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

In this case report we describe a child with mild neurologic impairment who developed debilitating gagging and retching, and severe oral-motor dysfunction following Nissen fundoplication and gastrostomy tube placement. All oral intake ceased after the operation. Evaluation for postoperative dumping syndrome was negative, and the child's symptoms failed to improve despite numerous medical and surgical measures. However, immediately following reversal of the Nissen fundoplication, the child's gagging and retching ceased, and his oral-motor function began to improve. This is a previously undescribed complication of Nissen fundoplication, a surgical procedure commonly employed in children with neurologic impairment.
Dysphagia 1992
PMID:Oral dysfunction following Nissen fundoplication. 142 37

From experience with various types of vagotomy in 3,102 patients and study of the late-term results, it was established that recurrent ulcer developed in 4.7%, dysphagia in 2.9%, incompetence of the esophagogastric junction in 9.7%, reflux esophagitis in 3.8%, dyskinesia of the duodenum in 2.6%, duodenostasis in 5.3%, the dumping syndrome in 5.4%, diarrhea in 6.1%, and hiatal hernia in 0.3% of cases. The surgical correction of disorders after vagotomy is marked by specific techniques which must be borne in mind to improve treatment.
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PMID:[The diagnosis and treatment of postvagotomy disorders]. 152 71

Between 1 October 1979 and 1 September 1983, 34 patients with 25 adenocarcinomas and nine squamous cell carcinomas of the cardia and lower part of the esophagus have been treated with resection of the celiac lymph nodes (metastasis in 83 per cent of the patients), the lesser curvature of the stomach, cardia and total esophagus without thoracotomy. There was transmural spread of the cancer in 88 per cent of the patients. The esophagus was replaced by a tube made from the greater curvature of the stomach, which was brought through the mediastinum and anastomosed to the cervical esophagus. There was a hospital mortality of 2.9 per cent and the median hospital stay was 15 days. Morbidity included seven anastomotic leaks which closed spontaneously, intrathoracic bleeding (one), secretion retention (six), transient hoarseness (12), persistent dysphagia (one) and transient dumping syndrome (four). No patient has complained of aspiration or reflux of gastric juices. Satisfactory long term relief of dysphagia was achieved in 94 per cent of the patients. There have been no recurrences of tumor at the site of the anastomosis. The one year survival rate is 70 per cent and the median survival time is 19 months.
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PMID:Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus. 257 73

A number of nutritional complications occur after total gastrectomy, such as protein malnutrition, dumping syndrome, diarrhoea, weight loss, iron deficiency and osteomalacia. Lack of appetite, absence of the sensation of hunger, oesophagitis, dysphagia and the limited capacity for food in most cases are the causes of suboptimal dietary intake after total gastrectomy. To avoid underweight and symptoms after gastrectomy it is necessary that all patients are seen soon after operation and at regular intervals thereafter not only by physicians but by dietitians additionally.
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PMID:[Dietary treatment following gastrectomy]. 332 49

In cases of mild symptomatic gastro-oesophageal reflux, standard antireflux surgery, such as fundoplication or the Angelchik prosthesis, produces satisfactory results. Duodenal diversion is recommended for use only in patients with severe oesophageal damage. This situation commonly arises where the gastro-oesophageal junction cannot be reduced into the abdomen, or where previous surgery has made reoperation at the hiatus difficult and hazardous. Fifty-seven patients with severe reflux oesophagitis have been treated by Roux-en-Y duodenal diversion and antrectomy. Thirty three patients had vagotomy in addition. Median follow-up after operation is 6.1 years. In 35 patients (61%), the technique was used as primary surgical treatment. These included 22 patients in a randomized trial of the method. Thirteen (23%) had previously had unsuccessful antireflux surgery. Nine (16%) had undergone previous operations for peptic ulcer or achalasia. There was no operative mortality. No patient in the series required stricture resection. Good or excellent overall results were achieved in 86% of patients. Eighteen of twenty seven patients with severe strictures required an average of three dilatations after operation before dysphagia was completely relieved. Heartburn was dramatically relieved and oesophagitis settled within an average period of 6 months. Poor or unsatisfactory overall results were observed in 8 (14%) patients. These included one tight fibrous stricture which required endoscopic intubation despite resolution of oesophagitis, and four patients who developed a stomal ulcer. No patients suffered from the dumping syndrome. Malignancy must be carefully excluded by biopsy in all cases of stricture.
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PMID:Duodenal diversion with vagotomy and antrectomy for severe or recurrent reflux oesophagitis and stricture: an alternative to operation at the hiatus. 378 11

Familial dysautonomia (FD) is a rare incurable genetic disorder with multisystem involvement. Most of its clinical manifestations are related to disorders of the autonomic nervous system. The disease is associated with specific disturbances of the upper gastrointestinal tract: pharyngoesophageal dyskinesia, gastroesophageal reflux, and prolonged gastric emptying. About 40% of the dysautonomic children manifest repeat vomiting crises. In view of the extensive gastrointestinal symptomatology, children with FD are prone to repeated aspiration pneumonia and chronic respiratory failure, while inadequate calory and fluid intake may lead to a chronic state of hypovolemia and severe failure to thrive. Control of vomiting, prevention of aspiration due to abnormal swallowing, and the assurance of adequate calory intake are three major objectives in the treatment of the dysautonomic child. Medical treatment of the gastrointestinal disorders using different drugs has had limited success. This study reviews the surgical experience in ten children with FD. The type of the procedure used was determined by the severity of the upper GI disturbances. Nine children underwent gastroesophageal Nissen fundoplication and gastrostomy. In seven of them, a pyloroplasty was added. Gastrostomy alone was done in one patient only. Postoperative complications included transient dysphagia in four patients, gastric dilatation in four patients, and dumping syndrome in one. There has been no incidence of immediate postoperative death. One child died 6 months after operation from severe and irreversible respiratory failure. Following operation, the patients still suffered from dysautonomic crises but these were not associated with vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The surgical management of children with familial dysautonomia. 408 89

Sequelae of vagotomy in peptic ulcer are dysphagia, dumping syndrome, gastric emptying disturbances, diarrhoea, and functional disturbances of liver, bile ducts and pancreas. All these disturbances, except dysphagia, are less pronounced after high selective vagotomy than after surgical procedures including drainage techniques. Relapsing ulcer is the most frequent complication; this is rarely a direct consequence of vagotomy, but it is more likely due to non-complete transection of the nerve or to transections not indicated.
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PMID:[Sequelae of vagotomy in peptic ulcer (author's transl)]. 709 46

The frequency of bariatric surgery has increased markedly in France in recent years, partly due to a better appreciation of the problem of morbid obesity but also due to the commercial introduction of adjustable gastric banding devices which can be placed by laparoscopic approach. Numerous complications of this surgery are known and require recognition to be appropriately treated. Studies of complications suffer from selection bias, methodologic flaws, and lack of follow-up. The incidence and type of complication are affected by the learning curve and surgical techniques. Postoperative mortality varies from 0.14% for laparoscopic gastric banding (LGB), to 0.31% for vertical banded gastroplasty (VBGP) and 0.35% for Roux-en-Y gastric bypass (GBP); pulmonary embolus accounts for 60-70% of deaths in all groups combined. Early post-operative complications vary with specific procedures. Abdominal wall complications, already frequent in an obese population, are decreased from 10% for open procedures to 6% for laparoscopic gastric banding. Both VBGP and GBP are now being done laparoscopically with increasing frequency. Complications specific to LGB include gastric perforation (0.3%), or port problems (5%). Complications with VBGP and GBP include fistula (1-3%), deep abscess, and pulmonary embolus (2%). Global early morbidity is 4.2% for LGB, and varies from 6.4%-22% for VBGP and 6.2%-11.3% for GBP depending on laparoscopic versus open approach. Late mechanical complications are also specific to type of surgery. Pouch dilatation is the most common late complication of LGB (6.3%) and seems related both to operative experience and to site of placement of the band; it has decreased with higher positioning of the band to leave a minimal gastric pouch and with dissection through the pars flaccida of the lesser omentum instead of directly along the muscular wall of the stomach. It usually requires reintervention. Erosion of the gastric band into the stomach (1.6%) is often asymptomatic and is suggested by late weight gain. With VBGP, disruption of a gastric staple line occurs in 12.1% and stenosis of the outlet with proximal dilatation in 6.5%; erosion of the calibrating band of Marlex or silastic occurs in 2.7%. With GBP, the disruption of a staple line across an intact stomach (23%) has become less of a problem with division of the gastric pouch from the distal stomach (2%). Stenosis of the gastrojejunostomy (3.7%) and marginal ulcer (3.5%) are not uncommon. The incidence of wound hernia, obstructive adhesions, and late cholecystectomy vary with the length and thoroughness of follow-up. Late functional complications such as vomiting, dysphagia, heartburn and esophagitis vary with the quality and length of follow-up study. GBP may cause diarrhea and dumping syndrome. Nutritional complications are more common with GPB than with purely restrictive procedures; iron, folate, and Vitamin B12 deficiency are the rule with GBP and require routine replacement therapy; iron deficiency has been noted even with LGB. ate death seems more related to co-morbidities than to the intervention itself. Thorough long-term follow-up study of complications is indispensable for assessment of outcomes and improvement of laparoscopic techniques. Even the less traumatic surgical approach of laparoscopic band placement should not be considered free of risk; strict adherence to pre-operative surgical indications should be maintained.
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PMID:[Surgery for morbid obesity: 2. Complications. Results of a Technologic Evaluation by the ANAES]. 1270 48

The colonic segment is the most frequently used material for replacing the esophagus in children; however, the use of a gastric tube has become a reliable alternative operation. Since 1987, we have used an isoperistaltic gastric tube to replace the esophagus in children, and we present a series of 21 patients. Indications for operation included caustic injury (nine), esophageal atresia (eight), peptic stricture (two), congenital stricture (one), and esophageal duplication (one). There was no death or necrosis of the graft during the early postoperative period. The esophagogastric anastomosis leaked in two cases, but both of them closed spontaneously. A temporary dumping syndrome was encountered in two children. Two patients had strictures of their upper anastomosis responding to dilatations. The two patients who had a pharyngogastric anastomosis developed either intractable stricture or nonfunctioning anastomosis. One of them died 9 months later from aspiration pneumonitis. At follow-up, 16 of 21 patients could accept a normal diet (13 were entirely asymptomatic, and three suffered occasional mild dysphagia). Two patients suffered significant dysphagia (one had a durable dilation of his gastric tube), and three needed a feeding jejunostomy. Acid secretion of the gastric tube was proved in nine cases. Two patients were shown to have cervical Barrett's esophagus above the anastomosis. These findings indicate the need for lifelong endoscopic follow-up for these patients.
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PMID:Esophageal replacement in children by an isoperistaltic gastric tube: a 12-year experience. 1524 76

In children with medically refractory gastroesophageal reflux disease (GERD), fundoplication is effective and safe. However, in a subset of patients, gastrointestinal dysfunction occurs postoperatively. Symptoms include chest pain, persistent dysphagia in 5%, gas bloat in 2% to 4%, diarrhea in up to 20%, and dumping syndrome in up to 30%. Symptoms are often nonspecific, arising from recurrent or persistent GERD, anatomic complications such as disrupted or herniated wrap, functional disturbances such as rapid gastric emptying or altered gastric accommodation, or alternative diagnoses such as cyclic vomiting syndrome or food allergy. Detailed investigation, including various combinations of pHmetry, videofluoroscopy, endoscopy, motility studies, and dumping provocation testing, may be required to clarify pathophysiology and guide management.
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PMID:Gastrointestinal complications of fundoplication. 1591 82


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