Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty consecutive patients with globus sensation who were referred to a psychosomatic clinic prospectively underwent otolaryngological, videokinematographic, and manometric examinations of pharynx and esophagus to evaluate whether morphological abnormalities or motility disorders underlay their symptom. When indicated by findings, 24-hour pH-metry, scintigraphy of bolus transport, and esophagogastroscopy were performed. Seven patients were shown to have achalasia, 10 had "hypochalasia" (lower esophageal sphincter relaxation less than 75% with esophageal contraction abnormalities but no complete distal aperistalsis), and 1 had diffuse esophageal spasms; 2 patients had also hyperplastic lingual tonsils, 1 had tonsillitis, and 1 had a cervical spondylophyte. Nutcracker esophagus and nonspecific contraction abnormalities were found in 7 patients, and gastroesophageal reflux with esophagitis and a low lower esophageal sphincter resting pressure was found in 1; only 3 patients had normal esophageal motility. None had volunteered dysphagic symptoms at primary evaluation. Psychometric investigations in consenting patients showed no higher mean scores for state and trait anxiety, depression, hysteria, and hypochondriasis than in general medical outpatients. Esophageal motor disorders may, before giving rise to dysphagia, be sensed more vaguely and induce the globus sensation. However, only disappearance of the sensation after treatment allows inferring an etiological significance of such a disorder.
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PMID:High incidence of esophageal motor disorders in consecutive patients with globus sensation. 195 17

Clinical and manometric data from 13 elderly subjects with idiopathic achalasia (mean age 79 +/- 2 years) were compared with findings from younger subjects with the same disease (n = 79) to see if aging altered the presentation and outcome of this motor disorder. Fewer elderly subjects complained of chest pain (27% vs 53%), and the pain was significantly less severe (P less than 0.01). Other presenting features (including sex, duration of symptoms, and presence and severity of dysphagia) did not differ between the groups. Across all patients, age weakly and inversely correlated with residual postdeglutitive lower esophageal sphincter; (LES) pressure (R = -0.34), and residual pressure was significantly lower in the older subjects (8.0 +/- 1.3 mm Hg vs. 11.9 +/- 0.8 mm Hg; P = 0.02). No differences in basal LES pressure or esophageal-body contraction amplitudes were present between the groups. Initial success with pneumatic dilation was similar in the two subject groups, but the number of older subjects available for analysis was too small to draw strong conclusions. These results indicate that aging decreases the elevation of LES residual pressure that occurs with achalasia. As elderly achalasia patients also present with less chest pain, the findings may be interrelated.
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PMID:Achalasia in the elderly. Effects of aging on clinical presentation and outcome. 198 68

Achalasia of the oesophagus is an uncommon neuromuscular disorder characterized by symptoms of dysphagia and regurgitation of undigested food. The results of treatment of 43 patients with achalasia over 10 years are presented. Clinical data on presenting complaints and duration, and all subsequent treatments, were recorded. Patients were contacted to assess their current symptomatic status.
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PMID:Achalasia of the oesophagus: results of treatment. 199 84

Calcium channel blockers have been previously shown to decrease lower esophageal sphincter (LES) pressure and improve symptoms in achalasia. We performed a placebo-controlled, double-blind, crossover study to assess the effects of oral nifedipine and verapamil on LES pressure, amplitude of esophageal body contraction, and clinical symptomatology in eight patients with symptomatic achalasia diagnosed by endoscopy, barium swallow, and manometry. Patients were randomized to receive up to 20 mg nifedipine, 160 mg verapamil, or placebo and underwent esophageal manometry before (baseline) and after four weeks on each drug. Diary cards were kept to record and grade symptoms and drug plasma level determinations were correlated with manometric and clinical findings. Both nifedipine and verapamil caused a statistically significant decrease in mean LES pressure, but only nifedipine caused a significant decrease in the amplitude of contractions of the smooth muscle portion of the esophagus. No statistically significant differences in the overall clinical symptomatology were noted with any of the drugs, although some individual improvements in dysphagia and chest pain were noted. We conclude that, despite the reduction in LES pressure and contraction amplitude of the distal esophageal body, oral nifedipine and verapamil do not significantly alter the clinical symptomatology of patients with achalasia.
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PMID:Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo. 199 57

Fifty-three patients suffering from dysphagia because of suspected esophageal motor disorders were treated by pneumatic dilatation using the Rider-Moeller technique. Fifteen had achalasia demonstrated by manometric studies. Forty-nine of them had remarkable clinical improvement after the procedure. During the mean period of follow-up (average 5 years, range 1-11), 75% of the patients needed a new dilatation, with a delay of two years. The results of the dilatation were excellent or good in 80% of the cases. Early complications consisted in two esophageal perforations surgically treated. There was no mortality. We did not observe late complications of the procedure. We conclude that pneumatic dilatation should be the initial procedure in the treatment of dysphagia in suspected esophageal motor disorders.
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PMID:Management of dysphagia in suspected esophageal motor disorders. 829 13

The results of 124 pneumatic dilatations done in 92 patients with achalasia cardia were assessed. Relief of dysphagia and other symptoms was obtained in 90 (97.8%) patients--in 68 (73.9%) after one dilatation, in 16 (17.8%) after two dilatations and in six (6.5%) after three dilatations. Two patients who did not obtain relief after three sittings of dilatation underwent surgery and both became totally asymptomatic thereafter. Most of the patients successfully treated with pneumatic dilatation remained asymptomatic during a follow up of 6 months--5 years. The few who did become symptomatic (8.01%) within a year after pneumatic dilatation responded well to the same procedure when repeated. Immediate and late complications of pneumatic dilatation occurred in 3.3% and 4.35% of patients respectively and were all medically manageable. In our assessment, pneumatic dilatation is a simple, quick, safe and effective method for treating achalasia. It should be used as the primary mode of treatment and surgery should be offered only to those patients who fail to respond to at least three attempts at pneumatic dilatation.
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PMID:Pneumatic dilatation is a satisfactory first-line treatment for achalasia. 200 4

In a patient with progressive dysphagia, postprandial vomiting, and a history of Alport syndrome, barium and manometric studies had been interpreted as consistent with achalasia, but a subsequent computed tomographic (CT) scan of the thorax was suggestive of a lower esophageal intramural mass. Multiple leiomyomas of the esophagus were later proved at thoracotomy. Differences between adult and pediatric leiomyomas and the association of leiomyomas with Alport syndrome are discussed.
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PMID:Diffuse esophageal leiomyomatosis in a patient with Alport syndrome: CT demonstration. 200 73

Today, esophageal manometry is the diagnostic test that enables one to establish a diagnosis of esophageal motor disorder, to make the correct diagnosis among various forms of esophageal motor dyskinesia and to guide the diagnostician, whether physician or surgeon, in making the proper choice of therapy. Achalasia and diffuse esophageal spasm are two of the better known primitive esophageal motor disorders, in which an investigation into motility makes it possible to reach a diagnosis in physiopathological terms and provides guidance in selecting the appropriate therapy. The surgical indications for these two diseases are indeed conditioned significantly by the pre-operative manometric data. The extension of the extramucous esophageal myotomy is in fact guided by the manometric tracing that precisely defines the anatomic and functional boundaries of the motor disorder. Additional support provided by esophageal manometry occurs when there are indications of repeated surgery after myotomy, whether a cardiomyotomy or a long myotomy. In these cases accurate manometry can in fact clarify the origin of the possible post-operative dysphagia and, therefore, the nature of the possible stenosis, functional or organic. It should therefore be emphasized that, as now universally recognized, it would be rather careless today to confront the chapter of functional esophageal disease without the aid of manometry.
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PMID:[Esophageal manometry as a surgical indication in primary esophageal motility disorders]. 206 78

Two patients were referred because of persistent dysphagia which developed for the first time after Nissen fundoplication. Investigations, including oesophageal manometry, demonstrated the presence of achalasia in one case, confirmed histologically, and aperistaltic oesophagus associated with an underlying connective tissue disorder in the other case. Our observations highlight the importance of assessing oesophageal motility before referring patients for anti-reflux surgery and illustrate the effect of such surgery on patients in whom oesophageal dysmotility was not suspected.
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PMID:Aperistaltic oesophageal disorders unmasked by severe post-fundoplication dysphagia. 208 51

Cricopharyngeal myotomy was performed on 60 patients suffering from cervical oesophageal dysphagia. Of 37 that had a Zenker diverticulum the diverticulum was excised in 24. All patients were free of symptoms on post-operative follow-up at 2-10 years. In 10 patients with a cervical oesophageal web or postcricoid stenosis, the ability to eat normal food was restored. In 7 of 9 patients with neuromuscular diseases affecting swallowing and 2 of 4 patients with cricopharyngeal achalasia, food intake improved after myotomy. Apart from 4 transient palsies of the left recurrent nerve and 2 patients with aspiration pneumonia, no serious complications occurred. Cricopharyngeal myotomy can be a safe and effective method to improve the swallowing and quality of life of patients suffering from cervical oesophageal dysphagia of varied aetiology.
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PMID:Cricopharyngeal myotomy in the treatment of dysphagia. 211 33


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