TOMAS NAVARRO RODRIGUEZ
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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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.- 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.
conferenceObject Transcutaneous electrogastrography: Normal parameters in Brazilian population(2018) CARVALHO, N.; CARVALHO, P.; RODRIGUEZ, T.; BARBUTI, R.; PAULA, G. Andrade de