SUMMARYBackground: Population-based data on gastro-oesophageal reflux in Latin America are lacking. Aim: To assess gastro-oesophageal reflux symptom prevalence, clinical spectrum and association with the atypical symptoms in our country. Methods: Gastro-oesophageal reflux self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-80 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census.

We review the treatment of esophageal achalasia by means of pneumatic dilatation (PD), analyzing its results and comparing them with those of the literature. We conclude that our personal experience is similar to that of the literature: PD and surgery produce similar results (67-95%), morbidity (2-9.5%), and mortality (0.7-1%); and PD is cheaper than surgery. According to these conclusions, we believe that the decision of the appropriate treatment should be based on a combination of the choice of the properly informed patient and the operator's experience. However, we also conclude that surgery is mandatory in selected cases, such as achalasia associated with hiatus hernia, esophageal diverticula and neoplasia, history of previous PD failure (since in our experience the results after a second PD are very poor), postoperative relapse, and patients with grade IV mega-esophagus according to Resano-Malenchini's classification.

We sought to assess the prevalence, severity of symptoms, and risk factors of uninvestigated dyspepsia in a population-based study in Argentina. Eight hundred thirty-nine valid questionnaires were evaluated. Dyspepsia was present in 367 subjects (43.2%; 95% confidence interval [CI], 39.8-46.6); 110 (13.6%) had overlap with gastroesophageal reflux disease (GERD). The group with dyspepsia without GERD consisted of 257 subjects (29.6%; 95% CI, 26.5-32.7), 183 (71.1%) had ulcer-like dyspepsia, and 74 (28.9%) had dysmotility-like dyspepsia. Symptoms were considered very severe in 1.9%, severe in 14.0%, moderate in 59.5%, and mild in 24.5% of the subjects. Dyspepsia was associated with a score >14 on the psychosomatic symptom scale (PSC) (OR, 2.52; 95% CI, 1.75-3.61), a family history of diseases of the esophagus or stomach (OR, 1.73; 95% CI, 1.19-2.52) and an educational level >12 years (OR, 1.55; 95% CI, 1.05-2.29). Dyspepsia is especially prevalent in Argentina. In a significant proportion of dyspeptic subjects, the severity of symptoms interferes with daily activities. A higher PSC, positive family history, and a higher educational level are risk factors for dyspepsia.

Peptic esophageal stricture (PES) is a major complication of gastroesophageal reflux disease. The aims of this paper were to determine the characteristics of these patients with regard to demography, morphology, functional status and results of therapy. The charts of the patients treated at our service who underwent esophageal dilatation for PES between 1971 and 1998 were reviewed. Statistical analyses were performed by means of chi2, Mann-Whitney and Student's t-tests. One hundred and thirty-five patients with PES were dilated by various means. The mean age was 61.1 +/- 16.3 years, the ratio of men to women was 2.75/1 and mean duration of symptoms was 44.4 +/- 74.6 months. Their symptoms were dysphagia in 100%, pyrosis in 70%, and regurgitation in 40% of the cases. There was an average weight loss of 3.3 +/- 6 kg. The upper gastro-intestinal series showed pre- and post-dilatation diameters at the stricture of 8 +/- 2.5 mm and 15.9 +/- 1.2 mm, respectively. The stricture was located at the lower third of the esophagus in 97% and at the middle third in 3% of the cases. We found PES endoscopically in all instances, with different degrees of erosions in 64%, ulcers in 20% and Barrett's esophagus in 16% of the cases. The biopsy samples showed intestinal metaplasia in 16% and esophagitis in 75.5%, being normal in the remaining 8.5%. Brush cytology was negative for malignancy in 100% of the cases. Esophageal manometry showed peristaltic wave amplitude of 40 +/- 3 mmHg and presence of peristaltic waves of 62 +/- 38.6%. LES pressure was 8.6 +/- 6.3 mmHg (NV 24.2 +/- 6.3 mmHg). Measurement of pH showed 15% of patients had pH < 4. Patients needed a mean of 4.7 +/- 1.6 dilations per case, with successful results in 87.2% of cases. The perforation rate was 0.1% of the total number of procedures and 0.7%, of patients. The mortality rate was 0.7% (one case). We observed PES relapse in 32% of the cases. There was no correlation between relapse, age, duration of the stenosis or pharmacological treatment with H2 blockers or proton pump inhibitors. We conclude that in Argentina, demography, morphology, functional status and results of dilatation of PES patients are similar to those reported in the Western world, with the exception of the different behavior seen after treatment with H2 blockers or proton pump inhibitors.

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