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)

Between October 1980 and December 1985, 50 patients with esophageal cancer were treated with combined radiotherapy and chemotherapy (5-fluorouracil [5-FU] and mitomycin C). Thirty patients with stage I or II disease received definitive treatment consisting of 6,000 cGy in 6 to 7 weeks and 5-FU (1,000 mg/m2/24 h) as a continuous intravenous (IV) infusion for 96 hours, starting on days 2 and 29. Mitomycin C (10 mg/m2) was administered as a bolus injection on day 2. Twenty patients received palliative treatment (5,000 cGy plus chemotherapy) for stage III or IV disease (extraesophageal spread or distant metastases). All patients treated in this program had an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2. Of the 30 definitively treated patients, 23 had squamous cell cancer, while seven had adenocarcinoma. Follow-up ranged from 6 months to 63 months. The complete response rate at 1 to 3 months following completion of treatment was 87% (26 of 30) documented by barium swallow and endoscopy (+/- biopsy). The actuarially determined local relapse-free rate at 1 year and beyond was 73%, and the actuarial survivals at 1, 2, and 5 years were 68%, 47%, and 32%, respectively. Of the 20 palliatively treated patients, ten had squamous cell carcinoma, eight had adenocarcinoma, and two had undifferentiated carcinoma. Seventeen patients were evaluable for freedom from dysphagia 1 or more months following completion of treatment. Eighty-two percent of evaluable patients (14 of 17) had no dysphagia posttreatment, while 64% (11 of 17) remained free of dysphagia until death or last follow-up, emphasizing the significant local control of those patients. The median survival for this group was 8 months. Treatment was well tolerated, and acute toxicity included esophagitis, stomatitis, oral candidiasis, and hematologic toxicities of thrombocytopenia and neutropenia. Late toxicities were predominantly manifested as a mild to moderate benign stricture, which required dilatation in four patients. One patient developed a perforation into the mediastinum in the absence of tumor, while two patients with persistent local disease developed tracheoesophageal fistula, and radiation pneumonitis was observed in two patients. This combination of radiation therapy with infusional 5-FU and mitomycin C is an effective and relatively well-tolerated regimen in the treatment of esophageal cancer. Surgical resection may not be necessary when high-dose radiation and chemotherapy are used.
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PMID:Nonsurgical management of esophageal cancer: report of a study of combined radiotherapy and chemotherapy. 244 31

We studied 85 patients with esophageal symptoms of a motor abnormality in whom esophagitis, achalasia or other organic lesions were ruled out by endoscopy. Main symptoms were dysphagia and severe retrosternal pain. Cardiac origin of the pain was ruled out by clinical and EKG evaluation in 72% of patients. Mean age was 43 years and female to male ratio was 3:1. Manometric study, performed in all patients, revealed diffuse spasm in 42, hypertensive sphincter in 16, nutcraker esophagus in 11 and nonspecific motor abnormalities in 16 patients. Only manometric studies can identify these esophageal disturbances. These studies should be performed in patients with non cardiac retrosternal pain.
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PMID:[Primary motor disorders of the non-achalasic esophagus: a manometric analysis]. 248 21

A patient with acquired immune deficiency syndrome (AIDS) who presented with dysphagia is described. Barium swallow demonstrated diffuse esophagitis with longitudinal ulceration and sinus tracts to the mediastinum. Mycobacteria were seen on esophageal biopsies and Mycobacterium tuberculosis was cultured from a pleural effusion. Mycobacterial esophagitis should be considered in the differential diagnosis of esophagitis in AIDS, particularly when sinus tracts are demonstrated.
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PMID:Mycobacterial esophagitis in AIDS. 249 1

The incidence and nature of acute secondary irradiation esophagitis was studied in a series of 38 patients undergoing 60Co teletherapy for carcinoma of the lung. Thirty-four patients were male and four female, with ages ranging from 38 to 78 years. The mediastinum being irradiated in the process, all the patients underwent endoscopy for signs of esophagitis and/or gastritis after a dose of 30-40 Gy was delivered to the esophagus. Eighteen patients complained of dysphagia, but only in 12 of them did endoscopy show esophagitis. Of the remaining patients without complaints five had endoscopic signs of esophagitis. Gastritis was found in 18 cases and confirmed histologically in 14. In 17 cases, esophagitis and/or gastritis were confirmed histologically. It is believed that there is a fairly close correlation among clinical, endoscopic, and histological findings to support the claim that esophagitis in these patients is radiation induced. However, the cause of gastritis is not well understood. Data in the literature suggest that nonsteroid anti-inflammatory agents can act as prophylactic means of preventing radiation esophagitis.
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PMID:Acute secondary effects in the esophagus in patients undergoing radiotherapy for carcinoma of the lung. 253 15

In a prospective study of 154 AIDS patients, 48 (31%) complained of pain on swallowing both liquids and solids and 32 (21%) of these also had dysphagia. While candidiasis was the most common cause of symptoms (26 patients), discrete ulceration of the oesophagus occurred in 12 instances in 10 patients (four cytomegalovirus, four herpes simplex virus, three aphthous ulcer, one peptic ulcer). One patient had a diffuse oesophagitis caused by Mycobacterium avium intracellulare. No cause was found for the oesophageal symptoms in four patients. Kaposi's sarcoma (KS) was found in seven patients associated with other pathology in four. All 26 patients with oesophageal candidiasis only, also had oral involvement. All the patients with herpes simplex virus (four) and aphthous ulcers (three) had obvious perioral involvement. Three of the four patients with cytomegalovirus ulceration had evidence of disease elsewhere (colon or retina). All patients with Kaposi's sarcoma lesions had skin and buccal cavity involvement. The cause of oesophageal disease was usually obvious at endoscopy. The appearance of candidiasis was typical and the various ulcerating lesions also had different macroscopic configurations. Cytomegalovirus infection produced deep linear ulcers in the distal oesophagus, herpes simplex oesophagitis is similar in appearance to the typical perioral lesions of fluid filled vesicles. Diagnostic radiology was not helpful in most patients. In nine of 17 patients with candidiasis, the barium swallow examination performed within 24 hours of presentation was normal. In only three of seven patients with oesophageal ulceration (three cytomegalovirus, two herpes simplex virus, one aphthous, one peptic) was there evidence of an abnormality. Treatment produces symptomatic relief. All patients with candidiasis responded to ketoconazole, the four with herpes simplex virus to acyclovir and one of three with aphthous ulceration had a dramatic response to thalidomide. The three patients with cytomegalovirus infection who were treated with foscarnet had a prolonged remission of symptoms. The overall prognosis of patients with oesophageal symptoms is poor, with an average survival time from a definitive diagnosis of five months (range one to 13).
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PMID:Oesophageal symptoms, their causes, treatment, and prognosis in patients with the acquired immunodeficiency syndrome. 254 33

Eleven Human Immunodeficiency Virus 1 (HIV1)-infected patients (10 male, 1 female; age 23-51 years (median 36); 10 male homosexuals, 1 IV drug abuser; WR3 1 patient, WR5 5, WR6 5) with intestinal Cytomegalovirus (CMV)-manifestations were compared with a group of 78 HIV1-infected patients in respect to their clinical, immunological and virus-serological data and the results of the histological and microbiological examination of endoscopically obtained biopsies. No differences were observed on age, sex, risk of infection, stage and immunological status. Bloody diarrhea was most important in discriminating CMV-colitis and non-CMV-related intestinal manifestations. Dysphagia and other symptoms occurring in patients with CMV-esophagitis were not able to predict CMV-esophagitis specifically. 6 of 11 patients with serological findings consistent with an active CMV-infection had no detectable CMV-manifestations; 6 of 11 patients with intestinal CMV-manifestations did not show serological findings suggestive of active CMV-infection. Ulcerative alternations of intestinal mucosa represent the most powerful indicator of intestinal CMV-disease in endoscopical examination. Only in two patients, ulcerative alterations were seen without diagnosis of CMV-disease being established. CMV was isolated in one of 11 patients, in two patients CMV was isolated from biopsies of unchanged mucosa. Simultaneous infection by HSV and CMV was detected in three patients, in one patient in the same localisation. Histology revealed inclusion bodies in 8 of 11 patients with intestinal CMV-disease, in no case inclusion bodies were seen without CMV-disease.
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PMID:[Diagnosis and clinical aspects of gastrointestinal cytomegalovirus diseases in patients with human immunodeficiency virus 1 infection]. 255 29

Gastro-oesophageal reflux occurs when the pressure barrier of the lower oesophageal sphincter (LOS) fails due to a low basal pressure (less than or equal to 6 mm Hg), sphincteric relaxations or a noncompensated increase in intragastric pressure. This reflux becomes pathological when it leads to symptoms severe enough for the patient to seek medical help or results in reflux oesophagitis or its complications. Damage to the oesophageal mucosa develops when the balance between aggressive and defensive factors is no longer in equilibrium. The main aggressive factor is acid-pepsin or alkaline bile secretion. Defence against this aggression is based on rapid removal of the refluxate from the oesophagus (oesophageal clearance) and on poorly understood mucosal resistance. The length of time acid is in contact with the oesophageal mucosa is shortened by adoption of an upright position, by swallow-induced oesophageal peristalsis and saliva. Treatment of pathological reflux aims (1) to decrease acid aggression by means of H2-receptor antagonists or proton pump inhibitors; (2) to strengthen the anti-reflux barrier and improve oesophageal clearance by prokinetic drugs that increase the LOS pressure and enhance peristaltic contractions; and (3) to boost mucosal resistance by sucralfate or prostaglandin analogues. Initial treatment of gastro-oesophageal reflux disease may be symptomatic provided that there are no alarming symptoms, such as dysphagia, anaemia or weight loss. Usually either H2-receptor blockers or prokinetic drugs are used. Endoscopy is indicated whenever alarming symptoms are present and when there is insufficient symptomatic improvement after a 4-6-week therapeutic trial. Moderate oesophagitis may be treated in the same way.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology and treatment of gastro-oesophageal reflux disease. 257 7

Between 1976-1987, 408 patients were studied for Reflux Esophagitis. Clinical, endoscopic, manometric characteristic were analyzed, and scintigraphic studies for gastroesophageal and duodenogastric reflux were done. Esophagitis was classified according endoscopic findings in Esophagitis grade I (non confluent erosion), grade II (confluent erosions), grade III ("uncomplicated Barrett syndrome") and grade IV (esophageal ulcer or stricture ("complicated Barrett syndrome"). Fifty six (56) patients with mild (grade I), 52 with moderate (grade II) and 146 patients with severe esophagitis (56 grade III, and 90 grade IV) were included in this protocol. No significative differences were found in clinical feature except dysphagia and bleeding, symptoms more frequent in severe esophagitis than mild or moderate grades. Lower esophageal sphincter pressure was similar in both groups of patients, but the frequency of motor disorders was significative higher in severe esophagitis. Scintigraphic gastroesophageal reflux was positive in all patients and no differences in gastric emptying and duodenogastric reflux were detected. In conclusion, the differences in subjective and objective analysis between different grade of esophagitis suggest to employ different models of management.
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PMID:[Clinical and laboratory correlation of severe esophagitis compared to mild or moderate esophagitis]. 260 19

Thirty-one cases of pivmecillinam-associated oesophagitis or ulceration verified at endoscopy have been reported in Sweden between 1978 and 1987. There were 29 women and two men of average age 30 years (range 15-77 years). Dysphagia and retrosternal pain often developed within the first days of treatment and resolved without complications within days of stopping treatment. Based on sales and prescription data, this complication appears to be rare, with 25-36 reported cases per million treatment courses. Further galenical development of the tablets and better patient information should reduce the number of patients injured.
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PMID:Oesophageal injury associated with pivmecillinam tablets. 261 57

Gastric transplants using the Akiyama method were used to treat esophageal carcinoma in 12 patients. Endoscopic examination, prolonged manometry (greater than 30 min), and 24 h pH monitoring were performed postoperatively to evaluate functional results. All patients could swallow without difficulty at the time of examination and had no dysphagia, regurgitation, heartburn, or sensation of abdominal fullness. Histologic examinations of residual esophagus showed microscopic esophagitis in 5 patients. Percentage of time that pH less than 4 was 42.6 +/- 10.9% (mean +/- SEM) and median pH was 4.3 +/- 1.0. The manometric examination showed no 'esophageal-like' peristaltic waves, but synchronous contractions were demonstrated in 9 patients, gastric type activity in two patients, and no activity was detected in one patient. We conclude that retained gastric peristaltic function is not a prerequisite for a good clinical outcome for swallowing and that despite vagotomy, the stomach continues to produce enough acid to maintain an acidic pH.
Dysphagia 1989
PMID:Functional evaluation of gastric transplants used in esophageal reconstruction. 264 Jan 79


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