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

During one six-month period 11 patients were referred with a diagnosis of coronary artery disease, because of recurrent episodes of severe, prolonged retrosternal chest pain necessitating from one to seven hospital admissions per patient for "suspect myocardial infarction". In no instance was this diagnosis proved by electrocardiogram or serum enzyme changes, but 7 of the 11 patients had abnormal resting electrocardiograms. Selective coronary arteriograms were normal in 10 patients and revealed nonobstructive coronary artery disease in the 11th patient. Esophageal studies revealed hiatus hernia in 9 and mild to severe disordered motored activity of the esophagus in all 11. Acid perfusion into the esophagus reproduced the chest pain in nine patients and in the other two, the hiatus hernia was incarcerated. On direct questioning, all patients indicated that the pain was worsened by lying down and bending over, and in eight patients there was a history of pharyngoesophageal or gastroesophageal dysphagia. In this day when the problem of chest pain with normal coronary arteries is very topical, our report emphasizes the need to consider symptomatic esophageal disease in the differential diagnosis of this problem.
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PMID:Esophageal disease as a cause of severe retrosternal chest pain. 112 87

Esophageal distention, motor abnormalities, or exposure of the esophageal mucosa to acidic gastric juice can cause chest pain indistinguishable from that of myocardial ischemia in patients with and without coronary artery disease. In these situations the exact cause of the symptom needs to be established prior to any surgical therapy. An antireflux procedure relieves chest pain in patients with increased esophageal acid exposure more reliably than medical therapy. The best results are obtained in patients in whom a direct correlation of the symptom with reflux episodes can be documented on 24-hour esophageal pH monitoring. Ambulatory 24-hour esophageal motility monitoring shows that esophageal motor disorders are a less frequent cause of noncardiac chest pain than suggested by standard manometry or provocation tests. Furthermore, chest pain episodes in patients with esophageal motor abnormalities are not associated with single contractions of excessively high amplitude or duration. Rather, the symptom appears to be triggered by an increased frequency of simultaneous, multipeaked, and repetitive motor activity. In appropriately selected patients with chest pain and dysphagia secondary to an esophageal motor abnormality, a long esophageal myotomy eliminates the ability of the esophagus to produce these contractions, reduces or eliminates dysphagia, and decreases the frequency and severity of chest pain episodes.
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PMID:Therapy of noncardiac chest pain: is there a role for surgery? 159 57

35 patients with angina-like chest pain underwent esophageal manometry after a coronary artery disease had been ruled out by angiography. Furthermore, patients after gastric or esophageal surgery, with pathologic upper gastrointestinal endoscopy or with pathologic gastroesophageal reflux as seen on 24-hour-pH-metry were excluded from this study. 29 out of 35 patients (83%) had a normal manometric study, six patients (17%) had a motility disorder; five of these showed an unspecific dismotility pattern and were asymptomatic while the study was done; only one patient presented with esophageal spasm. Since only this latter patient was symptomatic while the study was done, a correlation between symptoms and this motility disorder seems likely. --If pathologic gastroesophageal reflux has been ruled out, esophageal manometry can establish a diagnosis in only 3% of patients with angina-like chest pain without esophageal symptoms (dysphagia, odynophagia, heartburn or regurgitation). We conclude that this complicated examination should not be done in these patients.
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PMID:[Esophageal motility disorders with thoracic pain of unknown origin]. 188 9

Nutrition plays an important role in health and disease, both in prevention and treatment. Increasing emphasis is being placed upon nutrition as a therapeutic tool to decrease the morbidity and mortality associated with obesity, hypertension, coronary artery disease, and cancer. Adequate nutrition should be a concern for all health care workers because of its impact on the overall health of patients. Health care professionals should be familiar with the essentials of nutritional assessment and basic nutritional requirements and be able to improve their patients' care in the face of nutritional deficiencies or excesses.
Dysphagia 1990
PMID:Nutritional assessment and requirements. 220 96

Neuronal intranuclear hyaline inclusion disease (NIHID) has been recognized in 14 patients. It usually occurs in the first and second decades but has been seen in the sixth. Both sexes are affected by this sporadic multisystem degenerative disorder that has involved the central and peripheral nervous systems with fibrillar and granular intranuclear inclusions. NIHID appears to be several variants of a multisystem degenerative disease as illustrated by the combination of a spontaneous, degenerative central and peripheral nervous system disorder with neuronal intranuclear inclusions and severe atherosclerotic coronary artery disease in a 23-year-old white man. Beginning at 11 years of age, this patient had experienced diffuse muscle spasms, dysarthria, dysphagia, tremors, ataxia, oculogyric crises, progressive muscle weakness, and atrophy. At autopsy, neuronal intranuclear hyaline inclusions and neuronal loss were seen in his brain, brainstem, cerebellum, spinal cord, bowel, bladder, and esophagus. These fibrillary and granular Cowdry type A and B intraneuronal inclusions were consistent with the diagnosis of NIHID associated with severe coronary atherosclerosis.
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PMID:Neuronal intranuclear hyaline inclusion disease associated with premature coronary atherosclerosis. 244 45

We reviewed 123 consecutive patients who underwent esophageal function testing to determine the prevalence and clinical characteristics of the syndrome of high-amplitude peristaltic contractions (HAPC). Twenty-eight patients (23%) were found to have HAPC, including 16 males and 12 females with a median age of 54 years. Barium esophograms yielded no evidence of motility disorders, while 35% of those tested had pathologic gastroesophageal acid reflux. Twenty (71%) were initially referred for evaluation of angina-like chest pain, and 8 were referred with other symptoms. Of those with chest pain, 19 initially underwent extensive evaluation for coronary artery disease before the diagnosis of HAPC. Symptoms of heartburn, regurgitation, and dysphagia were absent or minimal in most patients. Lower esophageal sphincter pressure was normal in 27 patients, and lower esophageal sphincter relaxation was normal in all patients. Mean distal esophageal peak peristaltic pressure was 147.8 mm Hg, while the highest peak peristaltic pressure for each patient averaged 193.2 mm Hg. Seven patients had mean peristaltic wave durations of more than 7 seconds. Patients with atypical chest pain or those with typical angina in whom coronary artery disease is eliminated as a possible cause should be evaluated for HAPC with esophageal manometry. Patients with symptoms are usually successfully treated with smooth muscle relaxants, and surgical intervention is rarely necessary.
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PMID:Angina-like chest pain associated with high-amplitude peristaltic contractions of the esophagus. 317 68

Fifty-eight consecutive patients were investigated for spontaneous chest pain without symptoms of effort angina, previous myocardial infarction or other signs of cardiac disease, to determine the incidence of oesophageal spasm. The character of the chest pain, its context and the results of resting ECGs were analysed. An ECG recorded during chest pain was available in 23 cases and exercise stress testing was performed in 43 cases. Coronary angiography was carried out in all patients. The coronary arteries were normal or showed little change in 44 patients. Further investigations were ordered: oesophageal manometry (42 cases), echocardiography 44 cases) and ergometrine provocation tests (44 cases). The patients were then divided into 4 groups: 23 patients (40 p. 100) with coronary artery disease; either atheroma (14 cases) or spasm (9 cases); 8 patients (13,5 p. 100) with non-coronary cardiac pathology (myocardial hypertrophy or mitral valve prolapse); 15 patients (26 p. 100) with oesophageal spasm alone; 12 patients (20,5 p. 100) with no obvious organic disease. Often simulating spontaneous angina, clinically and electrocardiographically, oesophageal spasm may sometimes be distinguished (6 out of 15 cases) by the finding of painful dysphagia on swallowing ice-cold liquid. The condition is confirmed by oesophageal manometry which shows abnormalities of oesophageal contraction. In addition, 13 out of 15 patients in our series had hypotonia of the gastro-oesophageal sphincter. Dyskinetic phenomena and this hypotonia should be taken into consideration in the treatment of this condition.
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PMID:[Esophageal spasm: a common cause of spontaneous precordial pain]. 643 62

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty-three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia. Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre-test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.
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PMID:Evaluation of a method to teach cardiothoracic surgery to medical students. 836 83

Ten patients presenting with central chest pain and/or dysphagia were diagnosed to have oesophageal motility disorders (OMD) with an incoordinate motor function using computerised radionuclide oesophageal transit study (RT). The criteria for diagnosis of OMD with incoordination using RT were: an 'incoordinate' or 'to and fro' pattern characterised by multiple peaks of activity, prolonged total transit time or radionuclide bolus through entire length of oesophagus and a significant portion of bolus entering the stomach. These features are characteristic but not pathognomonic of diffuse oesophageal spasm (DES) as they are also seen in non-specific motility disorders (NSMD) and occasionally in order oesophageal motility disorders. Mechanical obstruction in the oesophagus and coronary artery disease were excluded appropriately in these patients. When manometry is not available, RT is a sensitive, safe, simple, rapid and non-invasive alternative modality in confirming certain oesophageal motility disorders.
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PMID:Oesophageal motility disorders: rapid functional diagnosis using computerised radionuclide oesophageal transit study. 855

Indications to manometric measurements in patients complaining for esophageal disorders are discussed. Such symptoms most frequently include: dysphagia, heartburn, and angina-like pain after exclusion of the coronary artery disease. Radiological and endoscopic examinations should precede esophageal motility measurements to eliminate organic causes of patients' complaints. Initial manometric measurements may be repeated after the application of pharmacologic stimuli or functional tests. Most frequent esophageal motor disorders have been described.
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PMID:[Manometric examination in diagnosis of esophageal motility disorders]. 896 71


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