Características clínicas e manométrica de pacientes com doença de Parkinson e sintomas esofágicos. Diseases of the Esophagus 2017; 30: 1–6
DOI : 10.1093/dote/dow038
Disfagia no paciente com doença de Parkinson é considerada, mais frequentemente, como conseqüência de alterações nas funções motoras orais e/ou faríngeas. Neste trabalho é demonstrado que a motilidade do esôfago é frequentemente comprometida. Embora o trabalho tenha sido realizado em pacientes com sintomas atribuídos ao esôfago, o que aumenta a possibilidade de haver doença no órgão, a frequência de alterações na motilidade é alta, como espasmo difuso em 48% e motilidade ineficaz em 58%. Os dados epidemiológicos do momento indicam que esta havendo aumento da proporção de pessoas idosas na população, portanto cada vez iremos encontrar pacientes com doenças relacionadas ao processo de envelhecimento. Existe boa chance de que mais pacientes com doença de Parkinson comecem a freqüentar as clinicas de gastroenterologia do que acontecia no passado.
Clinical and manometric characteristics of patients with Parkinson’s disease and esophageal symptoms.
A. Su, R. Gandhy, C. Barlow, G. Triadafilopoulos
Dysphagia is a common problem in patients with Parkinson’s disease (PD); its etiology is multifactorial and its management is challenging. In this retrospective cohort analysis using prospectively collected data, we aimed to objectively characterize dysphagia and/or other esophageal symptoms in patients with PD, assess the prevalence of outflow obstruction as well as major or minor disorders of esophageal peristalsis leading to impaired esophageal clearance and highlight objective parameters that can help in the current management algorithm. Thirty three consecutive patients with PD presenting with dysphagia, odynophagia, heartburn, regurgitation, chest pain, and weight loss underwent clinical and functional evaluation by high-resolution manometry (HRM). Esophagogastric junction (EGJ) outflow obstruction and major as well as minor disorders of peristalsis were then assessed using the Chicago classification. Thirty-three PD patients with esophageal symptoms were enrolled in the study; 12 of them reported weight loss that was considered as potentially reflecting underlying esophageal dysfunction. The median age of the patients was 70 years (range: 53–89 years), 24 (75%) were men. The majority (62%) experienced
dysphagia, likely contributing to weight loss in 41% of patients. Odynophagia was rare (6%) while GER symptoms, such as heartburn, regurgitation, and chest pain were noted in 37%, 31%, and 28% of patients, respectively. Using the hierarchy of the Chicago classification, 12 patients (39%) exhibited EGJ outflow obstruction, 16 (48%) diffuse esophageal spasm (DES), 18 (55%), ineffective esophageal peristalsis (IEM), 16 (48%) fragmented peristalsis, and only 2 patients (6%) had normal HRM tracings. There were
no patients with HRM features of achalasia. Dysphagia is common in patients with PD and is associated with a high prevalence of underlying motility disturbances as identified by HRM. The exact impact of these motility abnormalities on symptom induction and their role in influencing clinical management are unclear and will require further study.