Avaliação do refluxo gastroesofágico e da barreira antirrefluxo em repouso e após manobras inspiratórias padronizadas em pacientes com asma controlada

• Ano de defesa: 2015
• Autor(a) principal: Oliveira, Esther Cristina Arruda
• Orientador(a): Souza, Miguel Ângelo Nobre e
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Asma; Diafragma; Refluxo Gastroesofágico
• Link de acesso: http://www.repositorio.ufc.br/handle/riufc/15353

Background: The antireflux barrier, located in the gastroesophageal junction (EGJ), is primarily responsible for preventing the development of GERD. It is an anatomically complex area where the antireflux function depends on the intrinsic pressure of the lower esophageal sphincter (LES) and extrinsic compression of the crural diaphragm, besides the integrity of phreno-esophageal ligament and maintaining the angle of His. The GERD can induce symptoms in patients with asthma using proximal GERD causing bronchoconstriction and vagal reflexes. Objective: To evaluate gastroesophageal reflux and the antireflux barrier at rest and after standard inspiratory maneuvers in patients with controlled asthma. Methods: This was a quantitative, descriptive study in 15 volunteers with controlled asthma presenting symptoms of GERD and 10 clinically asymptomatic volunteers without symptoms of GERD and asthma. All patients underwent clinical evaluation (questionnaire), spirometry, high resolution manometry (HRM), manovacuometry (IPmax) and pH monitoring. Results: The sample consisted of 25 female volunteers divided into 2 groups: Group A, consisting of 15 patients with asthma controlled with a mean age of 46.1 and standard deviation(SD) 8.41; and group C, Control, composed of 10 healthy volunteers with a mean age of 36.2 and standard deviation 12.61. Patients undergoing high-resolution manometry at rest and during sinus arrhythmia maneuvers had mean baseline pressures in group A was 19.58; standard deviation 6.87 and group C basal medium pressure 30.61; standard deviation of 8.01 (p = 0.001). The contractility index in group A had a mean of 49.58; standard deviation 63.50 and average group C 121.58; standard deviation of 95.40 (p = 0.021) which was statistically significant. Baseline mean pressures before sinus arrhythmia maneuver and resistive loads through threeshold 12 and 48 in controlled asthma were ASR: 19.58; SD: 6.87 (p = 0.001); Th 12: 23.273; SD: 7.41 (p = 0.028); Th 24: 26.78; SD: 14.50 (p: 0.267); Th 48: 24.773; SD: 5.94 (p = 0.009). The results were statistically significant lower than the control group. Mean baseline pressures before performing the ASR and resistive loads maneuvers in controlled group of asthmatic patients showed significant statistical increase between the basal medium pressure before performing ASR maneuver and the mean baseline pressure prior to TH 24 (p <0.001). Conclusion: The mean baseline pressure within the gastroesophageal junction and contractility index were significantly lower, as well as before performing respiratory sinus arrhythmia maneuver and resistive loads of threshould 12 and 48 in controlled asthmatic volunteers compared with control group. The mean baseline pressure before performing ASR maneuver and the mean baseline pressure before performing TH 24 observed in the study in controlled asthma had a statistically significant increase.