Diagnosis and management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Redução do MELD em paciente em lista de transplante hepático após o uso de aminoácidos de cadeia ramificada: relato de caso

Liver cirrhosis (LC) is a disease with high mortality rates and its only definitive treatment is the orthotopic liver transplantation (OLT). Unfortunately, not all patients have access to OLT and many of them end up dying on the transplant waiting list. The use of branched chain amino acids (BCAA) is widely known as an effective treatment for improving the quality of life of these patients. For the first time, in this paper we documented a great improvement of clinical and laboratorial tests of a patient treated with BCAA, which allowed him to be out of the transplant waiting list. In addition to the increase of the MELD score, the patient achieved restabilization of body weight and recovery of the quality of life registered by the SF-36 questionnaire.

Diagnóstico diferencial entre Doença de Crohn e Hidradenite Supurativa: relato de caso

Crohn’s disease is a chronic infl ammatory bowel disease with segmental transmural infl ammation, which complicate with formation of fi stulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is diffi cult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn’s disease complicated with perianal and rectovaginal fi stula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofl oxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fi stula at the site of resection, consistent with Crohn’s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fi stulas. Currently in therapy with good biological evolution of fi stulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn’s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient’s quality of life.

Encefalopatia hepática: relatório da 1º reunião monotemática da Sociedade Brasileira de Hepatologia

Hepatic encephalopathy (HE) is a functional disorder of the central nervous system (CNS) associated with liver failure, either end-stage chronic liver disease or fulminant hepatic failure. Its pathogenesis remains complex and poorly understood. In view of recent advances in the management of HE, the Brazilian Society of Hepatology endorsed a monothematic meeting regarding HE in order to gather experts in the field to discuss related data and to draw evidence-based recommendations concerning: management of HE and intracranial hypertension in FHF, treatment of episodic HE in cirrhosis, controversies in the management of EH including difficult to treat cases and diagnostic and treatment challenges for minimal HE. The purpose of this review is to summarize the lectures and recommendations made by the panel of experts of the Brazilian Society of Hepatology.

A análise morfométrica para avaliar a taxa de progressão da fibrose hepática na hepatite C crônica após o transplante renal: uma série de casos

The real role of renal transplantation in hepatic fi brosis progression caused by hepatitis C virus is still unpredictable. Histological evaluation of the liver is the best form to estimate fi brosis evolution, although semiquantitative analysis carries important limitations. Objective: To apply a morphometric quantitative assay on hepatic fi brosis progression in renal recipients with hepatits C. Methods: Thirty patients were initially evaluated, but only seven were included. They underwent the fi rst biopsy near the transplantation date and the second biopsy at least 4 years later. The immunosuppressant therapy adopted in all cases was azatioprine and micofenolate. Fibrosis progression rate (FPR) was calculated before and after the surgery date in each patient according to Metavir score and morphometric analysis. Results: The FPR calculated by Metavir score showed no statistical difference between pre- and post-transplantation (p=0.9). The FPR calculated by the morphometric analysis was 0.58 ± 0.78 before transplantation and 3.0 ± 3.3 after the surgery, with statistical signi- fi cance between these values (p=0.0026). Conclusion: In the sample assessed, the progression of hepatic fi brosis was documented and quantifi ed only by the morphometric analysis, which is as a promising approach to histological evaluation of these patients.

Pancreatic hemangioma manifesting as variceal gastroesophageal bleeding during pregnancy: case report

There are only 10 reported cases of pancreatic hemangiomas in adults, only one of them causing digestive bleeding. We present a case of variceal bleeding and portal hypertension caused by a pancreatic hemangioma. The patient had 19 year-old and was received at her 16th week of pregnancy. She had massive hematemesis, controlled after variceal band ligation. Her image exams revealed a cystic lesion of 164 cm³ in the pancreas tail and signs of portal hypertension. Two months after, the ultrassonographic exam documented the lesion growth, achieving 200 cm³ at that time. The patient was submitted to distal pancreatectomy, and the histopathological analysis revealed a pancreatic hemangioma of 11 x 9 x 8 cm. Therefore, we report the second case of digestive bleeding caused by a pancreatic hemangioma, which had a well documented growth during the pregnancy. Additionally, we review the previous reports of pancreatic hemangiomas and discuss the hypothesis of hormonal infl uence on the natural history of these tumors.

Cinética digestiva e eficiência de síntese de proteína microbiana em novilhos alimentados com farelo de girassol e diferentes fontes energéticas

Objetivou-se avaliar o efeito da substituição parcial do milho pela casca de soja e pelo farelo de gérmen de milho sobre a produção e eficiência de síntese de proteína microbiana e sobre as taxas de diluição e passagem ruminal. Foram utilizados três novilhos de corte, mestiços, canulados no rúmen e no duodeno, distribuídos em dois delineamentos em quadrado latino 3 x 3. As dietas experimentais, à base de silagem de milho (60%), apresentavam como fonte de proteína farelo de girassol e, como fonte de energia, milho (MI) ou sua substituição parcial pela casca de soja (CS) ou pelo farelo de gérmen de milho (FGM). Para o isolamento da massa microbiana, foram coletadas amostras de conteúdo ruminal às 3, 6, 9 e 12 horas após a alimentação. Utilizaram-se RNA como marcador microbiano e dicromato de sódio e Co-EDTA como indicadores das taxas de passagem e de diluição, respectivamente. A composição dos microrganismos ruminais não foi influenciada pelas dietas experimentais ou pelos horários de coleta. Não houve diferenças significativas no fluxo de matéria orgânica, carboidratos totais, nitrogênio e nitrogênio microbiano para o duodeno e na eficiência de síntese de proteína microbiana. As taxas de diluição foram semelhantes entre as dietas, com média de 13,4%/h. A taxa de passagem da silagem de milho mordentada foi menor, com tendência de menor taxa de passagem também para o farelo de girassol na dieta MI. A casca de soja e o farelo de gérmen de milho podem substituir parcialmente o milho, proporcionando ambiente ruminal adequado ao desenvolvimento da flora microbiana e conseqüente produção de proteína microbiana ruminal em novilhos confinados.

Carcinoma de pequenas células do esôfago: estudo clínico patológico de dois casos

RACIONAL: O carcinoma de pequenas células primário do esôfago é tumor raro, agressivo, morfologicamente indistinguível de seu correspondente no pulmão. OBJETIVO: Apresentar os aspectos clínico-patológicos de dois pacientes com carcinoma de pequenas células do esôfago. RELATO DE CASOS: Paciente 1: masculino, 56 anos com disfagia progressiva há seis meses e emagrecimento, com antecedentes de tabagismo e etilismo. A endoscopia mostrou lesão vegetante dos 30 aos 40 cm da arcada dentária superior e o exame anatomopatológico, diagnosticou neoplasia maligna indiferenciada de pequenas células com marcadores imunoistoquímicos positivos para cromogranina e sinaptofisina, caracterizando a linhagem neuroendócrina da neoplasia. Após dois ciclos de quimioterapia (cisplatina e etoposide) associada à radioterapia ele apresentou remissão da disfagia. Paciente 2: masculino, 55 anos, com queixas de pirose, disfagia, rouquidão há seis meses, com emagrecimento de 10 kg no período. A endoscopia mostrou lesão vegetante à 30 cm da arcada dentária superior, obstrutiva. O exame anatomopatológico revelou carcinoma de pequenas células, com os mesmos marcadores imunoistoquímicos positivos para linhagem neuroendócrina. Tomografia computadorizada mostrou metástases hepáticas. Frente ao estadio avançado da doença optou-se pela indicação de gastrostomia. O paciente desenvolveu pneumonia e faleceu dois meses após o diagnóstico. CONCLUSÃO: A evolução dos portadores de carcinoma de pequenas células do esôfago depende do estadiamento da doença e apesar da alta agressividade biológica, este tumor apresenta boa resposta à quimioterapia associada à radioterapia.

Endoscopia do trato gastrointestinal de cães e gatos

Endoscopy of the gastrointestinal tract is a specialized minimally invasive diagnostic method and with both diagnostic and therapeutic possibilities. It is divided into two major groups, the rigid and flexible endoscopy. The first most widely used for visualization of body cavities that do not have a light, like the chest, for example, and the second for those with light as the gastrointestinal tract. In Brazil there are few professionals, veterinary hospitals or clinics that offer this type of service. Thus, endoscopy is an area of expertise of the veterinarian who is in huge expansion and has shown great applicability with excellent results in both clinical medicine and surgical small animals

Capacidade digestiva durante a ontogenia de larvas de pacu Piaractus mesopotamicus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise do padrão de resposta Th17 e de células T regulatórias em pacientes com a forma digestiva da doença de Chagas crônica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeitos da dieta e ontogenia no crescimento e fisiologia digestiva do lagarto Teiu, Tupinambis Merianae

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O uso da endoscopia para o rastreamento do câncer do trato aerodigestório alto em população de alto risco

Pós-graduação em Bases Gerais da Cirurgia - FMB

Digestive and functional properties of a partially hydrolyzed cassava solid waste with high insoluble fiber concentration

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Manejo nutricional e digestibilidade no quilotórax canino

O quilotórax corresponde ao acúmulo de fluido linfático em um ou em ambos os espaços pleurais, resultante do extravasamento de linfa do ducto torácico ou de uma de suas divisões principais. Este pode estar associado à ascite quilosa em pacientes com distúrbios linfáticos sistêmicos, como na linfangiectasia, em decorrência de defeitos no transporte linfático-venoso do quilo da cavidade torácica para a circulação sistêmica. A linfangiectasia intestinal é um distúrbio obstrutivo que envolve o sistema linfático do órgão e revela-se como a causa mais comum de enteropatias associadas à má absorção e perda de proteínas em cães. São apresentados no presente relato o controle clínico com o uso de dieta caseira com baixa gordura e a quantificação da função digestiva, por meio da determinação da digestibilidade do alimento, em um cão acometido por quilotórax secundário à linfangiectasia intestinal. A dieta caseira incluiu arroz, peito de frango, cenoura, carbonato de cálcio, levedura de cerveja, suplemento vitamínico e mineral e sal. O ensaio de digestibilidade foi conduzido pelo método de coleta total de fezes. A dieta caseira foi eficaz em interromper o acúmulo de efusão quilosa torácica, restabelecer as concentrações de proteína total e albumina e promover ganho de peso no paciente. Os resultados da digestibilidade demonstraram menor aproveitamento de todos os nutrientes no cão com linfangiectasia em relação ao controle sadio.