Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O exercÃcio fÃsico de varias intensidades influencia vÃrios sistemas fisiolÃgicos como (neuromuscular) promovendo aumento de forÃa e massa muscular, (cardiovascular) induzindo bradicardia de repouso e adaptaÃÃes vasculares, endÃcrino favorecendo a liberaÃÃo de vÃrios hormÃnios hipotalÃmicos e atà mesmo o sistema gastrintestinal. O exercÃcio fÃsico dependendo da intensidade e volume pode levar alteraÃÃes de volemia e isquemia gastrintestinal promovendo alteraÃÃes da motilidade gastrintestinal. O objetivo desse trabalho foi investigar o efeito do exercÃcio fÃsico agudo e crÃnico sobre o esvaziamento gÃstrico de lÃquidos, bem como os possÃveis mecanismos envolvendo o equilÃbrio Ãcido-bÃsico e as vias neuro-humorais em tais eventos. Utilizamos ratos machos wistas pesando entre 180 a 250g. Os protocolos de exercÃcio foram divididos em exercÃcio agudo e crÃnico. O agudo consistiu de nataÃÃo em um tanque coletivo 5/dias/10-40min. ApÃs 48h da ultima sessÃo, os ratos foram submetidos a uma sessÃo aguda de exercÃcio com 5% PC. O exercÃcio crÃnico consistiu de adaptaÃÃo ao meio liquido por 5 dias de nataÃÃo coletiva sem sobrecarga. Quarenta e oito horas apÃs a adaptaÃÃo, dos ratos foram submetidos ao protocolo de exercÃcio de saltos (4x10 intervalo de 30seg, 5dias/semana/4semanas). ApÃs a sessÃo de exercÃcio agudo foram avaliados o EG, gasometria arterial, parÃmetros hemodinÃmicos e mecanismos neurohumorais relacionados aos hormÃnios OT e CCK bem como a expressÃo gÃnica desses hormÃnios em tecidos gastrintestinais. Jà no exercÃcio crÃnico, foram avaliados o esvaziamento gÃstrico, trÃnsito intestinal, complacÃncia gÃstrica e parÃmetros hemodinÃmicos. Observamos que tanto os exercÃcios fÃsicos agudos quanto crÃnico promoveram diminuiÃÃo significativa (p < 0,05) no esvaziamento gÃstrico de lÃquidos. AlÃm disso, o exercÃcio crÃnico aumentou significativamente (p < 0,05) a complacÃncia gÃstrica em relaÃÃo aos ratos sedentÃrios, sem alteraÃÃo no transito intestinal. Em relaÃÃo aos ratos sedentÃrios, os ratos exercÃcio agudo apresentaram quadro de acidose metabÃlica com diminuiÃÃo significativa (p < 0,05) nos valore de pH, [HCO3]. Tal alteraÃÃo no equilÃbrio Ãcido-bÃsico foi prevenido significativamente (p < 0,05) com o prÃtratamento de NaHCO3 500mg/kg v.o, 40min antes do exercÃcio. Observamos ainda que o prÃ-tratamento com antagonista de OT e de CCK preveniu significativamente (p < 0,05) a diminuiÃÃo do esvaziamento gÃstrico induzido por exercÃcio agudo. O exercÃcio agudo diminuiu significativamente (p < 0,05) os valores relativos na expressÃo gÃnica dos hormÃnios OT e ANP no fundo e piloro dos ratos, quando comparados aos ratos sedentÃrios. Por outro lado, observamos que o exercÃcio agudo aumentou significativamente (p < 0,05) os valores da expressÃo gÃnica de CCK no fundo, piloro e duodeno dos ratos quando comparados aos sedentÃrios. O exercÃcio fÃsico agudo quanto crÃnico induziu dismotilidade gÃstrica com diminuiÃÃo do esvaziamento gÃstrico. O prÃtratamento com NaHCO3, Atosibana, Devazepide e Ondansetrona preveniu a diminuiÃÃo do esvaziamento gÃstrico induzido por exercÃcio agudo. Sugerimos que a dismotilidade induzida pelo exercÃcio pode ser influenciada por uma via relacionada a OT, 5-HT e CCK alÃm de sofrer influencia do equilÃbrio acido-bÃsico / &#65279;In the recent years, there is a general consensus on the benefits of regular physical activity on health caliber, prevention and treatment of various chronic diseases besides improving general quality of life. Specifically, physical activity of varied intensities broadly influence vital physiological systems involving the neuromuscular system (promoting increased muscle strength and mass) cardiovascular (induced basal bradycardia at rest), endocrine (favoring the release of several hypothalamic hormones) and even the gastrointestinal system. Published literature report that depending on the intensity and volume of exercise, changes in blood volume may result to associated gastrointestinal ischemia, which would possibly alter gastrointestinal motility. However, the mechanisms involved in altered gastrointestinal motility due to exercise are yet to be fully elucidated. Thus, the objective of this study was to investigate the effect of acute and chronic exercise on gastric emptying of liquids, as well as explain the possible mechanisms involving acid-base balance and subsequent neurohumoral pathways. Male Wistar rats (180 to 250g), were obtained from the vivarium of the Department of Physiology and Pharmacology, University Federal do Ceara. They were initially assigned to adapt to either acute or chronic exercise protocols. The acute exercise protocol adaptation consisted of collective swimming in a bath tub over increasing scale periods over 5 days, with a single and final swim 48hs after the fifth day, with a 5% body weight load so as to exploit the lactate threshold. The chronic exercise protocol consisted of collective swimming in a bath tub over 5 days without a specific time count pattern. Forty-eight hours after this adaptation, they were submitted to exercise protocol jumps (4x10 30sec interval, 5days/week/4weeks). After a session of intense exercise, we evaluated gastric emptying, blood analysis, hemodynamic and neurohumoral mechanisms related to hormones 5-HT, OT and CCK as well as the gene expression of these hormones in gastrointestinal tissues. In chronic exercised animals, we evaluated gastric emptying, intestinal transit, gastric compliance and hemodynamic parameters. We found that both acute and chronic exercise promoted a significant decrease (p <0.05) gastric emptying of liquids. Moreover, chronically exercised rats had significant (p <0.05) increased gastric compliance, when compared to sedentary rats; but no change in the intestinal transit. When compared to sedentary rats, acute exercised mice showed metabolic acidosis with a significant decrease (p <0.05) in pH values due to low bicarbonate. This change in acid-base balance was significantly (p <0.05) prevented with pretreating the animals to an oral dose of NaHCO3 (500mg/kg) 40min before exercise. We also observed that pretreatment with OT antagonist and CCK significantly prevented (p <0.05) the decrease in gastric emptying induced by acute exercise. Acute exercise decreased significantly (p <0.05) values for the gene expression of hormones OT and ANP in the fund and pylorus of the rats, when compared to sedentary rats. On the other hand, we found that acute exercise significantly (p <0.05) increased CCK-gene expression values in the fund, pylorus and duodenum of rats, in comparison to sedentary. Concluding, exercise induced changes in gastric motility in both acute and chronic exercise protocols. The pre-treatment with NaHCO3, Atosibana, and Ondansetron Devazepide prevented the decrease in gastric emptying induced by acute exercise. We suggest that dysmotility induced by exercise may be influenced by a pathway related to oxytocin, serotonin and cholecystokinin, which too have a role in the acid-base homeostasis

No description available.

Introduction Ehlers-Danlos syndrome (EDS), specifically the hypermobility type (hEDS), is associated with a variety of gastrointestinal (GI) conditions. This study aims to evaluate the prevalence of and factors associated with gut dysmotility in patients with hEDS. Methods This is a retrospective study of hEDS patients conducted at the Cleveland Clinic's Center for Personalized Genetic Healthcare between January 2007 and December 2017. Demographics, GI motility testing, endoscopic, and imaging data were extracted from the patients' charts. Results A total of 218 patients with hEDS were identified. Among them, 136 (62.3%) patients had at least one GI symptom at the time of EDS diagnosis. Motility testing was performed and reported in 42 (19.2%) patients. Out of them, five (11.9%) had esophageal dysmotility, 18 (42.8%) had gastroparesis, five (11.9%) had small bowel/colon altered transit time, and four (9.5%) had global dysmotility. In univariable analysis, patients with postural orthostatic tachycardia syndrome (POTS) [odds ratio (OR): 8.88, 95% CI: 3.69-24.9, p<0.0001], fibromyalgia (OR: 4.43, 95% CI: 2.04-10.1, p=0.0002), history of irritable bowel syndrome (OR: 5.01, 95% CI: 2.31-11.2, p<0.0001), and gastroesophageal reflux disease (OR: 3.33, 95% CI: 1.55-7.44, p=0.002) were more likely to be diagnosed with GI dysmotility. On multivariable analysis, only POTS (OR: 5.74, 95% CI: 2.25-16.7, p=0.0005) was significantly associated with an increased likelihood of GI dysmotility. Conclusions This study suggests that GI symptoms are relatively common among patients with hEDS. Of the patients tested for dysmotility, 76.2% were found to have some form of dysmotility. POTS was found to be an independent predictive factor for GI dysmotility.

Chest pain is one of the most common symptoms responsible for emergency department and primary care office visits in the United States. Chest pain can be noncardiac and may be attributed to multiple causes. Esophageal disorders including reflux, motility and functional conditions, affect a large proportion of patients with NCCP and lead to significant morbidity. The use of HRM has changed the diagnostic approach to esophageal motility disorders. It is the most specific and sensitive test for diagnosing motor disorders and a promising procedure in detecting dysmotility disorders in patients with NCCP. Despite the increased sensitivity of HRM, the main indications for esophageal manometry exclude NCCP. This study assessed the percentage of undiagnosed esophageal motility disorders in patients with NCCP referred for high resolution manometry. Differences in HRM findings in patients with NCCP versus patients meeting AGA recommendations for the clinical use of esophageal manometry were also compared. A retrospective descriptive design was utilized. Two hundred-nineteen patient charts were reviewed. One hundred sixty-eight (77%) patients underwent HRM and met AGA recommendations for esophageal manometry; 51 (23%) patients underwent the procedure after receiving a NCCP diagnosis. Findings showed that 116 (69%) patients in the AGA group had abnormal findings while 52 (31%) did not. In the NCCP group 34 (67%) had abnormal findings compared to 17 (33%) who did not. To compare normal and abnormal HRM findings in patients with NCCP versus those meeting AGA criteria, Chi-Square analysis was performed between the groups. The results were not statistically significant (p = 0.10). iv There were no significant differences in the results of HRM in both groups indicating the findings on HRM are the same despite the indication for the procedure. The findings support the use of HRM as a diagnostic tool in patients with chest pain after cardiac workup and endoscopic evaluation. This indicates a possible need to update the AGA indications for esophageal manometry and increase the awareness among healthcare providers regarding the use of HRM in patients with chest pain. Implication for future research is also discussed.

Introdução: A fisiopatologia da Doença do Refluxo Gastroesofágico (DRGE) é multifatorial, sendo a motilidade esofágica um dos fatores implicados na sua gênese. Todavia, ainda não há consenso sobre a existência de associação entre dismotilidade e Hérnia Hiatal (HH) em pacientes com DRGE. Esse estudo tem como objetivo estabelecer a prevalência de Dismotilidade Esofágica (DE) em pacientes com HH e avaliar se a herniação é fator relacionado à DE. Métodos: Foram estudados 356 pacientes com diagnóstico clínico de DRGE submetidos à Endoscopia Digestiva Alta e Manometria Esofágica. Hérnia Hiatal foi definida endoscopicamente por uma distância igual ou maior que 2 cm entre o pinçamento diafragmático e a junção escamo-colunar e Dismotilidade Esofágica quando a ME identificou amplitude das ondas peristálticas no esôfago distal < 30 mmHg e/ou menos de 80% de contrações efetivas. Foi feita a divisão dos pacientes para a análise estatística em 2 grupos, com e sem HH. Resultados: Pacientes com DRGE portadores de HH tiveram prevalência de DE igual a 14,8% e os sem HH, prevalência de 7,7% (p = 0,041). O grupo de pacientes com HH apresentou também maior frequência de esofagite erosiva (47,5% contra 24,2%, p <0,001), menor valor de pressão no EEI (10,4 versus 13,10; p < 0,001) e maior frequência de indivíduos com valores de pH-metria anormais (p < 0,001). A razão bruta de prevalências de DE, segundo a presença de HH, foi 1,92 (IC: 1,04 - 3,53; p = 0,037), porém essa associação não persistiu quando controlada por idade, esofagite, pH-metria alterada e EEI alterado (RP ajustada: 1,69; IC: 0,68 – 4,15; p = 0,257). Conclusão: Apesar da prevalência de DE no grupo HH ter sido maior do que no grupo sem HH, a associação entre HH e DE em indivíduos com DRGE desaparece ao se controlar por co-variáveis relevantes, levando a crer que neste tipo de paciente, HH não é fator de risco independente destas variáveis. / Introduction: The pathophysiology of gastroesophageal reflux disease is multifactorial, where esophageal motility is one of the factors implicated in its genesis. However, there is still no consensus on the existence of an association between esophageal dysmotility and hiatal hernia in patients with gastroesophageal reflux disease. The objective of this study was to establish the prevalence of esophageal dysmotility in patients with hiatal herina and to determine if herniation is a factor related to esophageal dysmotility. Methods: The study included 356 patients with a clinical diagnosis of gastroesophageal reflux disease submitted to upper digestive endoscopy and esophageal functional dagnostics. Hiatal Hernia was defined endoscopically by a distance equal to or greater than 2 cm between the diaphragmatic constriction and the squamo-columnar junction and esophageal dysmoyility when the esophageal manometry identified the amplitude of the peristaltic waves in the distal esophagus are < 30 mmHg and/or less than 80% of effective contractions. For statistical analysis, the patients were divided into 2 grups: with and without HH. Results: Gastroesophageal reflux disease patients with hiatal hernia had a prevalence of esophageal dysmotility equal to 14.8% and those without hiatal hernia, a prevalence of 7.7% (p = 0.041). The group of patients with hiatal hernia also showed a greater frequency of erosive esophagitis (47.5% versus 24.2%, p <0.001), lower low esophageal sphincter pressure (10.4 versus 13.10; p < 0.001) and greater frequency of individuals with abnormal pH-metry values (p < 0.001). The crude prevalence ratios for esophageal dysmotility, according to the presence of hiatal hernia, was 1.92 (CI: 1.04 - 3.53; p = 0.037), but this association did not persist when controlled for age, esophagitis, altered pH-metry and altered low esophageal sphincter (adjusted PR: 1.69; CI: 0.68 – 4.15; p = 0.257). Conclusion: Despite the prevalence of esophageal dysmotility in the hiatal hernia group being higher than that in the group without hiatal hernia, the association between hiatal hernia and esophageal dysmotility in individuals with gastroesophageal reflux disease disappeared on controlling for relevant co-variables, leading us to believe that in this type of patient, hiatal hernia is not a risk factor independent of these variables.

Introdução: A fisiopatologia da Doença do Refluxo Gastroesofágico (DRGE) é multifatorial, sendo a motilidade esofágica um dos fatores implicados na sua gênese. Todavia, ainda não há consenso sobre a existência de associação entre dismotilidade e Hérnia Hiatal (HH) em pacientes com DRGE. Esse estudo tem como objetivo estabelecer a prevalência de Dismotilidade Esofágica (DE) em pacientes com HH e avaliar se a herniação é fator relacionado à DE. Métodos: Foram estudados 356 pacientes com diagnóstico clínico de DRGE submetidos à Endoscopia Digestiva Alta e Manometria Esofágica. Hérnia Hiatal foi definida endoscopicamente por uma distância igual ou maior que 2 cm entre o pinçamento diafragmático e a junção escamo-colunar e Dismotilidade Esofágica quando a ME identificou amplitude das ondas peristálticas no esôfago distal < 30 mmHg e/ou menos de 80% de contrações efetivas. Foi feita a divisão dos pacientes para a análise estatística em 2 grupos, com e sem HH. Resultados: Pacientes com DRGE portadores de HH tiveram prevalência de DE igual a 14,8% e os sem HH, prevalência de 7,7% (p = 0,041). O grupo de pacientes com HH apresentou também maior frequência de esofagite erosiva (47,5% contra 24,2%, p <0,001), menor valor de pressão no EEI (10,4 versus 13,10; p < 0,001) e maior frequência de indivíduos com valores de pH-metria anormais (p < 0,001). A razão bruta de prevalências de DE, segundo a presença de HH, foi 1,92 (IC: 1,04 - 3,53; p = 0,037), porém essa associação não persistiu quando controlada por idade, esofagite, pH-metria alterada e EEI alterado (RP ajustada: 1,69; IC: 0,68 – 4,15; p = 0,257). Conclusão: Apesar da prevalência de DE no grupo HH ter sido maior do que no grupo sem HH, a associação entre HH e DE em indivíduos com DRGE desaparece ao se controlar por co-variáveis relevantes, levando a crer que neste tipo de paciente, HH não é fator de risco independente destas variáveis. / Introduction: The pathophysiology of gastroesophageal reflux disease is multifactorial, where esophageal motility is one of the factors implicated in its genesis. However, there is still no consensus on the existence of an association between esophageal dysmotility and hiatal hernia in patients with gastroesophageal reflux disease. The objective of this study was to establish the prevalence of esophageal dysmotility in patients with hiatal herina and to determine if herniation is a factor related to esophageal dysmotility. Methods: The study included 356 patients with a clinical diagnosis of gastroesophageal reflux disease submitted to upper digestive endoscopy and esophageal functional dagnostics. Hiatal Hernia was defined endoscopically by a distance equal to or greater than 2 cm between the diaphragmatic constriction and the squamo-columnar junction and esophageal dysmoyility when the esophageal manometry identified the amplitude of the peristaltic waves in the distal esophagus are < 30 mmHg and/or less than 80% of effective contractions. For statistical analysis, the patients were divided into 2 grups: with and without HH. Results: Gastroesophageal reflux disease patients with hiatal hernia had a prevalence of esophageal dysmotility equal to 14.8% and those without hiatal hernia, a prevalence of 7.7% (p = 0.041). The group of patients with hiatal hernia also showed a greater frequency of erosive esophagitis (47.5% versus 24.2%, p <0.001), lower low esophageal sphincter pressure (10.4 versus 13.10; p < 0.001) and greater frequency of individuals with abnormal pH-metry values (p < 0.001). The crude prevalence ratios for esophageal dysmotility, according to the presence of hiatal hernia, was 1.92 (CI: 1.04 - 3.53; p = 0.037), but this association did not persist when controlled for age, esophagitis, altered pH-metry and altered low esophageal sphincter (adjusted PR: 1.69; CI: 0.68 – 4.15; p = 0.257). Conclusion: Despite the prevalence of esophageal dysmotility in the hiatal hernia group being higher than that in the group without hiatal hernia, the association between hiatal hernia and esophageal dysmotility in individuals with gastroesophageal reflux disease disappeared on controlling for relevant co-variables, leading us to believe that in this type of patient, hiatal hernia is not a risk factor independent of these variables.

Introdução: A fisiopatologia da Doença do Refluxo Gastroesofágico (DRGE) é multifatorial, sendo a motilidade esofágica um dos fatores implicados na sua gênese. Todavia, ainda não há consenso sobre a existência de associação entre dismotilidade e Hérnia Hiatal (HH) em pacientes com DRGE. Esse estudo tem como objetivo estabelecer a prevalência de Dismotilidade Esofágica (DE) em pacientes com HH e avaliar se a herniação é fator relacionado à DE. Métodos: Foram estudados 356 pacientes com diagnóstico clínico de DRGE submetidos à Endoscopia Digestiva Alta e Manometria Esofágica. Hérnia Hiatal foi definida endoscopicamente por uma distância igual ou maior que 2 cm entre o pinçamento diafragmático e a junção escamo-colunar e Dismotilidade Esofágica quando a ME identificou amplitude das ondas peristálticas no esôfago distal < 30 mmHg e/ou menos de 80% de contrações efetivas. Foi feita a divisão dos pacientes para a análise estatística em 2 grupos, com e sem HH. Resultados: Pacientes com DRGE portadores de HH tiveram prevalência de DE igual a 14,8% e os sem HH, prevalência de 7,7% (p = 0,041). O grupo de pacientes com HH apresentou também maior frequência de esofagite erosiva (47,5% contra 24,2%, p <0,001), menor valor de pressão no EEI (10,4 versus 13,10; p < 0,001) e maior frequência de indivíduos com valores de pH-metria anormais (p < 0,001). A razão bruta de prevalências de DE, segundo a presença de HH, foi 1,92 (IC: 1,04 - 3,53; p = 0,037), porém essa associação não persistiu quando controlada por idade, esofagite, pH-metria alterada e EEI alterado (RP ajustada: 1,69; IC: 0,68 – 4,15; p = 0,257). Conclusão: Apesar da prevalência de DE no grupo HH ter sido maior do que no grupo sem HH, a associação entre HH e DE em indivíduos com DRGE desaparece ao se controlar por co-variáveis relevantes, levando a crer que neste tipo de paciente, HH não é fator de risco independente destas variáveis. / Introduction: The pathophysiology of gastroesophageal reflux disease is multifactorial, where esophageal motility is one of the factors implicated in its genesis. However, there is still no consensus on the existence of an association between esophageal dysmotility and hiatal hernia in patients with gastroesophageal reflux disease. The objective of this study was to establish the prevalence of esophageal dysmotility in patients with hiatal herina and to determine if herniation is a factor related to esophageal dysmotility. Methods: The study included 356 patients with a clinical diagnosis of gastroesophageal reflux disease submitted to upper digestive endoscopy and esophageal functional dagnostics. Hiatal Hernia was defined endoscopically by a distance equal to or greater than 2 cm between the diaphragmatic constriction and the squamo-columnar junction and esophageal dysmoyility when the esophageal manometry identified the amplitude of the peristaltic waves in the distal esophagus are < 30 mmHg and/or less than 80% of effective contractions. For statistical analysis, the patients were divided into 2 grups: with and without HH. Results: Gastroesophageal reflux disease patients with hiatal hernia had a prevalence of esophageal dysmotility equal to 14.8% and those without hiatal hernia, a prevalence of 7.7% (p = 0.041). The group of patients with hiatal hernia also showed a greater frequency of erosive esophagitis (47.5% versus 24.2%, p <0.001), lower low esophageal sphincter pressure (10.4 versus 13.10; p < 0.001) and greater frequency of individuals with abnormal pH-metry values (p < 0.001). The crude prevalence ratios for esophageal dysmotility, according to the presence of hiatal hernia, was 1.92 (CI: 1.04 - 3.53; p = 0.037), but this association did not persist when controlled for age, esophagitis, altered pH-metry and altered low esophageal sphincter (adjusted PR: 1.69; CI: 0.68 – 4.15; p = 0.257). Conclusion: Despite the prevalence of esophageal dysmotility in the hiatal hernia group being higher than that in the group without hiatal hernia, the association between hiatal hernia and esophageal dysmotility in individuals with gastroesophageal reflux disease disappeared on controlling for relevant co-variables, leading us to believe that in this type of patient, hiatal hernia is not a risk factor independent of these variables.