As Repercussões da Lesão Medular sobre a Ação da Crura Diafragmática e na Contenção do Refluxo Gastroesofágico: um estudo transversal, não experimental / The repercussions of spinal cord injury on the action of the diaphragmatic crura for gastroesophageal reflux containment

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

30/09/2009

RESUMO

Study design: Cross-sectional and non-experimental. Objective: To detect and compare functional abnormalities in the esophagus and esophagogastric junction in two groups with chronic spinal injuries, one with injuries at the phrenic innervation level and the other at upper thoracic levels, and to relate these to gastroesophageal reflux containment. Summary of background data: There are no studies on esophageal manometry with pH metering among spinal cord injury patients. Worldwide statistics reveal that the prevalence of gastroesophageal reflux disease among spinal cord injury patients is greater than among the general population, at around 22 to 27%. The "diaphragmatic crura" has been recognized as an important antireflux barrier and should functionally be considered to be a muscle separated from the costal diaphragm. However, doubts remain regarding whether this difference relates to its innervation. Methods: This was a cross-sectional study on 29 patients with complete spinal cord injuries: 14 quadriplegics (level C4) and 15 paraplegics (levels T1 to T7). Functional abnormalities of the esophagogastric junction, esophagus and diaphragm were investigated using esophageal manometry and diaphragmatic video fluoroscopy. Presence of gastroesophageal reflux was investigated subjectively (pyrosis and regurgitation) and objectively (pH metering and endoscopy). Results: The prevalence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crura pressures were compared (quadriplegics: 37.5  17.8; paraplegics: 26.6  7.2; p=0.048). It was also significant in relation to the prevalence of at least one of the objective and/or subjective reflux findings and/or esophageal peristaltism (quadriplegics: 85.7%; paraplegics: 40%; p=0.011). Conclusions: Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics towards greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crura contractility among the quadriplegics.

ASSUNTO(S)

lesão medular crura diafragmática inervação frênica refluxo gastroesofágico junção esôfago-gástrica medicina spinal cord injury diaphragmatic crura phrenic innervation reflux gastroesophageal esophagogastric junction esophageal manometry ph metering

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