Influência do refluxo bílio-pancreático nas complicações da doença do refluxo gastro-esofágico (DRGE)

The reflux of duodenal content through the pylorus into the stomach is a norma lphysiologic event occurring most commonly at night but also in post-prandial periods; and itoften caused symptoms and primary diseases. However, when it’s excessive, it may bepathologic and associated with gastritis, gastric ulcers, gastric carcinoma, dyspepsia andgastric-esophageal reflux disease (GERD). The incidence and prevalence of GERD are highand it represents the main gastroenterologic disease. The patophysiology of GERD’s complications, e.g. Barrett’s Esophagus, is also related, but after the introduce of bile monitoring,some of changes of esophagus’s epithelium have been attributed by duodenal-gastricesophageal reflux (DGER). Before introducing the bilirrubin monitoring, all techniques indetecting DRGE had poor sensitivity and specificity. Recently, a new fiberoptic spectrophtometer was developed which detects DGER, and a great of controversial issues have started in literature.Parallel, experimental studies have been developed and it seems that the excessive DGER has relationship with Barrett’s Esophagus and adenocarcinoma. The aim of this study is todiscuss the controversial of literature, and to evaluate all techniques in detecting DGER(advantages, disadvantages, sensibility and specificity). We’ll discuss the real importance ofDGER in Barrett’s Esophagus and your complications.O refluxo do conteúdo duodenal através do piloro para o estômago é um evento fisiológico, que ocorre predominantemente à noite e no período pós-prandial; e raramente causa sintomas e doenças primárias. Entretanto, quando excessivo, pode ser patogênico, associando-se a complicações como gastrite, úlcera gástrica, carcinoma gástrico, síndromedispéptica e doença do refluxo gastro-esofágico (DRGE). A DRGE é altamente prevalente e incidente, representando a principal doença dentro das afecções gastroenterológicas. A fisiopatologia de suas complicações, como o esôfago de Barrett, é amplamente estudada e cada vez mais, modificações no epitélio esofágico são atribuídas ao refluxo duodeno-gastroesofágico(RDGE), principalmente após o advento de métodos diagnósticos específicos para o RDGE, como a espectrofotometria de bilirrubina (BilitecR). Até então, os métodos de diagnósticos se apresentavam com pouca sensibilidade e pouca especificidade, porém, com a bilimetria iniciaram-se grandes estudos, e ao mesmo tempo surgiram muitas controvérsias. Paralelamente, estudos experimentais relacionam cada vez mais a presença de excessivo RDGE com o desenvolvimento de esôfago de Barrett e adenocarcinoma de esôfago. Este trabalho discute as principais controvérsias desses estudos, avaliando os principais métodos de diagnóstico para o RDGE destacando suas vantagens, desvantagens, sensibilidade e especificidade. Discutiremos a real importância do RDGE na patogênese do esôfago de Barrette suas complicações

CHARACTERIZATION OF THE PSYCHOLOGICAL TYPOLOGY IN ESOPHAGEAL CANCER PATIENTS

ABSTRACT BACKGROUND: Esophageal cancer is an environment-related disease, and the most important risk factors are alcohol intake and smoking, in addition to gastroesophageal reflux in obese patients. The characterization of the patients’ personality can contribute to the perception of how everyone adapts to the social environment and what relationship one can establish with themselves and with others. AIM: The aim of this study was to identify the psychological typology in patients with esophageal cancer. METHODS: The psychological typology of patients was defined using the Typological Assessment Questionnaire. In addition, the aspects of psychological assessment were studied to access the particularities of each patient, especially their reaction to the diagnosis and the meaning attributed to the disease. RESULTS: A total of 90 patients with esophageal cancer, aged over 18 years, who completed high school, and were interviewed at the first medical appointment, were included. The introverted attitude was predominant (83.33%). The most common psychological type was introverted sensation, with feeling as a secondary function (43.3%), and the second most frequent was introverted feeling, with sensation as a secondary function (24.4%). From this psychological assessment, a variety of defensive mechanisms were found to minimize distress. Most patients made use of adaptive defenses in the face of the illness process. CONCLUSION: The identification of the psychological typology allows the most effective assistance in directing the peculiar needs of each patient. In addition, it contributes to the care team to individualize treatments based on specific psychological characteristics

Primary malignant melanoma of the esophagus: a rare and aggressive disease

Primary malignant melanoma of the esophagus is an uncommon tumor, with approximately 300 cases having been reported thus far. The purpose of this study was to describe a case of a 60 year-old man with a 10 month history of progressive dysphagia and thoracic pain, the investigations of which led to a diagnosis of primary malignant melanoma of the esophagus. The patient underwent a transhiatal esophagectomy with subcarinal lymphadenectomy, and isoperistaltic gastric tube replacement of the esophagus. Nine months after surgery, he developed ischemic colitis, and metastasis in the mesentery was diagnosed. His disease progressed and he died one year after the esophagectomy. A review of the literature was performed