Study carried out at Universidade Federal do Ceará. 1 Universidade Federal do Ceará. Correspondin... more Study carried out at Universidade Federal do Ceará. 1 Universidade Federal do Ceará. Corresponding author: Veralice Meireles Sales de Bruin. Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará. Rua Cel. Nunes de Melo no 1315, Fortaleza CE. Brazil. CEP: 60.430-270. Phone: 55 (85) 3242-1681. Fax: 55 (85) 3261-5540. E-mail: veralice@superig.com.br Financial Support: MCT/CNPq. Received: June 29, 2012; Accepted: April 11,2013. ABSTRACT
Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de d... more Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de desenvolver esôfago de Barrett. Este pode evoluir para displasia e adenocarcinoma esofágico. Objetivo: avaliar fatores relacionados à detecção de displasia em pacientes com esôfago de Barrett longo. Metodologia: estudo retrospectivo com análise de informações de 18 pacientes com diagnóstico de esôfago de Barrett longo, colhidas de bancos de dados dos serviços de Endoscopia e Patologia e prontuários do Hospital Universitário Walter Cantídio (HUWC-UFC), no período de 2010 a 2015. Os pacientes foram divididos em dois grupos para comparação, grupo sem displasia (N=11) e grupo com displasia/adenocarcinoma (N=7). Resultados: do total de 18 pacientes com esôfago de Barrett longo no HUWC, 72% eram do sexo masculino, 47% tinham mais de 50 anos, 64% apresentavam sintomas típicos de DRGE, 23% eram tabagistas, 77% tinha hérnia hiatal, 50% realizaram fundoplicatura. Não houve diferenças estatísticas d...
BACKGROUND: The diagnosis of eosinophilic esophagitis (EoE) is performed by the detection of 15 o... more BACKGROUND: The diagnosis of eosinophilic esophagitis (EoE) is performed by the detection of 15 or more eosinophils per field in an esophageal biopsy sample, but the endoscopic findings alone are not validated for a diagnosis of the disease. OBJECTIVE: To evaluate the association between the endoscopic findings and histopathological diagnosis in patients with suspected EoE in endoscopy. METHODS: A retrospective study of 24 patients with suspicion of EoE during endoscopy was held. The information was collected from databases of Endoscopy and Pathology services of the Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, from March 2012 to April 2018. The patients were divided into a group with positive biopsy (>15 Eosinophils/field, N=8) and a group with negative biopsy (<15 Eosinophils/field, N=16), and the endoscopic findings were compared between the two groups. RESULTS: From a total of 24 patients, 79.1% had longitudinal grooves, 20.8% white exudates, 33.3%...
Background: Inflammatory bowel disease (IBD) is associated with delay in gastric emptying, increa... more Background: Inflammatory bowel disease (IBD) is associated with delay in gastric emptying, increase in ghrelin, and decrease in leptin. The aim was to investigate the correlation between gastroduodenal (GD) symptoms, gastric emptying, and serum levels of active ghrelin and leptin in IBD. Twenty-seven IBD patients and 26 healthy volunteers were asked to complete the Porto Alegre Dyspeptic Symptoms Questionnaire. A gastric emptying test for solids was performed using a C13 octanoic acid breath test. During this test, serum samples were collected for measuring active ghrelin and leptin concentrations by radioimmunoassay. Summary: Patients with IBD demonstrated delayed gastric emptying compared with healthy volunteers. In patients with GD symptoms, the delay in gastric emptying was more pronounced, and there were significant correlations of satiety and vomiting with gastric emptying. Basal leptin, but not active ghrelin, increased in patients with GD symptoms compared with patients with...
Background: Microscopic inflammation and impairment of the esophageal epithelial barrier are cons... more Background: Microscopic inflammation and impairment of the esophageal epithelial barrier are considered relevant for perception of symptoms in patients with nonerosive reflux disease (NERD). In these patients, the receptor transient receptor potential vanilloid 1 (TRPV1) is overexpressed in the esophageal mucosa, but its role is not yet fully understood. We evaluated the role of TRPV1 in esophageal inflammation and mucosal barrier impairment in a murine model of NERD. Methods: Nonerosive reflux disease was surgically induced in Swiss mice by pyloric substenosis and ligature of the gastric fundus, and the mice were killed 7 days post surgery. The experimental groups were: I, sham surgery (negative control); II, NERD untreated; III and IV, NERD + SB366791 or capsazepine (TRPV1 antagonists); and V, NERD + resiniferatoxin (for long-term desensitization of TRPV1). The esophagus was collected for western blotting and histopathology and for evaluation of wet weight, myeloperoxidase (MPO), keratinocyte-derived chemokine (KC), transepithelial electrical resistance (TEER), and basal permeability to fluorescein. Key Results: Compared to sham, NERD mice had increased esophageal wet weight and MPO and KC levels. The mucosa had no ulcers but exhibited inflammation. NERD mice showed mucosal TRPV1 overexpression, a more pronounced decrease in TEER at pH 0.5 (containing pepsin and taurodeoxycholic acid), and increased basal permeability. Pharmacological modulation of TRPV1 prevented esophageal inflammation development, TEER changes by acidic exposure, and increase in esophageal permeability. Conclusions & Inferences: The TRPV1 receptor has a critical role in esophageal inflammation and mucosal barrier impairment in NERD mice, suggesting that TRPV1 might be a pharmacological target in patients with NERD.
Background-Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when ... more Background-Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when larger than 2 cm, has a high malignancy probability. The histopathological types are mainly fundic gland polyps, hyperplastic polyps and adenomatous polyps. Objective-To evaluate the agreement between three different pathologists in the histopathological diagnosis of 128 biopsied gastric polyps in Digestive Endoscopy Unit from Walter Cantídeo University Hospital, between May 2010 to May 2012. Methods-To describe the intensity of agreement between observers, we use kappa index that is based on the number of concordant measures between them. Results-There was substantial agreement in the diagnosis of adenoma (kappa=0.799, CI: 0.899-0.698) and fundic glands (kappa=0.655, CI: 0.755-0.555). Regarding to hyperplastic polyps (kappa=0.415, CI: 0.515-0.315) and inflammatory (kappa=0.401, CI: 0.501-0.301), we obtained a moderate agreement. Regarding the presence of Helicobacter pylori in biopsy of the polyp, there was a low agreement (kappa=0.219, CI: 0.319-0.119). Conclusion-It is clear that the agreement between pathologists depends on the histological type of the biopsied polyp and this agreement is more substantial in adenoma, or fundic gland polyps. HEADINGS-Polyps, diagnosis. Diagnostic techniques and procedures. Adenomatous polyps.
American journal of physiology. Gastrointestinal and liver physiology, Jan 16, 2017
Non-erosive reflux disease (NERD) is a highly prevalent phenotype of the gastroesophageal reflux ... more Non-erosive reflux disease (NERD) is a highly prevalent phenotype of the gastroesophageal reflux disease (GERD). In this study, we developed a novel murine model of NERD in mice with microscopic inflammation and impairment in the epithelial esophageal barrier. Female Swiss mice were subjected to the following surgical procedure: the transitional region between the forestomach and the glandular portion of the stomach was ligated, and a nontoxic ring was placed around the duodenum near the pylorus. The control group underwent sham surgery. The animals were sacrificed at 1, 3, 7, and 14 days post-surgery. Survival and body weight were monitored daily. Esophageal wet weight, macroscopic lesion, histopathological alterations, myeloperoxidase (MPO) activity, cytokines levels, transepithelial electrical resistance (TEER), and mucosal permeability were evaluated. The survival rate was 78% at 14 days, with mild loss in body weight. Surgery did not induce erosive esophagitis, but instead indu...
A married, 51-year-old male patient was referred for a digestive endoscopy to the Walter Cantidio... more A married, 51-year-old male patient was referred for a digestive endoscopy to the Walter Cantidio University Hospital, in Fortaleza, Brazil, for burning sensation and intense epigastric pain over a period of five months, associated with nausea, gastric fullness, and anorexia, with an estimated 17-kg weight loss. He was unaware of comorbidities. An upper digestive endoscopy was performed, revealing reduced distensibility of the stomach as well as body and fundus mucosa with edematous, fused, hypertrophic folds, with intense diffuse erythema and friability (Figure 1). This article is protected by copyright. All rights reserved.
Objetivo: Avaliar a correlação entre o diagnóstico endoscópico e anatomopatológico dos pólipos gá... more Objetivo: Avaliar a correlação entre o diagnóstico endoscópico e anatomopatológico dos pólipos gástricos e buscar possíveis associações. Metodologia: Estudo retrospectivo com análise de 128 pólipos em 121 pacientes , cujas informações foram colhidas a partir dos bancos de dados dos setores de endoscopia e patologia do HUWC-UFC, no período de maio de 2010 a maio de 2012. Resultados: 22% dos pacientes eram do sexo masculino e 78% do feminino. Quanto às características endoscópicas, observamos mais comumente pólipos únicos, localizados no corpo e medindo menos que 1,0 cm, 60,9% dos pólipos eram hiperplásicos, 17,2% inflamatórios, 9,4% de glândulas fúndicas e 4,6% adenomas. A análise comparativa entre os adenomas e os demais pólipos definiu que 50% dos adenomas eram maiores que 1 cm, enquanto que 88% dos não-adenomas eram menores que 1 cm…
Background: Symptoms compatible with GI functional disorders are higher in patients with IBD comp... more Background: Symptoms compatible with GI functional disorders are higher in patients with IBD compared with controls. We demonstrated that delayed gastric emptying was associated with dyspeptic symptoms in inactive Crohn's disease. Serum ghrelin and leptin levels were elevated in IBD patients and it was described that these hormones couldmodify the gastrintestinal motility. High ghrelin or leptin serum concentrations are associated with symptoms in functional dyspepsia. The relationship between ghrelin and leptin with GI symptoms and gastric motility in IBD patients has not been studied. Aim: To investigate the relationship between dyspeptic symptoms, gastric emptying, serum levels of ghrelin and leptin in IBD. Methods: Twenty seven patients with IBD (14 with Crohn's disease and 13 with ulcerative colitis) underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (PADYQ, The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms; fasting blood samples were also collected to measure active ghrelin or leptin by a RIA. Then, IBD patients were allocated in two groups according to their total PADYQ score: non-dyspeptic (score=0), dyspeptic (score > 0). Control group was composed by 26 sex-matched healthy volunteers. The study was approved by the local Ethical Committee (049.07.08). Results: IBD patients had a significantly (p<0.01) slower gastric emptying (t1⁄2= 243.9 ± 14.2 min) than the controls (t1⁄2= 174.1 ± 6.3 min). IBD patients with dyspepsia (t1⁄2=265.9 ± 21.7 min, N=14) had significantly (p<0.05) prolonged gastric emptying when compared to IBD patients without dyspeptic symptoms (t1⁄2= 220.2 ± 16.1 min, N=13). Leptin (25.9 ± 5.8 ng/ml), but not active ghrelin (28.5 ± 2.4 pg/ml), was significantly (p<0.05) higher in IBD patients with dyspepsia than in IBD patients without dyspepsia (leptin= 13.7 ± 3.4 ng/ml, ghrelin=33.2 ± 6.0 pg/ml). In IBD patients with dyspepsia, only vomiting had positive linear correlation with gastric emptying (t1⁄2) (p=0.03) and leptin levels (p=0.06). No difference between the subgroups of patients with respect to type of disease (Crohn or ulcerative colitis), gender or age was found. However, the group with dyspepsia had more patients with active diseases than the group without dyspepsia (p<0.01). Conclusion: In IBD patients, dyspeptic symptoms, particularly vomiting, were associated with prolonged gastric emptying, high leptin serum levels and the presence of disease activity. The clinical relevance of the present findings remains to be demonstrated. Financial support: Capes, CNPq.
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2008
Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia... more Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia is an important cause of death in these patients, swallowing function remains an underinvestigated field in this condition. The aim of this study was to characterize swallowing dynamics in WD patients. Eight WD patients and 15 age-matched controls underwent scintigraphic evaluation of oral and pharyngeal deglutition. Patients had significantly slower oral transit (P = 0.008) and a greater percentage of oral residue (P = 0.006) when compared to controls. Two of eight patients were free of neurological symptoms at time of examination. Impaired oropharyngeal function was found in patients without dysphagia and without neurological symptoms. Our findings indicate that WD may present with objective swallowing dysfunction, even in the absence of neurological manifestations. Further studies are necessary to investigate the impact of this dysfunction on morbidity and mortality in WD.
World journal of gastroenterology : WJG, Jan 21, 2015
To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution m... more To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers. Eight SSc volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A high-resolution manometry/impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak pressures during forced inhalation under 12 and 24 cmH2O loads). Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM. SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7 ± 2.8 mmHg vs 32.2 ± 2.7 mmHg, P = 0.007). Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls...
Study carried out at Universidade Federal do Ceará. 1 Universidade Federal do Ceará. Correspondin... more Study carried out at Universidade Federal do Ceará. 1 Universidade Federal do Ceará. Corresponding author: Veralice Meireles Sales de Bruin. Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará. Rua Cel. Nunes de Melo no 1315, Fortaleza CE. Brazil. CEP: 60.430-270. Phone: 55 (85) 3242-1681. Fax: 55 (85) 3261-5540. E-mail: veralice@superig.com.br Financial Support: MCT/CNPq. Received: June 29, 2012; Accepted: April 11,2013. ABSTRACT
Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de d... more Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de desenvolver esôfago de Barrett. Este pode evoluir para displasia e adenocarcinoma esofágico. Objetivo: avaliar fatores relacionados à detecção de displasia em pacientes com esôfago de Barrett longo. Metodologia: estudo retrospectivo com análise de informações de 18 pacientes com diagnóstico de esôfago de Barrett longo, colhidas de bancos de dados dos serviços de Endoscopia e Patologia e prontuários do Hospital Universitário Walter Cantídio (HUWC-UFC), no período de 2010 a 2015. Os pacientes foram divididos em dois grupos para comparação, grupo sem displasia (N=11) e grupo com displasia/adenocarcinoma (N=7). Resultados: do total de 18 pacientes com esôfago de Barrett longo no HUWC, 72% eram do sexo masculino, 47% tinham mais de 50 anos, 64% apresentavam sintomas típicos de DRGE, 23% eram tabagistas, 77% tinha hérnia hiatal, 50% realizaram fundoplicatura. Não houve diferenças estatísticas d...
BACKGROUND: The diagnosis of eosinophilic esophagitis (EoE) is performed by the detection of 15 o... more BACKGROUND: The diagnosis of eosinophilic esophagitis (EoE) is performed by the detection of 15 or more eosinophils per field in an esophageal biopsy sample, but the endoscopic findings alone are not validated for a diagnosis of the disease. OBJECTIVE: To evaluate the association between the endoscopic findings and histopathological diagnosis in patients with suspected EoE in endoscopy. METHODS: A retrospective study of 24 patients with suspicion of EoE during endoscopy was held. The information was collected from databases of Endoscopy and Pathology services of the Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, from March 2012 to April 2018. The patients were divided into a group with positive biopsy (>15 Eosinophils/field, N=8) and a group with negative biopsy (<15 Eosinophils/field, N=16), and the endoscopic findings were compared between the two groups. RESULTS: From a total of 24 patients, 79.1% had longitudinal grooves, 20.8% white exudates, 33.3%...
Background: Inflammatory bowel disease (IBD) is associated with delay in gastric emptying, increa... more Background: Inflammatory bowel disease (IBD) is associated with delay in gastric emptying, increase in ghrelin, and decrease in leptin. The aim was to investigate the correlation between gastroduodenal (GD) symptoms, gastric emptying, and serum levels of active ghrelin and leptin in IBD. Twenty-seven IBD patients and 26 healthy volunteers were asked to complete the Porto Alegre Dyspeptic Symptoms Questionnaire. A gastric emptying test for solids was performed using a C13 octanoic acid breath test. During this test, serum samples were collected for measuring active ghrelin and leptin concentrations by radioimmunoassay. Summary: Patients with IBD demonstrated delayed gastric emptying compared with healthy volunteers. In patients with GD symptoms, the delay in gastric emptying was more pronounced, and there were significant correlations of satiety and vomiting with gastric emptying. Basal leptin, but not active ghrelin, increased in patients with GD symptoms compared with patients with...
Background: Microscopic inflammation and impairment of the esophageal epithelial barrier are cons... more Background: Microscopic inflammation and impairment of the esophageal epithelial barrier are considered relevant for perception of symptoms in patients with nonerosive reflux disease (NERD). In these patients, the receptor transient receptor potential vanilloid 1 (TRPV1) is overexpressed in the esophageal mucosa, but its role is not yet fully understood. We evaluated the role of TRPV1 in esophageal inflammation and mucosal barrier impairment in a murine model of NERD. Methods: Nonerosive reflux disease was surgically induced in Swiss mice by pyloric substenosis and ligature of the gastric fundus, and the mice were killed 7 days post surgery. The experimental groups were: I, sham surgery (negative control); II, NERD untreated; III and IV, NERD + SB366791 or capsazepine (TRPV1 antagonists); and V, NERD + resiniferatoxin (for long-term desensitization of TRPV1). The esophagus was collected for western blotting and histopathology and for evaluation of wet weight, myeloperoxidase (MPO), keratinocyte-derived chemokine (KC), transepithelial electrical resistance (TEER), and basal permeability to fluorescein. Key Results: Compared to sham, NERD mice had increased esophageal wet weight and MPO and KC levels. The mucosa had no ulcers but exhibited inflammation. NERD mice showed mucosal TRPV1 overexpression, a more pronounced decrease in TEER at pH 0.5 (containing pepsin and taurodeoxycholic acid), and increased basal permeability. Pharmacological modulation of TRPV1 prevented esophageal inflammation development, TEER changes by acidic exposure, and increase in esophageal permeability. Conclusions & Inferences: The TRPV1 receptor has a critical role in esophageal inflammation and mucosal barrier impairment in NERD mice, suggesting that TRPV1 might be a pharmacological target in patients with NERD.
Background-Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when ... more Background-Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when larger than 2 cm, has a high malignancy probability. The histopathological types are mainly fundic gland polyps, hyperplastic polyps and adenomatous polyps. Objective-To evaluate the agreement between three different pathologists in the histopathological diagnosis of 128 biopsied gastric polyps in Digestive Endoscopy Unit from Walter Cantídeo University Hospital, between May 2010 to May 2012. Methods-To describe the intensity of agreement between observers, we use kappa index that is based on the number of concordant measures between them. Results-There was substantial agreement in the diagnosis of adenoma (kappa=0.799, CI: 0.899-0.698) and fundic glands (kappa=0.655, CI: 0.755-0.555). Regarding to hyperplastic polyps (kappa=0.415, CI: 0.515-0.315) and inflammatory (kappa=0.401, CI: 0.501-0.301), we obtained a moderate agreement. Regarding the presence of Helicobacter pylori in biopsy of the polyp, there was a low agreement (kappa=0.219, CI: 0.319-0.119). Conclusion-It is clear that the agreement between pathologists depends on the histological type of the biopsied polyp and this agreement is more substantial in adenoma, or fundic gland polyps. HEADINGS-Polyps, diagnosis. Diagnostic techniques and procedures. Adenomatous polyps.
American journal of physiology. Gastrointestinal and liver physiology, Jan 16, 2017
Non-erosive reflux disease (NERD) is a highly prevalent phenotype of the gastroesophageal reflux ... more Non-erosive reflux disease (NERD) is a highly prevalent phenotype of the gastroesophageal reflux disease (GERD). In this study, we developed a novel murine model of NERD in mice with microscopic inflammation and impairment in the epithelial esophageal barrier. Female Swiss mice were subjected to the following surgical procedure: the transitional region between the forestomach and the glandular portion of the stomach was ligated, and a nontoxic ring was placed around the duodenum near the pylorus. The control group underwent sham surgery. The animals were sacrificed at 1, 3, 7, and 14 days post-surgery. Survival and body weight were monitored daily. Esophageal wet weight, macroscopic lesion, histopathological alterations, myeloperoxidase (MPO) activity, cytokines levels, transepithelial electrical resistance (TEER), and mucosal permeability were evaluated. The survival rate was 78% at 14 days, with mild loss in body weight. Surgery did not induce erosive esophagitis, but instead indu...
A married, 51-year-old male patient was referred for a digestive endoscopy to the Walter Cantidio... more A married, 51-year-old male patient was referred for a digestive endoscopy to the Walter Cantidio University Hospital, in Fortaleza, Brazil, for burning sensation and intense epigastric pain over a period of five months, associated with nausea, gastric fullness, and anorexia, with an estimated 17-kg weight loss. He was unaware of comorbidities. An upper digestive endoscopy was performed, revealing reduced distensibility of the stomach as well as body and fundus mucosa with edematous, fused, hypertrophic folds, with intense diffuse erythema and friability (Figure 1). This article is protected by copyright. All rights reserved.
Objetivo: Avaliar a correlação entre o diagnóstico endoscópico e anatomopatológico dos pólipos gá... more Objetivo: Avaliar a correlação entre o diagnóstico endoscópico e anatomopatológico dos pólipos gástricos e buscar possíveis associações. Metodologia: Estudo retrospectivo com análise de 128 pólipos em 121 pacientes , cujas informações foram colhidas a partir dos bancos de dados dos setores de endoscopia e patologia do HUWC-UFC, no período de maio de 2010 a maio de 2012. Resultados: 22% dos pacientes eram do sexo masculino e 78% do feminino. Quanto às características endoscópicas, observamos mais comumente pólipos únicos, localizados no corpo e medindo menos que 1,0 cm, 60,9% dos pólipos eram hiperplásicos, 17,2% inflamatórios, 9,4% de glândulas fúndicas e 4,6% adenomas. A análise comparativa entre os adenomas e os demais pólipos definiu que 50% dos adenomas eram maiores que 1 cm, enquanto que 88% dos não-adenomas eram menores que 1 cm…
Background: Symptoms compatible with GI functional disorders are higher in patients with IBD comp... more Background: Symptoms compatible with GI functional disorders are higher in patients with IBD compared with controls. We demonstrated that delayed gastric emptying was associated with dyspeptic symptoms in inactive Crohn's disease. Serum ghrelin and leptin levels were elevated in IBD patients and it was described that these hormones couldmodify the gastrintestinal motility. High ghrelin or leptin serum concentrations are associated with symptoms in functional dyspepsia. The relationship between ghrelin and leptin with GI symptoms and gastric motility in IBD patients has not been studied. Aim: To investigate the relationship between dyspeptic symptoms, gastric emptying, serum levels of ghrelin and leptin in IBD. Methods: Twenty seven patients with IBD (14 with Crohn's disease and 13 with ulcerative colitis) underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (PADYQ, The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms; fasting blood samples were also collected to measure active ghrelin or leptin by a RIA. Then, IBD patients were allocated in two groups according to their total PADYQ score: non-dyspeptic (score=0), dyspeptic (score > 0). Control group was composed by 26 sex-matched healthy volunteers. The study was approved by the local Ethical Committee (049.07.08). Results: IBD patients had a significantly (p<0.01) slower gastric emptying (t1⁄2= 243.9 ± 14.2 min) than the controls (t1⁄2= 174.1 ± 6.3 min). IBD patients with dyspepsia (t1⁄2=265.9 ± 21.7 min, N=14) had significantly (p<0.05) prolonged gastric emptying when compared to IBD patients without dyspeptic symptoms (t1⁄2= 220.2 ± 16.1 min, N=13). Leptin (25.9 ± 5.8 ng/ml), but not active ghrelin (28.5 ± 2.4 pg/ml), was significantly (p<0.05) higher in IBD patients with dyspepsia than in IBD patients without dyspepsia (leptin= 13.7 ± 3.4 ng/ml, ghrelin=33.2 ± 6.0 pg/ml). In IBD patients with dyspepsia, only vomiting had positive linear correlation with gastric emptying (t1⁄2) (p=0.03) and leptin levels (p=0.06). No difference between the subgroups of patients with respect to type of disease (Crohn or ulcerative colitis), gender or age was found. However, the group with dyspepsia had more patients with active diseases than the group without dyspepsia (p<0.01). Conclusion: In IBD patients, dyspeptic symptoms, particularly vomiting, were associated with prolonged gastric emptying, high leptin serum levels and the presence of disease activity. The clinical relevance of the present findings remains to be demonstrated. Financial support: Capes, CNPq.
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2008
Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia... more Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia is an important cause of death in these patients, swallowing function remains an underinvestigated field in this condition. The aim of this study was to characterize swallowing dynamics in WD patients. Eight WD patients and 15 age-matched controls underwent scintigraphic evaluation of oral and pharyngeal deglutition. Patients had significantly slower oral transit (P = 0.008) and a greater percentage of oral residue (P = 0.006) when compared to controls. Two of eight patients were free of neurological symptoms at time of examination. Impaired oropharyngeal function was found in patients without dysphagia and without neurological symptoms. Our findings indicate that WD may present with objective swallowing dysfunction, even in the absence of neurological manifestations. Further studies are necessary to investigate the impact of this dysfunction on morbidity and mortality in WD.
World journal of gastroenterology : WJG, Jan 21, 2015
To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution m... more To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers. Eight SSc volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A high-resolution manometry/impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak pressures during forced inhalation under 12 and 24 cmH2O loads). Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM. SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7 ± 2.8 mmHg vs 32.2 ± 2.7 mmHg, P = 0.007). Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls...
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