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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastroesophageal reflux disease typically manifests as heartburn and regurgitation, but it may also present with atypical or extraesophageal symptoms, including asthma, chronic cough, laryngitis, hoarseness, chronic sore throat, dental erosions, and noncardiac chest pain. Diagnosing atypical manifestations of gastroesophageal reflux disease is often a challenge because heartburn and regurgitation may be absent, making it difficult to prove a cause-and-effect relationship. Upper endoscopy and 24-hour pH monitoring are insensitive and not useful for many patients as initial diagnostic modalities for evaluation of atypical symptoms. In patients with gastroesophageal reflux disease who have atypical or extraesophageal symptoms, aggressive acid suppression using proton pump inhibitors twice daily before meals for three to four months is the standard treatment, although some studies have failed to show a significant benefit in symptomatic improvement. If these symptoms improve or resolve, patients may step down to a minimal dose of antisecretory therapy over the following three to six months. Surgical intervention via Nissen fundoplication is an option for patients who are unresponsive to aggressive antisecretory therapy. However, long-term studies have shown that some patients still require antisecretory therapy and are more likely to develop dysphagia, rectal flatulence, and the inability to belch or vomit.
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PMID:Atypical presentations of gastroesophageal reflux disease. 1875 56

Eosinophilic esophagitis is an increasingly recognized cause of a variety of esophageal symptoms, including dysphagia, food impaction, atypical chest pain, and heartburn that does not respond to medical therapy. Its cause is unknown, but allergic and immune-mediated mechanisms similar to those of asthma and other atopic diseases are implicated.
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PMID:Eosinophilic esophagitis: an increasingly recognized cause of dysphagia, food impaction, and refractory heartburn. 1878 23

Eosinophilic esophagitis has become a diagnosis familiar to allergists and immunologists who treat pediatric patients presenting with complaints of recurrent vomiting, feeding difficulty, abdominal pain, dysphagia, and food impaction. Over the past 3 years, published research has addressed several clinically important issues, including incidence among special patient populations, adult patients and familial cases, diagnostic features, natural history and complications, therapies with topical steroids, and pathogenesis with distinct genetic markers of the disorder.
Curr Allergy Asthma Rep 2009 Jan
PMID:Gastrointestinal eosinophil-mediated disorders and their treatment. 1906 21

Right aortic arch with retroesophageal left innominate artery is an unusual pathology. The presence of patent ductus arteriosus, or left ductal ligament, does complete the vascular ring (Type "D" double aortic arch). In infants with dysphagia, stridor and/ or recurrent wheezing, presence of vascular rings may be suspected. In older patients this diagnosis is less common. Children in school age or older with risk factors, positive bronchodilator test and bad evolution, could have other unusual etiologies. We report an 8 year old patient with previous diagnosis of asthma with inadequate response to treatment in whom this non-frequent type of vascular ring was confirmed.
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PMID:[Chronic wheezing child and type "D" double aortic arch: case report]. 1910 12

A global evidence-based consensus has defined gastroesophageal reflux disease (GERD) as 'a condition, which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.' The manifestations of GERD can be divided into esophageal and extraesophageal syndromes, and include vomiting, poor weight gain, dysphagia, abdominal or substernal/retrosternal pain, esophagitis and respiratory disorders. The extraesophageal syndromes have been divided into established and proposed associations: established would include cough, laryngitis, asthma and dental erosion ascribable to reflux, whereas proposed associations would include pharyngitis, sinusitis, idiopathic pulmonary fibrosis and recurrent otitis media. Uninvestigated patients with esophageal symptoms without evidence of esophageal injury would be considered to have asymptomatic esophageal syndromes, whereas those with demonstrable injury are considered to have esophageal syndromes with esophageal injury. Therefore, this allows symptoms to define the disease but permits further characterization if mucosal injury is found. Within the syndromes with associated injury are reflux esophagitis, stricture, Barrett's esophagitis and adenocarcinoma. This review will address definitions of GER and GERD-associated symptoms and treatment options.
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PMID:GERD or not GERD: the fussy infant. 1939 14

The inlet patch is an area of heterotopic gastric mucosa most commonly located in the postcricoid portion of the esophagus at, or just below, the level of the upper esophageal sphincter. Esophageal and supraesophageal symptoms are commonly associated with inlet patch, while esophageal adenocarcinoma rarely complicates it. Laryngeal adenocarcinoma associated with inlet patch is not described in the literature. Herein, we present the first reported case of inlet patch associated with laryngeal carcinoma. A 33-year-old female with long-standing asthma and presumed gastroesophageal reflux developed laryngeal cancer at age 22 years that was treated with concomitant radiation and induction chemotherapy. Subsequently, she had refractory heartburn, dysphagia, and cough. These symptoms continued despite two Nissen fundoplications, glottic web division, and optimal medical management. Upper endoscopy at our institution revealed an upper esophageal stricture and a 1 cm inlet patch. Biopsies showed columnar mucosa (predominantly gastric cardiac/fundic type) consistent with inlet patch, with focal intestinal metaplasia. Subsequent endoscopic mucosal resection of the inlet patch resulted in an amelioration of throat and chest pain, cough, and hoarseness. Dysphagia and regurgitation were improved by serial dilatations of the upper esophageal stricture. This case reveals a number of clinical findings associated with inlet patch--chest pain, dysphagia, cough, and hoarseness--as well as a clinical finding that has not been previously associated with inlet patch: laryngeal cancer. Symptoms refractory to optimal medical management and/or surgical intervention should make the clinician and endoscopist more cognizant of the inlet patch.
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PMID:Heterotopic gastric mucosa (inlet patch) in a patient with laryngopharyngeal reflux (LPR) and laryngeal carcinoma: a case report and review of literature. 1947 8

We report the anesthetic management of esophagectomy for a patient with Alport-leiomyomatosis syndrome. A 23-year-old woman complained of dysphagia and severe chest pain. Her chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) showed an enlarged esophagus, in contact with the trachea, heart, aorta, and large vessels. She frequently experienced severe asthma attacks. Because various risks in both respiration and circulation, especially in anesthesia induction, were of concern, her right femoral vessels were exposed, for the emergency use of percutaneous cardiopulmonary support (PCPS), prior to anesthesia induction. Anesthesia was induced and maintained with propofol, fentanyl, and vecuronium. Esophagectomy was performed uneventfully and no severe events were seen in anesthesia management. Alportleiomyomatosis syndrome is a very rare disease. When we are involved in the anesthetic management of a patient with this disease, evaluation of the influence of the enlarged esophagus on both respiration and circulation, and careful preparation for emergence, are very important.
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PMID:Anesthetic management of a patient with Alport-leiomyomatosis syndrome. 1968 35

Eosinophilic esophagitis in adults (EE) is a disease of unknown cause, characterized by symptoms such as reflux and dysphagia that traditionally do not respond to antacid treatment. It affects mostly young men with a strong personal or familial history of atopy asthma and allergies. We report three male patients aged 10, 14 and 15 years, all with symptoms of dysphagia, two of them with chest pain caused by spasm of the esophagus, with heterogeneous endoscopic findings which included from leucoplakia to stenosis that needed endoscopic dilatation. All of them had abnormal findings in immunity studies (prick test or IgE levels). They received treatment based on diet measures, acid suppression and leukotriene inhibitors, with satisfactory clinical, endoscopic and histological response. EE should be suspected in children and adults with esophageal symptoms and personal or family history of allergy and asthma.
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PMID:[Eosinophilic esophagitis: report of three cases]. 1970 56

Over the past decade, there has been a significant increase in the number of children and adults with eosinophilic esophagitis (EE). This recently recognized form of chronic pan-esophagitis is characterized by dense eosinophilic infiltration of the esophageal mucosa. EE is closely associated with male gender and allergic disorders, such as food allergy, eczema and asthma. The diagnosis relies on demonstration of increased numbers of eosinophils (>/= 15 per high power field) in esophageal biopsies. There is clinical overlap between EE and gastroesophageal reflux disease (GERD). Patients with EE typically present with reflux symptoms but are unresponsive to proton pump inhibitor therapy. While dysphagia, regurgitation and retrosternal pain are the clinical hallmarks of EE, many patients are asymptomatic. Treatment aims to prevent long-term complications, such as acute food bolus impaction or esophageal strictures. In childhood, treatment relies on elemental or elimination diets. Skin prick and atopy patch testing have proved useful in guiding specific dietary elimination. In adolescents and adults, broad-based elimination diets are commonly not tolerated or may be ineffective. These patients may respond to swallowed corticosteroid aerosols or other immune-modulating drugs. Further prospective clinical trials are needed to outline the most effective long-term treatment of EE.
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PMID:Eosinophilic esophagitis: example of an emerging allergic manifestation? 1971 May 18

Respiratory type-IV hypersensitivity reactions due to corticosteroids is a rare phenomenon. We describe two such cases. The first is a 37- year-old atopic woman who developed labial angioedema and nasal itching after the use of budesonide nasal spray. A month later, after the first puffs of a formoterol/budesonide spray prescribed for asthma, she noticed symptoms of tongue and oropharyngeal itching and redness with subsequent dysphagia, labial and tongue angioedema, and facial oedema. The second is a 15-year-old non-atopic woman who reported pruritic eruptions around the nostrils after using a budesonide nasal spray. A year later she presented with nasal pruritus with intense congestion and labial and facial oedema after using the same spray. Both patients were evaluated with patch-tests using the commercial T.R.U.E. test, a budesonide solution, and corticosteroid creams. Test evaluation was performed at 48 and 96 hours. In both patients, patch tests were positive to budesonide (++) on the second day. The first patient also had a positive (+) reaction to tixocortol-21-pivalate. All the other patch tests were negative. Clinicians should be aware that hypersensitivity reactions may occur during the use of nasal or inhaled corticosteroids.
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PMID:Type IV delayed-type hypersensitivity of the respiratory tract due to budesonide use: report of two cases and a literature review. 1982 44


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