Aspectos manométricos contributivos à Classificação de Chicago para categorização de pacientes como acalasia tipo I ou II

• Autor(a) principal: Anefalos, Alexandre [UNIFESP]
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9292512; https://hdl.handle.net/11600/64773
• topic: Esophageal Achalasia; Manometry; Classification; Parameters; Acalásia Esofágica; Manometria; Classificação; Parâmetros

Background: Phenotypes of achalasia are based on esophageal body pressurization. The reasons that lead to wave pressurization are still unclear. This study aims to evaluate manometric parameters that may determine esophageal pressurization in patients with achalasia. Methods: 100 achalasia high resolution manometry tests were reviewed. We measured before each swallow: upper esophageal sphincter (UES) basal pressure, esophageal length, lower esophageal sphincter (LES) basal pressure, LES length, gastric and thoracic pressure, transdiaphragmatic pressure gradient (TPG) and LES retention pressure; during swallow: UES post-relaxation contraction pressure, UES residual pressure, UES recovery time, LES relaxation pressure, gastric and thoracic pressure, TPG and after swallow: esophageal length, LES length, wave amplitude, gastric and thoracic pressure and TPG. Results: Univariate analysis showed in pressurized waves before swallow: higher thoracic, UES and LES basal pressure, longer LES length, higher TPG and decrease of LES retention pressure; during swallow: higher thoracic, gastric and UES post-relaxation contraction pressure, higher UES and LES relaxation pressure and higher TPG; and after swallow: higher thoracic and gastric pressure and higher TPG. Multivariate analysis in pressurized waves showed as significant before swallow: thoracic and UES basal pressure; during swallow: thoracic, gastric and UES post-relaxation contraction pressure, UES residual pressure and UES recovery time; and after swallow: thoracic pressure. Conclusions: Manometric parameters that determined esophageal pressurization in patients with achalasia were: thoracic pressure (before, during and after swallow); UES basal pressure (before swallow); and UES post-relaxation contraction pressure, UES residual pressure and recovery time (during swallow).