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

Nonpropulsive esophageal contractions radiologically described as tertiary contractions or "corkscrew" esophagus suggest the presence of an underlying motility disorder and may lead to impaired acid clearance. The goals of this study were to determine the prevalence and role of gastroesophageal reflux (GER) in patients with tertiary contractions. Thirty-five consecutive patients with spontaneous, repetitive, nonpropulsive esophageal contractions noted on esophagography were studied with endoscopy, infusion esophageal manometry, and 24-h ambulatory pH monitoring. All patients had esophageal symptoms, mainly dysphagia, heartburn, and chest pain, but only three were found to have esophagitis by endoscopy and biopsy. Nineteen patients had repetitive, nonlumen-obliterating, nonperistaltic (tertiary) contractions, six had corkscrew esophagus, and 10 had forceful, lumen-obliterating simultaneous contractions (rosary bead esophagus). Twenty patients (58%) had GER by pH criteria with mean values: % time pH less than 4, 40.9; %upright pH less than 4, 41; %supine pH less than 4, 44.3%; number of episodes with greater than 5 min of pH less than 4, 12. Esophageal motility revealed "nutcracker" esophagus in eight, low LESP in two, and nonspecific esophageal motility disorder in 10. Symptoms or severity of nonperistaltic contractions did not correlate with GER. Radiologically demonstrable free reflux or the presence of heartburn did not predict GER. We conclude that 1) GER occurs in up to 58% of patients with nonpropulsive (tertiary) esophageal contractions on esophagography, and may play a role in the induction of abnormal peristaltic activity of the esophageal body; 2) GER is usually not associated with endoscopic evidence of esophagitis or characteristic symptoms, and is recognized by 24-h pH monitoring. We speculate that detection and treatment of GER may improve the symptomatic management of patients with nonpropulsive esophageal contractions.
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PMID:Nonpropulsive esophageal contractions and gastroesophageal reflux. 199 26

Epidermolysis bullosa acquisita (EBA) is a well-characterized, subepidermal blistering disorder associated with autoimmunity to type VII collagen, which is the collagen localized to anchoring fibrils within the dermoepidermal junction of skin. Although the full clinical spectrum of EBA is still being defined, it is known that the clinical features of EBA may be reminiscent of hereditary dystrophic epidermolysis bullosa, a scarring blistering disease of children that is commonly associated with esophageal stenosis. We describe a patient with EBA who had both an acral-predominant mechanobullous disease akin to dystrophic epidermolysis bullosa and an inflammatory, widespread bullous eruption reminiscent of bullous pemphigoid in association with esophageal webs and dysphagia. Although esophageal involvement is common in dystrophic epidermolysis bullosa, a review of the literature shows that this is the first bonafide case of EBA with symptomatic esophageal disease.
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PMID:Epidermolysis bullosa acquisita and associated symptomatic esophageal webs. 199 68

Patients with esophageal motility disorders usually have dysphagia and many also have chest pain similar to angina. The diagnosis is suggested by the clinical presentation, and supporting evidence is often provided by contrast roentgenography. Esophageal manometry is usually necessary to confirm the diagnosis. Conservative therapy using pharmacologic agents is often useful as an initial trial, although many patients who continue to be symptomatic ultimately require surgical intervention.
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PMID:Disorders of esophageal motility. 200 64

Swallowing disorder is an increasing problem in our aging population. A majority of these patients have a functional abnormality of the oral, pharyngeal, and/or esophageal stage of swallowing. However, what constitutes normalcy is not well understood, and baseline swallowing in elderly persons without dysphagia has not been adequately described. We therefore evaluated 56 persons with a mean age of 83 years who had no symptoms of dysphagia or eating difficulty. Videofluoroscopy and radiographs with the subject erect and recumbent were obtained. Normal deglutition, as defined in young persons, was present in only 16%. Oral abnormalities (difficulty ingesting, controlling, and delivering bolus relative to swallowing initiation) were seen in 63%. Pharyngeal dysfunction (bolus retention and lingual propulsion or pharyngeal constrictor paresis) was seen in 25%. Pharyngoesophageal segment abnormalities were observed in 39% (mostly cricopharyngeal muscle dysfunction). Esophageal abnormalities (mostly motor in nature) were observed in 36%. What has been described as swallowing dysfunction in young persons may not be abnormal in very elderly persons. It is difficult to distinguish the effect of normal aging from the effects of specific diseases or gradual degenerative changes.
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PMID:Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. 162 75

Esophageal pH monitoring is recognized as the best diagnostic procedure for gastroesophageal reflux (GER) and operation is seldom recommended in the absence of abnormal pH data. To emphasize that operation should not be ruled out for children who may have false-negative pH studies, we report 14 patients operated on for GER in spite of normal pH-monitoring. The mean age was 54 months (range, 18 to 90). Clinical features included vomiting, dysphagia, respiratory disease, anemia, and torticollis. All had radiologic evidence of GER, and 10 had endoscopic and histological esophagitis. Conventional pH-monitoring values were normal but lower esophageal sphincter pressure and propulsive peristalsis were significantly decreased whereas nonpropulsive contractions were predominant. Operation was recommended after an average of 24 months of unsuccessful medical treatment. Independent postoperative assessment showed that 13 of the 14 patients were relieved of their symptoms and dysphagia persists in one. We suggest that the diagnosis of GER should be accepted on the basis of sound clinical judgement plus more than one abnormal test even when pH results are normal. Operation should not be withheld when clinically indicated. There are several explanations for false-negative pH studies, of which alkaline reflux is probably the most important and warrants further investigation in children.
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PMID:Surgery for gastroesophageal reflux in children with normal pH studies. 206 6

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

A 62-year-old male who complained of dysphagia, body weight loss and hoarseness was admitted to our hospital. Chest x-ray film disclosed right superior mediastinal mass compressing membranous portion of trachea. Esophageal fiberscope revealed carcinoma of cervical esophagus. Bronchofiberscope revealed the paralysis of right recurrent laryngeal nerve and the invasion of esophageal cancer to tracheal membranous portion from the 5th tracheal ring to the 12th. The cancer also invaded the right lobe of thyroid which was shown by echogram. Operation was performed. On dissecting the cervical region, it was found that the tumor invaded both sides of the trachea so that tracheal reconstruction could not be done without injuring left recurrent laryngeal nerve. Sternotomy was added. Anterior mediastinal tracheostomy was done after laryngeal resection with total thoracic esophagectomy and tracheal resection leaving 5 rings long cartilage from carina. The trachea was wrapped with pedicled omentum. Post-operative course was uneventful. This procedure helps to increase blood supply to the tracheal anastomosis and turns to advantage in preventing infectious extension around trachea to mediastinum as well as tracheal compression to major vessels.
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PMID:[A case of carcinoma of the esophagus involving the trachea undergoing anterior mediastinal tracheostomy with pedicled omental wrapping]. 207 83

A 28-year-old female with dysphagia due to the vascular ring (Edwards III B type) was operated successfully. Preoperative chest x-ray film showed a defect of the left first arch and deviation of the lower trachea to the left side. Esophagogram disclosed the upper thoracic esophagus stenotic and deviated left anteriorly. Arch aortogram showed the right aortic arch and aberrant left subclavian artery with the aortic diverticulum. Operation was performed through a left thoracotomy. Esophagus was squeezed by the aortic arch, aortic diverticulum and left ligamentum arteriosum. The left ligamentum arteriosum was divided. Its stump of aortic side was sutured and fixed with paravertebral pleura so that the squeeze by the diverticulum was released. The stenotic esophagus was dissected from surrounding tissue and its satisfactory distensibility was confirmed. Dysphagia disappeared after operation and postoperative esophagogram showed marked improvement of the stenosis. Eleven operated cases of this type of vascular ring in adult have been reported in Japan. Remarkable improvement of dysphagia was observed in all cases. Thus surgical treatment is recommended for cases suffering from severe dysphagia.
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PMID:[An operative case of vascular ring (Edwards III B type)]. 207 89

Esophageal candidosis was found endoscopically in 135 of 496 AIDS patients with upper gastrointestinal symptoms. Vomiting, dysphagia and retrosternal pain were the leading symptoms. Endoscopy showed different stages of esophagitis with Candida patches as early changes up to severe esophagitis with hemorrhage. 36 patients were treated with fluconazole orally or intravenously administered (100 mg per day). In 33 of 36 patients clinical, endoscopic and microbiological results were good with complete cure of the lesions after 7, 14 or 21 days of treatment. In 3 patients with wasting syndrome and severe opportunistic infections a resistance to the drug was discussed because of lack of sufficient therapy results. Maintenance therapy seems to be necessary to prevent relapses.
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PMID:[The therapy of Candida esophagitis in AIDS patients with fluconazole]. 210 62

Esophageal intramural pseudodiverticulosis is a rare condition of yet unknown etiology. Histologic findings of pseudodiverticulosis are characterized by dilated submucosal mucous glands in the esophagus wall. The clinical features including slowly progressive dysphagia mimic those of esophageal carcinoma. The diagnosis is established by radiologic examination, revealing numerous tiny outpouchings of the esophagus wall filled with contrast material. Endoscopic biopsy of the frequently associated stenosis of the upper esophagus is mandatory. Computer tomography shows localized thickening of the esophagus wall. Manometry reveals motoric dysfunction. Etiology and therapeutic management are discussed.
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PMID:[Intramural pseudodiverticulosis of the esophagus]. 210 34


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