članak: 1 od 1  
Acta chirurgica iugoslavica
2010, vol. 57, br. 2, str. 37-43
jezik rada: engleski
stručni članak
doi:10.2298/ACI1002037d

Korelacija između patološkog gastroezofagealnog refluksa i neefektivnog motiliteta jednjaka
aDepartment of Surgery, School of Medicine, Federal University of Rio Grande do Sul, Brazil
bUniverzitet u Beogradu, Medicinski fakultet

Sažetak

Cilj: Procena korelacije između poremećaja motiliteta jednjaka, okarakterisanog kao neefektivni motilitet jednjaka (NMJ) i prisustva patološkog gastroezofagealnog refluksa uzrokovanog strukturalno oštećenim donjim ezofagealnim sfinkterom (DES), hernijom hijatusa jednjaka ili ezofagitisom, kod bolesnika sa suspektnom gastroezofagealnom refluksnom bolešću (GERB). Metode: U studiju je uključeno 311 bolesnika kod kojih su načinjene dijgnostičke procedure u cilju dijagnostikovanja GERB-a. Kod svih bolesnika je načinjena procena njihovih kliničkih simptoma, gornja fleksibilna endoskopija, stacionarna manometrija kao i 24 časovna pH metrija. Upoređivani su sledeći faktori rizika kod bolesnika u zavisnosti od vrednsoti pH metrijskog nalaza: NMJ, nefunkcionalan DES, hernija hijatusa jednjaka i prisustvo ezofagitisa. Povezanost između NMJ i pozitvnog pHmetrijskog nalaza je procenjivana vrednostima univarijantne analize, a kasnije je određivana korišćenjem multivarijantne logističke regresione analize. Rezultati: Od ukupno 311 ispitivanih bolesnika, 208 je uključeno u studiju, od kojih je 88 imalo normalne a 120 patološke vrednosti na ezofagealnoj pH metriji. Univarijantna analiza je ukazala da je učestalost NMJ, nefunkcionalnog DES-a, kao i prisustvo hernije hijatusa jednjaka značajno veća kod bolesnika sa pozitivnim vrednostima na 24-časovnoj pH metriji. Praćanjem logističke regresione analize, prisustvo NMJ je ostalo značajno češće u grupi bolesnika sa pozitvnom ezofagealnom pH metrijom. Zaključak: NMJ je direktno povezana sa prisustvom patološ kog kiselinskog refluksa u jednjaka, dokazanog 24- časovnom pH metrijom, bez obzira na prisustvo nefunkcionalog DES-a, hernije hijatusa jednjaka ili endoskopski vidljivog ezofagitisa.

Ključne reči

gastroezofagealna refluksna bolest; neefektivni motilitet jednjaka; manometrija jednjaka; 24-časovna pH metrija jednjaka

Reference

Allison, P.R. (1951) Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet, 92(4): 419-31
Cadiot, G., Bruhat, A., Rigaud, D., Coste, T., Vuagnat, A., Benyedder, Y., Vallot, T., le Guludec, D., Mignon, M. (1997) Multivariate analysis of pathophysiological factors in reflux oesophagitis. Gut, 40(2): 167-74
Chrysos, E., Prokopakis, G., Athanasakis, E., Pechlivanides, G., Tsiaoussis, J., Mantides, A., Xynos, E. (2003) Factors affecting esophageal motility in gastroesophageal reflux disease. Archives of surgery, 138(3): 241-6
Crookes, P.F. (2006) Physiology of reflux disease: Role of the lower esophageal sphincter. Surgical endoscopy, 20 Suppl 2: S462-6
de Meester, T.R., Lafontaine, E., Joelsson, B.E., Skinner, D.B., Ryan, J.W., Sullivan, O.G.C., Brunsden, B.S., Johnson, L.F. (1981) Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction. Journal of thoracic and cardiovascular surgery, 82(4): 547-58
de Meester, T.R., Bonavina, L., Albertucci, M. (1986) Nissen fundoplication for gastroesophageal reflux disease: Evaluation of primary repair in 100 consecutive patients. Ann Surg, 204(1): 9-20
de Vault, K.R., Castell, D.O. (2005) Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. American journal of gastroenterology, 100(1): 190-200
Dent, J., El-Serag, H.B., Wallander, M.A., Johansson, S. (2005) Epidemiology of gastro-oesophageal reflux disease: A systematic review. Gut, 54(5): 710-7
Diener, U., Patti, M.G., Molena, D., Fisichella, P.M., Way, L.W. (2001) Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg, 5(3): 260-5
Fibbe, C., Layer, P., Keller, J., Strate, U., Emmermann, A., Zornig, C. (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology, 121(1): 5-14
Fornari, F., Callegari-Jacques, S.M., Scussel, P.J., Madalosso, L.F., Barros, E.F., Barros, S.G.S. (2007) Is ineffective oesophageal motility associated with reflux oesophagitis?. European journal of gastroenterology & hepatology, 19(9): 783-7
Fouad, Y.M., Katz, P.O., Hatlebakk, J.G., Castell, D.O. (1999) Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. American journal of gastroenterology, 94(6): 1464-7
Grossi, L., Ciccaglione, A.F., Travaglini, N., Marzio, L. (2001) Transient lower esophageal sphincter relaxations and gastroesophageal reflux episodes in healthy subjects and GERD patients during 24 hours. Digestive diseases and sciences, 46(4): 815-21
Herbella, F.A.M., Tedesco, P., Nipomnick, I., Fisichella, P.M., Patti, M.G. (2007) Effect of partial and total laparoscopic fundoplication on esophageal body motility. Surgical endoscopy, 21(2): 285-8
Johnson, L.F., de Meester, T.R. (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. American journal of gastroenterology, 62(4): 325-32
Johnson, L.F., de Meester, T.R. (1986) Development of the 24-hour intraesophageal pH monitoring composite scoring system. Journal of clinical gastroenterology, 8 Suppl 1: 52-8
Kahrilas, P.J. (2003) Diagnosis of symptomatic gastroesophageal reflux disease. Am J Gastroenterol, 98(3 Suppl):S15-23
Kahrilas, P.J., Shi, G., Manka, M., Joehl, R.J. (2000) Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology, 118(4): 688-95
Kahrilas, P.J., Dodds, W.J., Hogan, W.J., Kern, M., Arndorfer, R.C., Reece, A. (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology, 91(4): 897-904
Kahrilas, P.J., Lee, T.J. (2005) Pathophysiology of gastroesophageal reflux disease. Thoracic surgery clinics, 15(3): 323-33
Leite, L.P., Johnston, B.T., Barrett, J., Castell, J.A., Castell, D.O. (1997) Ineffective esophageal motility (IEM): The primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci, 42(9): 1859-65
Lemme, E.M.O., Abrahão-Junior, L.J., Manhães, Y., Shechter, R., Carvalho, B.B., Alvariz, A. (2005) Ineffective esophageal motility in gastroesophageal erosive reflux disease and in nonerosive reflux disease: are they different?. Journal of clinical gastroenterology, 39(3): 224-7
Lindeboom, M.Y.A., Ringers, J., Straathof, J.W.A., Rijn, P.J.J., Neijenhuis, P., Masclee, A.A.M. (2007) The effect of laparoscopic partial fundoplication on dysphagia, esophageal and lower esophageal sphincter motility. Diseases of the esophagus, 20(1): 63-8
Lundell, L.R., Dent, J., Bennett, J.R., Blum, A.L., Armstrong, D., Galmiche, J.P., Johnson, F., Hongo, M., Richter, J.E., Spechler, S.J., Tytgat, G.N., Wallin, L. (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut, 45(2): 172-80
Meneghetti, A.T., Tedesco, P., Damani, T., Patti, M.G. (2005) Esophageal mucosal damage may promote dysmotility and worsen esophageal acid exposure. Journal of gastrointestinal surgery, 9(9): 1313-7
Moraes-Filho, J., Cecconello, I., Gama-Rodrigues, J., Castro, L., Henry, M.A., Meneghelli, U.G., i dr. (2002) Brazilian consensus on gastroesophageal reflux disease: proposals for assessment, classification, and management. American Journal of Gastroenterology, 97(2): 241
Nasi, A., de Moraes-Filho, J.P., Cecconello, I. (2006) Gastroesophageal reflux disease: An overview. Arq Gastroenterol, 43(4), str. 334-41
Oberg, S., Peters, J.H., de Meester, T.R., Chandrasoma, P., Hagen, J.A., Ireland, A.P., Ritter, M.P., Mason, R.J., Crookes, P., Bremner, C.G. (1997) Inflammation and specialized intestinal metaplasia of cardiac mucosa is a manifestation of gastroesophageal reflux disease. Ann Surg, 226(4): 522-30; di
Schneider, J.H., Kramer, K.M., Königsrainer, A., Granderath, F.A. (2007) The lower esophageal sphincter strength in patients with gastroesophageal reflux before and after laparoscopic Nissen fundoplication. Diseases of the esophagus, 20(1): 58-62
van Herwaarden, M.A., Samsom, M., Smout, A.J. (2000) Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology, 119(6): 1439-46
Xenos, E.S. (2002) The role of esophageal motility and hiatal hernia in esophageal exposure to acid. Surgical endoscopy, 16(6): 914-20
Zaninotto, G., DeMeester, T.R., Schwizer, W., Johansson, K.E., Cheng, S.C. (1988) The lower esophageal sphincter in health and disease. American journal of surgery, 155(1): 104-11