Avaliação da espessura do ramo direito do diafragma crural e níveis de grelina e leptina plasmática em pacientes com doença do refluxo gastroesofágico (drge) infectados com helicobacter pylori

Abstract

Patients with reflux esophagitis have lower thickness and functional fai lure of the crural diaphragm (CD ), a fact that supports the possible ex istence of a skeletal muscle deficiency in patients with Gastroesophageal Reflux Disease GERD )). In addition, the relationship between Helicobacter pylori and GERD presents some divergences between the studies, requiring a greater number of studies capable of clarifying this relationship. The objective of the present study was to evaluate the thickness and echogenicity of the righ t branch of CD as well as to measure plasma levels of ghrelin and leptin in patients with GERD, with and without H. pylori infect ion. This was a cross sectional study, which included patients who presented a total reflux time fraction of 4.2 at 24h pHmetry. Blood was collected and the samples wer e centrifuged and stored at 80 C until ghrelin and le ptin dosages were performed by E nzyme Linked Immunosorbent A ssay (ELISA). Upper Digestive Endoscopy ( UDE ) was performed to remove biopsies for histopathological analysis, urease and Polymerase Chain Reaction (PCR), and then performed the echoendoscopy to capture the CD images. The thickn ess of the muscle was measured in millimeters and the mean intensity of the gray scale of the pixels was considered as the echogenicity. H. pylori positive group consisted of 9 patients, 4 men and 5 women, with a mean age of 41.44 10.77 years and negative H. pylori by 21 volunteers, 9 men and 12 women, with a mean age of 48. 62 15.56 years. The embedding was more present in the H. pylori positive group (p = 0.004). Lower leve ls (p = 0.012 ) of the total ghrelin ratio were obtained in the H. pylori po si tive group (0.43 0.1 4) compare d to the negative group (0.62 0.19 ) and levels t aller (p = 0.033 ) of total ghrel in in the infected group (854.1 0 328.6 0 ) compared to the uninfected group (593.2 0 249.5 0 No difference was observed between groups with respe ct to active ghrelin (p = 0.892), leptin (p = 0.560) and echogenicity (p = 0.365 ). With r egard to the thickness of the CD , higher levels of leptin, inflammatory activity scores and H. pylori scores were obtained in the group with finer crural diaphragm ( 4 m m). Despite limitations in sample size, this study concludes that H. pylori infection may interfere with ghrelin levels but did not alter the echogenicity of CD In addition, there were higher scores of H. pylori infection (p = 0.008) and higher levels of leptin (p = 0.027) in the group with the finest DC 4 mm).