dysphagia for solids and liquids and a positive serologic test for the disease, 14 with complete LES relaxation, 4 with partial (incomplete) LES relaxation, and 10 with absent LES relaxation; only 2 of them had mild dilatation. The patients (21 women), aged 43-74 years (median 60 years), were evaluated by clinical, radiographic, and manometric methods that were repeated 3-14 years (median 7 years) later. Dysphagia improved in 13 (46.4%) patients, was worse in 5 (17.9%), and did not change in 10 (35.7%). The radiographic examination did not change in 24 (85.7%) and was worse in 3 (10.7%). Esophageal manometry revealed a change from peristaltic to simultaneous contractions in 2 patients (7.1%), LES relaxation changed from complete to partial in 5 (17.9%), and from partial to absent in 2 (7.1%). There was no further clinical, radiographic, or manometric impairment in 15 (53.6%) patients. The symptom duration was longer and the age when they were evaluated was older in patients with no progression of the disease. We conclude that a conspicuous part of this group of patients with esophageal Chagas' disease and dysphagia had no progression of esophageal disease after 3-14 years. This possibility should be considered when making therapeutic decisions.