{"id":9835,"date":"2025-05-22T06:30:00","date_gmt":"2025-05-22T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=9835"},"modified":"2025-05-07T23:32:28","modified_gmt":"2025-05-08T02:32:28","slug":"ausencia-de-contratilidade-esofagica","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ausencia-de-contratilidade-esofagica\/","title":{"rendered":"Aus\u00eancia de contratilidade esof\u00e1gica"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/9835?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/9835?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<h2 class=\"wp-block-heading\" id=\"h-introducao\">Introdu\u00e7\u00e3o<\/h2>\n\n\n\n<p>A aus\u00eancia de contratilidade (AC) \u00e9 um dist\u00farbio motor esof\u00e1gico raro, com preval\u00eancia estimada em 3% a 4% dos pacientes submetidos \u00e0 manometria esof\u00e1gica de alta resolu\u00e7\u00e3o (MAR) e em 5% a 7% entre aqueles avaliados por disfagia.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-background has-fixed-layout\" style=\"background:linear-gradient(135deg,rgb(238,238,238) 0%,rgb(255,255,255) 43%,rgb(214,214,250) 79%,rgb(169,184,195) 100%)\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\">De acordo com a Classifica\u00e7\u00e3o de Chicago vers\u00e3o 4.0 (<a href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/esofago\/classificacao-de-chicago-4-0-o-que-ha-de-novo-na-manometria-de-alta-resolucao\/\">relembre aqui!<\/a>), a aus\u00eancia de contratilidade \u00e9 definida como 100% de peristalse falha na presen\u00e7a de relaxamento adequado da jun\u00e7\u00e3o esofagog\u00e1strica (ver Figura 1).<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=9837\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"768\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/04\/figura-1.jpg\" alt=\"\" class=\"wp-image-9837\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/04\/figura-1.jpg?v=1744243681 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/04\/figura-1-300x225.jpg?v=1744243681 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/04\/figura-1-768x576.jpg?v=1744243681 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2025\/04\/figura-1-585x439.jpg?v=1744243681 585w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 1<\/strong> \u2013 Manometria de Alta Resolu\u00e7\u00e3o demonstrando aus\u00eancia de contratilidade esof\u00e1gica.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-apresentacao-clinica\"><br><strong>Apresenta\u00e7\u00e3o cl\u00ednica<\/strong><\/h2>\n\n\n\n<p>Os sintomas da aus\u00eancia de contratilidade s\u00e3o variados e, muitas vezes, inespec\u00edficos. As principais queixas incluem:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Regurgita\u00e7\u00e3o (68%)<\/li>\n\n\n\n<li>Pirose (40% a 82%)<\/li>\n\n\n\n<li>Disfagia (30% a 66%)<\/li>\n<\/ul>\n\n\n\n<p><br>Outras manifesta\u00e7\u00f5es poss\u00edveis s\u00e3o:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dor tor\u00e1cica n\u00e3o card\u00edaca (17% a 21%)<\/li>\n\n\n\n<li>Eructa\u00e7\u00f5es (57%)<\/li>\n\n\n\n<li>N\u00e1useas e v\u00f4mitos (23% a 33%)<\/li>\n\n\n\n<li>Tosse recorrente (49%)<\/li>\n\n\n\n<li>Perda ponderal (24%)<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-condicoes-associadas\"><br><strong>Condi\u00e7\u00f5es associadas<\/strong><\/h2>\n\n\n\n<p>A aus\u00eancia de contratilidade \u00e9 considerada uma \u201cdescendente\u201d do chamado <strong>\u201ces\u00f4fago esclerod\u00e9rmico\u201d<\/strong>, previamente descrito pela manometria convencional. Embora n\u00e3o seja um achado espec\u00edfico, \u00e9 fortemente associado a doen\u00e7as do col\u00e1geno, especialmente \u00e0 esclerose sist\u00eamica.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-background has-fixed-layout\" style=\"background:linear-gradient(135deg,rgb(238,238,238) 0%,rgb(255,255,255) 37%,rgb(169,184,195) 100%)\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\">Dist\u00farbios motores esof\u00e1gicos est\u00e3o presentes em at\u00e9 80%\u201390% dos pacientes com esclerose sist\u00eamica, sendo que a aus\u00eancia de contratilidade representa 51% a 60% desses casos, e a motilidade esof\u00e1gica ineficaz (MEI), 18% a 19%. A esclerose sist\u00eamica \u00e9 uma doen\u00e7a autoimune sist\u00eamica complexa, que cursa com disfun\u00e7\u00e3o endotelial e excesso de deposi\u00e7\u00e3o de col\u00e1geno, comprometendo m\u00faltiplos \u00f3rg\u00e3os, inclusive o trato gastrointestinal<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><br>Al\u00e9m das doen\u00e7as reumatol\u00f3gicas, outras condi\u00e7\u00f5es frequentemente associadas \u00e0 aus\u00eancia de contratilidade esof\u00e1gica incluem:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Doen\u00e7a do refluxo gastroesof\u00e1gico (DRGE)<\/strong>: at\u00e9 36% dos pacientes com AC t\u00eam hist\u00f3ria de DRGE. A preval\u00eancia de esofagite erosiva nesses casos varia entre 31% e 65%. A hipomotilidade pode ser causa ou consequ\u00eancia da agress\u00e3o esof\u00e1gica cr\u00f4nica.<\/li>\n\n\n\n<li><strong>Cirurgias g\u00e1stricas pr\u00e9vias<\/strong>: cerca de 14,9% dos pacientes com AC j\u00e1 realizaram cirurgias g\u00e1stricas, como fundoplicatura ou procedimentos bari\u00e1tricos.<\/li>\n\n\n\n<li><strong>Doen\u00e7a pulmonar intersticial<\/strong>: \u00e9 comum encontrar AC em pacientes candidatos a transplante pulmonar, tanto pela doen\u00e7a de base (ex: colagenose) quanto por altera\u00e7\u00f5es mec\u00e2nicas, como a tra\u00e7\u00e3o lateral gerada pela fibrose. H\u00e1 relatos de melhora da motilidade esof\u00e1gica ap\u00f3s transplante.<\/li>\n\n\n\n<li><strong>Uso de \u00e1lcool<\/strong>: estudos sugerem maior preval\u00eancia de consumo alco\u00f3lico em pacientes com AC comparados a controles, embora a relev\u00e2ncia cl\u00ednica dessa associa\u00e7\u00e3o ainda demande mais evid\u00eancias.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-diagnostico\"><strong><br>Diagn\u00f3stico<\/strong><\/h2>\n\n\n\n<p>O exame de escolha \u00e9 a manometria esof\u00e1gica de alta resolu\u00e7\u00e3o.<\/p>\n\n\n\n<p>Segundo a Classifica\u00e7\u00e3o de Chicago v4.0, o diagn\u00f3stico de aus\u00eancia de contratilidade exige:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Relaxamento adequado do esf\u00edncter esofagiano inferior (IRP &lt; 15 mmHg)<\/li>\n\n\n\n<li>100% de degluti\u00e7\u00f5es com falha perist\u00e1ltica (DCI &lt; 100 mmHg\u00b7s\u00b7cm)<\/li>\n<\/ul>\n\n\n\n<p><strong>A aus\u00eancia de contratilidade pode representar um est\u00e1gio precoce da acalasia tipo I<\/strong>. Em um seguimento m\u00e9dio de 20,5 meses, 6,8% dos pacientes inicialmente diagnosticados com AC evolu\u00edram para acalasia. Isso se deve, possivelmente, \u00e0 progressiva degenera\u00e7\u00e3o neuronal, que pode comprometer o corpo esof\u00e1gico antes do esf\u00edncter esofagiano inferior. Al\u00e9m disso, o valor do IRP pode ser afetado por erros t\u00e9cnicos ou por varia\u00e7\u00f5es fisiol\u00f3gicas.<\/p>\n\n\n\n<p><strong>Em pacientes com disfagia significativa e IRP lim\u00edtrofe (10\u201315 mmHg), a acalasia tipo I deve ser considerada no diagn\u00f3stico diferencial<\/strong>. Estudos mostram que at\u00e9 25% dos pacientes com aus\u00eancia de contratilidade ou acalasia tipo I podem ser incorretamente classificados apenas com base no IRP. Alguns pacientes com aperistalse e IRP normal (&lt; 15 mmHg) apresentam na verdade hist\u00f3ria cl\u00ednica, apar\u00eancia radiogr\u00e1fica e achados endosc\u00f3picos mais consistentes com acalasia. Por isso, testes adicionais s\u00e3o fundamentais para diferenciar essas condi\u00e7\u00f5es \u2013 <em>tema que ser\u00e1 abordado em uma pr\u00f3xima publica\u00e7\u00e3o neste site<\/em>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-tratamento\"><br><strong>Tratamento<\/strong><\/h2>\n\n\n\n<p>O tratamento da aus\u00eancia de contratilidade \u00e9 desafiador, pois <strong>n\u00e3o h\u00e1 terapias farmacol\u00f3gicas eficazes<\/strong> para melhorar o vigor contr\u00e1til esof\u00e1gico. O manejo deve ser individualizado, com foco nos sintomas predominantes e e no tratamento de qualquer refluxo concomitante, quando presente.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-medidas-comportamentais-uteis-incluem\"><strong>Medidas comportamentais \u00fateis incluem:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fracionar e mastigar bem os alimentos<\/li>\n\n\n\n<li>Associar alimentos s\u00f3lidos com l\u00edquidos<\/li>\n\n\n\n<li>Comer em posi\u00e7\u00e3o ereta<\/li>\n\n\n\n<li>Evitar dec\u00fabito por algumas horas ap\u00f3s as refei\u00e7\u00f5es<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-terapias-farmacologicas\"><strong>Terapias farmacol\u00f3gicas:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prucaloprida<\/strong>: pode aumentar a amplitude das contra\u00e7\u00f5es prim\u00e1rias do es\u00f4fago em pacientes com DRGE e ajudar no controle de sintomas em casos associados com gastroparesia ou constipa\u00e7\u00e3o, mas n\u00e3o \u00e9 considerada op\u00e7\u00e3o de tratamento para hipomotilidade esof\u00e1gica;<\/li>\n\n\n\n<li><strong>Buspirona<\/strong>: mostrou aumento da contratilidade esof\u00e1gica em pacientes com esclerose sist\u00eamica, mas n\u00e3o se mostrou superior ao placebo em al\u00edvio sintom\u00e1tico.<\/li>\n\n\n\n<li><strong>Neuromoduladores<\/strong>: podem ajudar quando a dor tor\u00e1cica \u00e9 o sintoma predominante.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-tratamento-da-drge-associada\"><strong>Tratamento da DRGE associada:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Deve-se realizar controle agressivo da acidez com IBPs em altas doses (ou bloqueadores \u00e1cidos competitivos de canais de pot\u00e1ssio).<\/li>\n\n\n\n<li><strong>Fundoplicatura<\/strong>: tem efic\u00e1cia limitada (50%\u201360%) e pode agravar a disfagia em at\u00e9 70% dos pacientes com esclerose sist\u00eamica. Fundoplicatura parcial pode ser discutida no caso de sintomas refrat\u00e1rios.<\/li>\n\n\n\n<li><strong>Bypass g\u00e1strico com anastomose em Y de Roux<\/strong>: de modo semelhante a uma cirurgia bari\u00e1trica, mas com uma al\u00e7a mais curta para evitar perda de peso p\u00f3s-operat\u00f3ria significativa, surge como uma alternativa mais eficaz que a fundoplicatura. Essa abordagem permitiria, afinal, abrandar a DRGE refrat\u00e1ria sem levar ao agravamento dos sintomas disf\u00e1gicos.<br><\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-consideracoes-finais\"><strong>Considera\u00e7\u00f5es finais<\/strong><\/h2>\n\n\n\n<p>A aus\u00eancia de contratilidade \u00e9 um raro, por\u00e9m grave dist\u00farbio motor do es\u00f4fago associado a disfagia e sintomas refrat\u00e1rios de doen\u00e7a do refluxo gastroesof\u00e1gico. O seu adequado diagn\u00f3stico por meio da manometria esof\u00e1gica \u00e9 fundamental para evitar tratamentos inapropriados e orientar adequadamente os pacientes.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-referencias\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Aggarwal N, Lopez R, Gabbard S, Wadhwa N, Devaki P, Thota PN.<br>Spectrum of esophageal dysmotility in systemic sclerosis on high-resolution esophageal manometry as defined by Chicago classification. Dis Esophagus. 2017;30(12):1\u20136.<\/li>\n\n\n\n<li>Alcal\u00e1-Gonz\u00e1lez LG, Jimenez-Masip A, Relea-P\u00e9rez L, Barber-Caselles C, Barba-Orozco E. Underlying etiology associated with the diagnosis of absent contractility on high resolution esophageal manometry. Gastroenterol Hepatol. 2023 Jan;46(1):10\u20136.<\/li>\n\n\n\n<li>Cohen D, Dickman R, Bermont A, Richter V, Shirin H, Mari A. The Natural History of Esophageal \u201cAbsent Contractility\u201d and Its Relationship with Rheumatologic Diseases: A Multi-Center Case\u2013Control Study. J Clin Med. 2022 Jul 5;11(13):3922.<\/li>\n\n\n\n<li>Dao HV, Hoang LB, Luu HTM, Nguyen HL, Goldberg RJ, Allison J, et al. Clinical symptoms, endoscopic findings, and lower esophageal sphincter characteristics in patients with absent contractility. Med (United States). 2022;101(43):E31428.<\/li>\n\n\n\n<li>Laique S, Singh T, Dornblaser D, Gadre A, Rangan V, Fass R, et al. Clinical Characteristics and Associated Systemic Diseases in Patients With Esophageal \u201cAbsent Contractility\u201d\u2014A Clinical Algorithm. J Clin Gastroenterol. 2019 Mar;53(3):184\u201390.<\/li>\n\n\n\n<li>Surjan RCT, Silveira S, Figueira ER. First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis. Cureus. 2023;15(1):1\u20136.<\/li>\n\n\n\n<li>Tran S, Gray R, Kholmurodova F, Thompson SK, Myers JC, Bright T, et al. Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility. J Gastrointest Surg. 2021;25(9):2192\u2013200.<\/li>\n\n\n\n<li>Yan J, Strong AT, Sharma G, Gabbard S, Thota P, Rodriguez J, et al. Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis. Surg Endosc. 2018;32(9):3855\u201360.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-como-citar-este-artigo\">Como citar este artigo<\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Fontes LH, Lages RB. Aus\u00eancia de contratilidade esof\u00e1gica Gastropedia 2025, Vol 1. Dispon\u00edvel em: <a href=\"https:\/\/gastropedia.pub\/pt\/?p=9835\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ausencia-de-contratilidade-esofagica\/<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introdu\u00e7\u00e3o A aus\u00eancia de contratilidade (AC) \u00e9 um dist\u00farbio motor esof\u00e1gico raro, com preval\u00eancia estimada em 3% a 4% dos pacientes submetidos \u00e0 manometria esof\u00e1gica de alta resolu\u00e7\u00e3o (MAR) e&hellip;<\/p>\n","protected":false},"author":5843,"featured_media":9863,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,18],"tags":[],"ano":[413],"tipo":[121],"volume":[57],"class_list":["post-9835","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-esofago","category-gastroenterologia","ano-413","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - 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