Papel do gradiente de pressão transdiafragmático na fisiopatologia da doença do refluxo gastroesofágico no paciente obeso

• Ano de defesa: 2019
• Autor(a) principal: Grande, Leonardo De Mello Del [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Pressure Gradient; DRGE; Obesity; Gradiente De Pressão; Obesidade
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7801857; https://repositorio.unifesp.br/handle/11600/59444

Introduction: Pathophysiology of gastroesophageal reflux disease (GERD) is multifactorial. An increased transdiaphragmatic pressure gradient (TPG) may be a main element for GERD in the obese patient. This study aims to evaluate the role of TGP in obese individuals. Methods: We studied 47 unselected consecutive candidates for bariatric operations (body mass index - BMI > 35). All patients underwent high resolution manometry and esophageal pH monitoring. Individuals were grouped as GERD + or GERD – based on DeMeester Score. Abdominal (AP) and thoracic pressures (TP), transdiaphragmatic pressure gradient (AP-TP) and lower esophageal sphincter (LES) retention pressure (LES basal pressure – TPG) were determined. Manometric variables were compared to a group of 20 lean healthy individuals (BMI <25). Results: There were 27 (57%) GERD + patients and 20 (43%) GERD – patients. TPG, waist circumference, LES retention pressure and AP were higher in GERD + group as compared to GERD - individuals. GERD – group had manometric parameters similar to controls except for AP. GERD + patients had higher AP and TGP; and lower LES retention pressure compared to controls. TPG and LES retention pressure correlated with waist circumference and DeMeester Score. BMI correlated with AP but not with waist circumference or DeMeester score. Conclusion: In the obese, GERD presence and severity were associated to a high TPG due to increase AP that correlates with waist circumference.