Endoscopic cervical bariatric surgery: follow-up study in a porcine model.

Abstract Background The realisation of bariatric surgery has to date modified the digestive process solely through procedures within the abdominal cavity. However, endocrine surgeons have recently demonstrated the feasibility of a minimally invasive approach to the neck. In this study, we explored the feasibility, safety and weight progression of a bariatric procedure performed at the neck. Methods Eleven 40–50 kg Yorkshire pigs underwent endoscopic placement of an adjustable band to the cervical esophagus (ECB). Weight was monitored at postoperative days 15, 30, and after 7 weeks; weight progression was compared with an identical group of pigs who underwent a sham procedure. At autopsy, the surgical site was evaluated in a microscopic and macroscopic manner. Results Mean operating time was 66±5.76 min. All pigs tolerated the procedure well, except one subject that experienced food intolerance. The ECB group experienced significantly slower weight gain than the sham group (P= 0.005). Proper location of the band and absence of microscopic lesions at the esophageal wall were confirmed at autopsy and pathological examination. Conclusion Bariatric surgery at the neck is feasible and produces effects on weight reduction. Further refinements and longer observation periods are required to propose this procedure as safe and effective alternative in humans

Protector mechanisms of the association between gastroesophageal reflux disease and asthma: experimental study in rats Mecanismos protetores: doença do refluxo gastroesofágico e asma. Estudo experimental em ratos

BACKGROUND: It is well known the association between gastroesophageal reflux disease and asthma. The hyperreactivity of the airways is a characteristic of an asthmatic. Many studies associate the increase of the airways reactivity with gastroesophageal reflux disease. AIM: In this study we have evaluated the effect of the intraluminal exposition to gastric juice of trachea on the reactivity to methacholine from rats submitted to a pulmonary allergic inflammation. METHODS: Group of rats were sensitized and challenged with ovalbumin. After 24 hours the animals were sacrificed, and their tracheae were removed to be cultured with gastric juice. The gastric juice was obtained from a donor rat. Subsequently the segments were placed into plastic plates with RPMI-1640 for incubation, under suitable atmosphere and time. After the period of incubation the segments were put into chambers for the analysis of the contractile response to methacholine. RESULTS: We observed reduction in the contractile response of trachea cultured with gastric juice from allergic rats. This result was confirmed by the pharmacological treatments with compound 48/80 and dissodium cromoglicate (mast cells blockade), L-NAME (nitric oxide inhibitor, NO), capsaicin (neuropeptides depletion) and indomethacin (ciclooxigenase inhibitor). CONCLUSIONS: Our results highlight to the existence of a complex interaction between pulmonary allergy and gastric juice in the airways. The involvement of the non-adrenergic non-cholinergic system, NO, prostanoids and mast cells are directly related to this interaction. We suggest that the reduced contractile response observed in vitro may represent a protector mechanism of the airways. Despite its presence in the human body it can not be observed due to the predominant effects of excitatory the non-adrenergic non-cholinergic system.<br>RACIONAL: É bem estabelecida a relação entre a doença do refluxo gastroesofágico e a asma. A hiperreatividade das vias aéreas é uma das características que o indivíduo asmático desenvolve e diversos estudos associam o aumento da reatividade das vias aéreas com o refluxo gastroesofágico. OBJETIVO: Avaliar a reatividade à metacolina de traquéia exposta intraluminalmente ao suco gástrico de ratos submetidos a inflamação alérgica pulmonar. MÉTODOS: Grupos de ratos foram sensibilizados e broncoprovocados com ovoalbumina. Após 24 horas, os animais foram sacrificados e a traquéia removida para preenchimento de seu lúmen com suco gástrico obtido de um animal doador. A seguir, os segmentos foram colocados em placas plásticas com RPMI-1640 e mantidos em estufa por 3 horas em condições ambientais adequadas. Após o tempo de incubação, os fragmentos foram montados em cubas de vidro para órgão isolado para registro isométrico de contração, através da construção de curvas concentração-efeito à metacolina. RESULTADOS: Observou-se redução da resposta contrátil em traquéia exposta ao suco gástrico proveniente de ratos alérgicos. Os tratamentos farmacológicos com composto 48/80 e cromoglicato de sódio (bloqueio de mastócitos), L-NAME (inibidor de óxido nítrico, NO), capsaicina (depleção de neuropeptídios) e indometacina (inibidor da ciclooxigenase) corroboraram esta observação. CONCLUSÕES: Os resultados apontam para a existência de complexa interação entre a alergia pulmonar e o suco gástrico nas vias aéreas, com o envolvimento do sistema não-adrenérgico não-colinérgico, NO, prostanóides e mastócitos. À luz das evidências in vivo sobre a hiperreatividade das vias aéreas na associação asma e refluxo gastroesofágico, sugere-se que a reduzida resposta contrátil detectada in vitro pode representar um mecanismo protetor das vias aéreas. A despeito de sua presença, esta redução pode não ser observada in vivo devido à proeminência dos efeitos do sistema não-adrenérgico não-colinérgico excitatório

Estudo de alterações na cavidade oral em pacientes com doença do refluxo gastroesofágico Study in oral cavity alterations in patients with gastroesophageal reflux disease

RACIONAL: A doença do refluxo gastroesofágico, afecção de elevada e crescente incidência, pode se manifestar através de sintomas típicos (pirose e regurgitação) e atípicos (pulmonares, otorrinolaringológicos e bucais). OBJETIVO:Analisar as alterações na cavidade oral de pacientes com a doença do refluxo gastroesofágico. MÉTODOS: Foram estudados 100 pacientes, sendo 50 acometidos por doença do refluxo gastroesofágico (grupo 1) e 50 controles (grupo 2). Todos os pacientes foram submetidos a exame clínico oral e questionário específico, e naqueles do grupo 1, foram realizadas endoscopia digestiva alta e manometria e pHmetria esofágicas. RESULTADOS: A endoscopia digestiva alta demonstrou esofagite em todos os pacientes, sendo erosiva em 20, não-erosiva em 30 e hérnia hiatal em 38. A pressão média no esfíncter inferior do esôfago foi de 11 ± 4,8 mm Hg e no superior de 75 ± 26,5 mm Hg. Em 42 pacientes do grupo 1 (84%) foi observado refluxo gastroesofágico patológico. O exame clínico oral mostrou: erosões dentárias no grupo 1: 273 faces e no grupo 2: 5; dentes cariados no grupo 1: 23 e 115 no grupo 2; abrasão no grupo 1: 58 e no grupo 2: 95; desgaste por atrito: 408 no grupo 1 e 224 no grupo 2. A face dental mais acometida foi a palatina. No grupo 1, 21 pacientes referiam queixas de aftas freqüentes, 35 sensibilidade dentária, 26 ardência bucal e 42 gosto azedo na boca. Naqueles do grupo 2 estas queixas foram observadas em menor número de pacientes. CONCLUSÕES: Os doentes com doença do refluxo gastroesofágico apresentam maior incidência de erosões dentárias, aftas, ardência bucal, sensibilidade dentária e gosto azedo que os controles e menor incidência de lesões cariosas em relação aos controles.<br>BACKGROUND: The gastroesophageal reflux disease, which has become highly and increasingly incident, may be manifested by typical (pyrosis and regurgitation) and atypical (pulmonary, otorhinolaryngological and buccal) symptoms. AIM: To analyze alterations in the oral cavity patients with gastroesophageal reflux disease. METHODS: One hundred patients were studied being 50 gastroesophageal reflux disease patients (group 1) and 50 controls (group 2). All patients were submitted to an oral clinical exam and specific survey. Patients in group 1 were submitted to upper endoscopy, manometry and esophageal pH monitoring. RESULTS: The upper endoscopy revealed esophagitis in all patients, 20 erosive esophagitis, 30 no-erosive esophagitis and 38 hiatal hernia. Average pressure of the lower esophageal sphincter was 11 ± 4,8 mm Hg and of the upper esophageal sphincter 75 ± 26,5 mm Hg. In 42 patients of group 1 (84%) pathological gastroesophageal reflux was observed. Clinical exams revealed: dental erosions in group 1: 273 faces and in group 2: 5 tooth decays in group 1: 23 and 115 in group 2; abrasion in group 1: 58 and in group 2: 95; attrition wear: 408 in group 1 and 224 in group 2. The most damages was the palatine face. In group 1, 21 patients complained about frequent episodes of cankers sores, 35 of tooth sensibility, 26 of burning mouth and 42 of sour taste in the mouth. In group 2 the complaints were observed in lower number of patients. CONCLUSIONS: Patients with gastroesophageal reflux disease present higher incidence of dental erosion, cankers sores, mouth burning sensation, sensitivity and sour taste than controls. Patients with gastroesophageal reflux disease show lower incidence of tooth decays as compared to controls