Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000400011
Brazilian Journal of Anesthesiology
Review Article

O esvaziamento gástrico e a insuficiência renal crônica

Gastric emptying and chronic renal failure

Eunice Sizue Hirata; Maria Aparecida Mesquita; Gentil Alves Filho; Cecilia Hirata Terra

http://dx.doi.org/10.1590/S0034-70942007000400011 Braz J Anesthesiol, vol.57, n4, p.421-430, 2007
PDF Português
PDF English
Downloads: 4
Views: 1472

Resumo

INTRODUÇÃO E OBJETIVOS: A primeira referência de retardo no esvaziamento gástrico (EG) foi feita por Grodstein em 1979. Outros estudos foram publicados posteriormente, nem sempre confirmando essa observação. A importância do EG em anestesia pode ser resumida em um de seus aspectos principais, o jejum pré-operatório. O retardo no esvaziamento pode causar estase e aumentar o risco de vômito e aspiração pulmonar. A possibilidade de existir retardo do esvaziamento em urêmicos é atraente. Queixas dispépticas são comuns nesses pacientes e poderiam ser explicadas pela dificuldade de esvaziamento gástrico. Apesar das evidências, a literatura é muito controversa nesse aspecto. Não há consenso quanto aos resultados obtidos. Diferenças no método de estudo utilizado poderiam explicar esses resultados, observados em estudos clínicos e experimentais. O objetivo desse estudo foi rever alguns aspectos importantes da síndrome dispéptica em pacientes com insuficiência renal crônica (IRC) terminal, com ênfase no retardo do EG. CONTEÚDO: Serão abordados os aspectos básicos relacionados com a fisiologia do EG, os métodos mais empregados para o estudo do EG, a síndrome dispéptica e a uremia e o esvaziamento gástrico na insuficiência renal crônica. CONCLUSÕES: O EG é um processo fisiológico complexo de transferência do alimento do estômago para o duodeno, cujos mecanismos ainda não estão devidamente esclarecidos. A cintilografia, utilizando refeições acrescidas de radiofármacos, é o exame mais utilizado para o estudo do EG. Uma porcentagem expressiva de pacientes com IRC terminal apresenta retardo no EG. Possivelmente outros mecanismos, além da uremia que participa da função motora gástrica, estão envolvidos nesta disfunção.

Palavras-chave

DOENÇAS, Renal, FISIOLOGIA, Gastrintestinal

Abstract

BACKGROUND AND OBJECTIVES: The first reference to delayed gastric emptying (GE) was made by Grodstein in 1979. Other studies have since been published, not always confirming his work. The importance of GE in anesthesia can be resumed by one of its main aspects, preoperative fasting. Delayed gastric emptying can lead to stasis and increase the risk of vomiting and aspiration. The possibility that uremic patients present delayed gastric emptying is fascinating. Gastric complaints are common in this patient population, and could be explained by the difficulty to empty the stomach. Despite the evidence, there is controversy in the literature regarding this subject. There is no consensus regarding the results. Differences in the methods of the studies could explain the results obtained in clinical and experimental trials. The objective of this study was to review a few important aspects of the dyspeptic syndrome in patients with chronic renal failure (CRF), emphasizing the delayed GE. CONTENTS: The basic aspects of the physiology of GE, methods used more often to study GE, dyspeptic syndrome and uremia, and gastric emptying in chronic renal failure will be discussed. CONCLUSIONS: Gastric emptying is a complex physiological process that transfers food from the stomach to the duodenum, whose mechanisms are yet to be fully characterized. Scintigraphy, using meals with radiolabelled drugs, is the exam used more often to study GE. An expressive percentage of the patients with end-stage renal disease also present delayed GE. It is possible that other mechanisms, besides uremia, involved in gastric motor function also play a role in this dysfunction.

Keywords

DISEASES, PHYSIOLOGY, Gastrointestinal

References

Kallar SK, Everett LL. Potencial risks and preventive measures for pulmonary aspiration: new concepts in preoperative fasting guidelines. Anesth Analg. 1993;77:171-182.

Minami H, Mccallum RW. The physiology and pathophysiology of gastric emptying in humans. Gastroenterology. 1984;86:1592-1610.

Edelbroek M, Horowitz M, Maddox A. Gastric emptying and intragastric distribution of oil in the presence of liquid or a solid meal. J Nucl Med. 1992;33:1283-1290.

Cammack J, Read NW, Cann PA. Effect of prolonged exercise on the passage of a solid meal through the stomach and small intestine. Gut. 1982;23:957-961.

Thompson DG, Richelson E, Malagelada JR. Perturbation of upper gastrointestinal function by cold stress. Gut. 1983;24:277-283.

Scott AM, Kellow JE, Shuter B. Effects of cigarette smoking on solid and liquid intragastric distribution and gastric emptying. Gastroenterology. 1993;104:410-416.

Urbain JL, Vekemans MC, Bouillon R. Characterization of gastric antral motility disturbances in diabetes using a scintigraphic technique. J Nucl Med. 1993;34:578-581.

Levine RR. Factors affecting gastrointestinal absorption of drugs. Am J Dig Dis. 1970;15:171-188.

Watcha MF, White PF. Postoperative nausea and vomiting: Its etiology, treatment and prevention. Anestesiology. 1992;77:162-184.

Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obst Gynecol. 1946;52:191-204.

Horowitz M, Dent J, Fraser . Role and integration of mechanisms controlling gastric emptying. Dig Dis Sci. 1994.

Read NW, Houghton L. Physiology of gastric emptying and pathophysiology of gastroparesis. Gastroenterol Clin North Am. 1989;18:359-373.

Read NW. The stomach and duodenum: a functional emptying unit. Motility. 1989;8:10-13.

Malagelada JR. The Overview of the Physiology of Gastric Modility. Gastrointestinal Transit: Pathophysiology and Pharmacology. 1991:13-19.

Urbain JL, Charkes ND. Recent advances in gastric emptying scintigraphy. Sem Nucl Med. 1995;25:318-325.

Troncon LE, Bennett RJ, Ahluwalia NK. Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut. 1994;35:327-332.

Bueno L, Fioramonti J. Cerebral e Spinal Control of Gastointestinal Transit. Gastrointestinal Transit: Pathophysiology and Pharmacology. 1991:13-19.

Weisbrodt NW. Gastric Motility. Gastrointestinal Physiology. 1984:22-29.

Stark ME, Szurszewski JH. Role of nitric oxide in gastrointestinal and hepatic function and disease. Gastroenterology. 1992;103:1928-1949.

Azpiroz F. Control of gastric emptying by gastric tone. Dig Dis Sci. 1994;39(^ssuppl):18S-19.

Horowitz M, Fraser RJL. Gastroparesis: diagnosis and management. Scand J Gastroenterol. 1995;30(^ssuppl):7-16.

Hunt JN, Knox MT. The slowing of gastric emptying of four strong acids and three weak acids. J Physiol. 1972;222:187-208.

Collares EF, Brasil MR. Esvaziamento gástrico em crianças: Influência da temperatura de uma solução hidratante de uso oral. Arq Gastroenterol. 1981;18:123-126.

Sun WM, Houghton LA, Read NW. Effect of meal temperature on gastric emptying of liquids in man. Gut. 1988;29:302-305.

Collares EF, Souza NM. Esvaziamento gástrico em crianças: II. Influência da osmolaridade da solução hidratante de uso oral. Arq Gastroenterol. 1982;19:83-86.

Vantrappen G. Methods to study gastric emptying. Dig Dis Sci. 1994;39(^sSuppl):91S-94.

Fried M. Methods to study gastric emptying. Dig Dis Sci. 1994;39(^sSuppl):114S-115.

Ravelli AM. Gastrointestinal function in chronic renal failure. Pediatr Nephrol. 1995;9:756-762.

Margolis DM, Saylor JL, Geisse G. Upper gastrointestinal disease in chronic renal failure: A prospective evaluation. Arch Intern Med. 1978;138:1214-1217.

Milito G, Taccone-Gallucci M, Brancaleone C. Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation. Am J Gastroenterol. 1983;78:328-331.

Jaffé RH, Laing DR. Changes of the digestive tract in uremia. Arch Int Med. 1934;53:851-864.

Branicki FJ, Boey J, Fok PJ. Bleeding duodenal ulcer: A prospective evaluation of risk factors for rebleeding and death. Ann Surg. 1990;211:411-418.

Dumitrascu DL, Barnert J, Kirschner T. Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure. Dig Dis Sci. 1995;40:636-644.

Wright RA, Clement R, Wathen R. Gastric emptying in patients with chronic renal failure receiving hemodialysis. Arch Intern Med. 1984;144:495-496.

Soffer EE, Geva B, Helman C. Gastric emptying in chronic renal failure patients on hemodialysis. J Clin Gastroenterol. 1987;9:651-653.

Grodstein GP, Graybar GB, Tarpey H. Kidney Transplantation. Anesthesia and Organ Transplantation. 1987:61-110.

McNamee PT, Moore GW, McGeown MG. Gastric emptying in chronic renal failure. Br Med J (Clin Res Ed. 1985;291:310-311.

Freeman JG, Cobden I, Heaton A. Gastric emptying in chronic renal failure. Br Med J (Clin Res Ed). 1985;291.

Ravelli AM, Ledermann SE, Bisset WM. Foregut motor function in chronic renal failure. Arch Dis Child. 1992;67:-1347.

Kao CH, Lai TL, Wang SJ. Infuence of age on gastric empying in healthy Chinese. Clin Nucl Med. 1994;19:401-404.

Rigatto SZP. Estudo do esvaziamento gástrico na insuficiência renal crônica moderada em ratos. 1996.

Collins PJ, Horowitz M, Chatterton BE. Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol. 1988;61:12-18.

Akkermans LM, van Isselt JW. Gastric motility and emptying studies with radionuclides in research and clinical settings. Dig Dis Sci. 1994;39(^ssuppl):95S-96.

Hirata ES, Mesquita MA, Alves Filho G. O estudo do esvaziamento gástrico na insuficiência renal crônica. 1997.

Belangero VMS, Collares EF. Esvaziamento gástrico de refeições líquidas em ratos com insuficiência renal aguda. Anais. .

Alimchandani A, Pai-dhungat JV. A study of gastric emptying in chronic renal failure. J Assoc Physicians India. 1997;45:835-838.

Strid H, Simren M, Stotzer . Delay gastric emptying in patient with chronic renal failure. Scand J Gastroenterol. 2004;39:516-520.

5dd826b20e8825101613f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections