TOMAS NAVARRO RODRIGUEZ
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Reply to Iovino and Ciacci: Respiratory physiotherapy in GERD: A proof-of-concept study on the increment of LES pressure(2013) CHAVES, R. C. de Miranda; NAVARRO-RODRIGUEZ, T.
bookPart 0 Citação(ões) na Scopus Acid indigestion: Causes, symptoms and treatment options(2014) CHAVES, R. C. M.; NAVARRO-RODRIGUEZ, T.Acid indigestion is a term commonly used by patients and physicians to indicate some form of gastrointestinal tract upset [1]. It includes a wide variety of symptoms, such as early satiety, nausea, bloating and abdominal discomfort. These vague upper gastrointestinal symptoms have been termed dyspepsia [2]. Functional dyspepsia, which is characterized by persistent or recurrent pain or discomfort centered in the upper abdomen based on Rome criteria, is accounted to be approximately 20% in the general population [3]. Occasionally, patients use the term indigestion to describe heartburn. However, it is defined more specifically as a burning sensation in the retroesternal area of variable intensity [4]. Likewise, this retroesternal burning, is the mainly symptom associated with gastroesophageal reflux disease (GERD) [5]. The epidemiological aspects of heartburn and GERD have been object of growing interest in the last decade because its increasing prevalence and the complications of the disease [6]. Population-based studies suggest that GERD is a common condition with a prevalence ranging between 10-20% in North America [4]. The impact of GERD extends beyond its economic burden, as it significantly impaired health-related quality of life [5]. Both dyspepsia and GERD are frequent chronic, often need long term treatment. Moreover, several studies have reported a higher prevalence of dyspeptic symptoms in patients with GERD [3]. In this chapter, we will review the cause, identify the symptoms and discuss treatment of patients with heartburn and acid indigestion. © 2014 by Nova Science Publishers, Inc. All rights reserved.conferenceObject High resolution manometry parameters to assess barrier function of the gastro-esophageal junction and to identify patients with gastro-esophageal reflux disease: a case-control study(2016) FREITAS-QUEIROZ, N.; JASPER, D.; HOLLENSTEIN, M.; MISSELWITZ, B.; LAYER, P.; NAVARRO-RODRIGUEZ, T.; FOX, M.; KELLER, J.- 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.
- Esophageal motility patterns are altered in older adult patients(2020) KUNEN, L. C. B.; FONTES, L. H. S.; MORAES-FILHO, J. P.; ASSIRATI, F. S.; NAVARRO-RODRIGUEZ, T.Introduction and aims: Since the 1960s, several studies have shown the effect of aging on esophageal motility, with inconsistent results. The aim of the present study was to evaluate the manometric results in older adult patients (>= 60 years of age) with an esophageal disorder and compare them with adults under 60 years of age. Materials and methods: A cross-sectional, retrospective study was conducted that included a sample of 1,175 patients (936 older adults and 239 non-older adults). The patients were evaluated and compared with respect to (i) sex, (ii) main complaint for which esophageal manometry was indicated, (iii) comorbidities, (iv) current medications, (v) smoking, and (vi) manometry results. Results: Patient age ranged from 19 to 92 years (women made up 76.5% of the older adults and 72.8% of the non-older adults). Normal lower esophageal sphincter relaxation and normal peristalsis were more frequent in the non-older patient group (91.1% vs. 84.8% and 87.4% vs. 76%, respectively). The manometry results for the non-older adults vs. the older adults, respectively, were: achalasia (2.9% vs. 5.9%); hypercontractile disorder (9.2% vs. 10.4%); hypocontractile disorder (38.5% vs. 47.6%); and normal values (49.4% vs. 36.1%). After excluding the variables that could change esophageal motility, the results revealed significant differences between the two study groups. Conclusions: Esophageal manometry demonstrated statistically significant differences between the older adult and non-older adult study population evaluated. (C) 2019 Asociacion Mexicana de Gastroenterologia.
- Prolonged measurement improves the assessment of thebarrier function of the esophago-gastric junction by high-resolution manometry(2017) JASPER, D.; FREITAS-QUEIROZ, N.; HOLLENSTEIN, M.; MISSELWITZ, B.; LAYER, P.; NAVARRO-RODRIGUEZ, T.; FOX, M.; KELLER, J.BackgroundEtiology of gastro-esophageal reflux disease (GERD) is multifactorial, but incompetence of the esophago-gastric junction (EGJ) appears to be of crucial importance. Established manometric parameters for assessment of EGJ barrier function are sub-optimal, potentially because they reflect only a very brief (up to 30seconds), not necessarily representative period. This prospective, case-control study tested the performance of novel, high-resolution manometry (HRM) parameters of EGJ function in the assessment of GERD. MethodsPatients with reflux symptoms and healthy controls (HC) underwent standard HRM and 24-hour pHimpedance measurements. EGJ morphology, lower esophageal sphincter pressure integral (LES-PI), EGJ contractile integral (EGJ-CI) were compared with total-EGJ-CI, a novel parameter summarizing EGJ barrier function during the entire HRM protocol. Esophageal acid exposure 4.2%/24h (A-Reflux-pos) or 73 reflux episodes in 24hours (V-Reflux-pos) were considered pathological. Key ResultsSixty five HC and 452 patients completed HRM, 380 (84%) patients underwent ambulatory reflux-monitoring. LES-PI, EGJ-CI and total-EGJ-CI correlated with EGJ morphology subtypes (all P<.00001). Only total-EGJ-CI was consistently lower in A-Reflux-pos and V-Reflux-pos subjects compared with HC and patients without GERD. Total-EGJ-CI was also the single best parameter for prediction of pathological reflux (optimal cut-off 47mmHg cm, AUC 0.746, P<.0001). This cut-off value, approximately 1 SD below the mean normal value, showed modest sensitivity 54% and positive predictive value 46%, but good specificity 85% and negative predictive value 89% for GERD diagnosis. Conclusion & InferencesTotal EGJ-CI, a new metric that summarizes EGJ contractility over time, allows an improved assessment of EGJ barrier function. Pathological reflux is unlikely if this metric is within the upper two-thirds of the normal range.
- Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux(2013) SILVA, R. C. V. da; SA, C. C. de; PASCUAL-VACA, A. O.; FONTES, L. H. de Souza; FERNANDES, F. A. M. Herbella; DIB, R. A.; BLANCO, C. R.; QUEIROZ, R. A.; NAVARRO-RODRIGUEZ, T.The treatment of gastroesophageal reflux disease may be clinical or surgical. The clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. The objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease - 16 submitted to sham technique and 22 submitted osteopathic technique - were randomly selected. The average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann-Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. The MEP had no statistical difference (P= 0.146). The values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.