Esophageal Motility in Cirrhotics with and without Esophageal Varices

Passaretti, Sandro; Mazzotti, Guido; Franchis, Roberto de; Cipolla, M.; Testoni, P.A.; Tittobello, A.

doi:10.3109/00365528909093056

Cited by 31 publications

(29 citation statements)

References 13 publications

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“…Studies have demonstrated that no changes in LES pressure occur in patients with EV, with or without ascites (3,28,37). Some authors, have found esophageal motor disorders in cirrhotic patients with EV, as well as a decrease in amplitude of the peristaltic waves, in opposition to that observed in cirrhotic without varices and an asymptomatic control group (32) . These changes associated to EV, independent of the cirrhosis itself, could delay esophageal clearance and increase contact time between acid and mucosa, promoting injury (32) .…”

Section: Child-pugh Score and Abnormal Refluxmentioning

confidence: 91%

“…In the last years, the role of esophageal varices (EV) as a factor for the development of esophageal motors disorders and abnormal gastroesophageal reflux (GER) in liver cirrhotic patients has been discussed (1,3,15,32) . It is doubtful whether these abnormalities can contribute to the bleeding of varices.…”

Section: Introductionmentioning

confidence: 99%

“…It is doubtful whether these abnormalities can contribute to the bleeding of varices. Some studies demonstrate motors disorders in the esophageal body, a delay in esophageal clearance time (12) and abnormal gastroesophageal reflux (1) in cirrhotic patients with EV (3,15,32) , as compared to cirrhotic patients without varices and a control group. These studies suggest that motor disorders would be caused by EV and not by cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

Schechter

Lemme

Coelho

2007

Arq. Gastroenterol.

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-Background -Portal hypertension in patients with liver cirrhosis causes manifestations such as esophageal varices, ascites and edema. Some studies have been conducted about the role of esophageal varices in the development of esophageal motor disorders and abnormal gastroesophageal reflux in these patients. Ascites could be a factor promoting gastroesophageal reflux and it has been questioned whether reflux would favor the rupture of varices. However there are a few studies using ambulatory esophageal pH recording in the evaluation of these patients. Aims -Evaluate gastroesophageal reflux by pH recording in cirrhotic patients with esophageal varices and possible predictors. Methods -Fifty one patients (28 men, 23 women, mean age of 54 years) with liver cirrhosis, diagnosed by clinical, laboratorial, image and histological findings were prospectively evaluated. All patients had esophageal varices confirmed by endoscopy and were submitted to a questionnaire about typical gastroesophageal reflux disease symptoms (heartburn and or acid regurgitation). pH recording was performed with the probe placed 5 cm above the superior lower esophageal sphincter limit, as determined by manometry. Abnormal reflux (% total time with pH <4 >4.5%) was related to the size of varices, congestive gastropathy, ascites, severity of cirrhosis and typical gastroesophageal reflux disease symptoms. Results -The caliber of the varices was considered to be small in 30 patients (59%), medium in 17 (33%) and large in 4 (8%), 21 (41%) congestive gastropathy. Ascites was observed in 17 (33%), 32 patients (63%) were classified as Child-Pugh A, 17 (33%) Child-Pugh B and 2 (4%) Child-Pugh C. Twenty seven patients (53%) presented with typical gastroesophageal reflux disease symptoms. Abnormal reflux at pH recording was found in 19 patients (37%). One of them presented with erosive esophagitis at endoscopy. There was no relation between ascites, variceal size, congestive gastropathy and Child-Pugh score and abnormal reflux. There was a correlation between typical gastroesophageal reflux disease symptoms and abnormal reflux. Conclusions -Abnormal gastroesophageal reflux was found in 37% of the patients with hepatic cirrhosis and esophageal varices. Only typical gastroesophageal reflux disease symptoms predicted these findings.

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Section: Child-pugh Score and Abnormal Refluxmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

Schechter

Lemme

Coelho

2007

Arq. Gastroenterol.

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“…Concluíram também que a porcentagem de ondas terciárias foi mais elevada após a ligadura, e que o comprimento do EIE não sofreu modificações quando comparado ao grupo controle. Estes resultados também foram confirmados por Kim et al 16 e Passaretti et al 17 , por outro lado, relataram que a presença de varizes residuais no terço inferior do esôfago após procedimentos endoscópicos pode diminuir a amplitude e duração das ondas peristálticas.…”

Section: Discussionunclassified

Estudo da motilidade esofágica após ligadura elástica endoscópica das varizes

Soares¹,

Morais²,

Santos³

et al. 2006

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVOS. Estudar a motilidade esofágica de doentes cirróticos antes e após a ligadura elástica endoscópica das varizes. MÉTODOS. Vinte e quatro portadores de cirrose hepática atendidos no Gastrocentro -UNICAMP, no programa de ligadura elástica para tratamento de varizes, foram estudados (média de idade de 49,5 anos, sendo 19 masculinos e 5 femininos). Os critérios de inclusão foram hepatopatia crônica e varizes esofágicas com alto risco de sangramento. Inicialmente foram realizados endoscopia digestiva alta e manometria esofágica em todos os doentes. A seguir, foram submetidos a sessões de ligadura elástica (o número médio foi de 3,4±2,1), em regime ambulatorial, com intervalo de duas a quatro semanas. A manometria foi repetida quatro semanas após a erradicação das varizes. Os parâmetros estudados foram a amplitude, a duração, a velocidade de propagação das ondas contráteis e o peristaltismo. RESULTADOS. A análise do tônus do EIE não mostrou diferença entre pré e pós-ligadura elástica. Em dez casos (41,6%), ocorreu alteração na motilidade, e a amplitude das ondas de deglutição elevou-se no exame pré de 70,7 mmHg (52,3 e 108,4) para 89,7 mmHg (69,9 e 122,8) no pós (p= 0,004 -p<0,05), e a duração aumentou de 3,55 seg±0,58 no pré para 3,90 seg±0,72 no pós (p=0,02 -p<0,05). A velocidade das ondas não diferiu entre o exame pré 3,43±0,97cm/seg e pós 3,61±0,99 cm/seg (p=0,15 -p>0,05). CONCLUSÕES. A análise final mostra que ocorreu alteração de motilidade esofágica após ligadura elástica das varizes esofágicas, caracterizada por aumento na amplitude e duração das ondas contráteis. INTRODUÇÃOA hemorragia digestiva alta (HDA) secundária à hipertensão portal é uma das principais complicações observadas em doentes hepatopatas crônicos. Dois procedimentos endoscópicos são indispensáveis para o seu tratamento adequado: a escleroterapia e a ligadura elástica das varizes esôfago-gástricas 1,2 . A escleroterapia é um procedimento de baixo custo, realizado na maioria dos serviços de endoscopia, podendo ser utilizado não apenas nos episódios de hemorragia digestiva, como na prevenção e no controle das varizes esofágicas 2,3 . Entretanto, vários estudos já demonstraram que os agentes esclerosantes aplicados durante a escleroterapia causam alterações macro e microscocópicas na parede do esôfago e conseqüentes efeitos adversos na motilidade esofágica 4-8 . Estudo pré-vio realizado em nosso serviço comparando a manometria esofágica antes e após a escleroterapia mostrou modificações no peristaltismo esofágico, secundário à seqüela da fibrose que ocorre na mucosa e submucosa do órgão 6 . A ligadura elástica é um método mais recente que a escleroterapia. É considerado mais seguro no tratamento das varizes esofágicas e de custo acessível para ser utilizado em larga escala 3,9,10,11 . Tanto a escleroterapia quanto a ligadura são efetivas no tratamento das varizes esofágicas, entretanto, a incidência de complicações e a recorrência de sangramento são menos freqüentes após a ligadura 12 . Steigmann 9 e colaboradores relataram que a ...

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“…Secondary manifestations of portal hypertension may, however, influence esophageal motility. The presence of ascites does not alter LES pressure 18,19 but the presence of varices has been associated with decreased DEA for some 20 although questioned by others. 10 Endoscopic therapy for esophageal varices may affect esophageal motility due to the development of esophageal fibrosis.…”

Section: Discussionmentioning

confidence: 99%

High-resolution Manometry Findings in Patients After Sclerotherapy for Esophageal Varices

Herbella

Colleoni

Bot

et al. 2016

J Neurogastroenterol Motil

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Background/AimsEndoscopic therapy for esophageal varices may lead to esophageal dysmotility. High-resolution manometry is probably the more adequate tool to measure esophageal motility in these patients. This study aimed to evaluate esophageal motility using high resolution manometry following eradication of esophageal varices by endoscopic sclerotherapy. MethodsWe studied 21 patients (11 women, age 52 [45-59] years). All patients underwent eradication of esophageal varices with endoscopic sclerotherapy and subsequent high resolution manometry. ConclusionsEsophageal motility after endoscopic sclerotherapy is characterized by: (1) defective lower sphincter and (2) defective and hypotensive peristalsis. Esophageal dysmotility is associated to an increased number of endoscopic sessions, but manometric parameters do not predict symptoms.

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Esophageal Motility in Cirrhotics with and without Esophageal Varices

Cited by 31 publications

References 13 publications

Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

Estudo da motilidade esofágica após ligadura elástica endoscópica das varizes

High-resolution Manometry Findings in Patients After Sclerotherapy for Esophageal Varices

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