polidocanol and Gastroesophageal-Reflux

Sclerotherapy results in significant local complications, both immediate and delayed. This study was designed to examine the esophageal pathophysiology underlying these complications.. We prospectively evaluated esophageal transit, motility abnormalities and gastroesophageal reflux (GER) with barium studies and esophageal functional scintigraphy in 24 patients (20 men, 4 women; mean age 33 +/- 12.4 yr) before sclerotherapy (Phase I), after two sessions (Phase II), following variceal eradication (Phase III) and 4 wk later (Phase IV).. Varices were obliterated after 5.6 +/- 1.9 sessions of intravariceal sclerotherapy performed weekly with 1% polidocanol (17.3 ml per session). There was no baseline Phase I dysmotility or reflux. Phase II studies recorded a marked delay of esophageal global and segmental (mid and distal) transit time in 98.2% of patients by scintigraphy and 90% by barium studies. Incoordinate contractions and aperistalsis were observed in 0, 66.7%, 58.3% and 33.8% of patients from Phases I-IV studies, respectively. Barium studies revealed tertiary waves and reverse peristalsis in 0, 50%, and 75% of patients from Phases I-III; strictures were observed in 0, 1, and 3 patients during Phases I-III. GER was detected scintigraphically in 0, 58.3%, 25% and 16.6% during Phases I-IV sequentially. In contrast, barium studies grossly underestimated GER (0, 5% and 15% at phases I-III).. There was strong concordance between esophageal symptoms, transit, motility abnormalities and GER (p < 0.05). Variceal eradication (Phases III and IV) was associated with a gradual recovery of esophageal symptoms, ulcers and all abnormal scintigraphic parameters. Sclerosant-induced chemical esophagitis in association with peptic esophagitis due to gross reflux following sclerotherapy possibly can explain the symptoms in most patients.

Topics: Adult; Barium Sulfate; Esophageal and Gastric Varices; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Organotechnetium Compounds; Peristalsis; Phytic Acid; Polidocanol; Polyethylene Glycols; Radiography; Radionuclide Imaging; Sclerosing Solutions; Sclerotherapy

The effect of sclerotherapy of esophageal varices on the gastroesophageal reflux was studied. Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. The results of pH monitoring of 16 patients who underwent sclerotherapy were compared with those of 21 patients with untreated varices. Seven of the 16 treated patients showed high occurrence rates of gastroesophageal reflux comparable to those observed in cases with severe reflux esophagitis. In the untreated group, only one patient showed pathological reflux (there was a significant difference between treated and untreated groups; p less than 0.01). When the level of reflux was compared with factors that might influence sclerotherapy-induced gastroesophageal reflux, there was a positive correlation between the magnitude of reflux and amount of sclerosant injected paravariceally in the submucosal tissue (p less than 0.05). The results indicate that the paravariceal injection of sclerosant for the treatment of esophageal varix may cause pathological gastroesophageal reflux after sclerotherapy is completed.

Topics: Analysis of Variance; Esophageal and Gastric Varices; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Middle Aged; Monitoring, Physiologic; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

An examination of esophageal function using manometric techniques and long-term pH measurement was carried out on 14 patients suffering from cirrhosis of the liver who had esophageal varices. The resting pressure in the lower esophageal sphincter was found to be slightly reduced in 50 per cent of those examined, while 100 per cent showed a slightly reduced contraction amplitude in the distal tubular esophagus which became progressively lower in the distal direction, and a pathological gastro-esophageal reflux was observed in 57 per cent. We were able to carry out a control examination on 10 of these patients after sclerosing procedure. Sclerotherapy was found to have lowered resting pressures in the lower esophageal sphincter in 80 per cent of those patients, while all of them showed a grossly impaired tubular peristalsis in the form of simultaneous, mostly repetitive contractions with a considerably lowered contraction amplitude, however it had no negative influence on gastro-esophageal reflux patterns.

Topics: Adult; Aged; Alcoholism; Esophageal and Gastric Varices; Esophagus; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hypertension, Portal; Male; Manometry; Middle Aged; Peristalsis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Acid gastroesophageal reflux was determined by long-term pH monitoring in 19 consecutive variceal bleeders after 5 to 20 (mean, 10.3 +/- 1 SEM) sclerotherapy sessions with the flexible endoscope using polidocanol 1% as sclerosant. Fifteen cirrhotics with untreated varices served as controls. Percentage time of esophageal pH less than 4 (3.3 +/- 0.7 SEM vs. 5.2 +/- 2.2 in the controls) and mean duration of reflux episodes (2.9 +/- 0.4 vs. 3.0 +/- 0.7 min) showed no significant differences between both groups. The findings indicate that repeated injection sclerotherapy with the flexible endoscope does not lead to an enhancement of acid gastroesophageal reflux.

Topics: Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions