The esophagus

Avaliação do tempo de trânsito esofágico pelo ultrassom: influência do gênero e índice de massa corpórea

OBJETIVO: Utilizar a ultrassonografia do esôfago intra-abdominal para avaliar o tempo de trânsito esofágico para água e iogurte, em posição ortostática, e avaliar a influência do gênero e índice de massa corpórea. MATERIAIS E MÉTODOS: Foram estudados 89 indivíduos adultos jovens, sem clínica de doenças do trato gastrintestinal superior, sendo 40 do gênero feminino (média de 20,13 ± 1,62 anos) e 49 do gênero masculino (média de 20,43 ± 2,17 anos). O tempo de trânsito esofágico foi cronometrado, com o paciente em posição ortostática, durante a deglutição de água e iogurte. RESULTADOS: O tempo de trânsito esofágico para as mulheres e para os homens foi, respectivamente: para água, de 5,84 ± 1,60 segundos versus 6,66 ± 1,68 segundos, e para iogurte, de 9,12 ± 1,96 segundos versus 9,28 ± 1,70 segundos. Não se constatou diferença entre os gêneros masculino e feminino, apesar de o fator índice de massa corpórea ser menor nas mulheres. CONCLUSÃO: Os dados obtidos do tempo de trânsito esofágico para alimento líquido (água) e pastoso (iogurte), em posição ortostática, em adultos jovens não mostraram diferença entre os gêneros, mesmos nas mulheres com índice de massa corpórea menor em relação aos homens.

The role of proton pump inhibitors in the treatment of heartburn during pregnancy

PURPOSE

To review the problem of heartburn in gravid women, discuss the present treatment options, and examine the use of proton pump inhibitors (PPIs) as one of the treatment options for moderate to severe heartburn.

DATA SOURCES

Extensive review of worldwide scientific literature on the use and safety of PPIs during pregnancy and heartburn during pregnancy.

CONCLUSIONS

Preliminary information indicates that use of PPIs during pregnancy is safe for both the fetus and the woman and that obstetrical practitioners are using them more frequently. Randomized controlled trials are needed to examine the efficacy of PPIs to treat heartburn during pregnancy, especially as they are compared to histamine(2) receptor antagonists.

IMPLICATIONS FOR PRACTICE

Heartburn during pregnancy is at risk for being undertreated, given that delivery is the cure. As PPIs are more widely used by women, questions will arise regarding their use in the first trimester as well as throughout pregnancy. This article brings nurse practitioners up to date on the safety of PPIs through the literature review and suggests various treatment options that can be discussed with the patient.

Drug-induced esophageal injuries and dysphagia

OBJECTIVE

To review and analyze medical literature documenting drug-induced esophageal injury and dysphagia and to formulate strategies to enhance pharmacists' prevention, detection, and treatment of these iatrogenic complications.

DATA SOURCES

A MEDLINE search (1966-April 2002) was conducted to identify primary and secondary literature using variable combinations of the following search terms: pill-induced, drug-induced, or iatrogenic with esophageal injury, esophageal damage, or dysphagia. Bibliographies were also reviewed to identify additional relevant references.

STUDY SELECTION AND DATA EXTRACTION

All case reports, reviews, and clinical studies relating to drug-induced esophageal injury or swallowing dysfunction were evaluated.

DATA SYNTHESIS

Drug-induced esophageal injury may be under-recognized. Several drugs have been associated with physical or chemically mediated injuries. Risk factors for injury have been identified and preventive and treatment strategies have been successful in limiting esophageal injury. Drug-induced dysphagia can have serious complications and is most often associated with typical neuroleptics such as haloperidol.

CONCLUSIONS

Pharmacists can play a pivotal role in proactively identifying situations where there is a higher likelihood of drug-induced esophageal injury or dysphagia. They can recommend preventive strategies to promote safe medication use, help identify iatrogenic complications when they occur, and assist in formulation of appropriate treatment strategies.