Flores Priscila Pollo, Lemme Eponina Maria de Oliveira, Coelho Henrique Sérgio Moraes
Serviço de Gastroenterologia, Hospital Clementino Fraga Filho, Rio de Janeiro, RJ.
Arq Gastroenterol. 2005 Oct-Dec;42(4):213-20. doi: 10.1590/s0004-28032005000400005. Epub 2006 Jan 19.
The hepatic cirrhosis has as one of the main morbid-mortality causes, the portal hypertension with the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices.
To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictive factors.
Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry.
Esophageal motility disorders have been found in 44 patients (60%). The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices.
The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.
肝硬化是主要的发病和死亡原因之一，会引发门静脉高压并导致食管静脉曲张，存在消化道出血和肝功能不全恶化的可能性。识别病因预测因素或加重因素并尽可能预防它们很重要。近年来，已观察到肝硬化合并食管静脉曲张患者存在食管运动障碍和胃食管反流的关联。
研究肝硬化合并食管静脉曲张且未接受过内镜治疗患者的食管运动障碍患病率，以及其中无效食管运动的患病率和预测因素。
前瞻性评估74例肝硬化合并食管静脉曲张且未接受过内镜治疗的患者。所有患者均接受临床方案、食管测压检查，55例患者还进行了动态食管pH监测。
44例患者（60%）存在食管运动障碍。最常见的是无效食管运动，占28%。通过pH监测诊断出35%的患者存在异常反流疾病。一般测压异常，特别是无效食管运动与食管或胃食管反流疾病症状、异常反流、疾病严重程度、腹水存在情况以及静脉曲张程度之间均无相关性。
大多数未治疗食管静脉曲张的肝硬化患者存在食管运动障碍。未发现预测因素。这些发现的临床相关性需要在该范围内进行更多研究以确定这些异常的真正意义。
