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A Hemorragia Digestiva (HD) é defi¬nida como todo e qualquer sangramento gas¬trointestinal caracterizado pela manifestação clínica de hematêmese, melena, enterorragia ou hematoquezia, secundária as mais diversas causas.

O objetivo deste trabalho foi verificar a utilização de coprodutos industriais na alimentação de ruminantes. Com o acentuado crescimento do agronegócio brasileiro, surgem várias preocupações com a quantidade e diversidade dos resíduos agrícolas e agroindústrias e seu possível descarte no ambiente. Esta alternativa torna viável economicamente e vem sendo uma opção ao produtor para reduzir custos com a alimentação do rebanho em épocas de vazio forrageiro ou em sistemas de confinamento. Coprodutos como farelo de canola, torta de amendoim, torta de caroço de algodão, coprodutos do processamento de frutas, vinificação e olivícola, são muito utilizados na substituição de alguns farelos na constituição da parcela de concentrado e empregados como fibras na dieta dos animais. Embora exista um grande potencial de utilização destes coprodutos pela indústria na alimentação de ruminantes, ainda são poucas as informações sobre valores nutricionais, antinutricionais, quantidades a serem utilizadas nas dietas e respostas nos aspectos biológicos e econômicos.

Background Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual’s well-being. Objective To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. Methods A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. Results The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient’s needs. Conclusion CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized. RESUMO Contexto A constipação idiopática crônica (CIC) é uma condição que afeta amplamente a população global, representa um grande custo econômico, causa substancial utilização de recursos em saúde e impacta o bem-estar do indivíduo. Objetivo Revisar os consensos de Sociedades de especialistas e diretrizes publicados sobre o diagnóstico e tratamento da CIC em adultos, buscando auxiliar o raciocínio e a tomada de decisão para a conduta médica frente ao paciente e oferecer um material prático de referência. Métodos Uma força tarefa médica brasileira realizou uma busca na literatura científica nas bases de dados eletrônicos Medline/PubMed, SciELO, Embase e Cochrane, tendo sido utilizados os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation. Adicionalmente, foi realizada uma revisão de artigos sobre o mecanismo de ação, segurança e eficácia das opções terapêuticas disponíveis no Brasil. Resultados A abordagem diagnóstica e o entendimento da fisiopatologia presente na CIC são itens fundamentais para que seja indicada a terapêutica apropriada e seja compreendido o ecossistema de necessidades do paciente. Conclusão A CIC é uma condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. O manejo correto é definido pela anamnese e exame físico detalhados, juntamente com a terapêutica apropriada, independentemente de ser farmacológica ou não, conforme o melhor momento de indicação. Desta forma, o impacto na qualidade de vida também é otimizado.

Bipolar disorder (BD) is a psychiatric disease characterized by mood episodes. Blueberry is rich in bioactive compounds and shows excellent therapeutic potential against chronic diseases. The aim of this study was to evaluate the effects of blueberry extract on behavior, energetic metabolism, Ca

As Poaceae (gramíneas) são a base da alimentação dos ruminantes. Essas plantas precisam expressar toda sua capacidade de produção de biomassa com altos valores de nutrientes para suprir as necessidades dos animais de produção. Como exemplo disso, temos o capim-elefante (Pennisetum purpureum), uma forrageira de elevado valor nutritivo, podendo ser utilizada tanto na forma de ensilado quanto de pastejo. Neste contexto, objetivou-se nesta revisão buscar informações na bibliografia que possam conferir características agronômicas, morfológicas e de manejo ao capim elefante e suas novas cultivares BRS Kurumi e BRS Capiaçu. O capim elefante de porte alto para pastejo traz limitações, devido a seu hábito de crescimento apresentar alongamento rápido dos entrenós. Isso resulta em um porte fora do alcance de captação pelos animais e na necessidade de roçadas frequentes. A Empresa Brasileira de Pesquisa Agropecuária, iniciou um programa de criação do capim elefante, desenvolvendo cultivares para sistema de corte e transporte e pastoreio. Neste cenário, foi desenvolvida a nova cultivar BRS Kurumi, com reduzido alongamento de colmos o que facilita o manejo do pasto com porte adequado ao pastejo pelos animais. A cultivar representa uma alternativa devido a sua alta produção de forragem, excelente estrutura de pasto e valor nutritivo. No que se refere ao sistema de corte e transporte, a BRS Capiaçu é a nova cultivar de capim elefante de porte alto desenvolvida, podendo ser utilizada como capineira ou silagem, com elevado potencial de biomassa e reduzidos teores de fibra.

The Poaceae family (grasses) are the basis of ruminants feeding. These plants need to express their full capacity of biomass production with high nutrient values to supply the nutritional exigencies of the livestock animals. As an example, we have elephant grass (Pennisetum purpureum), a forage with high nutritional value, its use may be in both silage or grazing forms. In this context, the aim of this review was to obtain information from literature to concede agronomic, morphological and management characteristics to the elephant grass and its new cultivars BRS Kurumi and BRS Capiaçu. The tall statured elephant grass has limitations for grazing due to its habit of growth presents rapid internode elongation. This results in a size out of reach by the animals and necessity of frequent cuts. The Empresa Brasileira de Pesquisa Agropecuária started a program to create elephant grass, developing cultivars for cutting and transport systems and grazing. In this scenario, the new cultivar BRS Kurumi was developed with reduced stalk length, which facilitates the pasture management in an adequate size to be grazed by the animals. The cultivar represents an alternative due to its high forage production, excellent pasture structure and nutritive value. Considering the cutting and transport system, BRS Capiaçu is the new cultivar of tall structure elephant grass developed, being able to be used as grass or silage, with high potential of biomass and reduced fiber contents. As Poaceae (gramíneas) são a base da alimentação dos ruminantes. Essas plantas precisam expressar toda sua capacidade de produção de biomassa com altos valores de nutrientes para suprir as necessidades dos animais de produção. Como exemplo disso, temos o capim-elefante (Pennisetum purpureum), uma forrageira de elevado valor nutritivo, podendo ser utilizada tanto na forma de ensilado quanto de pastejo. Neste contexto, objetivou-se nesta revisão buscar informações na bibliografia que possam conferir características agronômicas, morfológicas e de manejo ao capim elefante e suas novas cultivares BRS Kurumi e BRS Capiaçu. O capim elefante de porte alto para pastejo traz limitações, devido a seu hábito de crescimento apresentar alongamento rápido dos entrenós. Isso resulta em um porte fora do alcance de captação pelos animais e na necessidade de roçadas frequentes. A Empresa Brasileira de Pesquisa Agropecuária, iniciou um programa de criação do capim elefante, desenvolvendo cultivares para sistema de corte e transporte e pastoreio. Neste cenário, foi desenvolvida a nova cultivar BRS Kurumi, com reduzido alongamento de colmos o que facilita o manejo do pasto com porte adequado ao pastejo pelos animais. A cultivar representa uma alternativa devido a sua alta produção de forragem, excelente estrutura de pasto e valor nutritivo. No que se refere ao sistema de corte e transporte, a BRS Capiaçu é a nova cultivar de capim elefante de porte alto desenvolvida, podendo ser utilizada como capineira ou silagem, com elevado potencial de biomassa e reduzidos teores de fibra.

Esta investigación tuvo como objetivo planificar e implementar una propuesta de los grupos de estudio en un trabajo de colaboración, la formación de maestros de la comunidad de las escuelas municipales Jaguarão, basados en el estudio de la legislación que apoya la educación integral, tratando de evaluar si estos grupos de estudio nutrir la propuesta de calificación. Este informe crítico y reflexivo se divide en dos capítulos de revisión: en primer lugar, la gestión en curso de Educación Integral hacer frente a los retos de la gestión de la perspectiva de la educación integral, con lo que en los conceptos de subcapítulos Más Programa de Educación, Educación a tiempo completo y Educación Integral; La segunda obra, en colaboración: grupos de estudio Vygotsky, desarrollado a través de los grupos de estudio. La metodología utilizada en la intervención fue la observación directa, registrada en un diario de campo del investigador, el libro de la metacognición en los ocho maestros de la comunidad hizo registros acerca de las reuniones y el cuestionario con nueve preguntas, que puso en duda la de trabajo, los objetivos y la contribución Más del Programa de Educación Integral en perspectiva de implementación Educación. El procedimiento de análisis se divide en tres categorías: la primera categoría habla de los grupos de estudio: inicio de la caminata, las reuniones, las discusiones y diálogos que se han producido de forma satisfactoria, con la participación efectiva de los docentes de la comunidad. La segunda categoría reúne los tres ejes de esta obra, Más Programa de Educación Educación, el final del partido, el conocimiento y teorías esenciales para la formación de profesores de la comunidad y el investigador. Por último, la tercera categoría, que es fundamental para el análisis del proceso de intervención, ya que se ocupa de la inscripción de los maestros de la comunidad en relación a las horas de las reuniones y la intervención del investigador. De acuerdo con ellas, muy productivo, produciendo muchas de aprendizaje. El análisis de los registros mostró que el grupo de estudio se llevó a cabo de manera satisfactoria, lo que demuestra que los maestros de la comunidad indican la continuación de esta investigación. Este trabalho de pesquisa teve por objetivo planejar e implementar uma proposta de grupos de estudo em um trabalho colaborativo, para qualificação dos professores comunitários de escolas municipais de Jaguarão, baseada no estudo da legislação que embasa a Educação Integral, procurando avaliar se estes grupos de estudo oportunizam a qualificação proposta. Este relatório crítico-reflexivo está dividido em dois capítulos de revisão: no primeiro, gestão no percurso da Educação Integral abordando os desafios do gestor na perspectiva da Educação Integral, trazendo em subcapítulos os conceitos sobre Programa Mais Educação, Educação em Tempo Integral e Educação Integral; o segundo, Trabalho Colaborativo: grupos de estudo em Vygotski, desenvolvido por meio de grupos de estudo. A metodologia utilizada na intervenção foi a observação direta, registrada em um diário de campo da pesquisadora, o caderninho de metacognição, em que os oito professores comunitários fizeram registros sobre os encontros e o questionário com nove perguntas, que questionava o trabalho, objetivos e contribuição do Programa Mais Educação na perspectiva de implantação da Educação Integral. O procedimento de análise dividiu-se em três categorias: a primeira categoria fala sobre os grupos de estudo: início da caminhada, os encontros, seus debates e os diálogos, que ocorreram satisfatoriamente, com a participação efetiva dos professores comunitários. A segunda categoria traz os três focos deste trabalho, Programa Mais Educação, Educação em Tempo Integral, conhecimentos e teorias essenciais à formação dos professores comunitários e a pesquisadora. Por fim, a terceira categoria, fundamental à análise do processo de intervenção, pois trata dos registro dos professores comunitários em relação aos momentos dos encontros e intervenção da pesquisadora. Segundo esses, muito produtivo, rendendo muitas aprendizagens. A análise dos registros mostrou que os grupos de estudo aconteceram de forma satisfatória, evidenciando que os professores comunitários indicam a continuidade desta pesquisa.

In GERD patients, ineffective esophageal motility (IEM), a hypocontractile disorder, is the most common motor abnormality. IEM has been associated with reflux in both the supine and upright position, prolonged esophageal clearance, and delayed of bolus transport. IEM has been equally present in erosive and in nonerosive GERD.Considering that reflux has been found to be more severe in erosive GERD than in nonerosive GERD patients and that IEM delays esophageal clearance, our hypothesis is that patients with erosive GERD have more severe IEM than those with nonerosive disease.A retrospective review of consecutive manometries of patients with the chief complaint of heartburn and a diagnosis of IEM were performed, and patients with both erosive and nonerosive GERD were selected. According to the number of ineffective contractions, IEM was stratified into three groups: 30% to 40%, mild; 50% to 60%, moderate; and greater than 60%, severe. We also registered the number of low amplitude, failed, and normal waves in each manometry of both groups. We evaluated 110 patients: 70 (64%) with erosive GERD and 40 (36%) with nonerosive GERD. The percentage of mild, moderate and severe IEM was similar in erosive and in nonerosive GERD patients, as well the number of low amplitude, failed or normal waves (P0.5).There were no differences between the severity of IEM in erosive and in nonerosive GERD patients.

As lesoes osteoarticulares tem etiologia complexa, pois varios fatores as provocam, tais como manejo inadequado, geneticados planteis e controle sanitario deficiente. A ocorrencia de lesoes osteoarticulares provocam condenacoes parciais ou totaisde carcacas, implicando perdas economicas, pela atuacao da inspecao sanitaria. Numa regiao do Estado de Sao Paulo,foram colhidas 67 amostras de ossos e articulacoes, sendo processadas histologicamente 31. As amostras foram colhidasde acordo com a macroscopia e a patologia suspeitada, encontrando-se duas com deformacao "valgus", 27 com quadro tipicode contusao (hemorragia, congestao e edema), indicativo de tecnopatia; sendo. sete na tibia e vinte no femur e, duas amostrasde tibias negativas.

CONTEXTO: Existe uma noção geral de que indivíduos obesos desenvolvem mais freqüentemente a doença do refluxo gastroesofagiano, sendo a orientação de perder peso parte integrante do seu tratamento. Entretanto, uma base científica para esta associação não está plenamente estabelecida. OBJETIVOS: Avaliar a prevalência de obesidade e sobrepeso em pacientes com sintomas típicos de refluxo, com e sem esofagite erosiva. Analisar a prevalência de hérnia hiatal e a intensidade do refluxo anormal em relação ao índice de massa corporal nos dois grupos de pacientes. MÉTODOS: Foram examinadas retrospectivamente 362 pHmetrias de pacientes com pirose, todos com endoscopia digestiva alta prévia, definindo-se esofagite erosiva pela presença de erosões esofagianas macroscópicas e hérnia de hiato quando à junção esôfago-gástrica estava 2 cm ou mais acima do pinçamento diafragmático. Pacientes com esôfago de Barrett ou estenose péptica foram excluídos. A população foi dividida em três grupos de acordo com o índice de massa corpórea: peso normal, com índice de massa corporal entre 20 e 24,9, sobrepeso, com 25 e 29,9 e obesos com índice superior a 30. O diagnóstico de refluxo gastroesofagiano anormal com sua intensidade foi avaliado de acordo com os resultados de pHmetrias, analisados nos grupos de pacientes com e sem esofagite erosiva em relação ao índice de massa corporal. RESULTADOS: Entre os 362 pacientes, havia 148 (41%) com e 214 (59%) sem esofagite erosiva, sendo a pHmetria anormal em 100% e 57% dos pacientes, retrospectivamente. Entre os 148 (61% do sexo masculino, mediana de idade de 50 anos), 41 (28%) apresentavam peso normal, 82 (55%) sobrepeso e 25 (17%) eram obesos. Havia 88 (60%) com hérnia hiatal, sendo 29 (71% dos pacientes com peso normal), 45 (55% dos com sobrepeso) e 14 (56% dos obesos). Nos 121 indivíduos sem esofagite erosiva e com pHmetria anormal, diagnosticados como doentes com doença do refluxo não-erosiva (38% masculino, mediana de idade de 50 anos), havia 51 (42%) pacientes com peso normal, 55 (46%) com sobrepeso e 15 (12%) eram obesos. Detectou-se hérnia de hiato em 52 (43%) dos 121 pacientes, sendo 21 (41% dos indivíduos com peso normal), 24 (44% dos com sobrepeso) e 7 (47% dos obesos). Naqueles 93 pacientes sem esofagite erosiva e com pHmetria normal (39% homens, mediana de idade de 43 anos) havia 43 (46%) pacientes com peso normal, 38 (41%) com sobrepeso e 12 (13%) obesos, sendo 26 (28%) com hérnia hiatal. A prevalência de hérnia de hiato, assim como o número de pacientes com obesidade e sobrepeso foi significantemente maior no grupo de doença do refluxo erosiva, quando comparado ao grupo sem esofagite erosiva. A intensidade do refluxo, assim como a prevalência de hérnia hiatal foram similares nos pacientes com peso normal, sobrepeso e obesos, em ambos os grupos. CONCLUSÃO:A prevalência de obesidade e sobrepeso é maior em indivíduos com doença do refluxo erosiva do que naqueles sem esofagite erosiva. Não houve diferença na intensidade do refluxo entre as várias categorias de índice de massa corporal, em nenhum dos grupos estudados. Embora a hérnia hiatal seja mais prevalente na doença do refluxo erosiva, esta superioridade não se relacionou ao excesso de peso. CONTEXT: Weight loss is commonly recommended as a treatment for gastroesophageal reflux; however, a relationship between excessive body weight and gastroesophageal reflux disease is not well established. OBJECTIVES: To evaluate the prevalence of obesity and over-weight in patients with heartburn, with and without erosive esophagitis; to analyze the prevalence of hiatal hernia and the intensity of abnormal gastroesophageal reflux in both groups of patients, and its relation to body mass index. METHODS: The data of pH monitoring of 362 individuals with heartburn were evaluated retrospectively. All patients had an upper gastrointestinal endoscopy and erosive esophagitis was defined by the presence of macroscopic erosion on the esophageal mucosa. Hiatal hernia was considered when the gastroesophageal junction was positioned 2 cm or more above the diaphragm. Patients with Barrett's esophagus or esophageal peptic stenosis were excluded. The population was categorized according to body mass index as normal weight (body mass index between 20 and 24.9); over-weight (between 25 and 29.9), and obese (greater than 30). The diagnosis as well as the intensity of abnormal gastroesophageal reflux were obtained through the analysis of the results of pH monitoring in patients with and without erosive esophagitis and in the various categories of body mass index. RESULTS: Among the 362 patients there were 148 (41%) with erosive esophagitis and 214 (59%) without erosive esophagitis, while the pH monitoring was abnormal in 100% and 57%, respectively. Among the 148 individuals with erosive esophagitis (61% male, median age 50 years), 41 (28%) had normal weight, 82 (55%) had over-weight and 25 (17%) were obese. There were 88 (60%) patients with hiatal hernia, which was present in 29 (71% of patients with normal weight), 45 (55% of patients with over-weight) and 14 (56% of obese individuals). In 121 patients without erosive esophagitis who had abnormal pH monitoring, diagnosed as non erosive reflux disease (38% male, median age 50 years), 51 (42%) patients had normal weight, 55 (46%) had over-weight and 15 (12%) were obese. Hiatal hernia was detected in 52 out of 121 (43%) patients and in 21 (41%) out of 51 individuals with normal weight, 24 (44%) of over-weight and 7 (47%) of obese. In the group of 93 patients without erosive esophagitis and normal pH monitoring (29% male, median age 43 years), 26 (28%) had hiatal hernia and there were 43 (46%) individuals with normal weight, 38 (41%) with over-weight and 12 (13%) were obese. The number of patients with obesity and over-weight was significantly higher in the group with erosive esophagitis compared to the ones without erosive esophagitis. The prevalence of hiatal hernia was also superior in the erosive reflux disease patients. The reflux intensity and the prevalence of hiatal hernia were similar in patients with normal weight, over-weight and obesity in the group with erosive reflux disease and non-erosive reflux disease. CONCLUSION: There was a greater prevalence of obesity and over-weight in the group of patients with erosive esophagitis compared to patients with non-erosive reflux disease. There was no difference in reflux intensity measurements in any of the body mass index categories, in both groups. Although there was a major prevalence of hiatal hernia in the group of erosive reflux disease patients, this superiority was not extended to the categories of excessive weight in both groups.

CONTEXT: Weight loss is commonly recommended as a treatment for gastroesophageal reflux; however, a relationship between excessive body weight and gastroesophageal reflux disease is not well established. OBJECTIVES: To evaluate the prevalence of obesity and over-weight in patients with heartburn, with and without erosive esophagitis; to analyze the prevalence of hiatal hernia and the intensity of abnormal gastroesophageal reflux in both groups of patients, and its relation to body mass index. METHODS: The data of pH monitoring of 362 individuals with heartburn were evaluated retrospectively. All patients had an upper gastrointestinal endoscopy and erosive esophagitis was defined by the presence of macroscopic erosion on the esophageal mucosa. Hiatal hernia was considered when the gastroesophageal junction was positioned 2 cm or more above the diaphragm. Patients with Barrett's esophagus or esophageal peptic stenosis were excluded. The population was categorized according to body mass index as normal weight (body mass index between 20 and 24.9); over-weight (between 25 and 29.9), and obese (greater than 30). The diagnosis as well as the intensity of abnormal gastroesophageal reflux were obtained through the analysis of the results of pH monitoring in patients with and without erosive esophagitis and in the various categories of body mass index. RESULTS: Among the 362 patients there were 148 (41%) with erosive esophagitis and 214 (59%) without erosive esophagitis, while the pH monitoring was abnormal in 100% and 57%, respectively. Among the 148 individuals with erosive esophagitis (61% male, median age 50 years), 41 (28%) had normal weight, 82 (55%) had over-weight and 25 (17%) were obese. There were 88 (60%) patients with hiatal hernia, which was present in 29 (71% of patients with normal weight), 45 (55% of patients with over-weight) and 14 (56% of obese individuals). In 121 patients without erosive esophagitis who had abnormal pH monitoring, diagnosed as non erosive reflux disease (38% male, median age 50 years), 51 (42%) patients had normal weight, 55 (46%) had over-weight and 15 (12%) were obese. Hiatal hernia was detected in 52 out of 121 (43%) patients and in 21 (41%) out of 51 individuals with normal weight, 24 (44%) of over-weight and 7 (47%) of obese. In the group of 93 patients without erosive esophagitis and normal pH monitoring (29% male, median age 43 years), 26 (28%) had hiatal hernia and there were 43 (46%) individuals with normal weight, 38 (41%) with over-weight and 12 (13%) were obese. The number of patients with obesity and over-weight was significantly higher in the group with erosive esophagitis compared to the ones without erosive esophagitis. The prevalence of hiatal hernia was also superior in the erosive reflux disease patients. The reflux intensity and the prevalence of hiatal hernia were similar in patients with normal weight, over-weight and obesity in the group with erosive reflux disease and non-erosive reflux disease. CONCLUSION: There was a greater prevalence of obesity and over-weight in the group of patients with erosive esophagitis compared to patients with non-erosive reflux disease. There was no difference in reflux intensity measurements in any of the body mass index categories, in both groups. Although there was a major prevalence of hiatal hernia in the group of erosive reflux disease patients, this superiority was not extended to the categories of excessive weight in both groups.

Weight loss is commonly recommended as a treatment for gastroesophageal reflux; however, a relationship between excessive body weight and gastroesophageal reflux disease is not well established.To evaluate the prevalence of obesity and over-weight in patients with heartburn, with and without erosive esophagitis; to analyze the prevalence of hiatal hernia and the intensity of abnormal gastroesophageal reflux in both groups of patients, and its relation to body mass index.The data of pH monitoring of 362 individuals with heartburn were evaluated retrospectively. All patients had an upper gastrointestinal endoscopy and erosive esophagitis was defined by the presence of macroscopic erosion on the esophageal mucosa. Hiatal hernia was considered when the gastroesophageal junction was positioned 2 cm or more above the diaphragm. Patients with Barrett's esophagus or esophageal peptic stenosis were excluded. The population was categorized according to body mass index as normal weight (body mass index between 20 and 24.9); over-weight (between 25 and 29.9), and obese (greater than 30). The diagnosis as well as the intensity of abnormal gastroesophageal reflux were obtained through the analysis of the results of pH monitoring in patients with and without erosive esophagitis and in the various categories of body mass index.Among the 362 patients there were 148 (41%) with erosive esophagitis and 214 (59%) without erosive esophagitis, while the pH monitoring was abnormal in 100% and 57%, respectively. Among the 148 individuals with erosive esophagitis (61% male, median age 50 years), 41 (28%) had normal weight, 82 (55%) had over-weight and 25 (17%) were obese. There were 88 (60%) patients with hiatal hernia, which was present in 29 (71% of patients with normal weight), 45 (55% of patients with over-weight) and 14 (56% of obese individuals). In 121 patients without erosive esophagitis who had abnormal pH monitoring, diagnosed as non erosive reflux disease (38% male, median age 50 years), 51 (42%) patients had normal weight, 55 (46%) had over-weight and 15 (12%) were obese. Hiatal hernia was detected in 52 out of 121 (43%) patients and in 21 (41%) out of 51 individuals with normal weight, 24 (44%) of over-weight and 7 (47%) of obese. In the group of 93 patients without erosive esophagitis and normal pH monitoring (29% male, median age 43 years), 26 (28%) had hiatal hernia and there were 43 (46%) individuals with normal weight, 38 (41%) with over-weight and 12 (13%) were obese. The number of patients with obesity and over-weight was significantly higher in the group with erosive esophagitis compared to the ones without erosive esophagitis. The prevalence of hiatal hernia was also superior in the erosive reflux disease patients. The reflux intensity and the prevalence of hiatal hernia were similar in patients with normal weight, over-weight and obesity in the group with erosive reflux disease and non-erosive reflux disease.There was a greater prevalence of obesity and over-weight in the group of patients with erosive esophagitis compared to patients with non-erosive reflux disease. There was no difference in reflux intensity measurements in any of the body mass index categories, in both groups. Although there was a major prevalence of hiatal hernia in the group of erosive reflux disease patients, this superiority was not extended to the categories of excessive weight in both groups.

RACIONAL: Na doença do refluxo gastroesofágico pode-se encontrar, como parte do quadro clínico da doença, queixas respiratórias, otorrinolaringológicas, dor torácica ou disfagia. As duas primeiras são intituladas de manifestações supra-esofágicas da doença. É discutível a prevalência destas alterações em pacientes com doença do refluxo gastroesofágico nas formas erosiva e não-erosiva. OBJETIVOS: Avaliar a prevalência de manifestações supra-esofágicas em pacientes com doenças do refluxo erosiva e não-erosiva. MÉTODOS: Foram revistas as fichas de pacientes que realizaram endoscopia digestiva alta, esofagomanometria e pHmetria prolongada nos últimos 5 anos, na investigação de doença do refluxo gastroesofágico (pirose como queixa principal), em que havia informações a respeito de queixas respiratórias e otorrinolaringológicas. Foram selecionados pacientes com doença do refluxo erosiva (graus I a III, pela classificação de Savary-Miller) e com doença do refluxo não-erosiva (endoscopia negativa, com pHmetria prolongada anormal). A análise estatística utilizou o teste de qui-quadrado. RESULTADOS: Duzentos e oitenta pacientes preencheram os critérios de inclusão, sendo 162 com doença do refluxo erosiva (70% com esofagite grau I) e 118 com doença do refluxo não-erosiva. No grupo total, 88 apresentavam queixas otorrinolaringológicas (31%), com predomínio de rouquidão e pigarro e 42, queixas respiratórias (15%), predominando a tosse crônica. Dos pacientes com queixas otorrinolaringológicas, 45 pertenciam ao grupo doença do refluxo erosiva (28%) e 43 ao grupo doença do refluxo não-erosiva (36,4%). Em relação aos com queixas respiratórias, 21 pacientes (13%) pertenciam ao grupo doença do refluxo erosiva e 21 (18%) ao grupo doença do refluxo não-erosiva. CONCLUSÃO: Não houve diferença entre a prevalência das queixas supra-esofágicas em pacientes com doenças do refluxo erosiva e não-erosiva. BACKGROUND: Respiratory, ear-nose and throat complaints, chest pain and dysphagia can be a part of clinical manifestations of gastroesophageal reflux disease. The first two are named supraesophageal manifestations of gastroesophageal reflux disease. Controversy about the prevalence of these clinical manifestations in patients with non-erosive and erosive gastroesophageal reflux disease exists. AIMS: Evaluate the prevalence of supraesophageal manifestations in patients with erosive and non-erosive gastroesophageal reflux disease. METHODS: Files from patients submitted to upper endoscopy, esophageal manometry and pH monitoring for the investigation of gastroesophageal reflux disease (heartburn as the chief complaint) were reviewed and respiratory and ear, nose and throat symptoms were recorded. Patients with erosive disease (grades I to III according to Savary-Miller classifi cation) and with non-erosive disease (normal endoscopy with abnormal pH monitoring were selected. Statistical analysis included the chi-square test. RESULTS: Two hundred and eighty patients fulfi lled the inclusion criteria being 162 with erosive disease (70% with grade I esophagitis) and 118 with non-erosive disease. Overall, 88 patients had ear, nose and throat symptoms (31%), the more frequent were hoarseness and clearing and 42, respiratory manifestations (15%), being cough the more prevalent. In the ear, nose and throat symptoms group, 45 were erosive disease (28%) and 43 non-erosive disease (36.4%). As for the respiratory symptom group, 21 patients (13%) were erosive disease and 21 (18%) were non-erosive disease. CONCLUSION: There was no difference in the prevalence of supraesophageal manifestations between patients with gastroesophageal erosive and non-erosive reflux disease.

RACIONAL: Na doença do refluxo gastroesofágico pode-se encontrar, como parte do quadro clínico da doença, queixas respiratórias, otorrinolaringológicas, dor torácica ou disfagia. As duas primeiras são intituladas de manifestações supra-esofágicas da doença. É discutível a prevalência destas alterações em pacientes com doença do refluxo gastroesofágico nas formas erosiva e não-erosiva. OBJETIVOS: Avaliar a prevalência de manifestações supra-esofágicas em pacientes com doenças do refluxo erosiva e não-erosiva. MÉTODOS: Foram revistas as fichas de pacientes que realizaram endoscopia digestiva alta, esofagomanometria e pHmetria prolongada nos últimos 5 anos, na investigação de doença do refluxo gastroesofágico (pirose como queixa principal), em que havia informações a respeito de queixas respiratórias e otorrinolaringológicas. Foram selecionados pacientes com doença do refluxo erosiva (graus I a III, pela classificação de Savary-Miller) e com doença do refluxo não-erosiva (endoscopia negativa, com pHmetria prolongada anormal). A análise estatística utilizou o teste de qui-quadrado. RESULTADOS: Duzentos e oitenta pacientes preencheram os critérios de inclusão, sendo 162 com doença do refluxo erosiva (70% com esofagite grau I) e 118 com doença do refluxo não-erosiva. No grupo total, 88 apresentavam queixas otorrinolaringológicas (31%), com predomínio de rouquidão e pigarro e 42, queixas respiratórias (15%), predominando a tosse crônica. Dos pacientes com queixas otorrinolaringológicas, 45 pertenciam ao grupo doença do refluxo erosiva (28%) e 43 ao grupo doença do refluxo não-erosiva (36,4%). Em relação aos com queixas respiratórias, 21 pacientes (13%) pertenciam ao grupo doença do refluxo erosiva e 21 (18%) ao grupo doença do refluxo não-erosiva. CONCLUSÃO: Não houve diferença entre a prevalência das queixas supra-esofágicas em pacientes com doenças do refluxo erosiva e não-erosiva.

El período post-devaluación 2003-2005 presenta una combinación de cambios y continuidades en la dinámica socioeconómica y territorial con respecto a la fase de recesión y crisis del Régimen de Convertibilidad. Se registra una significativa recuperación de la actividad socioeconómica en diversos sectores, ramas y empresas que no se traduce con el mismo vigor en los indicadores sociales sobre mercado de trabajo y pobreza, o incluso sin que se produzcan modificaciones sustantivas en los referidos a distribución del ingreso. En el territorio argentino estos procesos se reflejan a través de una desigual distribución de las inversiones y de la captación de los beneficios que el crecimiento económico genera. El presente artículo tiene como objetivos caracterizar este período a partir de un análisis de las principales variables socioeconómicas, presentar los principales debates en torno a los cambios y continuidades respecto del régimen de convertibilidad y dar cuenta de sus vinculaciones con la dinámica territorial., The post-devaluation period (2003-2005) introduces a combination of changes and continuities in the socio-economic and territorial dynamics with respect to the Convertibility recession and crisis. An important recovery of the socio-economic activity in various areas, branches and businesses is noticed, though it does not directly correlate with the job market and poverty social indicators; nor does it even bring about substantial change in income distribution. In Argentina, these processes are seen in the uneven distribution of investments and of benefits reception generated by economic growth. This article aims at characterising this period by analysing the main socio-economic variables, at introducing the most significant debates around the changes and continuities concerning the Convertibility regime, and at accounting for the connections with the territory dynamics., Departamento de Geografía

The post-devaluation period (2003-2005) introduces a combination of changes and continuities in the socio-economic and territorial dynamics with respect to the Convertibility recession and crisis. An important recovery of the socio-economic activity in various areas, branches and businesses is noticed, though it does not directly correlate with the job market and poverty social indicators; nor does it even bring about substantial change in income distribution. In Argentina, these processes are seen in the uneven distribution of investments and of benefits reception generated by economic growth. This article aims at characterising this period by analysing the main socio-economic variables, at introducing the most significant debates around the changes and continuities concerning the Convertibility regime, and at accounting for the connections with the territory dynamics.

In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence.To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease.We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH4 (%TT) and by % of time of pH4 in upright (%UT) and supine (%ST) positions. Patients were classified as non-erosive reflux disease if no erosive esophagitis was found in endoscopy and pH monitoring was abnormal and as erosive reflux disease if they had erosive esophagitis. Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large ifor = 5 cm.A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 +/- 7.1; 13.4 +/- 7.4 and 12.3 +/- 11.5 in small hiatal hernias and 20.2 +/- 12.3; 17.8 +/- 14.1 and 20.7 +/- 14.1 in large hiatal hernias, respectively (P0.05 for %TT and %TS). In non-erosive reflux disease patients, %TT, %UT and %ST were 9.6 +/- 4.8; 10.8 +/- 6.8 and 8.6 +/- 7.3 in small hiatal hernias and of 14.6 +/- 13.3; 11.2 +/- 7.5 and 18.1 +/- 21.0 in large hiatal hernias respectively (P0.05 for %TT and %TS).Large hiatal hernias increase acid exposure time only in supine position in erosive esophagitis patients and in non-erosive patients.

RACIONAL: Nos últimos anos, estudos têm demonstrado a importância da hérnia hiatal na etiopatogenia da doença do refluxo gastroesofágico, atuando por vários mecanismos, sendo enfatizado que quanto maior a hérnia, maior seria a possibilidade de refluxo e esofagite. OBJETIVOS: Avaliar por parâmetros de pHmetria prolongada, se a presença de hérnias volumosas se correlaciona com maior intensidade do refluxo, em pacientes com a doença do refluxo erosiva e doença do refluxo não-erosiva. PACIENTES E MÉTODOS: Foram revistas as pHmetrias prolongadas anormais consecutivas de pacientes em investigação de doença do refluxo gastroesofágico (pirose como queixa principal) e analisadas as percentagens de tempo total (%TT), em posição ereta (%TE) e posição supina (%TS) com pH 5 cm. RESULTADOS: Cento e noventa e dois pacientes preencheram os critérios de inclusão, sendo 115 com doença do refluxo erosiva e 77 com doença do refluxo não-erosiva. No primeiro grupo, 94 (81%) pacientes apresentavam hérnias hiatais não-volumosas, enquanto que 21 (19%) apresentavam hérnias hiatais volumosas. No grupo com doença do refluxo não-erosiva, 66 (85%) pacientes apresentavam hérnia hiatal não-volumosa e 11 (15%) hérnia hiatal volumosa. Na doença do refluxo erosiva, as %TT, %TE e %TS foram de 13,1 + 7,1, 13,4 + 7,4 e 12,3 + 11,5 nas hérnias hiatais não-volumosas, aumentando para 20,2 + 12,3, 17,8 + 14,1 e 20,7 + 14,1 nas hérnias hiatais volumosas, respectivamente, sendo este aumento estatisticamente significante nos tempos total e supino. Na doença do refluxo não-erosiva, as %TT, %TE e %TS foram de 9,6 + 4,8, 10,8+ 6,8 e 8,6 + 7,3 nas hérnias hiatais não volumosas e de 14,6 + 13,3, 11,2 + 7,5 18,1 + 21,0 nas hérnias volumosas, respectivamente, com significância semelhante à anterior. CONCLUSÃO: As hérnias volumosas aumentam o tempo de exposição ácida esofágica exclusivamente na posição supina nos pacientes com doença do refluxo erosiva e doença do refluxo não-erosiva. BACKGROUND: In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence. AIM: To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease. PATIENTS AND METHODS: We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH 5 cm. RESULTS: A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 + 7.1; 13.4 + 7.4 and 12.3 + 11.5 in small hiatal hernias and 20.2 + 12.3; 17.8 + 14.1 and 20.7 + 14.1 in large hiatal hernias, respectively (P

Respiratory, ear-nose and throat complaints, chest pain and dysphagia can be a part of clinical manifestations of gastroesophageal reflux disease. The first two are named supraesophageal manifestations of gastroesophageal reflux disease. Controversy about the prevalence of these clinical manifestations in patients with non-erosive and erosive gastroesophageal reflux disease exists.Evaluate the prevalence of supraesophageal manifestations in patients with erosive and non-erosive gastroesophageal reflux disease.Files from patients submitted to upper endoscopy, esophageal manometry and pH monitoring for the investigation of gastroesophageal reflux disease (heartburn as the chief complaint) were reviewed and respiratory and ear, nose and throat symptoms were recorded. Patients with erosive disease (grades I to III according to Savary-Miller classification) and with non-erosive disease (normal endoscopy with abnormal pH monitoring were selected. Statistical analysis included the chi-square test.Two hundred and eighty patients fulfilled the inclusion criteria being 162 with erosive disease (70% with grade I esophagitis) and 118 with non-erosive disease. Overall, 88 patients had ear, nose and throat symptoms (31%), the more frequent were hoarseness and clearing and 42, respiratory manifestations (15%), being cough the more prevalent. In the ear, nose and throat symptoms group, 45 were erosive disease (28%) and 43 non-erosive disease (36.4%). As for the respiratory symptom group, 21 patients (13%) were erosive disease and 21 (18%) were non-erosive disease.There was no difference in the prevalence of supraesophageal manifestations between patients with gastroesophageal erosive and non-erosive reflux disease.