JOAQUIM PRADO PINTO DE MORAES FILHO
Projetos de Pesquisa
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Departamento de Gastroenterologia, Faculdade de Medicina - Docente
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bookPart Esofagite eosinofílica(2013) DOMINGUES, Gerson Ricardo de S; MORAES-FILHO, Joaquim Prado Pinto de; DOMINGUES, Aline Gonçalves LeitebookPart Doença do Repluxo Gastroesofágico(2016) LUGãO, Renata dos Santos; MORAES FILHO, Joaquim Prado Pinto de; HASHIMOTO, Cláudio Lyoiti- Refractory gastroesophageal reflux disease(2012) MORAES-FILHO, Joaquim Prado P.CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. RESULTS: In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. CONCLUSIONS: The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.
- Vonoprazan in the management of gastric/peptic ulcers: a systematic review of safety data(2022) MORAES-FILHO, Joaquim Prado P.; DOMINGUES, Gerson; GUEDES, Juliana Leite Soares; ZATERKA, SchliomaIntroduction: Although potassium-competitive acid blockers (P-CABs) prompted safety concerns when first developed, they ultimately proved to have a favourable safety profile.Aim: To assess the safety of vonoprazan in the management of gastroesophageal reflux disease (GERD), peptic ulcers, or gastroduodenal mucosal lesions induced by chronic use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs).Material and methods: From March to June 2021, a literature search was conducted using Medline via PubMed, Cochrane library, Lilacs, SciELO, and Centre for Reviews and Dissemination (CRD) electronic databases. After applying the eligibility criteria, 10 studies were included in this review. Of these 10 articles, vonoprazan was used as initial therapy in 6 and as maintenance therapy in 4. Adverse event rates were similar for vonoprazan and proton-pump inhibitors (PPIs). Conclusions: Our findings suggest that vonoprazan is a safe option for the management of erosive oesophagitis, gastric/ peptic ulcers, or peptic ulcers induced by chronic use of aspirin or NSAIDs.
bookPart Síndrome do intestino irritável(2013) MORAES-FILHO, Joaquim Prado Pinto debookPart Doença do refluxo gastresofágico(2013) MORAES-FILHO, Joaquim Prado Pinto de; CHAVES, Renata Carvalho de Miranda; DIB, Ricardo Anuar; NAVARRO-RODRIGUEZ, Tomás- Commentary: daily pantoprazole vs. esomeprazole for GERD - authors' reply(2014) MORAES-FILHO, J. P.; PEDROSO, M.; QUIGLEY, E. M. M.
- Randomised clinical trial: daily pantoprazole magnesium 40 mg vs. esomeprazole 40 mg for gastro-oesophageal reflux disease, assessed by endoscopy and symptoms(2014) MORAES-FILHO, J. P.; PEDROSO, M.; QUIGLEY, E. M. M.BackgroundPantoprazole magnesium (pantoprazole-Mg) may display extended inhibition of the proton pump with the potential for improved clinical efficacy in gastro-oesophageal reflux disease (GERD). AimTo compare the efficacy of pantoprazole-Mg and esomeprazole in GERD. MethodsGastro-oesophageal reflux disease (Los Angeles grades A-D) patients were randomised to 4weeks of treatment with pantoprazole-Mg (n=290) or esomeprazole (n=288), both 40mg once daily, in this multicentre (14 Brazilian sites in 9 cities), double-blind study, with an additional 4weeks' treatment in nonresponding patients. Severity of oesophagitis (at endoscopy) and GERD-related symptoms (ReQuest-GI) were assessed. The primary end point was the proportion of patients in complete remission (ReQuest-GI score <1.73 plus endoscopic healing) at week 4. ResultsComplete remission occurred in 61% of patients in each treatment group at 4weeks (primary endpoint) and in 81% and 79% of patients in the pantoprazole-Mg and esomeprazole groups at 8weeks, with no significant differences. Mucosal healing rates were high and not significantly different. At 8weeks, symptom relief with pantoprazole-Mg was significantly greater than that with esomeprazole (91.6% vs. 86.0%, P=0.0370) because of continued improvement in symptoms with pantoprazole-Mg from week 4 to week 8 (P=0.0206). ConclusionsPantoprazole-Mg 40mg was at least as effective as esomeprazole 40mg for complete remission and the mucosal healing rate was high. Symptom relief with pantoprazole-Mg continued to improve from 4 to 8weeks and was greater than that with esomeprazole at week 8, suggesting an extended period of treatment effect (ClinicalTrials.gov identifier: NCT01132638).
- GASTROESOPHAGEAL REFLUX DISEASE: A PRACTICAL APPROACH(2021) DOMINGUES, Gerson; MORAES-FILHO, Joaquim Prado P deABSTRACT Gastroesophageal reflux disease (GERD) presents typical manifestations such as heartburn and/or regurgitation as well as atypical manifestations such as throat symptoms, laryngitis, hoarseness, chronic cough, asthma, and sleep alterations. There are two phenotypes of the disease: erosive GERD, when erosions are identified by upper digestive endoscopy, and non-erosive GERD, when the esophageal mucosa presents a normal endoscopic aspect. Relevant clinical findings are usually absent in the physical examination, but it should be highlighted that obesity is an important aggravating factor of reflux. The treatment is established based on clinical findings and, according to the clinical situation, on complementary exams such as upper digestive endoscopy. In dubious cases where a precise diagnosis is required, the indicated test is esophageal pHmetry or impedance-pHmetry. Clinical treatment is divided into behavioral/dietary measures and pharmacological measures. Most patients benefit from clinical treatment, but surgical treatment may be indicated in the presence of a larger hiatal hernia and complications of the disease.
bookPart Tumores do Esôfago(2016) HASHIMOTO, Cláudio Lyoiti; ROSSINI, Alessandra Rita Asayama Lopes; OTTONI, Leandro Ferreira; MORAES FILHO, Joaquim Prado Pinto de