Ana Henríquez D

Reflujo gastroesofágico patológico en pacientes con obesidad severa, mórbida e hiper obesidad

Background: Overweight can be a risk factor for pathological gastroesophageal reflux or hiatal hernia. Aim: To study the prevalence of gastroesophageal reflux in patients with severe obesity. Patients and methods: Sixty seven patients, 51 female, aged 17 to 56 years old with a body mass index over 35 kg/m2, were studied. An upper gastrointestinal endoscopy was performed in all, esophageal manometry was done in 32 and 24 h pH monitoring was done in 32 patients. Results: Seventy nine percent of patients complained of heartburn and 66% of regurgitation. In 16 patients, endoscopy was normal. An erosive esophagitis was found in 33 patients, a short columnar epithelium in 12 and a Barret esophagus with intestinal metaplasia in six. Normal endoscopic findings and erosive esophagitis were present with a higher frequency in women. No association between the degree of obesity and esophageal lesions was observed. Lower esophageal sphincter pressure and abdominal length were significantly higher in subjects with a body mass index over 50 compared to those with a body mass index between 35 and 39.9 kg/m2. No differences were observed in 24 h pH monitoring. Conclusions: A high proportion of severely obese patients had symptoms and endoscopical findings of pathological gastroesophageal reflux (Rev Med Chile 2001; 129: 1038-43

Gastrointestinal motility disturbances in Chagas disease

Serum antibodies against Trypanosoma Cruzi have been observedin 19% of the Chilean population. Marked differences in organ involvement have been reported inpatients with Chagas disease. Chagas disease is rarely an aetiological factor for achalasia inChile, which is different from reports in other countries of South America. In contrast, a high inci-dence of megacolon among these patients have been reported.

Prevalencia de los diferentes trastornos motores primarios del esófago: Estudio prospectivo de 5.440 casos

Background: The esophagus can suffer several motor disturbances of striated or smooth muscle. Aim: To determine the presence of primary motor disturbances of the esophagus among a group of patients with esophageal symptoms. Material and methods: Prospective study of 5,440 patients consulting for heartburn, chest pain or dysphagia, with primary esophageal motor disturbances, studied between 1994 and 2004. All were subjected to an esophageal manometry with eight perfused catheters connected to pressure transducers. Results: Nineteen percent of subjects had a normal esophageal manometry, 60% had unspecific motor disturbances usually associated to gastroesophageal reflux, 13% had a nutcracker esophagus, 5% had diffuse esophageal spasm, 2% had achalasia and 0,3% had an hypertensive sphincter. Conclusions: Primary esophageal motor disturbances are common among patients with esophageal symptoms. A manometry should be performed to these patients (Rev Med Chile 2007; 135: - ). (Key words: Esophageal manometry; Esophageal motility disorders; Gastroesophageal reflux)

Correlación entre síntomas de reflujo gastroesofágico y resultados de la pHmetría de 24 horas en pacientes con estudio endoscópico normal o levemente alterado

: Abnormal acid reflux was found in 131 patients (70%). Nodifferences in the frequency of symptoms, gender or pathologic findings were observed betweenpatients with or without abnormal acid reflux. However, a higher frequency of esophageal ero-sions and a lower resting pressure of the inferior sphincter of the esophagus was observed inpatients with abnormal acid reflux.

Comparación entre el aspecto endoscópico del cardias, hallazgos manométricos y pHmetría de 24 horas en pacientes con síntomas de reflujo gastroesofágico crónico

The cardia of a group of 150 patients (aged 19 to 72 years, 89 women) withgastroesophageal reflux symptoms was classified as normal or open, during uppergastrointestinal endoscopy. All subjects were subjected to a manometric study to measure LESpressure and determine LES incompetence and to a 24 h esophageal pH measurement.

SÍNTOMAS LARÍNGEOS Y LARINGITIS POSTERIOR: ¿SIEMPRE ES SECUNDARIO A REFLUJO GASTROESOFÁGICO?*

Association of gastroesophageal reflux with posterior laryngitis. Study of 43 patients Background: Gastroesophageal reflux (GER) is syndicated as a cause of posterior laryngitis. However the evidence for the association is weak. Aim: To determine if the presence of posterior laryngitis is associated with GER. Material and Methods: Cross sectional study of 43 patients (19 males) with endoscopically confirmed posterior laryngitis derived for the study of GER. All patients underwent a clinical examination, upper gastrointestinal endoscopy, esophageal manometry and 24 hour pH monitoring. Results: Forty eight percent of patients had GER. Among 28 patients with dysphonia, 10 (36%) had heartburn and 11 (39%) had regurgitation. A hypotensive lower esophageal sphincter was associated with dysphagia in 100% of patients, regurgitation in 81%, cough in 100% and hoarseness in 87% of patients. Upper digestive endoscopy revealed the presence of esophagitis in 6 patients (14%) and was normal in the rest. Dysphonia had the best association with GER with a positive predictive value of 64%. Conclusions: Most patients with laryngeal symptoms and posterior laryngitis do not have GER.

Síntomas, hallazgos radiológicos, endoscópicos y estudios funcionales del esófago en pacientes con hernia hiatal mayor a 5 cm

El hallazgo de una hernia hiatal durante un estudio endoscopico se informa frecuentemente. Sin embargo, no hay referencias especificas acerca de los sintomas y los trastornos funcionales del esofago segun el tipo de hernia hiatal. Objetivo: Determinar los sintomas predominantes, los hallazgos radiologicos y endoscopicos y de los estudios funcionales en pacientes con los diferentes tipos de hernia hiatal. Metodo: Se evaluaron 115 pacientes, todos con diagnostico radiologico de hernia hiatal mayor a 5 cm, realizando estudios endoscopicos, histologicos y manometria esofagica, junto a pHmetria de 24 h. Resultados: La edad fue similar en los 4 tipos de hernia hiatal. Sintomas de reflujo gastroesofagico se presentaron con gran frecuencia en hernias tipo I y III, mientras que sintomas mecanicos se manifestaron en hernias tipo IV. El estudio manometrico mostro un esfinter hipotensivo junto con reflujo acido patologico en casi 90% de las hernias tipo I y IIII. Conclusion: El estudio mas util para el diagnostico de hernia hiatal es el radiologico. La endoscopia es necesaria para comprobar el dano de la mucosa esofagica. Los estudios funcionales muestran una alta prevalencia de reflujo acido patologico en hernias hiatales tipo I y II.

Resultados preliminares de la esofagomiotomía por video laparoscopia en pacientes con acalasia esofágica: Preliminary results in 19 patients

Background: Laparoscopic esophagomyotomy is becoming a good alternative to pneumatic dilatation, injection of botulinic toxin or classical surgery in the treatment of achalasia. Aim: To report the results of laparoscopic esophagomyotomy in patients with achalasia. Patients and methods: Nineteen patients with achalasia, nine women, aged 9 to 66 years old, operated between 1996 and 2001 are reported. Results: There was no surgical mortality. One patient had a subphrenic abscess due to an unnoticed tear of the esophageal mucosa. During surgery, esophageal mucosa was perforated in 4 patients, that was sutured in three. One patient with an extensive tear of the mucosa required conversion to classical surgery. Patients were followed for 2 to 48 months. Radiological controls showed a significant increase in the diameter of gastroesophageal junction and a diameter reduction of the mid third esophageal segment. Lower esophageal pressure was significantly reduced. All patients experienced a weight increase and reduction of dysphagia. Conclusions: Laparoscopic esophagomyotomy is a safe an effective therapeutic alternative for achalasia (Rev Med Chile 2001; 129: 1142-46)