JAIME NATAN EISIG
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- Influence of exercise testing in gastroesophageal reflux in patients with gastroesophageal reflux disease(2014) MENDES-FILHO, Antonio Moreira; MORAES-FILHO, Joaquim Prado Pinto; NASI, Ary; EISIG, Jaime Natan; RODRIGUES, Tomas Navarro; BARBUTTI, Ricardo Correa; CAMPOS, Josemberg Marins; CHINZON, DecioBackground : Gastroesophageal reflux disease is a worldwide prevalent condition that exhibits a large variety of signs and symptoms of esophageal or extra-esophageal nature and can be related to the esophagic adenocarcinoma. In the last few years, greater importance has been given to the influence of physical exercises on it. Some recent investigations, though showing conflicting results, point to an exacerbation of gastroesophageal reflux during physical exercises. Aim : To evaluate the influence of physical activities in patients presenting with erosive and non erosive disease by ergometric stress testing and influence of the lower esophageal sphincter tonus and body mass index during this situation. Methods : Twenty-nine patients with erosive disease (group I) and 10 patients with non-erosive disease (group II) were prospectively evaluated. All the patients were submitted to clinical evaluation, followed by upper digestive endoscopy, manometry and 24 h esophageal pH monitoring. An ergometric testing was performed 1 h before removing the esophageal pH probe. During the ergometric stress testing, the following variables were analyzed: test efficacy, maximum oxygen uptake, acid reflux duration, gastroesophageal reflux symptoms, influence of the lower esophageal sphincter tonus and influence of body mass index in the occurrence of gastroesophageal reflux during these physical stress. Results : Maximum oxigen consumption or VO 2 max, showed significant correlation when it was 70% or higher only in the erosive disease group, evaluating the patients with or without acid reflux during the ergometric testing (p=0,032). The other considered variables didn't show significant correlations between gastroesophageal reflux and physical activity (p>0,05). Conclusions : 1) Highly intensive physical activity can predispose the occurrence of gastroesophageal reflux episodes in gastroesophageal reflux disease patients with erosive disease; 2) light or short sessions of physical activity have no influence on reflux, regardless of body mass index; 3) the lower esophageal sphincter tonus does not influence the occurrence of reflux disease episodes during exercise testing.
- Probiotics intake and metabolic syndrome: A proposal (Retracted article. See vol. 39, pg. 85, 2014)(2011) BOGSAN, Cristina Stewart B.; FLORENCE, Ana Carolina R.; PERINA, Natalia; BARBUTI, Ricardo C.; NAVARRO-RODRIGUEZ, Tomas; EISIG, Jaime N.; OLIVEIRA, Marice N.Probiotics are practical tools to provide the modulation of microbiota. The ingestion of food or ingredients containing anti-inflammatory activity components as probiotics should be useful in obesity control and associated co-morbidities treatment. Metabolic syndrome is a metabolic dysfunction associated with visceral obesity and insulin resistance, in which the alterations in host microbiota interactions play an important role. Besides diet and physical activity, new strategies are necessary to control metabolic syndrome, and as consequence improving quality of life. This article revises the actual knowledge concerning probiotic intake and obesity as a proposal to control metabolic syndrome.
- Endoscopic findings in uninvestigated dyspepsia(2014) FAINTUCH, Jacob Jehuda; SILVA, Fernando Marcuz; NAVARRO-RODRIGUEZ, Tomas; BARBUTI, Ricardo Correa; HASHIMOTO, Claudio Lyoiti; ROSSINI, Alessandra Rita Asayama Lopes; DINIZ, Marcio Augusto; EISIG, Jaime NatanBackground: It is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in Sao Paulo. Methods: Outpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Results: Three hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs. Conclusions: The endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status.
- Low levels of adherence with proton pump inhibitor therapy contribute to therapeutic failure in gastroesophageal reflux disease(2012) DAL-PAZ, K.; MORAES-FILHO, J. P.; NAVARRO-RODRIGUEZ, T.; EISIG, J. N.; BARBUTI, R.; QUIGLEY, E. M. M.To assess adherence to proton pump inhibitor (PPI) treatment and associated variables in patients with gastroesophageal reflux disease (GERD). Cross-sectional and prospective comprising 240 consecutive adult patients, diagnosed with GERD for whom continuous use of standard or double dose of omeprazole had been prescribed. Patients were ranked as ne-GERD (162: 67.5%) or e-GERD classified according to the Los Angeles classification as A (48:20.0%), B (21:8.6%), C (1:0.5%), D (1:0.5%), and Barrett's esophagus (7:2.9%). The Morisky questionnaire was applied to assess adherence to therapy and a GERD questionnaire to assess symptoms and their impact. Adherence was correlated with demographics, cotherapies, comorbidities, treatment duration, symptoms scores, endoscopic findings, and patient awareness of their disease. 126 patients (52.5%) exhibited high level of adherence and 114 (47.5%) low level. Youngers (P= 0.002) or married (O.R. 2.41, P= 0.03 vs. widowers) patients had lower levels of adherence; symptomatic patients exhibited lower adherence (P= 0.02). All other variables studied had no influence on adherence. Patients with GERD attending a tertiary referral hospital in Sao Paulo exhibited a high rate of low adherence to the prescribed PPI therapy that may play a role in the therapy failure. Age <60 years, marital status and being symptomatic were risk factors for low adherence.
conferenceObject Diabetes and Dislipidemia Increase Significantly the Risk of Gastric Intestinal Metaplasia: A Prospective Study(2015) NAVARRO-RODRIGUEZ, Tomas; BARBUTI, Ricardo C.; EISIG, Jaime N.; DIB, Ricardo A.; ABRANTES, Eduardo F.; RIBEIRO, Karina B.; REIS, Luiz Fernando L.; MONTAGNINI, Andre L.conferenceObject Bifidobacterium Lactis B420/Streptococcus thermophilus TA040-Fermented Milk Improves Dyspepsia. A Prospective, Randomized, Double-Blind Trial(2014) BARBUTI, Ricardo C.; OLIVEIRA, Marice N.; PERINA, Natalia P.; HARO, Christiane; BOGSAN, Cristina S.; EISIG, Jaime N.; NAVARRO-RODRIGUEZ, Tomys- Efficacy of levofloxacin, amoxicillin and a proton pump inhibitor in the eradication of Helicobacter pylori in Brazilian patients with peptic ulcers(2015) SILVA, Fernando Marcuz; QUEIROZ, Elaine Cristina Silveira de; NAVARRO-RODRIGUEZ, Tomás; BARBUTI, Ricardo Correa; MATTAR, Rejane; IRIYA, Kiyoshi; LEE, Jin Hwa; EISIG, Jaime NatanOBJECTIVES: The eradication of Helicobacter (H.) pylori allows peptic ulcers in patients infected with the bacteria to be cured. Treatment with the classic triple regimen (proton pump inhibitor, amoxicillin and clarithromycin) has shown decreased efficacy due to increased bacterial resistance to clarithromycin. In our country, the eradication rate by intention to treat with this regimen is 83%. In Brazil, a commercially available regimen for bacterial eradication that uses levofloxacin and amoxicillin with lansoprazole is available; however, its efficacy is not known. Considering that such a treatment may be an alternative to the classic regimen, we aimed to verify its efficacy in H. pylori eradication. METHODS: Patients with peptic ulcer disease infected with H. pylori who had not received prior treatment were treated with the following regimen: 30 mg lansoprazole bid, 1,000 mg amoxicillin bid and 500 mg levofloxacin, once a day for 7 days. RESULTS: A total of 66 patients were evaluated. The patients’ mean age was 52 years, and women comprised 55% of the sample. Duodenal ulcers were present in 50% of cases, and gastric ulcers were present in 30%. The eradication rate was 74% per protocol and 73% by intention to treat. Adverse effects were reported by 49 patients (74%) and were mild to moderate, with a prevalence of diarrhea complaints. CONCLUSIONS: Triple therapy comprising lansoprazole, amoxicillin and levofloxacin for 7 days for the eradication of H. pylori in Brazilian peptic ulcer patients showed a lower efficacy than that of the classic triple regimen.
- Eosinophilic esophagitis in patients with typical gastroesophageal reflux disease symptoms refractory to proton pump inhibitor(2011) SA, Claudia Cristina de; KISHI, Humberto Setsuo; SILVA-WERNECK, Ana Luiza; MORAES-FILHO, Joaquim Prado Pinto de; EISIG, Jaime Natan; BARBUTI, Ricardo Correa; HASHIMOTO, Claudio Lyioti; NAVARRO-RODRIGUEZ, TomasBACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate. AIM: We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE. METHODS: Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies. RESULTS: Among the 103 studied patients, 79 (76.7%) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5% of patients, and erosive esophagitis was found in 12.6%. Only one patient presented lesions suggestive of EoE. Histological examination revealed > 20 eo/HPF in this patient. CONCLUSION: Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment.
- Standard Triple Therapy versus Sequential Therapy in Helicobacter pylori Eradication: A Double-Blind, Randomized, and Controlled Trial(2015) EISIG, Jaime Natan; NAVARRO-RODRIGUEZ, Tomas; TEIXEIRA, Ana Cristina Sa; SILVA, Fernando Marcuz; MATTAR, Rejane; CHINZON, Decio; HARO, Christiane; DINIZ, Marcio Augusto; MORAES-FILHO, Joaquim Prado; FASS, Ronnie; BARBUTI, Ricardo CorreaAim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected with H. pylori. Methods. One hundred H. pylori positive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or C-13-urea breath test. Results. In intention to treat (ITT) analysis, the rate of H. pylori eradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate of H. pylori eradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively. Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicating Helicobacter pylori patients. This study was registered under Clinical Trials with number ISRCTN62400496.
conferenceObject Standard Triple Therapy for Helicobacter pylori Is Still the Best First Line Treatment in Brazil, Compared With Sequential Therapy: A Randomized, Prospective, Double-Blind, Placebo-Controlled Study(2014) EISIG, Jaime N.; NAVARRO-RODRIGUEZ, Tomas; TEIXEIRA, Ana Cristina; SILVA, Fernando M.; MATTAR, Rejane; CHINZON, Decio; MORAES-FILHO, Joaquim P.; HARO, Christiane; BARBUTI, Ricardo C.