Esofagomanometria e phmetria de 24 horas para avaliar a fundoplicatura de lind laparoscópica na doença do refluxo gastroesofágico

Miguel, Pablo Roberto; Rosa, André Luiz Moreira da; Reusch, Marcus; Carlos, José Roberto Couto B.

doi:10.1590/S0100-69911998000400005

Resumos

As técnicas laparoscópicas e toracoscópicas proporcionaram uma nova dimensão para a correção dos distúrbios funcionais do esôfago. O sucesso terapêutico, entretanto, depende da confirmação da doença esofágica como causa dos sintomas, da compreensão da causa básica da disfunção e da identificação do paciente cirúrgico. O presente trabalho é um estudo retrospectivo em pacientes operados pela técnica de Lind para doença do refluxo gastroesofágico (DRGE). Tem por objetivo estabelecer o valor do uso sistemático da esofagomanometria e da pHmetria de 24 horas na seleção de pacientes e na avaliação funcional pré e pós-operatória. Quarenta e um pacientes (68,3%) tinham hipotonia do esfíncter inferior do esôfago. A pressão foi em média de 9,2 mmHg no pré-operatório e de 15,2mmHg no pós-operatório, com um aumento de 6,0 mmHg. Este aumento foi de 8,8mmHg nos hipotônicos e 4,3 mmHg nos normotônicos. Houve algum grau de hipomotilidade do corpo do esôfago em 14 pacientes (23,3%), sendo que, deste grupo, quatro (28,5%) obtiveram melhora pós-operatória. Refluxo ácido patológico foi constatado em 51 casos (85,0%) pela pHmetria. A média do score de DeMeester pré-operatório foi de 31,4, baixando depois para 3,2. A esofagomanometria e a pHmetria de 24 horas são métodos eficazes em revelar o nível de modificação funcional estabelecido pela cirurgia anti-refluxo e ajudam objetivamente na seleção.

Refluxo gastroesofágico; Cirurgia anti-refluxo; Motilidade digestiva

The recent introduction and widespread use of laparoscopic and thoracoscopic techniques has given a new dimension to esophageal functional surgery. A successful result depends on the documentation of esophageal disease as the cause of symptoms, the understanding of the cause of esophageal dysfunction, and the identification of patients who should have surgical treatment. This paper is a retrospective study developed in patients underwent Lind operation for gastroesophageal reflux. The study wants to establish the value of rotine use of esophageal manometry and 24 hour pH monitoring for selection and evaluation. Forty-one patients (68.3%) had mechanically defective lower esophageal sphincter. The preoperative pressure was 9.2 mmHg and postoperative 15.2 mmHg. The general increase was 6.0 mmHg, the increase in defective sphincters was 8.8 mmHg and in normal sphincters was 4.3. We found some diminished peristalsis of esophageal body in 14 patients (23.3%), and this group had four patients (28.5%) with improved peristalsis after surgery. Abnormal acid reflux was detected in 51 cases (85.0%) by pH monitoring. The preoperative DeMeester score was 31.4, decreasing to 3.2 at postoperative period. Esophageal manometry and 24 hour pH monitoring are efficient methods to detect and measure the functional modifications established with an antireflux procedure.

Gastroesophageal reflux; Antireflux surgery; Digestive motility

ARTIGOS ORIGINAIS

Esofagomanometria e phmetria de 24 horas para avaliar a fundoplicatura de lind laparoscópica na doença do refluxo gastroesofágico

Esophageal manometry and 24 hour ph monitoring to evaluate laparoscopic lind fundoplication in gastroesophageal reflux disease

Pablo Roberto Miguel, TCBC-RS^I; André Luiz Moreira da Rosa^I; Marcus Reusch^I; José Roberto Couto B. Carlos^II

^ICirurgião do Hospital. Mãe de Deus

^IIAnestesiologista

^{Endereço para correspondência} Endereço para correspondência: Dr. Pablo Roberto Miguel Rua Costa, 30 cj. 502 90110-270 - Porto Alegre - RS

RESUMO

As técnicas laparoscópicas e toracoscópicas proporcionaram uma nova dimensão para a correção dos distúrbios funcionais do esôfago. O sucesso terapêutico, entretanto, depende da confirmação da doença esofágica como causa dos sintomas, da compreensão da causa básica da disfunção e da identificação do paciente cirúrgico. O presente trabalho é um estudo retrospectivo em pacientes operados pela técnica de Lind para doença do refluxo gastroesofágico (DRGE). Tem por objetivo estabelecer o valor do uso sistemático da esofagomanometria e da pHmetria de 24 horas na seleção de pacientes e na avaliação funcional pré e pós-operatória. Quarenta e um pacientes (68,3%) tinham hipotonia do esfíncter inferior do esôfago. A pressão foi em média de 9,2 mmHg no pré-operatório e de 15,2mmHg no pós-operatório, com um aumento de 6,0 mmHg. Este aumento foi de 8,8mmHg nos hipotônicos e 4,3 mmHg nos normotônicos. Houve algum grau de hipomotilidade do corpo do esôfago em 14 pacientes (23,3%), sendo que, deste grupo, quatro (28,5%) obtiveram melhora pós-operatória. Refluxo ácido patológico foi constatado em 51 casos (85,0%) pela pHmetria. A média do score de DeMeester pré-operatório foi de 31,4, baixando depois para 3,2. A esofagomanometria e a pHmetria de 24 horas são métodos eficazes em revelar o nível de modificação funcional estabelecido pela cirurgia anti-refluxo e ajudam objetivamente na seleção.

Unitermos: Refluxo gastroesofágico; Cirurgia anti-refluxo; Motilidade digestiva.

ABSTRACT

The recent introduction and widespread use of laparoscopic and thoracoscopic techniques has given a new dimension to esophageal functional surgery. A successful result depends on the documentation of esophageal disease as the cause of symptoms, the understanding of the cause of esophageal dysfunction, and the identification of patients who should have surgical treatment. This paper is a retrospective study developed in patients underwent Lind operation for gastroesophageal reflux. The study wants to establish the value of rotine use of esophageal manometry and 24 hour pH monitoring for selection and evaluation. Forty-one patients (68.3%) had mechanically defective lower esophageal sphincter. The preoperative pressure was 9.2 mmHg and postoperative 15.2 mmHg. The general increase was 6.0 mmHg, the increase in defective sphincters was 8.8 mmHg and in normal sphincters was 4.3. We found some diminished peristalsis of esophageal body in 14 patients (23.3%), and this group had four patients (28.5%) with improved peristalsis after surgery. Abnormal acid reflux was detected in 51 cases (85.0%) by pH monitoring. The preoperative DeMeester score was 31.4, decreasing to 3.2 at postoperative period. Esophageal manometry and 24 hour pH monitoring are efficient methods to detect and measure the functional modifications established with an antireflux procedure.

Key words: Gastroesophageal reflux; Antireflux surgery; Digestive motility.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 20/8/97

Aceito para publicação em 16/4/98

Trabalho realizado no Laboratório Bioclínico Mãe de Deus - Unidade de Motilidade Digestiva do Hospital Mãe de Deus - Porto Alegre

1. Constantini M, DeMeester TR. Preoperative assessment of esophageal function. In: Modern Approach to Benign Esophageal Disease; Capo 2; Ed Lippincot-Raven; Philadelphia; 1997.
2. Lind JF, Duthie HL, Schleger JF, et al. Motility of the gastric fundus. Am J Physiol 1961;201:197-99.
3. Johnson LF, DeMeester TR. Development of 24 hour pH monitoring of de distal esophagus. Am J Gastrenterol 1974; 61: 325-30.
4. Rafferty MD, Rattner DW. Gastroesophageal reflux disease: indications for surgery, preoperative evaluation, and choice of operation. Problems in General Surgery 1996;13:29-37.
5. Traube M. The spectrurn of symptorns and presentations of gastro-esophageal reflux disease. Gastroenterol Clin North Am 1990; 19:609-16.
6. Zaninotto RK, DeMeester TR, Schwizer W, et al. The lower esophageal sphincter and health disease. Am J Surg 1988; 155:104-11.
7. Kuster E, Ros D, Toledo-Pimental V, et al. Predictive factors of the long term outcome in gastro-esophageal reflux disease: six year follow up of 107 patients. Gut 1994; 35:8-14.
8. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastro-esophageal reflux disease - evaluation of primary repair in 100 consecutive patients. Ann Surg 1986; 204:9-20.
9. Crookes PF, Peters JH, DeMeester TR. Physiology of the antireflux barrier and diagnostic tests of foregut function. Sem Laparosc Surg 1995; 2:10-26.
10. Mittal RK, Holloway RH, Penagini R, et al. Transient lower sphincter relaxation. Gastroenterology 1995;109:601-610.
11. McNally EF, Kelly JF, Ingelfinger FJ. Mechanisms of belching: effects of gastric distension with air. Gastroenterology 1964; 46:254-259.
12. Dodds WJ, Dent J, Hogan WJ, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 1982; 307:.1.547-52.
13. Mittal RK, McCallum RW. Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 1988; 95:593-9.
14. Karim SS, Pantom ON, Finley RJ, et al. Comparison of total vs. partial laparoscopic fundoplication in the management of gastroesophageal reflux disease. Am J Surg 1997; 173:375-78.
15. Thor KBA, Silander TA. A long-term randomized prospective trial of the Nissen procedure vs. a modified Toupet technique. Ann Surg 1989; 210-719.
16. Constantini M, Crookes PF, Bremner RM, et al. Value of physiologic assesment of foregut symptoms in a surgical practice. Surgery 1993; 114:780-6.
17. Kahrilas PJ, Dodds WJ, Hogan WJ, et al. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 1986;91: 897-904.
18. Ottigmon Y, Pelissier EP, Maution G, et al. Reflux gastro-oesophagien. Comparison des resultats cliniques pH-metriques et manometriques des proceds de Nissen et de Toupet. Gastroenterol Clin Biol 1994; 18:920-6.
19. Johnson LF, DeMeester TR. Development of the 24 hour intra-esophageal pH monitoring composite score system. J Clin Gastroenterol 1986; 8:52-8.
20. Kasapidis P, Xynos E, Mantides A, et al. Differences in manometry and 24-h ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease. Am J Gastroenterol 1993; 88:1893-9.
21. DeMeester TR, Wang CL, Wermly JA, et al. Technique, indications an clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 1980; 79:656-70.
22. DeMeester TR, Johnson LF. The evaluation of objective measurements of gastroesophageal reflux and their contribution to patient management. Surg Clin North Am 1976; 56:39-53.
23. Masclee AAM, De Best ACA, De Graf R, et al. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 1990; 25:225-30.
24. Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24 hour esophageal pH monitoring: normal values, optimal thresholds, specificity and reproducibility. Am J Gastroenterol 1992; 87: 1102- 1.111.

Endereço para correspondência:

Dr. Pablo Roberto Miguel

Rua Costa, 30 cj. 502

90110-270 - Porto Alegre - RS

Datas de Publicação

Publicação nesta coleção
23 Jul 2010
Data do Fascículo
Ago 1998

Histórico

Aceito
16 Abr 1998
Recebido
20 Ago 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Constantini M, DeMeester TR. Preoperative assessment of esophageal function. In: Modern Approach to Benign Esophageal Disease; Capo 2; Ed Lippincot-Raven; Philadelphia; 1997.

[2] 2. Lind JF, Duthie HL, Schleger JF, et al. Motility of the gastric fundus. Am J Physiol 1961;201:197-99.

[3] 3. Johnson LF, DeMeester TR. Development of 24 hour pH monitoring of de distal esophagus. Am J Gastrenterol 1974; 61: 325-30.

[4] 4. Rafferty MD, Rattner DW. Gastroesophageal reflux disease: indications for surgery, preoperative evaluation, and choice of operation. Problems in General Surgery 1996;13:29-37.

[5] 5. Traube M. The spectrurn of symptorns and presentations of gastro-esophageal reflux disease. Gastroenterol Clin North Am 1990; 19:609-16.

[6] 6. Zaninotto RK, DeMeester TR, Schwizer W, et al. The lower esophageal sphincter and health disease. Am J Surg 1988; 155:104-11.

[7] 7. Kuster E, Ros D, Toledo-Pimental V, et al. Predictive factors of the long term outcome in gastro-esophageal reflux disease: six year follow up of 107 patients. Gut 1994; 35:8-14.

[8] 8. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastro-esophageal reflux disease - evaluation of primary repair in 100 consecutive patients. Ann Surg 1986; 204:9-20.

[9] 9. Crookes PF, Peters JH, DeMeester TR. Physiology of the antireflux barrier and diagnostic tests of foregut function. Sem Laparosc Surg 1995; 2:10-26.

[10] 10. Mittal RK, Holloway RH, Penagini R, et al. Transient lower sphincter relaxation. Gastroenterology 1995;109:601-610.

[11] 11. McNally EF, Kelly JF, Ingelfinger FJ. Mechanisms of belching: effects of gastric distension with air. Gastroenterology 1964; 46:254-259.

[12] 12. Dodds WJ, Dent J, Hogan WJ, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 1982; 307:.1.547-52.

[13] 13. Mittal RK, McCallum RW. Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 1988; 95:593-9.

[14] 14. Karim SS, Pantom ON, Finley RJ, et al. Comparison of total vs. partial laparoscopic fundoplication in the management of gastroesophageal reflux disease. Am J Surg 1997; 173:375-78.

[15] 15. Thor KBA, Silander TA. A long-term randomized prospective trial of the Nissen procedure vs. a modified Toupet technique. Ann Surg 1989; 210-719.

[16] 16. Constantini M, Crookes PF, Bremner RM, et al. Value of physiologic assesment of foregut symptoms in a surgical practice. Surgery 1993; 114:780-6.

[17] 17. Kahrilas PJ, Dodds WJ, Hogan WJ, et al. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 1986;91: 897-904.

[18] 18. Ottigmon Y, Pelissier EP, Maution G, et al. Reflux gastro-oesophagien. Comparison des resultats cliniques pH-metriques et manometriques des proceds de Nissen et de Toupet. Gastroenterol Clin Biol 1994; 18:920-6.

[19] 19. Johnson LF, DeMeester TR. Development of the 24 hour intra-esophageal pH monitoring composite score system. J Clin Gastroenterol 1986; 8:52-8.

[20] 20. Kasapidis P, Xynos E, Mantides A, et al. Differences in manometry and 24-h ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease. Am J Gastroenterol 1993; 88:1893-9.

[21] 21. DeMeester TR, Wang CL, Wermly JA, et al. Technique, indications an clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 1980; 79:656-70.

[22] 22. DeMeester TR, Johnson LF. The evaluation of objective measurements of gastroesophageal reflux and their contribution to patient management. Surg Clin North Am 1976; 56:39-53.

[23] 23. Masclee AAM, De Best ACA, De Graf R, et al. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Scand J Gastroenterol 1990; 25:225-30.

[24] 24. Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24 hour esophageal pH monitoring: normal values, optimal thresholds, specificity and reproducibility. Am J Gastroenterol 1992; 87: 1102- 1.111.

Brasil

Brasil

Esofagomanometria e phmetria de 24 horas para avaliar a fundoplicatura de lind laparoscópica na doença do refluxo gastroesofágico

Esophageal manometry and 24 hour ph monitoring to evaluate laparoscopic lind fundoplication in gastroesophageal reflux disease

Resumos

Datas de Publicação

Histórico