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Doctoral Thesis
Full name
Edno Tales Bianchi
Knowledge Area
Date of Defense
São Paulo, 2020
Cecconello, Ivan (President)
Andreollo, Nelson Adami
Cardoso, Paulo Francisco Guerreiro
Sallum, Rubens Antonio Aissar
Title in Portuguese
A influência do tratamento cirúrgico do refluxo gastroesofágico em pacientes com estenose de traqueia
Keywords in Portuguese
Doenças da traqueia
Doenças do esôfago
Estenose traqueal
Refluxo gastroesofágico
Transtornos da motilidade esofágica
Abstract in Portuguese
Objetivo: Analisar o impacto do tratamento cirúrgico do refluxo gastroesofágico na condução aos pacientes com estenose de traqueia. Métodos: Estudo retrospectivo, incluindo 175 pacientes com estenose traqueal benigna submetidos à manometria esofágica e estudo de pHmetria de 24 horas. Os pacientes com pHmetria alterada foram tratados com fundoplicatura laparoscópica a Nissen ou clinicamente (omeprazol 80mg / dia, por via oral). Pacientes com pHmetria normal foram seguidos. Após 24 meses de acompanhamento, o desfecho foi considerado satisfatório se a estenose traqueal pudesse ser gerenciada por ressecção, sem necessidade de mais dilatação ou decanulação definitiva. Os grupos foram comparados usando propensity score matching (PSM), e significância estatística assumida para p < 0,05. Resultados: Foi encontrada pHmetria alterada em 74 pacientes (42,3% do total), e que apenas 22 (12,6%) apresentaram pirose e regurgitação, sintomas típicos de refluxo gastroesofágico. O acompanhamento foi concluído em 124 pacientes (20 submetidos à fundoplicatura, 32 receberam omeprazol e 72 foram observados). O resultado do tratamento da estenose traqueal no grupo da fundoplicatura foi semelhante ao grupo de observação (OR 1; p = 0,99) e superior ao grupo omeprazol (OR 5,31; p = 0,03). O grupo de observação (sem RGE) apresentou melhor resultado da estenose em comparação aos tratados com omeprazol (OR 3,54; p = 0,02). Conclusões: O resultado da estenose das vias aéreas foi superior após fundoplicatura laparoscópica em comparação ao tratamento médico com omeprazol e foi semelhante aos pacientes sem refluxo. Um estudo randomizado prospectivo é necessário realizar.
Title in English
The influence of surgical treatment of gastroesophageal reflux in patients with tracheal stenosis
Keywords in English
Esophageal diseases
Esophageal motility disorders
Gastroesophageal reflux
Tracheal diseases
Tracheal stenosis
Abstract in English
Objective: This study focuses on the impact of anti-reflux surgery in the outcome of tracheal stenosis. Methods: Retrospective study including 175 patients with benign tracheal stenosis who underwent esophageal manometry and dual probe 24-hour ambulatory esophageal pH study. Patients with abnormal pH study were managed either by laparoscopic modified Nissen fundoplication or medically (omeprazole 80mg/day, orally). Patients with normal pH study were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed either by resection, no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching (PSM), and statistical significance assumed for p < 0.05. Results: An abnormal pH study was found in 74 (42.3%), and 12.6% had typical GER symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). The outcome of the tracheal stenosis in the fundoplication group was similar to the observation group (OR 1; p = 0.99), and better than in the omeprazole group (OR 5.31; p = 0.03). The Observation (no GER) group had a better outcome of the stenosis compared to those treated with omeprazole (OR 3.54; p = 0.02). Conclusions: The outcome of the airway stenosis was superior after laparoscopic fundoplication compared to medical treatment with omeprazole, and was similar to patients without GER. A prospective randomized trial is warranted.
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