Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

A 30-yr-old white female with a history of focal dermal hypoplasia (Goltz syndrome), chronic gastroesophageal reflux, and dysphagia was found to have, by barium esophagram and esophagogastroduodenoscopy, multiple 2- to 3-mm papillary projections in the distal esophagus and an esophageal stricture. Biopsy of these lesions revealed squamous papillomas and a benign stricture. Although chronic irritation from gastroesophageal reflux has been suggested as a possible etiology of acquired esophageal papillomas, the previous association of congenital papillomas of the oral mucosa in Goltz syndrome suggests that the multiple papillomas in this patient are congenital in origin.
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PMID:Multiple squamous papillomas of the esophagus associated with Goltz syndrome. 367 98

Of 49 patients with achalasia treated surgically between 1975 and 1985, 12 (8 women, 4 men) had undergone transthoracic esophagomyotomy previously. Four had had concomitant upper gastrointestinal surgery. All 12 patients complained of dysphagia; other symptoms included regurgitation, nocturnal aspiration, heartburn, chest pain, vomiting, upper gastrointestinal bleeding and weight loss. The average time from initial operation to onset of symptoms was 9 months. Preoperative investigations and operative findings identified the cause of dysphagia as inadequate or healed esophagomyotomy with persistent or recurrent achalasia (eight patients--two had partially disrupted fundoplications contributing to their dysphagia), hiatus hernia with reflux esophagitis causing esophageal spasm or peptic esophageal stricture (two patients) and incorrect initial diagnosis and treatment (two patients). Treatment, with the aid of intraoperative manometry, included repeat Heller myotomy (five patients), Hill antireflux repair (four patients), takedown of Nissen fundoplication and extension of myotomy (two patients). The average follow-up was 16 months. Eight patients had good results, two required further operation and one underwent multiple dilatations postoperatively. The causes of recurrent dysphagia following surgery for achalasia are diverse and patients require individualized investigation and treatment. Remedial surgery for achalasia can correct postoperative dysphagia but results are less successful than those following an adequate initial operation.
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PMID:Reoperation after failed esophagomyotomy for achalasia. 370 56

One hundred one patients, 54 with cirrhosis of liver, 31 with noncirrhotic portal fibrosis (NCPF), and 16 with extrahepatic obstruction (EHO), were followed up at monthly intervals for a mean (+/- SD) period of 17.9 +/- 4.8 months after achieving total variceal eradication with endoscopic sclerotherapy. Recurrence of esophageal varices was seen in 19 (18.8%) patients, 12 with cirrhosis and seven with NCPF, within a mean (+/- SD) period of 5.7 +/- 1.6 months. No patient with EHO showed recurrence. Three (2.9%) patients rebled from the recurred varices. Mean (+/- SD) number of sclerotherapy sessions and the amount of absolute alcohol required for eradication of recurred varices were 1.6 +/- 0.8 and 3.6 +/- 1.8 ml, respectively. Dysphagia and esophageal stricture were present in 15 (14.9%) patients with nearly similar frequency in patients with cirrhosis, NCPF, and EHO. Dysphagia in four patients with stricture improved without dilatation. While there were no deaths in patients with NCPF and EHO, 11 patients with cirrhosis died. There was significant (p less than 0.01) improvement in the liver status of surviving patients with cirrhosis after variceal eradication. It can be concluded that variceal recurrence and rebleeding are not major problems after sclerotherapy. Sclerotherapy probably helps in spontaneous improvement of the liver status of surviving cirrhotics and reduces long-term morbidity and mortality of patients with NCPF and EHO.
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PMID:Follow-up of patients after variceal eradication. A comparison of patients with cirrhosis, noncirrhotic portal fibrosis, and extrahepatic obstruction. 372 86

One hundred consecutive patients had a primary Nissen fundoplication for gastroesophageal reflux disease. None of the patients had previous gastric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p less than 0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p less than 0.01). Second, shortening the length of the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p less than 0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p less than 0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.
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PMID:Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. 372 89

A case is reported of a 20-year-old married female who developed esophageal stricture following consumption of potassium permanganate as an abortifacient. The woman was admitted in May 1985 with progressive dysphagia of 4 weeks duration. A week before the onset of symptoms, she was given, by a "village quack", a powder to be taken with sugar for inducing abortion in the 1st trimester of pregnancy. Immediately after consuming about 25 g of this powder, the patient experienced intense pain in the retrosternal area. She vomited repeatedly the whole day and aborted 12 hours later. Soon thereafter, she began to have difficulty in swallowing, which increased progressively over the next month before she came to the hospital for advice. Examination revealed mild dehydration. The oral cavity did not show any ulceration. A barium swallow showed a long, narrow stricture of the esophagus. Endoscopy revealed a mild esophagitis from 20-24 cm, beyond which a long, narrow stricture could be seen. A feeding tube was put in, and 2 weeks later endoscopic dilatation with Eder-Puestow dilators was begun. She underwent 6 sittings of dilatation which led to complete recovery of her symptoms. A followup barium study was not done since the patient had conceived again. A sample of the "powder" which she had consumed was chemically analyzed and found to be potassium permanganate. This case illustrates that potassium permanganate (KMn04) can cause severe chemical burns to the esophagus, which on healing may reult in fibrosis leading to stricture formation.
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PMID:Potassium permanganate induced oesophageal stricture. 380 59

Endoscopic injection sclerotherapy is known to cause a variety of motility abnormalities, but the correlation between these changes and symptomatology has not been clearly defined. To assess the effects of endoscopic sclerosis of varices on esophageal function and symptoms, we prospectively studied esophageal motility in 25 patients undergoing sclerotherapy (group I). Thirteen patients underwent studies before and after sclerosis, and 12 patients were studied after completion of therapy. Acid clearance was studied in five patients (group I). Twenty-four of the 25 patients (group I) completed a course of sclerosis without the development of persistent dysphagia. We found that endoscopic sclerotherapy did not significantly alter the velocity of peristalsis or lower esophageal sphincter pressure, amplitude of contraction, or the duration of contraction. Acid clearance was diminished in three of five patients. Four patients who developed an esophageal stricture following sclerotherapy were studied manometrically (group II). Three of these four patients had a manometric pattern characterized by repetitive, nonperistaltic contractions, and all four patients experienced dysphagia which was relieved by bougienage. We conclude that esophageal motility is generally well preserved following endoscopic injection sclerotherapy and does not result in a long-lasting disturbance of swallowing. Dysphagia and disordered esophageal motility do occur after sclerotherapy when a sufficient fibrotic response has resulted in an esophageal stricture.
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PMID:Esophageal motility and symptoms after endoscopic injection sclerotherapy. 387 Nov 90

The combined Collis gastroplasty-Nissen fundoplication consists of a combination of an esophagus-lengthening Collis gastroplasty with 360 degrees complete Nissen fundoplication operation. This report reviews the clinical and radiographic features of 60 consecutive patients who underwent this operation for the control of symptomatic gastroesophageal reflux. The surgical procedure, the technique of postoperative radiographic examination, normal radiographic anatomy, and abnormalities detectable radiographically are briefly described. All patients were examined on the seventh postoperative day initially with iodinated water-soluble contrast medium followed by barium to establish integrity of the gastroplasty tube, fundoplication wrap, and dilated esophageal stricture. Later in the postoperative period, elective barium esophagrams were prompted by complaints of dysphagia (three patients) and symptoms of gastroesophageal reflux (five patients).
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PMID:The combined Collis gastroplasty-Nissen fundoplication: surgical procedure and radiographic evaluation. 387 91

The authors report their 2-year experience of esophageal endoscopic sclerotherapy for prevention of recurrent variceal bleeding in patients with liver cirrhosis. Sixty-three alcoholic cirrhotics underwent sclerotherapy 10 +/- 6 days (SD) after hospital admission for variceal bleeding. Varices were successfully eradicated in 43 patients (68 p. 100), with an average of 3 injection sessions, over a mean period of 5 weeks. Unsuccessful treatment was due to abbreviated course of treatment because of early rebleeding and early mortality. Early rebleeding episodes after therapy occurred in 19 patients (30 p. 100): 10 in whom the esophageal varices were eradicated, 9 in whom sclerotherapy had failed. Recurrent hemorrhage was the cause of death in 6 patients. After variceal eradication had been achieved, new varices were observed in 7 p. 100 of patients after a mean follow-up of 8 months. The risk of further variceal bleeding was 0.008 hemorrhage/patient/month. Minor complications (thoracic pain, dysphagia, esophageal ulcers, pleural effusion) occurred in 60 p. 100 of patients. An esophageal stricture developed in 13 out of the 43 successfully treated patients (30 p. 100). Major complications occurred in 5 patients and was the cause of death in 4: mediastinitis, esophageal perforation, bronchoesophageal fistulae, cardiogenic shock and aspiration pneumonitis. The survival curve, assessed by cumulative life analysis, showed a 60 p. 100 survival rate after 12 months and 56 p. 100 after 18 months. It was significantly different (p less than 0.001) between groups of cirrhosis classified according to Child-Pugh's criteria (95, 52 and 9 p. 100 at 12 months for groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of 2 years' experience with elective endoscopic sclerotherapy of hemorrhagic esophageal varices in cirrhotic patients]. 387 11

There have been a number of reports on the complications of the Angelchik silicone prosthesis since Angelchik and Cohen first reported the use of the device in 46 patients with gastroesophageal reflux. The exact incidence of complications is difficult to estimate; however, the company estimates 0.81 per cent for migration and 0.15 per cent for erosion of the prosthesis. The purpose of this paper is to review our experience with 13 complications related to the Angelchik prosthesis in eight patients referred to Emory University Hospital. These complications consisted of recurrent reflux esophagitis in six patients, intractable dysphagia in two, esophageal stricture in two, displacement of the prosthesis in two, disruption of the prosthesis in one patient, and gastric erosion in two patients. The management of these complications required removal of the prosthesis and performance of a Nissen fundoplication in six patients. Distal esophagectomy with esophagogastrostomy was performed in one patient, and colon interposition was performed in another patient. In summary, serious complications of the Angelchik prosthesis implanted for gastroesophageal reflux and their management are presented.
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PMID:Complications of the Angelchik prosthesis in the management of gastroesophageal reflux. 395 73

The pathologic reports of all 1,020 esophageal biopsy specimens obtained between 1975 and 1981 in patients with symptoms of gastroesophageal reflux were reviewed. Barrett's esophagus was identified in 84 patients (8 percent). The 362 patients seen between 1980 and 1981 were reviewed in detail. The symptoms in patients with Barrett's esophagus differed from those of the patients without Barrett's esophagus. Dysphagia was more often present in the former group (34 percent versus 16 percent, p less than 0.05) and epigastric distress was less frequent (11 percent versus 27 percent, p less than 0.05). Objective findings of hiatal hernia, esophageal stricture, and esophageal ulcers occurred more commonly in patients with Barrett's esophagus than in those without Barrett's esophagus (70 percent versus 48 percent, 31 percent versus 4 percent, and 14 percent versus 6 percent, respectively, p less than 0.05). Mid esophageal strictures were associated almost exclusively with Barrett's esophagus (five of six patients). At esophagoscopy, erythema was seen more commonly with Barrett's esophagus. The diagnosis was suspected by the endoscopist in only 34 percent of patients subsequently demonstrated histopathologically to have Barrett's esophagus. There was no significant difference in the prevalence of a positive Bernstein test result or gastroesophageal reflux on upper gastrointestinal series in patients with and without Barrett's esophagus. However, a hypotensive lower esophageal sphincter was found more commonly in patients with Barrett's esophagus (100 percent versus 53 percent, p less than 0.05). Thirteen of the 84 patients with Barrett's esophagus (15 percent) had a coexistent adenocarcinoma arising from Barrett's mucosa. These patients, when compared with the patients with Barrett's esophagus without carcinoma, were more often male (77 percent versus 51 percent, p = 0.1), more often had dysphagia (69 percent versus 34 percent, p less than 0.05), and more frequently had a comparatively short duration of symptoms (67 percent versus 36 percent, p less than 0.05). Our findings suggest that patients with Barrett's esophagus have a high risk of development of carcinoma. Because the entity is often not recognized at endoscopy, routine esophageal biopsy should be performed on all patients undergoing esophagoscopy for symptoms of gastroesophageal reflux. Patients with known Barrett's esophagus should be followed closely with repeated endoscopy and biopsy.
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PMID:Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux. 396 36


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