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

Allgrove syndrome (isolated glucocorticoid deficiency, achalasia and alacrima) was found in eight members of an inbred French Canadian/North American Indian pedigree. The high degree of consanguinity supports an autosomal recessive mode of inheritance for this disorder. Six patients presented with hypoglycaemia and other evidence of cortisol deficiency between 2.5 and 8 years of age; however, two others became cortisol deficient after initial testing showed normal cortisol responses to ACTH, evidence that the glucocorticoid insufficiency of this syndrome may not be congenital, but may develop as late as the third decade. No evidence of mineralocorticoid deficiency has been found during 65 patient-years of follow-up. Alacrima was the earliest and most consistent clinical sign of Allgrove syndrome. Other manifestations of peripheral or autonomic neuropathy were found in four patients. The patients showed similar facial features, and three had significant velo-pharyngeal incompetence. All showed oesophageal dysmotility even in the absence of symptomatic dysphagia. In-vitro studies of lymphocyte ACTH binding showed no differences from normal controls. If such lymphocyte binding, as has been suggested, reflects adrenal ACTH receptor activity, these data would suggest that the glucocorticoid deficiency of Allgrove syndrome is not the result of a defect in that receptor. However, the observation that ACTH does not elicit increased adenylate cyclase activity even in normal lymphocytes casts considerable doubt on the physiological significance of ACTH binding to lymphocytes. It seems likely, therefore, that true ACTH receptors are not expressed on peripheral lymphocytes, and any conclusions regarding a possible receptor defect in Allgrove syndrome must await studies of receptor expression on adrenal cell membranes.
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PMID:Allgrove syndrome: an autosomal recessive syndrome of ACTH insensitivity, achalasia and alacrima. 185 Jun 71

Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs, and with the presence of chest pain. However, no study using current manometric techniques has compared manometric, radiographic, and clinical findings in vigorous and classic achalasia or questioned the usefulness of making this distinction. Fifty-four cases involving patients with achalasia whose radiographic and manometric studies were performed within 6 months of each other were available for review. Patients with vigorous achalasia (n = 17), defined by amplitude greater than or equal to 37 mm Hg, and patients with classic achalasia (n = 37), defined as amplitude less than 37 mm Hg, had substantial overlap in radiographic parameters of esophageal dilation, tortuosity, and tertiary contractions. Manometric properties of repetitive waves and lower esophageal sphincter pressure and clinical aspects of chest pain, dysphagia, heartburn, and satisfactory responses to pneumatic dilation were similar in both forms of achalasia. A separate analysis of patients with mean contraction amplitude greater than 60 mm Hg revealed similar findings. It is concluded that use of amplitude as a criterion for classifying achalasia is arbitrary and of dubious value.
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PMID:Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. 145 95

Between 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.
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PMID:Early and long-term results of pneumatic dilation in the treatment of oesophageal achalasia. 187 77

Unusual problems in oesophageal surgery in childhood include problems seen both frequently and infrequently. The former includes oesophageal atresia, peptic oesophagitis and corrosive oesophagitis; the latter includes such conditions as neonatal rupture of the oesophagus, explosive rupture of the oesophagus, achalasia of the cardia, pharyngo-oesophageal fibromatosis, nasogastric intubation stricture and stricture in the immunologically compromised patient. Examples of all of these conditions have been presented and reference has also been made to a wide variety of other conditions which have been reported in the literature. Because diagnostic delay is relatively common it is important for the paediatric surgeon carefully to evaluate the symptom of dysphagia when it is present and appreciate the fact that although organic disease in childhood is relatively uncommon there are many conditions which demand diagnosis and appropriate treatment.
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PMID:Unusual problems in oesophageal surgery in childhood. 190 83

Esophageal spasm Teschendorf 's syndrome) is rarely distinguished among neuromuscular diseases of the esophagus, which leads to improper treatment. Primary esophageal spasm and secondary esophageal spasm should be distinguished, the latter developing in cardiospasm or achylia of the cardia. Retrosternal pain and dysphagia prevail in the clinical picture of ++esophageal spasm . X-ray and esophagomanometry are the most informative among the objective methods of examination. In a group of 106 patients 49 had primary and 57 had secondary esophageal spasm . A complex of measures should be applied in the management of esophageal spasm+. Primary esophageal spasm is treated only by nonoperative measures (spasmolytics, tranquilizers, vitamins, acupuncture reflex therapy and psychotherapy according to a suggested scheme), a course of pneumocardiodilatation (no more than 5 sessions) is included in the management of secondary esophageal spasm+. Such treatment produced good and satisfactory results in 100% of patients with primary and in 72% of patients with secondary esophagitis. The management of secondary esophagitis is a more difficult problem which calls for further study.
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PMID:[Clinical aspects, diagnosis and treatment of esophageal spasm]. 191 Sep 11

The authors report their experience with 43 patients treated for achalasia of the esophagus in a general hospital between 1971 and 1986. Patients were divided into two groups according to the type of surgery performed: group 1--29 patients treated by Heller myotomy, performed by nine general surgeons between 1971 and 1983; and group 2--14 patients treated by transthoracic Heller myotomy with the addition of a Belsey Mark-IV fundoplication. Dysphagia was reduced postoperatively in 82.6% of patients in group 1 and 92.8% of patients in group 2. Three patients in group 1 and one patient in group 2 had persistent dysphagia. Ten patients in group 1 had symptoms of gastroesophageal reflux (5 of them required a second antireflux procedure). In group 2, one patient had symptoms of gastroesophageal reflux, but was treated successfully medically. There was no difference in the degree of relief of dysphagia between the abdominal and thoracic approach, or in whether the operation was performed by a general surgeon without specific experience in the treatment of achalasia. The addition of a fundoplication to a Heller myotomy appeared to lessen the problem of postoperative gastroesophageal reflux. Since the Heller myotomy is technically difficult and may lead to obstruction of the poorly emptying esophagus the authors recommend that it be used selectively and only by the experienced esophageal surgeon.
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PMID:Surgical treatment of achalasia in a general hospital. 191 96

The effect of achalasia on the diet of patients and their spouses was investigated using a validated questionnaire. The discordance between the diet of the patients and their respective spouses was compared with matched controls. There is no statistically significant difference between the discordance of case couples and control couples. Patients with achalasia, and their spouses, eat a normal diet.
Dysphagia 1991
PMID:Achalasia and diet: assessment of the effect of achalasia on the diet of patients and their spouses. 191 43

The most common surgical treatment for achalasia is a modified anterior extramucosal esophagomyotomy. Unfortunately, a poor outcome may result secondary to recurrent dysphagia or gastroesophageal reflux. The reported incidence of reflux is 4 to 50 per cent. Our treatment for achalasia is an esophagomyotomy carried onto the cardia combined with a partial gastric fundoplication. Of 22 patients who presented with achalasia and moderate to severe symptoms of dysphagia and odynophagia, 19 had this procedure performed. Of these 19 patients, only two required a second procedure (postoperative dilatation) for recurrent symptoms. All three patients who had a full fundoplication required further surgical correction. Although fundoplication has been condemned in the past as treatment of achalasia to avoid the postoperative outcome of reflux, we have been successful with a partial fundoplication added to the standard esophagomyotomy. Given the fine line that needs to be tread to prevent recurrent signs and symptoms of achalasia or reflux when performing esophagomyotomy, our procedure offers a viable alternative to transthoracic esophagomyotomy alone.
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PMID:Transabdominal esophagomyotomy and partial fundoplication for treatment of achalasia. 192 63

In this paper the pharmacodynamic effects of calcium channel blockers (verapamil, nifedipine, diltiazem, fendiline, nitrendipine, nimodipine, and nisoldipine) on esophageal motility in man and their clinical effects in patients with various forms of primary esophageal motility disorders are critically analysed and summarized. The evaluation of efficacy and safety is mainly focused on nifedipine (Bay a 1040, Adalat; CAS 21829-25-4), since it has been best documented clinical pharmacologically and therapeutically in this field. Nifedipine and--with varying potency--the other calcium antagonists reduce effectively the increased lower esophageal sphincter pressure (LESP) and abnormally high and prolonged peristaltic and nonperistaltic contractions in the esophageal body in patients with achalasia, diffuse esophageal spasm (DES), and other disorders which may cause angina-like chest pain and/or dysphagia. Pharmacodynamic effects on esophageal motility are closely correlated with the plasma concentration of nifedipine in healthy volunteers and in patients. However, a final judgement on the therapeutic value of these compounds in esophageal motor abnormalities cannot be given due to conflicting results from clinical studies with fairly small numbers of patients and varying study designs. Among the different calcium antagonists investigated nifedipine represents the best investigated and the most suitable compound for the treatment of primary hypertensive esophageal motor disorders.
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PMID:Clinical efficacy of nifedipine and other calcium antagonists in patients with primary esophageal motor dysfunctions. 193 Mar 46

From 1985 to 1990, 62 patients have undergone pneumatic dilatation with the modified Gruntzig (Levine) dilator in the treatment of achalasia. A single dilatation with a 30-mm balloon dilator was successful in 85% of the patients. Nine patients required additional procedures. One elected for operative surgical repair, and eight patients underwent a second dilatation with a 35-mm balloon dilator. One patient required a third procedure with a 40-mm dilator. Two patients developed dysphagia for solids after pneumatic dilatation, and did not demonstrate delay or obstruction to the passage of technetium on follow up study. We have described this syndrome as dysfunctional dysphagia, and believe that it is related to the rapid ingestion of a food bolus, and is relieved by eating smaller portions at a slower rate. This is to be differentiated from reflux esophagitis and/or stricture secondary to reflux. One patient required bougie dilatation of a stricture, and three other patients were treated with omeprazole, ranitidine, or antacids with relief of reflux symptoms. The safety and efficacy of the procedure of pneumatic dilatation under direct endoscopic control with the modified Gruntzig dilator has been demonstrated in patients from 8 to 93 yr old, and in patients who have had prior Heller myotomy.
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PMID:Pneumatic dilation in patients with achalasia with a modified Gruntzig dilator (Levine) under direct endoscopic control: results after 5 years. 195 Dec 33


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