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 personal experience of reconstruction in 6 patients with combined pharyngeal and oesophageal corrosive stricture is reported. Oesophagectomy was performed in all patients and reconstruction was with whole stomach in 5 patients. In the sixth patient the stomach was destroyed by corrosive and reconstruction was attempted by colon interposition but this proved unsuccessful. In the 5 patients with pharyngogastrostomy, postoperative recovery was smooth without any instance of anastomotic leakage and swallowing was restored. Recurrent dysphagia occurring in the first two patients was due to construction of too narrow an anastomosis. Recurrent dysphagia did not occur in the subsequent 3 patients in whom a large pharyngogastrostomy anastomosis was established to the posterior pharyngeal wall. Minor tracheal aspiration occurred but even in the 2 patients with associated laryngeal injury, the symptoms subsided once swallowing was restored. Regurgitation was a problem only in one patient who developed gastric stasis; however the symptoms subsided after pyloroplasty. Reconstruction of pharyngo-oesophageal stricture by pharyngogastrostomy restores almost normal swallowing provided that laryngeal function is adequate and a large pharyngogastrostomy is established.
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PMID:The surgical treatment of combined corrosive pharyngeal and oesophageal stricture. 733 75

Records of 226 laryngectomies performed at the University of Minnesota Hospitals and Minneapolis Veterans Administration Hospital from 1967 to 1976 were surveyed, yielding 36 patients with significant dysphagia. The majority of these patients were treated with combined therapy of preoperative radiation followed by surgical intervention. They were evaluated by esophagographic and endoscopic examinations. Among this group of patients, 16 had a benign pharyngeal stricture, 14 had recurrent tumor, two had lower esophageal stricture, and four had malignant esophageal carcinoma. Early detection of recurrent tumor is often difficult in a firm, woody radiated neck. Dysphagia may be the first sign of recurrence preceding obvious detectable recurrent tumors by several months. A barium swallow may show signs of early recurrence that may not be detectable by endoscopic examination. The radiographic evidence of recurrent tumor is described.
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PMID:Dysphagia in laryngectomized patients. 739 99

A personal experience of 4 patients with combined pharyngeal and oesophageal stricture treated by total oesophagectomy with pharyngogastrostomy is reported. Postoperative recovery was smooth without any instance of anastomotic leakage and swallowing was restored. The major complication was recurrent dysphagia in the first 2 patients because of construction of too narrow an anastomosis, aggravated by postoperative scarring. Recurrent dysphagia did not occur during a 1-year follow-up in the subsequent 2 patients in whom a large pharyngogastrostomy anastomosis was established to the posterior pharyngeal wall. Minor tracheal aspiration occurred but even in the 2 patients wit associated laryngeal injury, the symptoms subsided once swallowing was restored. Regurgitation was a problem only in one patient who developed gastric stasis; however, the symptoms subsided after pyloroplasty. Reconstruction of pharyngo-oesophageal stricture by pharyngogastrostomy restores almost normal swallowing provided that laryngeal function is adequate and a large pharyngogastrostomy anastomosis is established.
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PMID:Oesophageal resection with pharyngogastrostomy for corrosive stricture of pharynx and oesophagus. 742 39

The clinical features of abnormal gastroesophageal reflux in infants and children extend beyond repeated vomiting and include dysphagia, pain, bleeding, failure to thrive, esophageal stricture, and recurrent respiratory symptoms including aspiration pneumonitis and cyanotic attacks. The unreliability of the traditional barium swallow examination as a diagnostic test is well known. This study reports the results of endoscopic assessment and esophageal biopsy in 100 infants and children and relates them to the clinical findings and the changes in the contrast esophagogram. The results show that further valuable diagnostic information can be gained from endoscopic examination of the esophageal mucosa, especially when there is esophagitis with ulceration, bleeding, or stricture. Endoscopic biopsies are useful to confirm the presence of esophagitis but biopsies alone do not give absolute diagnostic information.
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PMID:Endoscopy and biopsy in gastroesophageal reflux in infants and children. 743 49

We describe a patient in whom a gastric phytobezoar was regurgitated into the esophagus during an episode of vomiting, giving rise to sudden dysphagia. The bezoar remained impacted for 3 days during which time a sever ulcerative esophagitis due to pressure necrosis and secondary infection developed. Healing has been accompanied by esophageal stricture formation which still necessitates esophageal dilatation at intervals.
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PMID:Esophageal obstruction by phytobezoar. Rare complication of gastric bezoar. 746 Jul 11

There are many options as to the accuracy of a patient's subjective localization of an obstructing esophageal lesion. However, there are few studies specifically examining this issue. Over a 35-month period, all patients evaluated by our gastroenterology service undergoing endoscopy for dysphagia were prospectively identified. The patient's subjective localization for the level of obstruction was evaluated by an investigator blinded to the results of prior barium esophagography and recorded on a schematic of the bony skeleton. At the time of endoscopy, the most proximal level of the obstructing lesion was documented. In all, 139 patients with dysphagia and an esophageal stricture were evaluated. Barium esophagograms were performed prior to endoscopy in all but nine patients (6.5%). The most common lesions causing dysphagia were carcinoma (34.5%), gastroesophageal reflux disease (22.3%), and a Schatzki's ring (15.8%). The level of obstruction was localized exactly in 30 patients (21.6%), within +/- 2 cm in 72 (52%), and within +/- 4 cm in 31 additional patients (74%). Eight patients (15%) with a distal esophageal lesion localized the obstruction to the proximal esophagus, whereas only two patients (5%) with a lesion in the proximal esophagus localized the level of obstruction to the distal esophagus. Overall, patients with distal obstructing lesions were more likely to have referral > 6 cm proximally than proximal lesions with referral to the distal esophagus (P = 0.003). There were no significant differences in accuracy based on the cause of dysphagia. In conclusion, a patient's subjective localization of the level of an esophageal stricture is highly accurate. Patients appear to be most accurate in localizing proximal rather than distal lesions.
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PMID:Localization of an obstructing esophageal lesion. Is the patient accurate? 758 88

We report herein the case of a 60-year-old woman who presented with dysphagia and anorexia and was subsequently diagnosed as having gastric cancer of the reconstructed stomach tube 36 years after undergoing surgery for a benign esophageal stricture. Reports on carcinoma of the reconstructed stomach tube are rarely found and interestingly, all of the previous cases, which were documented only in the Japanese literature, corresponded to metachronous double cancers after esophageal malignancies. To our knowledge, this is the first case of carcinoma of the reconstructed stomach tube following esophageal resection for a benign stricture, and it is thought that the carcinoma probably developed at the site of the anastomosis a long time after the first operation. We reviewed 30 cases of carcinoma of the reconstructed stomach tube for which the clinicopathological data was complete, and we believe that this new type of cancer needs more than 10 years to develop and should be defined as "carcinoma of the gastric remnant".
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PMID:Carcinoma of the reconstructed stomach tube following esophageal resection for a benign stricture: report of a case and review of the literature. 764 Apr 56

Ninety-three adult patients with benign esophageal stricture were randomized to receive balloon or bougie dilatation. Eighty-five patients were eligible for analysis and were followed prospectively for a year. Twenty-four patients required repeat dilatation within a year, but 50 patients completed a year's follow-up without further dilatation. The bougie group initially had a better symptomatic result, experiencing significantly less dysphagia at five months, although this difference had disappeared at one year. Eighteen patients in the balloon group required redilatation for symptoms compared with six in the bougie group. The bougie group had a significantly greater increase in their stricture diameter, and this was still present at one year after dilatation. There was no significant difference in safety or patient acceptability. Balloons are probably more costly to use than bougies. Bougie dilatation is to be preferred to balloon dilatation in adults except in special circumstances.
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PMID:Balloon or bougie for dilatation of benign esophageal stricture? 792 27

In an effort to explore the utility of classic Nissen fundoplication performed laparoscopically, 16 adult patients with well documented gastroesophageal reflux underwent laparoscopic Nissen fundoplication. A full gastric fundal dissection was performed, with division of at least 2 short gastric vessels. The crura were approximated with 1-3 sutures, and a loose fundoplication was performed over an esophageal dilator (minimum 46 F) with three stitches, encompassing the esophageal wall (2.5 cm in length). All patients had symptoms of reflux refractory to medical therapy, and four had an esophageal stricture requiring preoperative dilatation. Fifteen of 16 procedures were completed laparoscopically; one patient required conversion to an open procedure to control bleeding from a posterior gastric vein. There were no other operative complications. The average operative time was 180 minutes (range 120-285). Clear liquids were begun at the passage of flatus (average 2.7 days postop), and patients were discharged an average of 4.1 days postoperatively. Postoperative complications included ileus (1 patient for 6 days), severe subcutaneous emphysema (1 patient), and dysphagia requiring dilatation (5 patients). In short follow-up (mean 4.43 mo., range 1-12 mo.) 14 of 15 patients had complete abolition of reflux symptoms, but one patient with persistent heartburn had reflux demonstrated on a postoperative upper GI series. Thirteen of 16 patients returned to full function within 14 days of surgery. We conclude that standard Nissen fundoplication is possible laparoscopically, and allows a rapid recovery from surgery. However, it is difficult, time consuming, and associated with a significant rate of recurrence in the short term (6%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Initial experience with laparoscopic Nissen fundoplication. 783 76

This report describes a rare case of superficial spreading esophageal carcinoma with a long sclerosis of the esophageal wall and dysphagia. The patient was a 64-year-old male with dysphagia. An esophagogram showed a long sclerosis from the upper-third to the lower-third of the esophagus. An esophagoscopy revealed a small ulcerative tumor (approximately 3 cm in size) at the level of 33 cm from the incisor teeth, and intraepithelial spread, 16 cm in length. However, esophageal stricture was not found in preoperative examinations. Histopathologically, most of the cancerous lesions were mucosal cancers with severe lymphocyte infiltration and the marked thickening of muscularis mucosa. These findings suggest the possibility that the sclerosis of the esophageal wall and esophageal dysfunction may be caused by these pathological changes.
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PMID:[A case of superficial spreading esophageal cancer with a long sclerosis of the esophageal wall and dysphagia]. 783 26


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