RESUMO
PURPOSE: To investigate the combined effects of reflux of duodenal contents through the pylorus and treatment with N-methyl-N'-nitro-nitrosoguanidine (MNNG) on the development of lesions in the glandular stomach, at the gastrojejunal anastomosis and in the forestomach of rats. METHODS: Eighty Male Wistar rats were divided into 4 groups: G1: MNNG + Reflux, G2: Reflux, G3: MNNG and G4: Gastrostomy. MNNG was given in the drinking water (100 mg/ml) for 12 weeks and then two groups (G1 and G2) were submitted to a gastrojejunal anastomosis followed by section of the afferent loop and suture of both stumps to allow reflux of duodenal contents through the pylorus. The animals were sacrificed 18 and 36 weeks after surgery. The lesions obtained in the antral mucosa, at the gastrojejunal anastomosis and in the forestomach were analysed histologically. RESULTS: Duodenal reflux induced proliferative lesions at both glandular and squamous mucosa of the stomach. In the antrum, adenomatous hyperplasia (AH) was observed in 20% and 50% of the animals at the 18th and 36th weeks respectively. Aditionally 85% of the animals presented AH at the gastrojejunal anastomosis and 60% developed squamous hyperplasia at the squamous portion of the stomach. MNNG treatment plus duodenal reflux enhanced the development of malignant tumors at both glandular and squamous mucosa, since there were 30% of antral adenocarcinomas and 45% of squamous carcinomas at the 18th week and the frequency of these malignant tumors rose to 50% in the antrum and 65% in the squamous mucosa at the 36th week. CONCLUSION: The reflux of duodenal contents through the pylorus enhanced the development of proliferative lesions, benign and malignant, in the glandular stomach and in the forestomach of rats.
Assuntos
Carcinoma de Células Escamosas/etiologia , Refluxo Duodenogástrico/complicações , Metilnitronitrosoguanidina , Neoplasias Gástricas/etiologia , Animais , Carcinoma de Células Escamosas/patologia , Refluxo Duodenogástrico/patologia , Duodeno/efeitos dos fármacos , Duodeno/patologia , Masculino , Ratos , Ratos Wistar , Estômago/efeitos dos fármacos , Estômago/patologia , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: To investigate the combined effects of reflux of duodenal contents through the pylorus and treatment with N-methyl-N'-nitro-nitrosoguanidine (MNNG) on the development of lesions in the glandular stomach, at the gastrojejunal anastomosis and in the forestomach of rats. METHODS: Eighty Male Wistar rats were divided into 4 groups: G1: MNNG + Reflux, G2: Reflux, G3: MNNG and G4: Gastrostomy. MNNG was given in the drinking water (100 mg/ml) for 12 weeks and then two groups (G1 and G2) were submitted to a gastrojejunal anastomosis followed by section of the afferent loop and suture of both stumps to allow reflux of duodenal contents through the pylorus. The animals were sacrificed 18 and 36 weeks after surgery. The lesions obtained in the antral mucosa, at the gastrojejunal anastomosis and in the forestomach were analysed histologically. RESULTS: Duodenal reflux induced proliferative lesions at both glandular and squamous mucosa of the stomach. In the antrum, adenomatous hyperplasia (AH) was observed in 20% and 50% of the animals at the 18th and 36th weeks respectively. Aditionally 85% of the animals presented AH at the gastrojejunal anastomosis and 60% developed squamous hyperplasia at the squamous portion of the stomach. MNNG treatment plus duodenal reflux enhanced the development of malignant tumors at both glandular and squamous mucosa, since there were 30% of antral adenocarcinomas and 45% of squamous carcinomas at the 18th week and the frequency of these malignant tumors rose to 50% in the antrum and 65% in the squamous mucosa at the 36th week. CONCLUSION: The reflux of duodenal contents through the pylorus enhanced the development of proliferative lesions, benign and malignant, in the glandular stomach and in the forestomach of rats.
OBJETIVO: Investigar os efeitos do refluxo duodenogástrico e sua interação com o cancerígeno químico N-methil-N'-nitro-nitrosoguanidina (MNNG) no desenvolvimento de lesões no estômago glandular, anastomose gastrojejunal e no estômago escamoso do rato. MÉTODOS: Foram utilizados 80 ratos Wistar divididos em 4 grupos: G1: MNNG + Refluxo, G2: Refluxo, G3: MNNG e G 4: Gastrostomia. O MNNG foi oferecido na água de beber (100mg/ml) por 12 semanas. A seguir foi feita anastomose gastrojejunal na porção glandular do estômago nos grupos G1 e G2, com secção da alça aferente junto ao estômago e sutura de ambos os cotos para permitir o refluxo do conteúdo duodenal para o estômago pelo piloro. Os animais foram sacrificados 18 e 36 semanas após a cirurgia. As lesões identificadas foram submetidas à exame histopatológico. RESULTADOS: O refluxo duodenogástrico levou ao desenvolvimento de lesões proliferativas no estômago glandular e na porção escamosa. No antro, hiperplasia adenomatosa (HA) foi diagnosticada em 20 e 50% dos animais (G2) na 18ª e 36ª semanas, respectivamente. Na anastomose gastrojejunal 85 por cento dos animais (G2) apresentaram HA e 60% apresentaram hiperplasia escamosa no estômago escamoso, na 36ª semana. No grupo MNNG+Refluxo foram identificados na 18ª semana, 30% adenocarcinomas no antro e 45%carcinomas escamosos. A freqüência destas lesões malignas aumentou, respectivamente, para 50% e 65% na 36ª semana. CONCLUSÃO: O refluxo duodenogástrico potencializou o desenvolvimento de lesões proliferativas benignas e malignas no estômago glandular e em sua porção escamosa, no rato.
Assuntos
Animais , Masculino , Ratos , Carcinoma de Células Escamosas/etiologia , Refluxo Duodenogástrico/complicações , Metilnitronitrosoguanidina , Neoplasias Gástricas/etiologia , Carcinoma de Células Escamosas/patologia , Refluxo Duodenogástrico/patologia , Duodeno/efeitos dos fármacos , Duodeno/patologia , Ratos Wistar , Neoplasias Gástricas/patologia , Estômago/efeitos dos fármacos , Estômago/patologiaRESUMO
PURPOSE: to investigate if combining VT to DGR through the pylorus can modulate the biological behavior of PL induced by DGR and to verify if TV alone can induce morphologic lesions in the gastric mucosa. METHODS: 62 male Wistar rats were assigned to four groups: 1 - Control (CT) gastrotomy; 2 - Troncular Vagotomy (TV) plus gastrotomy; 3 - Duodenogastric reflux through the pylorus (R) and 4 - Troncular vagotomy plus DGR (RTV). The animals were killed at the 54 week of the experiment. DGR was obtained by anastomosing a proximal jejunal loop to the anterior gastric wall. TV was performed through isolation and division of the vagal trunks. Gastrotomy consisted of 1 cm incision at the anterior gastric wall. PL were analyzed gross and histologically in the antral mucosa, at the gastrojejunal stoma and at the squamous portion of the gastric mucosa. RESULTS: Groups R and RTV developed exophytic lesions in the antral mucosa (R=90.9%; RTV=100%) and at the gastrojejunal stoma (R=54.54%; RTV=63.63%). Histologically they consisted of proliferative benign lesions, without cellular atypias, diagnosed as adenomatous hyperplasia. Both groups exposed to DGR presented squamous hyperplasia at the squamous portion of the gastric mucosa (R= 54.5%; RTV= 45.4%). TV, alone, did not induce gross or histological alterations in the gastric mucosa. TV did note change the morphologic pattern of the proliferative lesions induced by DGR. CONCLUSIONS: DGR induces the development of PL in the pyloric mucosa and at the gastrojejunal stoma. TV does not change the morphologic pattern of the proliferative lesions induced by DGR. TV alone is not able to induce morphologic lesions in the gastric mucosa.
Assuntos
Refluxo Duodenogástrico/patologia , Mucosa Gástrica/patologia , Gastrostomia , Estômago/patologia , Vagotomia Troncular , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Anastomose Cirúrgica , Animais , Modelos Animais de Doenças , Refluxo Duodenogástrico/complicações , Refluxo Duodenogástrico/cirurgia , Humanos , Hiperplasia , Jejuno/patologia , Jejuno/cirurgia , Masculino , Piloro/patologia , Piloro/cirurgia , Ratos , Ratos Wistar , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: to investigate if combining VT to DGR through the pylorus can modulate the biological behavior of PL induced by DGR and to verify if TV alone can induce morphologic lesions in the gastric mucosa. METHODS: 62 male Wistar rats were assigned to four groups: 1 - Control (CT) gastrotomy; 2 - Troncular Vagotomy (TV) plus gastrotomy; 3 - Duodenogastric reflux through the pylorus (R) and 4 - Troncular vagotomy plus DGR (RTV). The animals were killed at the 54 week of the experiment. DGR was obtained by anastomosing a proximal jejunal loop to the anterior gastric wall. TV was performed through isolation and division of the vagal trunks. Gastrotomy consisted of 1 cm incision at the anterior gastric wall. PL were analyzed gross and histologically in the antral mucosa, at the gastrojejunal stoma and at the squamous portion of the gastric mucosa. RESULTS: Groups R and RTV developed exophytic lesions in the antral mucosa (R=90.9 percent; RTV=100 percent) and at the gastrojejunal stoma (R=54.54 percent; RTV=63.63 percent). Histologically they consisted of proliferative benign lesions, without cellular atypias, diagnosed as adenomatous hyperplasia. Both groups exposed to DGR presented squamous hyperplasia at the squamous portion of the gastric mucosa (R= 54.5 percent; RTV= 45.4 percent). TV, alone, did not induce gross or histological alterations in the gastric mucosa. TV did note change the morphologic pattern of the proliferative lesions induced by DGR. CONCLUSIONS: DGR induces the development of PL in the pyloric mucosa and at the gastrojejunal stoma. TV does not change the morphologic pattern of the proliferative lesions induced by DGR. TV alone is not able to induce morphologic lesions in the gastric mucosa.
OBJETIVO: investigar se a adição da VT ao RDG através do piloro, interfere no comportamento biológico das LP induzidas pelo RDG e observar se a VT isoladamente leva ao desenvolvimento de lesões morfológicas na mucosa gástrica. MÉTODOS: Foram utilizados 62 ratos Wistar machos, distribuídos em quatro grupos experimentais: 1- Controle (CT) Gastrotomia; 2- Vagotomia Troncular + gastrotomia (VT); 3-Refluxo duodeno-gástrico (R) e 4- RDG através do piloro e VT (RTV). Os animais foram sacrificados na 54ª semana do experimento. O RDG foi obtido através de anastomose do jejuno proximal com a parede gástrica anterior. A vagotomia troncular foi realizada através da dissecção e divisão dos troncos vagais. A gastrotomia consistiu de secção e síntese de um cm na parede gástrica anterior. As LP foram analisadas macroscopicamente e histologicamente na mucosa gástrica, na anastomose gastrojejunal e no estômago escamoso. RESULTADOS: Os grupos R e RVT desenvolveram lesões exofíticas na mucosa do antro gástrico (R=90,9 por cento e RVT=100 por cento) e na anastomose gastrojejunal (R=54,5 por cento e RVT=63,6 por cento) que se caracterizaram no exame histológico por lesões proliferativas epiteliais benignas, sem atipias celulares, diagnosticadas como hiperplasia adenomatosa. Na região do estômago escamoso, ambos os grupos expostos ao RDG apresentaram hiperplasia escamosa (R= 54,5 por cento e RVT= 45,4 por cento). A VT não modificou o padrão histopatológico das LP induzidas pelo RDG. Os grupos VT e CT não apresentaram alterações macroscópicas ou histológicas significativas. CONCLUSÕES: o RDG induz o desenvolvimento de lesões proliferativas (LP) benignas na mucosa do antro gástrico e na anastomose gastrojejunal. A VT isoladamente não induz alterações proliferativas na mucosa gástrica e não modifica as características morfológicas das LP induzidas pelo RDG através do piloro.
Assuntos
Animais , Humanos , Masculino , Ratos , Refluxo Duodenogástrico/patologia , Gastrostomia , Mucosa Gástrica/patologia , Estômago/patologia , Vagotomia Troncular , Anastomose Cirúrgica , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Modelos Animais de Doenças , Refluxo Duodenogástrico/complicações , Refluxo Duodenogástrico/cirurgia , Hiperplasia , Jejuno/patologia , Jejuno/cirurgia , Piloro/patologia , Piloro/cirurgia , Ratos Wistar , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/patologiaRESUMO
OBJETIVO: Avaliar as lesões proliferativas que se desenvolvem na mucosa gástrica de ratos Wistar após modelo específico de refluxo duodeno-gástrico.MÉTODOS: Foram utilizados 75 ratos adultos machos divididos em três grupos experimentais: o grupo I (controle) submetido a gastrotomia na parede posterior do estômago glandular (25 animais); o grupo II (RDG), foi submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular (25 animais) e o grupo III (RDG-P) submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular, com secção e fechamento da alça (25 animais). Os animais foram observados durante 36 semanas, após o que foram realizados estudos macroscópicos e microscópicos da anastomose gastrojejunal, da região pré-pilórica e região escamosa do estômago. RESULTADOS: Os animais do Grupo I não apresentaram nenhum tipo de lesão. No grupo II observou-se 40% de lesões do tipo hiperplasia adenomatosa na anastomose e 12% de hiperplasia escamosa. No grupo III obteve-se 40% de hiperplasia adenomatosa na mucosa pré-pilórica, 72 % de hiperplasia adenomatosa na mucosa da anastomose, 20% de hiperplasia escamosa e 12 % de adenocarcinoma. CONCLUSÕES: O refluxo duodeno-gástrico induz a alta freqüência de lesões proliferativas na mucosa adjacente à anastomose gastrojejunal ou na mucosa pré-pilórica e o adenocarcinoma é um evento raro neste modelo experimental.(AU)
PURPOSE: To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats. METHODS: Seventy-five healthy and adult male rats were divided into three groups: group I control (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach. RESULTS: Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%). CONCLUSIONS: The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence.(AU)
Assuntos
Animais , Masculino , Ratos , Refluxo Duodenogástrico/complicações , Adenocarcinoma/etiologia , Neoplasias Duodenais/etiologia , Hiperplasia/etiologia , Refluxo Duodenogástrico/patologia , Adenocarcinoma/patologia , Neoplasias Duodenais/patologia , Hiperplasia/patologia , Ratos Wistar , Modelos Animais de Doenças , Anastomose Cirúrgica , Jejuno/patologia , Jejuno/cirurgia , Piloro/patologia , Piloro/cirurgia , Estudos de Casos e ControlesRESUMO
OBJETIVO: Avaliar as lesões proliferativas que se desenvolvem na mucosa gástrica de ratos Wistar após modelo específico de refluxo duodeno-gástrico.MÉTODOS: Foram utilizados 75 ratos adultos machos divididos em três grupos experimentais: o grupo I (controle) submetido a gastrotomia na parede posterior do estômago glandular (25 animais); o grupo II (RDG), foi submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular (25 animais) e o grupo III (RDG-P) submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular, com secção e fechamento da alça (25 animais). Os animais foram observados durante 36 semanas, após o que foram realizados estudos macroscópicos e microscópicos da anastomose gastrojejunal, da região pré-pilórica e região escamosa do estômago. RESULTADOS: Os animais do Grupo I não apresentaram nenhum tipo de lesão. No grupo II observou-se 40% de lesões do tipo hiperplasia adenomatosa na anastomose e 12% de hiperplasia escamosa. No grupo III obteve-se 40% de hiperplasia adenomatosa na mucosa pré-pilórica, 72 % de hiperplasia adenomatosa na mucosa da anastomose, 20% de hiperplasia escamosa e 12 % de adenocarcinoma. CONCLUSÕES: O refluxo duodeno-gástrico induz a alta freqüência de lesões proliferativas na mucosa adjacente à anastomose gastrojejunal ou na mucosa pré-pilórica e o adenocarcinoma é um evento raro neste modelo experimental.
Assuntos
Animais , Masculino , Ratos , Adenocarcinoma/etiologia , Neoplasias Duodenais/etiologia , Refluxo Duodenogástrico/complicações , Hiperplasia/etiologia , Anastomose Cirúrgica , Adenocarcinoma/patologia , Estudos de Casos e Controles , Modelos Animais de Doenças , Neoplasias Duodenais/patologia , Refluxo Duodenogástrico/patologia , Hiperplasia/patologia , Jejuno/patologia , Jejuno/cirurgia , Piloro/patologia , Piloro/cirurgia , Ratos WistarRESUMO
PURPOSE: To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats. METHODS: Seventy-five healthy and adult male rats were divided into three groups: group I--control (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II--DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III--DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach. RESULTS: Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%). CONCLUSIONS: The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence.
Assuntos
Adenocarcinoma/patologia , Neoplasias Duodenais/patologia , Refluxo Duodenogástrico/complicações , Estômago/patologia , Adenocarcinoma/etiologia , Anastomose Cirúrgica , Animais , Modelos Animais de Doenças , Neoplasias Duodenais/etiologia , Refluxo Duodenogástrico/patologia , Hiperplasia/etiologia , Hiperplasia/patologia , Jejuno/patologia , Jejuno/cirurgia , Masculino , Piloro/patologia , Piloro/cirurgia , Ratos , Ratos WistarRESUMO
OBJECTIVE: Our objective was to determine the relationship between reflux of duodenogastric contents with different degrees of esophagitis, and its levels and activity, with regard to the severity of esophagitis-induced duodenogastroesophageal reflux disease (DGERD). MATERIAL AND METHODS: Our study design was prospective, transversal, descriptive, observational, and open. We took samples of gastric and esophageal juices from patients with a diagnosis of gastroesophageal reflux disease (GERD) and esophagitis during the period from March to August 2002. Sample material was placed in black rubber-covered assay tubes to prevent bilirubin degradation. In our Unit's central laboratory, these samples were centrifuged for 30 min, the dissolved material separated, and a reactive strip was introduced to measure the amount of bile pigment. Endoscopic study reports were provided by this Department on terminating the procedure. Univariate analysis was used to obtain results. RESULTS: In 60% of cases, the esophageal liquid was positive for total bilirubin; 40% presented stage II esophagitis, 27% chronic esophagitis, and 27%, stage I esophagitis. Specific quantifications of total bilirubin at different stages of esophagitis demonstrated in stage II 50% with levels of 0.1-1, 33% with a level of 2-3, in cases of chronic esophagitis 75% with levels of 0.1-1, and with stage I esophagitis, 25% with levels of 2-3 mg/dl. Measurement of gastric pH showed 18 (69%) <3 and esophageal pH of 20 (67%) > 4, with 10 (33%) referring occasional or asymptomatic dyspepsia. We determined presence of duodenal elements in esophagus by means of quantification of total bilirubin in 60% of patients, observing greatest frequency of stage II esophagitis. Low but continuous levels of duodenal, principally biliary, elements continued in patients with DGERD, producing greatest damage in esophageal mucosa.
Assuntos
Refluxo Duodenogástrico/fisiopatologia , Esofagite Péptica/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Adulto , Bilirrubina/análise , Estudos Transversais , Refluxo Duodenogástrico/complicações , Refluxo Duodenogástrico/patologia , Esofagite Péptica/etiologia , Esofagite Péptica/patologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/patologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Estudos ProspectivosRESUMO
El reflujo del contenido duodenal dentro del estómago a través del píloro, es un evento fisiológico normal que ocurre más frecuentemente durante la noche, ejercicio fuerte, períodos de ayuno y postprandiales. Cuando es excesivo, puede ser patológico y asociarse a gastritis, úlcera gástrica, carcinoma gástrico y síndrome de dispepsia ulcerosa o no ulcerosa. El contenido duodenal, también puede refluir hacia el esófago, originando diferentes cambios en la mucosa, desde esofagitis leve, hasta esofagitis severa, esófago de Barrett y adenocarcinoma esofágico. Anteriormente se utilizaban los términos de reflujo biliar y reflujo alcalino para describir este proceso; el cual ha sido cambiado por reflujo duodenogastroesofágico (RDGE), debido a que el contenido duodenal está compuesto por algo más que bilis, como ha sido demostrado en recientes estudios, en los cuales refieren que el término reflujo alcalino es incorrecto, ya que el PH > 7 no se correlaciona con el reflujo del contenido duodenal. Así es que, el término reflujo duodenogastroesofágico es más apropiado para describir la regurgitación patológica del contenido duodenal dentro del estómago y de este hacia el esófago. Este tipo de entidades son altamente patológicas y su manejo médico es por lo general difícil al igual que el diagnóstico. Por lo anterior pretendemos hacer una revisión del tema esperando lograr clarificar muchos aspectos del mismo discutiendo su terapia y manejo quirúrgico
Assuntos
Humanos , Refluxo Duodenogástrico/etiologia , Refluxo Gastroesofágico/etiologia , Esôfago de Barrett/fisiopatologia , Esofagite/fisiopatologia , Neoplasias Gastrointestinais/etiologia , Refluxo Duodenogástrico/cirurgia , Refluxo Duodenogástrico/patologia , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/patologiaRESUMO
BACKGROUND: The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years. AIM: To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia. PATIENTS AND METHODS: A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content. RESULTS: Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia. CONCLUSIONS: These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.