Comparação da barreira antirrefluxo em repouso e durante as manobras inspiratórias padronizadas entre pacientes asmáticos

Abstract

Context: hyperinflation associated with bronchoconstriction in asthma patients can influence the crural diaphragm functioning by changing the physiological geometric position of the antireflux barrier components. Objective: to investigate the antireflux barrier in asthma patients with GERD through high-resolution manometry and standardized inspiratory maneuvers. Methods: Eight control (mean age of 31.05 years, all female) and 30 asthma patients with GERD, comprising 14 volunteers with controlled asthma (mean age of 46 years, all female) and 16 volunteers with uncontrolled asthma (mean age of 46.31 years, two male). A highresolution manometry/impedance system assessed the pressure of the gastroesophageal junction (GEJ) during 06 swallowing and two respiratory maneuvers: sinus arrhythmia maneuver (SAM), in which six average GEJ pressure peaks took place during 5-second deep breaths, and Threshold maneuver (TH), which achieved GEJ pressure peaks during forced inspirations under 12, 24 and 48 cm H2O. Results: patients with controlled asthma (ACQ-7 ≤0.75) showed lower esophageal sphincter pressure lower than control and uncontrolled asthma patients during normal breathing (15.72±4.68mmHg x 32.47±10.20mmHg x 29.96±11,32mmHg, p=0.029, respectively). Pressure during sinus arrhythmia maneuver did not present differences among controlled asthma (ACQ-7 <1.5), control, and uncontrolled asthma patients (145.80±70.57mmHg x 143.22±44.6mmHg x 158.23±76.5mmHg, p=0.836). Furthermore, there was no statistically significant difference in the GEJ pressure peaks among controlled asthma, control, and uncontrolled asthma patients during the inspiratory maneuvers with Threshold resistive loads comparing controlled asthma, control, and uncontrolled asthma patients in the 2nd second of the maneuver (TH 24 cm H2O: 144.90±57,53mmHg x 152.33±35.09mmHg x 185.61±65.77mmHg, p=0.059). Conclusion: controlled asthma patients have a hypotonic lower esophageal sphincter, without statistically significant differences between GEJ inspiratory pressures.