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

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
Dysphagia 1993
PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

Esophageal manometry allows to quantify intraluminal pressure changes as the basis of normal or abnormal esophageal motility. It is a complementary diagnostic procedure which should only be performed after endoscopic and fluoroscopic examinations and may be helpful in the detection of various motility disorders like diffuse esophageal spasm, nutcracker esophagus and vigorous achalasia. Manometry is recommendable for therapy control after medical and surgical therapy, and mandatory prior to surgical reflux therapy.
Dysphagia 1993
PMID:The place of esophageal manometry in the diagnosis of dysphagia. 846 32

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

This case report presents a patient with progressive dysphagia, accompanied by weight loss, in the absence of organic disease. Esophageal motility studies initially failed to reveal a diagnosis. At simultaneous manometry and fluoroscopy, with bread/barium boluses, the diagnosis of esophageal spasm in a relatively weak esophagus was made. All conservative treatment modalities failed. Thoracoscopic myotomy resulted in partial field of symptoms. Finally, an esophagectomy was performed because of sever dysphagia accompanied by persisting weight loss.
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PMID:Low-amplitude distal esophageal spasm as a cause of severe dysphagia for solid food. 856 Nov 16

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.
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PMID:Diagnostic imaging in the evaluation of dysphagia. 862 36

The aims of this study were to compare diagnostic accuracy, cost, and patient tolerance of videoesophagography and esophageal transit scintigraphy to esophageal manometry in the evaluation of nonobstructive esophageal dysphagia. Eighty-nine consecutive patients underwent videoesophagography, scintigraphy, and manometry. The sensitivities for diagnosing specific esophageal motility disorders, using esophageal manometry as the standard, were 75% and 68% for videoesophagography and scintigraphy, respectively, with positive predictive accuracies of 96% and 95% for achalasia, 100% and 67% for diffuse esophageal spasm, 100% and 75% for scleroderma, 50% and 67% for isolated LES dysfunction, 57% and 48% for nonspecific esophageal motility disorders, and 70% and 68% for normal esophageal motility. The cost for videoesophagography is less than that for either manometry or scintigraphy. Both videoesophagography and scintigraphy were better tolerated than manometry. It is concluded that videoesophagography and scintigraphy accurately diagnose primary esophageal motility disorders, achalasia, scleroderma, and diffuse esophageal spasm, but are less accurate in distinguishing nonspecific esophageal motility disorders from normal. When considering accuracy, cost, and patient acceptance, these findings suggest that videoesophagography is a useful initial diagnostic study for the evaluation of nonobstructive esophageal dysphagia.
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PMID:Optimal evaluation of patients with nonobstructive esophageal dysphagia. Manometry, scintigraphy, or videoesophagography? 868 12

Diffuse esophageal spasm (DES) is a motor disorder of the esophageal smooth muscle characterized by multiple spontaneous contractions and by swallow-induced contractions that are of simultaneous onset, large amplitude, long duration, and repetitive occurrence. Although the pathogenesis of DES is unknown, provocative studies with cholinergic stimulation, esophageal balloon distention, or acid instillation have suggested involvement of both sensory and motor mechanisms. This report describes a patient with DES who would predictably become symptomatic with dysphagia and chest pain upon inhalation of perfume or other strong odors. Using esophageal scintigraphy to quantitate and analyze esophageal transit in this patient, we report for the first time that olfactory stimulation triggers episodes of DES and that such phenomena are mediated through the vagus nerve, because they can be ameliorated by the administration of ipratropium bromide. These observations suggest a new (sensory) pathway for the induction of DES and raise the intriguing possibility that inhaled anticholinergics may have a therapeutic role in the management of spastic esophageal motility disorders.
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PMID:Olfactory stimuli provoke diffuse esophageal spasm: reversal by ipratropium bromide. 885 54

The purpose of this study was to determine if botulinum toxin injection at the lower esophageal sphincter improves symptoms in patients with nonachalasia spastic esophageal motility disorders. Fifteen patients with nonachalasia spastic esophageal motility disorders (diffuse esophageal spasm, nonspecific esophageal motility disorders, and lower esophageal sphincter dysfunction) unresponsive to medical therapy underwent endoscopic injection of botulinum toxin at the level of the gastroesophageal junction. Symptoms were scored (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe and 4 = very severe) before treatment, at seven days and every 30 days after treatment. There was significant improvement in chest pain, dysphagia, and regurgitation at 7,30,60 and 90 days after treatment. At one month after treatment, 11 of 15 (73%) patients had a good or excellent response to treatment. At the last patient interview (mean follow-up of 10.6 months), five (33%) patients continued to have a good to excellent response, whereas 10 (67%) underwent subsequent treatment with repeat botulinum toxin, pneumatic dilation, or bougienage. We conclude that botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia esophageal motility disorders. These results suggest that botulinum toxin may be an effective treatment option in some of these patients not responsive to conventional medical therapy.
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PMID:Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter. 888 17

Extramucosal myotomy involving the external longitudinal and internal circular layers of the musculature of the esophagus represent the surgical therapy in patients with dysphagia and regurgitation or with angina-like chest pain secondary to functional abnormalities of the musculature of the esophagel body and sphincters. Surgery has a palliative function, because cures symptoms and complication such a diverticula, but not the disease. Modern surgical techniques also prevent recurrence of symptoms and complications are minimal with better long-term results than conservative therapy. Myotomy of the lower esophageal sphincter extended to the distal part of the esophageal body (Heller's operation) is performed as first choice or following insucces of dilatation in patients with primary achalasia of the esophagus, using a trans-abdominal or a trans-thoracic approach. Myotomy of the upper esophageal sphincter is indicated in patients with Zenker's diverticulum following diverticulectomy or diverticulopessy. Segmental myotomies are performed after diverticulectomy in patients with epiphrenic pulsion diverticula. Trans-thoracic "long" esophageal myotomy performed from the thoracic portion of the lower esophageal sphincter to the aortic arch is indicated in patients with diffuse esophageal spasm and nutcracker esophagus and sometimes in patients with aspecific abnormalities of the esophageal motor function associated with diverticula. Circular miotomies limited to the external longitudinal layer of the esophageal musculature can be performed at the level of anastomosis in order to gain tissue and reduce tissutal tension. The recent introduction of the endoscopic surgery allowed some of these operations to be performed through minimally invasive approaches. Therefore laparoscopic and thoracoscopic Heller's myotomy is feasible with clinical and functional results similar to those obtained with traditional open approach and with less postoperative discomfort and shorter hospital stay. This paper deals with the indications and surgical techniques of myotomies of the esophageal body both limited and extended to the lower esophageal sphincter.
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PMID:[Myotomy of the esophageal body]. 894 93

After a wide revision of the Literature, the most frequent causes of failure in the surgical therapy of esophageal achalasia are described. Above all there is the uncorrect execution of the Heller's myotomy as for its upward and downward extension or its deepness. An uncorrect myotomy, in fact, might cause the persistence or relapse of pre-operative symptoms, such as dysphagia and regurgitation. A correct myotomy, according to the authors, should be always carried out with the aid of intraoperative manometry (IEM), which allows the documentation of the alterations caused by surgery in the area of the high pressure zone, which corresponds to the sphincter (LES). A correct myotomy must produce the complete annulment of such a pressure. This technique creates the conditions sufficient to the genesis of gastroesophageal reflux (GER), which is one of the most frequent causes of failure in the surgery of achalasia. In fact, it causes a reflux esophagitis which can quickly evolve into a stricture with the reappearance of dysphagia. It is essential, therefore, to combine always the Heller's procedure with an antireflux procedure, which can protect the esophagus from GER and at the same time does not produce a mechanical obstacle to deglutition. The Authors report their last experience based on 114 primary operations of Heller's myotomy + Nissen fundoplication, performed since 1985 to date. IEM has been always used both for controlling the completeness of the myotomy and for the "calibration" of the Nissen's. Two patients, which had undergone elsewhere a Heller's myotomy alone, have been operated of re-myotomy + Nissen fundoplication. One patient, also operated elsewhere of myotomy of the esophageal body for diffuse esophageal spasm (DES), complained of dysphagia and had manometrical evidence of LES dischalasia; this patient has been reoperated of Heller's myotomy + Nissen fundoplication; another patient suffering from a reflux stricture after a Heller's myotomy without antireflux procedure, has been treated with a Roux esophago-jejunostomy. A last patient operated by Heller's myotomy + Dor fundoplication presented alkaline esophagitis without dysphagia; the treatment consisted in a Roux gastro-jejunostomy + bilateral troncular vagotomy. These data bring to the conclusion that the best treatment of achalasia relapses is their prevention, only obtainable by a good primary therapeutic approach and the routine use of IEM. The IEM avoids incomplete myotomies and inadequate antireflux procedures related to the incompetence (reflux) or hypercompetence (dysphagia recurrence) of the fundoplication.
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PMID:[Failure of surgical treatment for achalasia: diagnosis and treatment]. 894 95


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