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

Foreign bodies of the esophagus in adults may be the result of a food bolus that becomes lodged proximal to a structural abnormality of the distal esophagus. A case of peptic stricture of the esophagus in a patient who presented with acute dysphagia after ingesting an over-the-counter diet pill composed of guar gum is discussed. It is recommended that anorectics composed of dietary fiber should not be used in patients with a history of esophageal stricture.
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PMID:Esophageal obstruction after ingestion of a fiber-containing diet pill. 222 97

Eight patients with esophageal reflux strictures and brachioesophagus were treated by endoscopic dilatation and the Collis-Nissen procedure between 1986 and 1990 at the Institute of Digestive Diseases, Belgrade University Clinical Center. Dilatation of the esophageal stricture was performed by the Eder-Puestow system. All strictures were dilated preoperatively to in average 45 Fr without any complications recorded. The average duration of the Collis-Nissen operation was 3.5 hours and it was hastened by the usage of GIA surgical stapler for construction of the Collis gastroplasty tube. Postoperative course was uneventrful in all eight patients and by dismissal all of them had satisfactory relief of dysphagia and barium esophagogram. Postoperative hospital stay averaged 13.0 days. Satisfactory symptomatic control of gastroesophageal reflux (no symptoms, no treatment) was achieved in 5 patients at a long-term follow-up. Two patients required periodic dilatations and antireflux therapy during the first postoperative year to achieve resolution of the dysphagia and no need for medical therapy. One patient had objective failure of reflux control and progression of stricture formation requiring reoperation. This patient underwent esophagectomy and esophagocoloplasty with a subsequent good result. The combined Collis gastroplasty-Nissen funduplication has become the operation of choice in patients with dilatable reflux stricture and esophageal shortening and a reasonable alternative to a formidable resectional procedures. This report evaluates the first experiences with a Collis-Nissen procedure in our country.
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PMID:[The Collis-Nissen operation in the treatment of reflux due to esophageal stenoses associated with brachioesophagus]. 224 10

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

Plummer-Vinson syndrome (PVS) is characterized by iron deficiency anemia, upper esophageal stricture, cervical dysphagia, and glossitis. The precise role of iron deficiency in PVS has yet to be defined and remains a subject of much debate. A 29-year-old woman with PVS is presented. The patient had a 4-year history of severe iron deficiency anemia, a 2-year history of progressive dysphagia and weight loss, and a greater than 90% benign upper esophageal stricture. Iron therapy alone resolved her dysphagia and anemia, and a follow-up esophagram 1 year later showed a residual stenosis of less than 30%. The development of severe iron deficiency anemia in this patient 2 years before the onset of dysphagia, as well as the response of the stricture to iron repletion, supports the theory that iron deficiency can cause dysphagia and upper esophageal strictures. The occurrence of glossitis, gastritis, and esophagitis in iron deficiency demonstrates the adverse effects of iron depletion on the rapidly proliferating cells of the upper alimentary tract.
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PMID:Importance of iron repletion in the management of Plummer-Vinson syndrome. 229 34

The results of surgery for benign oesophageal stricture in 53 consecutive cases referred to a sub-regional Cardiothoracic Unit are presented. The operations included retrograde dilatation and either total fundoplication or Allison repair, or an oesophageal resection with gastro-oesophageal anastomosis through a trans-thoracic approach. Postoperative fatality was 9%. Most subsequent deaths were due to unrelated acute events with a 5-year survival rate of 62%. Sixty per cent were free from dysphagia and 82% led active and independent lives without support. Surgery offers an alternative to dilatation in elderly patients with oesophageal stricture.
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PMID:Benign oesophageal stricture: the place of surgery in the management of elderly patients. 228 13

A 3 year old child with a tight and angulated stricture at the cervical oesophagogastric anastomosis developed marked dysphagia. Initial attempt at Savary-Gilliard bougienage failed because the bougies tended to coil up in the proximal oesophageal pouch. He was subsequently managed successfully by serial Gruntzig balloon catheter dilatation guided by flexible endoscope, with complete amelioration of dysphagia. The methodology of balloon catheter dilatation is described and its advantages for use in high cervical oesophageal stricture discussed.
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PMID:Gruntzig balloon catheter dilatation of a severe cervical oesophageal stricture. 232 19

With the aim of suggesting incision of peptic esophageal strictures, as an alternative to bougienage, we report the results of the first 20 patients so treated. We included as candidates for this treatment all those patients with moderate or severe dysphagia in whom a stricture of the distal esophagus was confirmed on esophagoscopy that could not be negotiated despite continuous and vigorous pressure with the tip of the fiberscope. On the basis of radiological films, the minimum diameter of the stenotic ring (+/- SD) was 4.4 +/- 2.2 mm, increasing up to 10.05 +/- 1.5 mm once the endoscopic procedure was made. Dysphagia was initially relieved in all the cases. Four patients had recurrence within a few days after the incision. Later, another 4 patients had recurrence. Finally, a further 4 cases were lost by non-compliance. The remaining 8 patients who underwent a 6-months' follow-up did not show a later tendency to re-stenosis. In total, 5 patients were surgically treated for hiatal hernia. One case of emphysema in the mediastinum was noted and treated conservatively. We conclude that endoscopic incision is an alternative to esophageal dilatation as initial treatment for peptic esophageal stricture, despite the fact that a significant number of patients will require additional surgical correction for gastro-esophageal reflux.
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PMID:Endoscopic incision as an alternative to bougienage in the treatment of peptic esophageal stricture. 235 32

An 11 month old child chewed the leaves of a philodendrum plant (Araceae) and developed oropharyngeal erosions and dysphagia. Esophageal erosions of the mid third of the esophagus and on esophageal stricture at the level of the cricoid were diagnosed 16 days post ingestion. Unexpected sudden death on day 17 was attributed to vagotonia secondary to the esophageal lesions caused by philodendron leaves.
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PMID:Philodendron--an infant death. 239 18

Radiotherapy of inoperable esophageal cancer provided palliation for dysphagia in only 40% of the patients treated over the past 5 years at our hospital. The remaining patients were unable to eat a regular diet even after radiotherapy and to provide them with nourishment, a gastrostomy and/or IVH were required. We feel that the release of the patient from a medical environment will lead to a better quality of remaining life. From our experience with a prosthesis tube for palliation of a malignant esophageal stricture, 4 patients showed excellent results with this way of improving their oral intake.
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PMID:[Usefulness of esophageal prosthesis in inoperable esophageal cancer]. 244 Oct 85

Patients with malignant esophageal stricture and dysphagia were prospectively randomized to receive palliative therapy with the bipolar tumor probe (17) or prosthetic tube insertion (13). Both treatments gave good relief of dysphagia compared with pretreatment values on a dysphagia score, the results being statistically significant (p less than 0.005). However, there was no difference in the improvement achieved by one method compared with the other. The tumor probe was not difficult to use and complication rates were comparable. In the Atkinson tube group, two patients developed complications related to the position of the prosthesis and in three others food blocked the tube. Treatment with the tumor probe needed repeating at intervals (median, 28 days; range, 2 to 86 days) in all but four individuals to maintain palliation, with each patient needing a median of two treatments (range, 1 to 8). The probe may have advantages in very high esophageal lesions and may facilitate the treatment of tumor overgrowth or undergrowth of a tube. The prosthetic tube may give long-lasting relief of dysphagia and remains the treatment of choice for bronchopulmonary fistulas.
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PMID:Palliative therapy of malignant esophageal stricture with the bipolar tumor probe and prosthetic tube. 248 Sep 26


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