O uso de corticoesteróides após dilatação esofágica em pacientes portadores de estenose por substâncias corrosivas: estudo prospectivo, randomizado e duplo-cego

Camargo, Marcelo Amade; Lopes, Luiz Roberto; Grangeia, Tiago De Araujo Guerra; Andreollo, Nelson Adami; Brandalise, Nelson Ary

doi:10.1590/s0104-42302003000300033

Cited by 31 publications

(16 citation statements)

References 14 publications

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“…Várias podem ser as consequências do refluxo gastroesofágico, dentre elas: azia, esofagite (Münster et al, 2013), estenose esofágica (Adamama-Moraitou et al, 2002;Camargo et al, 2003;Vlasin et al, 2004;Corgozinho et al, 2006;Favarato et al, 2010;Silva et al, 2010;Lam et al, 2013;Oliveira et al, 2013;Ovbey et al, 2014) e pneumonia aspirativa (Adamama-Moraitou et al, 2002;Favarato et al, 2010;Ovbey et al, 2014). Dessa forma, os autores indicam sempre o manejo clínico de pacientes nos quais se constata essa alteração, incluindo atualmente o uso de omeprazol, independentemente do grau de refluxo ocorrido.…”

Section: Resultsunclassified

“…A doença do refluxo gastroesofágico (DRGE) em humanos é considerada atualmente uma das afecções crônicas mais importantes na prática médica, com elevada morbidade, prejuízo na qualidade de vida, frequentes recidivas e necessidade do uso continuado de medicação (Barczinski e Moraes-Filho, 2006). Está associada ao fluxo de conteúdo gastroduodenal para o esôfago e/ou órgãos adjacentes, o que leva à ampla gama de sinais clínicos (Norton e Pena, 2000;Barczinski e Moraes-Filho, 2006;Carvalhaes et al, 2011;Abrahão Jr., 2014).…”

Section: Introdução unclassified

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Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida

Hartmann

Feranti

Oliveira

et al. 2018

Arq. Bras. Med. Vet. Zootec.

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RESUMO A doença do refluxo gastroesofágico decorre do fluxo de conteúdo gastroduodenal para o esôfago e/ou órgãos adjacentes, o que leva à ampla gama de sinais e implicações clínicas. A incidência de refluxo gastroesofágico transoperatório em caninos é desconhecida. O objetivo deste trabalho foi, por meio da endoscopia flexível, avaliar a presença e quantificar o refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia por duas abordagens cirúrgicas (convencional e videoassistida com dois portais), pré-medicadas com morfina. Cem por cento das cadelas submetidas à ovário-histerectomia videoassistida e 30% das cadelas submetidas à ovário-histerectomia convencional apresentaram algum grau de refluxo. A intensidade dos refluxos foi maior nas cadelas submetidas ao procedimento minimamente invasivo, visto que elas (10 entre 10 animais) apresentaram, no mínimo, um refluxo classificado em R4, enquanto as outras (três entre 10) apresentaram, no máximo, refluxos em grau R3, de acordo com a escala planejada para esta pesquisa. Concluiu-se que os procedimentos laparoscópicos sob o protocolo anestésico utilizado promovem mais refluxo gastroesofágico que os convencionais.

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Section: Resultsunclassified

Section: Introdução unclassified

Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida

Hartmann

Feranti

Oliveira

et al. 2018

Arq. Bras. Med. Vet. Zootec.

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“…Camargo et al [23] ont également utilisé les corticoï-des en intralésionnel à base de triamcinolone à raison de 20 mg/ml en solution diluée dans du sérum salé isotonique. Ils ont pu démontrer une bonne amélioration clinique, une réduction significative de survenue de complications sténotiques, ainsi qu'une réduction du nombre de séances de dilatation et donc de survenue de perforations instrumentales, mais les séries sont trop réduites pour en tirer des conclusions.…”

Section: Discussionunclassified

Évaluation de la corticothérapie à forte dose au cours des lésions digestives caustiques chez l’adulte

Bouabdellah

Hannache

Benmati

et al. 2010

J Afr Hepato Gastroenterol

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La prévention des sténoses caustiques oesophagiennes fait le sujet de nombreuses controverses. Le but de ce travail était d'étudier l'action des corticoïdes à forte dose au cours des lésions digestives caustiques. Matériels et méthodes : Dix-huit patients présentant des lésions digestives caustiques ont été inclus dans l'étude. Le groupe A comprenait sept hommes et deux femmes d'âge moyen 36,44 ± 18,62 ans mis sous méthyl-prédnisolone en perfusion intraveineuse à la dose de 1 g/1,73 m 2 par jour avec 40 mg/j d'oméprazole en perfusion. Le groupe B comprenait neuf cas témoins. Les lésions digestives dans les deux groupes étaient IIb (trois cas) IIIa (trois cas) IIIb (trois cas). Le produit caustique était un acide (huit cas) et une base (un cas) dans les deux groupes. Résultats : Un retard de cicatrisation de 19 jours (7-30 jours) dans trois cas du groupe B, avec apparition de sténose oesophagienne dans deux cas. Dans un cas, on a obtenu une cicatrisation à délai identique. Un cas de perforation digestive est survenu dans le groupe A. Conclusion : En l'absence de consensus de prise en charge des lésions digestives caustiques, la prévention des sténoses oesophagiennes par corticothérapie reste un essai thérapeutique. Mots clés Ingestion caustique · Sténose oesophagienne · Corticothérapie à forte dose · PréventionAbstract The prevention of corrosive esophageal stricture is always controversial. The aim of our publication was a study of the action of steroids in digestive caustic burns.Patients and methods: Eighteen patients with caustic burns were included in this study. Group A included seven men and two women with a mean age of 36.44 ± 18.62 years, all patients received methyl-prednisolone (1 g/1.73 m 2 /day) with omeprazole (40 mg/day). Group B included nine witness cases. In the two groups, the caustic burns were: grade IIb (three cases), grade IIIa (three cases), and grade IIIb (three cases). The corrosive substances ingested were acid (eight cases) and alkali (one case). Results: A delay of 19 days in healing (7-30 days) in three cases from the group B was noted, with development of esophageal stricture in two cases. In one case, healing was achieved at the same time. In group A, one case of digestive perforation occurred. Conclusion: Without a consensus management of corrosive injuries, the prevention of esophageal strictures with steroids remains a therapeutic trial.

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“…Later, Pereira-Lima et al, in a double-blind randomized trial, reported a significant improvement or resolution of dysphagia with complex esophagogastric anastomotic treatment-naive strictures (65). Camargo et al found no difference in dilation frequency or recurrent dysphagia in patients with caustic strictures treated by steroid injection or placebo (66). Conversely, Nijhawan et al, treating 11 patients with refractory corrosive esophageal strictures, showed a significantly improved periodic dilation index (number of dilatations per month) and dysphagia score from pre- to postintervention period (67).…”

Section: Treatmentmentioning

confidence: 99%

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

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Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

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O uso de corticoesteróides após dilatação esofágica em pacientes portadores de estenose por substâncias corrosivas: estudo prospectivo, randomizado e duplo-cego

Cited by 31 publications

References 14 publications

Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida

Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida

Évaluation de la corticothérapie à forte dose au cours des lésions digestives caustiques chez l’adulte

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

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