Alterações da motilidade esofagiana em pacientes cirróticos com varizes de esôfago não submetidos a tratamento endoscópico

This study describes the symptoms reported by patients with the indeterminate form of chronic Chagas disease and evaluates associations between these symptoms and alterations in esophageal motility. Esophageal manometry was performed on 50 patients, with measurements of the length and pressure of the lower esophageal sphincter, peristaltism and the amplitude of contractions of the esophageal body. Eight (16%) patients presented partial relaxation of the lower sphincter, 13 (26%) presented partial lack of peristalsis and 20 (40%) presented hypocontractility of the distal esophagus. Upper digestive symptoms were reported by 24 (48%) patients, and the most frequent of these were heartburn, regurgitation and intermittent discomfort when swallowing. Such symptoms were reported by 17 (51.5%) of the 33 patients with esophageal motor disorders and by 7 (41.2%) of the 17 patients with normal manometry, which was not a statistically significant difference (p=0.69). These findings suggest that patients with the indeterminate form of Chagas disease present nonspecific symptoms in the upper digestive tract that may make it difficult to classify the disease solely on the basis of radiological and clinical examination. Furthermore, a high proportion of patients with this form present esophageal motor disorders.

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Proton pump inhibitors in cirrhosis: Tradition or evidence based practice?

Lodato¹,

Azzaroli²,

Girolamo³

et al. 2008

WJG

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Proton pump inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence-based eventually leading to an increase in health costs.

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Alterações da motilidade esofagiana em pacientes cirróticos com varizes de esôfago não submetidos a tratamento endoscópico

Abstract: The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

Cited by 5 publications

References 36 publications

Insights to Indications and Harm of Proton Pump Inhibitors Usage in Patients with Liver Cirrhosis

Insights to Indications and Harm of Proton Pump Inhibitors Usage in Patients with Liver Cirrhosis

Sintomas do trato digestivo superior e distúrbios motores do esôfago em pacientes portadores da forma indeterminada da doença de Chagas crônica

Proton pump inhibitors in cirrhosis: Tradition or evidence based practice?

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