Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease
Autor(a) principal: | |
---|---|
Data de Publicação: | 2014 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFC |
Texto Completo: | http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12840 |
Resumo: | Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Gastroesophageal reflux disease (GERD) patients may be better identified by the inspiratory pressure of the lower esophageal sphincter (LES), which is lower, than the expiratory one, and symptoms may be alleviated by inspiratory muscle training. Three groups of human volunteers were selected for this study. Twenty patients with reflux esophagitis (ESOPHAGITIS), nine patients with symptoms of GERD but no esophagitis (NES), and eleven asymptomatic volunteers (Control Group). The volunteers answered GERD and quality-of-life related questionnaires, and underwent endoscopic ultrasound examination and high resolution manometry. The main goal was to study the gastroesophageal junction (GEJ) and the crural diaphragm (CD) in particular (right crus). The width of the CD right crus was measured in millimeters. A standard segment of the CD was analyzed for the average grey intensity of its pixels, and this was taken for ecogenicity. The CD width was thinner in the ESOPHAGITIS group relative to Controls (CD width mean: 3.45 Â 0.24 mm versus 5.19 Â 0.48 mm, p = 0.0077). CD ecogenicity was greater in the ESOPHAGITIS patients relative to Controls (mean ecogenicity: 32.38 Â 2.45 versus 18.35 Â 2.53, p = 0.0009). These findings suggest that some ESOPHAGITIS patients may have an atrophic CD with a greater fat or fibrosis content. There is a decreasing CD width across the ESOPHAGITIS, NES, and control groups. However, this finding was only significant between the ESOPHAGITIS and the Controls. The LES average pressure during resting was similar between the ESOPHAGITIS and Control groups. However, the LES minimal respiratory pressure, IRP, the LES maximal residual pressure, the mean wave amplitude at 3 and 7 cm above the LES, and the maximal DCI were smaller in the ESOPHAGITIS patients relative to controls. The more heartburn bothered the ESOPHAGITIS patients the thinner was the CD width (r = -0.5559, p = 0.0166). The findings of this study point to a possible CD atrophy in some patients with reflux esophagitis. These are in accordance with previous functional studies and set the stage for new studies about GERD physiopathology and the relationship between the diaphragm and esophageal diseases. |
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info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisWidth and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux diseaseMedida da espessura e ecogenicidade do ramo direito do diafragma crural em pacientes com doenÃa do refluxo gastroesofÃgico2014-08-27Miguel Ãngelo Nobre e Souza26744589334http://buscatextual.cnpq.br/buscatextual/visualizacv.jsp?id=K4728064U2Marcellus Henrique Loiola Ponte de Souza51211700330http://lattes.cnpq.br/400159652226394048042072368http://lattes.cnpq.br/5915797329818260Rivianny Arrais NobreUniversidade Federal do CearÃPrograma de PÃs-GraduaÃÃo em CiÃncias MÃdicasUFCBRMEDICINAWidth and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Gastroesophageal reflux disease (GERD) patients may be better identified by the inspiratory pressure of the lower esophageal sphincter (LES), which is lower, than the expiratory one, and symptoms may be alleviated by inspiratory muscle training. Three groups of human volunteers were selected for this study. Twenty patients with reflux esophagitis (ESOPHAGITIS), nine patients with symptoms of GERD but no esophagitis (NES), and eleven asymptomatic volunteers (Control Group). The volunteers answered GERD and quality-of-life related questionnaires, and underwent endoscopic ultrasound examination and high resolution manometry. The main goal was to study the gastroesophageal junction (GEJ) and the crural diaphragm (CD) in particular (right crus). The width of the CD right crus was measured in millimeters. A standard segment of the CD was analyzed for the average grey intensity of its pixels, and this was taken for ecogenicity. The CD width was thinner in the ESOPHAGITIS group relative to Controls (CD width mean: 3.45  0.24 mm versus 5.19  0.48 mm, p = 0.0077). CD ecogenicity was greater in the ESOPHAGITIS patients relative to Controls (mean ecogenicity: 32.38  2.45 versus 18.35  2.53, p = 0.0009). These findings suggest that some ESOPHAGITIS patients may have an atrophic CD with a greater fat or fibrosis content. There is a decreasing CD width across the ESOPHAGITIS, NES, and control groups. However, this finding was only significant between the ESOPHAGITIS and the Controls. The LES average pressure during resting was similar between the ESOPHAGITIS and Control groups. However, the LES minimal respiratory pressure, IRP, the LES maximal residual pressure, the mean wave amplitude at 3 and 7 cm above the LES, and the maximal DCI were smaller in the ESOPHAGITIS patients relative to controls. The more heartburn bothered the ESOPHAGITIS patients the thinner was the CD width (r = -0.5559, p = 0.0166). The findings of this study point to a possible CD atrophy in some patients with reflux esophagitis. These are in accordance with previous functional studies and set the stage for new studies about GERD physiopathology and the relationship between the diaphragm and esophageal diseases. Medida da espessura e ecogenicidade do ramo direito do diafragma crural em pacientes com doenÃa do refluxo gastroesofÃgico. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Pacientes com doenÃa do refluxo gastroesofÃgico (DRGE) podem ser melhor diferenciados pela pressÃo inspiratÃria do esfÃncter esofÃgico inferior (EEI), que à menor, que pela expiratÃria, e seus sintomas podem ser aliviados pelo treinamento muscular inspiratÃrio. Neste estudo em seres humanos, foram selecionados trÃs grupos de voluntÃrios. Um com DRGE com esofagite composto de 20 pacientes, outro com sintomas de RGE sem esofagite (NES), com 9 pacientes e outro de pessoas assintomÃticos (Grupo Controle), com n=11. Os voluntÃrios responderam questionÃrios de sintomas e de qualidade de vida relacionados a DRGE, e se submeteram a ecoendoscopia e manometria de alta resoluÃÃo, com o objetivo principal de estudar a junÃÃo esofagogÃstrica (JEG), em particular o diafragma crural (DC). A espessura do ramo direito do DC foi medida em milÃmetros. A intensidade mÃdia de cinzas dos pixel de um segmento padronizado do DC foi considerado como a ecogenicidade. A espessura do ramo direito do diafragma crural foi menor no grupo ESOFAGITE que nos controles (mÃdia do diafragma crural = 3,45  0,24 mm no grupo ESOFAGITE e 5,19  0,48 mm no grupo controle com p=0,0077). A ecogenicidade do DC foi maior no grupo ESOFAGITE que nos controles (mÃdia desta medida neste grupo foi 32,38  2,45 e 18,35  2,53 no grupo controle, p=0,0009). Estes achados sugerem um mÃsculo atrÃfico e com maior teor de outros tecidos como gordura ou fibrose em alguns voluntÃrios com DRGE e esofagite associada. Quando os trÃs grupos de estudo foram comparados (ESOFAGITE, NES e Controle) observou-se diminuiÃÃo progressiva na espessura, porÃm, mantendo-se diferenÃa significante somente entre o grupo ESOFAGITE e controle. Na manometria esofÃgica, a pressÃo basal mÃdia do esfÃncter esofagiano inferior nÃo teve diferenÃa estatÃstica, porÃm isto foi observado na pressÃo respiratÃria mÃnima do EEI, no IRP, na pressÃo residual mÃxima do EEI, na amplitude distal e no DCI mÃximo entre os grupos ESOFAGITE e controle, sendo menores nos primeiros. Com relaÃÃo aos sintomas, o grau de incÃmodo da pirose correlacionou-se negativamente com a espessura do diafragma crural (r = -0,5559, p = 0,0166). Os achados deste estudo indicam uma possÃvel atrofia do diafragma crural em alguns pacientes com esofagite de refluxo. Isto està de acordo com estudos funcionais prÃvios e abre uma ampla perspectiva de estudo da fisiopatologia da DRGE e a influÃncia do diafragma em doenÃas esofÃgicas. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12840application/pdfinfo:eu-repo/semantics/openAccessporreponame:Biblioteca Digital de Teses e Dissertações da UFCinstname:Universidade Federal do Cearáinstacron:UFC2019-01-21T11:26:05Zmail@mail.com - |
dc.title.en.fl_str_mv |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
dc.title.alternative.pt.fl_str_mv |
Medida da espessura e ecogenicidade do ramo direito do diafragma crural em pacientes com doenÃa do refluxo gastroesofÃgico |
title |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
spellingShingle |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease Rivianny Arrais Nobre MEDICINA |
title_short |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
title_full |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
title_fullStr |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
title_full_unstemmed |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
title_sort |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease |
author |
Rivianny Arrais Nobre |
author_facet |
Rivianny Arrais Nobre |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Miguel Ãngelo Nobre e Souza |
dc.contributor.advisor1ID.fl_str_mv |
26744589334 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.jsp?id=K4728064U2 |
dc.contributor.referee1.fl_str_mv |
Marcellus Henrique Loiola Ponte de Souza |
dc.contributor.referee1ID.fl_str_mv |
51211700330 |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/4001596522263940 |
dc.contributor.authorID.fl_str_mv |
48042072368 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/5915797329818260 |
dc.contributor.author.fl_str_mv |
Rivianny Arrais Nobre |
contributor_str_mv |
Miguel Ãngelo Nobre e Souza Marcellus Henrique Loiola Ponte de Souza |
dc.subject.cnpq.fl_str_mv |
MEDICINA |
topic |
MEDICINA |
dc.description.abstract.por.fl_txt_mv |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Gastroesophageal reflux disease (GERD) patients may be better identified by the inspiratory pressure of the lower esophageal sphincter (LES), which is lower, than the expiratory one, and symptoms may be alleviated by inspiratory muscle training. Three groups of human volunteers were selected for this study. Twenty patients with reflux esophagitis (ESOPHAGITIS), nine patients with symptoms of GERD but no esophagitis (NES), and eleven asymptomatic volunteers (Control Group). The volunteers answered GERD and quality-of-life related questionnaires, and underwent endoscopic ultrasound examination and high resolution manometry. The main goal was to study the gastroesophageal junction (GEJ) and the crural diaphragm (CD) in particular (right crus). The width of the CD right crus was measured in millimeters. A standard segment of the CD was analyzed for the average grey intensity of its pixels, and this was taken for ecogenicity. The CD width was thinner in the ESOPHAGITIS group relative to Controls (CD width mean: 3.45  0.24 mm versus 5.19  0.48 mm, p = 0.0077). CD ecogenicity was greater in the ESOPHAGITIS patients relative to Controls (mean ecogenicity: 32.38  2.45 versus 18.35  2.53, p = 0.0009). These findings suggest that some ESOPHAGITIS patients may have an atrophic CD with a greater fat or fibrosis content. There is a decreasing CD width across the ESOPHAGITIS, NES, and control groups. However, this finding was only significant between the ESOPHAGITIS and the Controls. The LES average pressure during resting was similar between the ESOPHAGITIS and Control groups. However, the LES minimal respiratory pressure, IRP, the LES maximal residual pressure, the mean wave amplitude at 3 and 7 cm above the LES, and the maximal DCI were smaller in the ESOPHAGITIS patients relative to controls. The more heartburn bothered the ESOPHAGITIS patients the thinner was the CD width (r = -0.5559, p = 0.0166). The findings of this study point to a possible CD atrophy in some patients with reflux esophagitis. These are in accordance with previous functional studies and set the stage for new studies about GERD physiopathology and the relationship between the diaphragm and esophageal diseases. Medida da espessura e ecogenicidade do ramo direito do diafragma crural em pacientes com doenÃa do refluxo gastroesofÃgico. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Pacientes com doenÃa do refluxo gastroesofÃgico (DRGE) podem ser melhor diferenciados pela pressÃo inspiratÃria do esfÃncter esofÃgico inferior (EEI), que à menor, que pela expiratÃria, e seus sintomas podem ser aliviados pelo treinamento muscular inspiratÃrio. Neste estudo em seres humanos, foram selecionados trÃs grupos de voluntÃrios. Um com DRGE com esofagite composto de 20 pacientes, outro com sintomas de RGE sem esofagite (NES), com 9 pacientes e outro de pessoas assintomÃticos (Grupo Controle), com n=11. Os voluntÃrios responderam questionÃrios de sintomas e de qualidade de vida relacionados a DRGE, e se submeteram a ecoendoscopia e manometria de alta resoluÃÃo, com o objetivo principal de estudar a junÃÃo esofagogÃstrica (JEG), em particular o diafragma crural (DC). A espessura do ramo direito do DC foi medida em milÃmetros. A intensidade mÃdia de cinzas dos pixel de um segmento padronizado do DC foi considerado como a ecogenicidade. A espessura do ramo direito do diafragma crural foi menor no grupo ESOFAGITE que nos controles (mÃdia do diafragma crural = 3,45  0,24 mm no grupo ESOFAGITE e 5,19  0,48 mm no grupo controle com p=0,0077). A ecogenicidade do DC foi maior no grupo ESOFAGITE que nos controles (mÃdia desta medida neste grupo foi 32,38  2,45 e 18,35  2,53 no grupo controle, p=0,0009). Estes achados sugerem um mÃsculo atrÃfico e com maior teor de outros tecidos como gordura ou fibrose em alguns voluntÃrios com DRGE e esofagite associada. Quando os trÃs grupos de estudo foram comparados (ESOFAGITE, NES e Controle) observou-se diminuiÃÃo progressiva na espessura, porÃm, mantendo-se diferenÃa significante somente entre o grupo ESOFAGITE e controle. Na manometria esofÃgica, a pressÃo basal mÃdia do esfÃncter esofagiano inferior nÃo teve diferenÃa estatÃstica, porÃm isto foi observado na pressÃo respiratÃria mÃnima do EEI, no IRP, na pressÃo residual mÃxima do EEI, na amplitude distal e no DCI mÃximo entre os grupos ESOFAGITE e controle, sendo menores nos primeiros. Com relaÃÃo aos sintomas, o grau de incÃmodo da pirose correlacionou-se negativamente com a espessura do diafragma crural (r = -0,5559, p = 0,0166). Os achados deste estudo indicam uma possÃvel atrofia do diafragma crural em alguns pacientes com esofagite de refluxo. Isto està de acordo com estudos funcionais prÃvios e abre uma ampla perspectiva de estudo da fisiopatologia da DRGE e a influÃncia do diafragma em doenÃas esofÃgicas. |
description |
Width and ecogenicity of the diaphragm right crus in patients with gastroesophageal reflux disease. RIVIANNY ARRAIS NOBRE. Tese (Doutorado). Programa de PÃs-GraduaÃÃo Stricto Sensu em CiÃncias MÃdicas. Orientador: Professor Doutor Miguel Ãngelo Nobre e Souza. Gastroesophageal reflux disease (GERD) patients may be better identified by the inspiratory pressure of the lower esophageal sphincter (LES), which is lower, than the expiratory one, and symptoms may be alleviated by inspiratory muscle training. Three groups of human volunteers were selected for this study. Twenty patients with reflux esophagitis (ESOPHAGITIS), nine patients with symptoms of GERD but no esophagitis (NES), and eleven asymptomatic volunteers (Control Group). The volunteers answered GERD and quality-of-life related questionnaires, and underwent endoscopic ultrasound examination and high resolution manometry. The main goal was to study the gastroesophageal junction (GEJ) and the crural diaphragm (CD) in particular (right crus). The width of the CD right crus was measured in millimeters. A standard segment of the CD was analyzed for the average grey intensity of its pixels, and this was taken for ecogenicity. The CD width was thinner in the ESOPHAGITIS group relative to Controls (CD width mean: 3.45 Â 0.24 mm versus 5.19 Â 0.48 mm, p = 0.0077). CD ecogenicity was greater in the ESOPHAGITIS patients relative to Controls (mean ecogenicity: 32.38 Â 2.45 versus 18.35 Â 2.53, p = 0.0009). These findings suggest that some ESOPHAGITIS patients may have an atrophic CD with a greater fat or fibrosis content. There is a decreasing CD width across the ESOPHAGITIS, NES, and control groups. However, this finding was only significant between the ESOPHAGITIS and the Controls. The LES average pressure during resting was similar between the ESOPHAGITIS and Control groups. However, the LES minimal respiratory pressure, IRP, the LES maximal residual pressure, the mean wave amplitude at 3 and 7 cm above the LES, and the maximal DCI were smaller in the ESOPHAGITIS patients relative to controls. The more heartburn bothered the ESOPHAGITIS patients the thinner was the CD width (r = -0.5559, p = 0.0166). The findings of this study point to a possible CD atrophy in some patients with reflux esophagitis. These are in accordance with previous functional studies and set the stage for new studies about GERD physiopathology and the relationship between the diaphragm and esophageal diseases. |
publishDate |
2014 |
dc.date.issued.fl_str_mv |
2014-08-27 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
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publishedVersion |
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doctoralThesis |
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http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12840 |
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http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12840 |
dc.language.iso.fl_str_mv |
por |
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info:eu-repo/semantics/openAccess |
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openAccess |
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Universidade Federal do Cearà |
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Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas |
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UFC |
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BR |
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Universidade Federal do Cearà |
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UFC |
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