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

A total of 61 patients with gastro-oesophageal reflux; resistant to medical therapy, were entered into a prospective randomized trial comparing the Angelchik antireflux prosthesis with Nissen's fundoplication. Both groups had a similar age and sex distribution and their reflux profiles were comparable. An Angelchik prosthesis was inserted in 30 patients and 31 underwent fundoplication. The mean duration of postoperative follow-up was 38 months. At clinical assessment 23 (77 per cent) of the Angelchik group were graded Visick grade I or II, compared with 29 (94 per cent) of the Nissen group. Assessment by 24 h pH monitoring and manometry between 3 and 6 months after operation showed that both procedures were equally effective in reducing reflux and increasing lower oesophageal sphincter pressure. However, long-term endoscopic follow-up revealed grade III oesophagitis in seven patients in the Angelchik group. No patient in the fundoplication group had grade III oesophagitis. Three of eight patients with strictures in the Angelchik group reported persistent dysphagia. All seven patients with strictures in the Nissen group were relieved of their dysphagia. Migration or erosion of the prosthesis did not occur. Three prostheses (10 per cent) were removed, two for dysphagia and one because of sepsis.
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PMID:A prospective randomized trial of angelchik prosthesis versus Nissen fundoplication. 264 16

The authors report their experience of the surgical treatment of gastroesophageal reflux using a circular cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degrees posterior fundoplication. 100 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 6 year period. Symptoms of reflux disappeared immediately in 99% cases, which corresponded to the healing of oesophagitis with 45 out of the 46 patients controlled with endoscopy, and to a significant increase of inferior sphincteric pressure (from 12 cm H20 to 24 cm H20). Objective controls by post prandial pHmetry evidenced persistent reflux with 4 patients, but 3 of them are totally free of symptoms. Operative mortality was 2%. Transient dysphagia was observed in 25% cases. 96 patients were reviewed with a mean follow up of 23 months. 3 clinical recurrence of reflux were observed (4%) but no oesophagitis was found on endoscopic controls with these 3 patients and none had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 96.6% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the esophagus and anchors the antireflux assembly within the positive pressure environment of the abdomen in a strong and flexible way. It seems to be an advisable procedure for the treatment of GE reflux.
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PMID:[Cardiopexy using the umbilical ligament of the liver in the treatment of gastro-esophageal reflux. Results of experience with 100 cases]. 264 75

Symptomatic gastroesophageal reflux is one of the most common complaints encountered by clinicians. The pathogenesis of reflux remains unclear, but multiple factors are involved. Heartburn is the most common clinical manifestation. The history and barium esophagram provide sufficient diagnostic information in most cases. Other studies, including ambulatory pH monitoring, the Bernstein test, endoscopy with biopsy, and esophageal manometry, are warranted if the patient has atypical symptoms, an incomplete response to therapy, dysphagia, or abnormalities on the esophagram. Proper utilization of these studies requires an understanding of the questions each test answers. Reflux disease is often a chronic problem. Many patients can be treated symptomatically by a combination of life-style modifications and use of antacids. Patients who do not respond adequately to these simple measures or who have documented erosive esophagitis usually require further drug therapy.
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PMID:Gastroesophageal reflux disease. Medical aspects. 265 7

The diagnosis of GERD requires the thoughtful evaluation of a patient's symptoms and clinical course. In young patients with classical reflux symptoms in the absence of untoward complications such as structure, bleeding or pulmonary aspiration, antireflux treatment can be instituted without the need for diagnostic testing. A large number of patients will demonstrate a good clinical response to medical therapy. The diagnostic challenge arises when symptoms of reflux masquerade as cardiac and pulmonary disease or do not respond to simple medical treatment. The use of diagnostic testing to determine the presence and quantity of reflux is helpful in establishing the diagnosis in atypical settings. Prolonged pH monitoring offers the opportunity to monitor symptoms in a physiologic setting over a prolonged period and to provide a correlation of symptoms with the presence of reflux. Endoscopic evaluation is most important in evaluating patients with complications such as peptic strictures, hemorrhagic esophagitis, or Barrett's metaplasia. In these situations, important diagnostic and prognostic information as well as therapeutic intervention can be gained through endoscopy. In patients with peptic strictures, palliation can be achieved by endoscopic dilatation. The number of options available for the medical management of reflux disease has increased significantly in recent years. The introduction of effective agents to block acid secretion has provided a significant advance in the medical treatment of gastroesophageal reflux. Prokinetic agents offer an attractive alternative either alone or in combination with acid inhibition. Early results using parietal cell proton-pump blocking agents suggest that they may be effective in the treatment of severe esophagitis previously resistant to medical therapy. Despite significant advances in the medical treatment of GERD, a number of patients (5 to 10 per cent) may require antireflux surgery. The Nissen fundoplication has been shown to be an effective means of attaining mucosal healing usually accompanied by symptomatic relief. The use of a "loose wrap" performed over a large bore dilator avoids the postoperative problems of dysphagia or gas bloat. Despite improvements in our diagnostic and therapeutic armamentarium, a number of patients continue to pose a challenge for the clinician. There remains a clear need for more well-designed, well-controlled studies to assist in the effective treatment of this ubiquitous and often debilitating disease.
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PMID:Detection and treatment of gastroesophageal reflux disease. 266 71

The topic of esophagitis due to Candida (ED), the most frequent infection of the esophagus, is reviewed. In recent years we have seen increased interest in candida esophagitis, fundamentally due to its relation with AIDS, for which it constitutes a diagnostic criteria. Candida esophagitis, although it can appear in apparently healthy subjects, is usually associated with processes that impair the immune system, as well as with local lesions of the esophagus. The typical clinical presentation is as odynophagia, dysphagia and/or retrosternal pain, although asymptomatic forms are frequent, and its association with oropharyngeal candidiasis is variable. Oral endoscopy is the diagnostic technique of choice, since it permits samples to be taken for histologic and cytologic study and cultures; cytology is the most sensitive and specific technique. The differential diagnosis should be made fundamentally with other infectious esophagitis pictures, particularly herpes, and with reflux esophagitis. Treatment is based on antifungal drugs, most frequently nystatin, amphotericin B and ketoconazole.
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PMID:[Esophagitis caused by Candida albicans]. 268 35

Thirty-one patients about to undergo surgery for gastroesophageal reflux were randomized into either a Nissen fundoplication group (12) or a modified Toupet semifundoplication group (19). All patients were followed on a long-term basis for 5 years with a standard questionnaire, endoscopy, and manometry. Ninety-five percent of the patients in the modified Toupet group had good or excellent results versus 67% for the Nissen group. However both procedures are effective in curtailing esophagitis with an improvement of the endoscopic grading in the Nissen group by 91% and 89% in the group undergoing the modified Toupet procedure. A significant improvement in symptoms (acid regurgitation, heartburn, retrosternal pain) was noted in both groups, except for dysphagia in the Nissen group. Three patients with a Nissen fundoplication had a slipped Nissen requiring reoperation and two had gas-bloat syndrome. These specific complications of the Nissen procedure were not found in the modified Toupet group.
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PMID:A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. 268 67

Over a 5-year period 82 patients underwent 244 fibreoptic endoscopic dilatations for oesophageal stricture. A total of 55 patients had benign peptic oesophageal stricture caused by reflux oesophagitis. Two-thirds of these patients had good symptomatic relief with dilatation combined with medical treatment of reflux, whereas one-third had an unsatisfactory result. The practice of endoscopic dilatation in benign stricture proved to be safe and was cost-effective as the procedure was carried out under intravenous sedation on a day-care basis. Three patients underwent dilatation for achalasia with good results in two cases. There were 16 patients with malignant oesophageal stricture and, in this group, fibreoptic endoscopic dilatation had little role to play in relieving dysphagia and its practice was associated with a substantial morbidity and mortality. Dilatation of malignant strictures facilitated biopsy and was used prior to oesophageal intubation. The virtues of the Atkinson or Celestin tube put in with the Nottingham introducer are summarised. Eight patients developed anastomotic stricture after resection of carcinoma of the oesophagus and dilatation provided only very transient relief of dysphagia in this group. Most anastomotic strictures represented recurrent malignancy and the difficulty in gaining biopsy proof endoscopically is emphasised. We advocate the early use of a CT scan in this situation to make the diagnosis of recurrent malignancy so that, if appropriate, palliative treatment can be instituted while the patient's general condition is good enough to benefit from it.
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PMID:A review of the practice of fibreoptic endoscopic dilatation of oesophageal stricture. 270 18

Dysphagia in the absence of organic esophageal stricture may occur in patients with reflux esophagitis. Although the exact mechanism of this "nonobstructive dysphagia" (NOD) is not known, it is believed to be related to transient segmental esophageal motor disorder. The goals of this study were to determine the frequency of NOD in patients with reflux esophagitis and correlate it with esophageal pH and motility changes. Sixty-three consecutive patients with symptoms of esophageal dysfunction were studied with endoscopy, infusion esophageal manometry, and 24-h ambulatory esophageal pH monitoring. Forty-seven had severe erosive esophagitis unresponsive to medical therapy; 16 with esophageal motility disorders were used as symptomatic controls. Twenty-eight of 63 patients studied experienced NOD during the 24-h pH study; 22 had esophagitis and six had esophageal dysmotility without esophagitis. NOD was noted with similar frequency in the two groups; 22/47 (46.8%) of patients with esophagitis and 6/16 (37.5%) with esophageal dysmotility experienced NOD during the period of study. NOD correlated with pH less than 4.0 in 88.6% of patients with esophagitis but in only 7% of patients with esophageal dysmotility (p less than 0.001). There was no difference in acid reflux patterns in esophagitis patients who experienced NOD (22/47), and in those who did not (25/47). There was no correlation between NOD and baseline esophageal motility abnormalities. In summary, 1) NOD is a common, intermittent symptom that occurred in up to 46.8% of esophagitis patients and 37.5% of symptomatic controls during the 24-h period of this study; 2) NOD correlates with esophageal pH less than 4.0 in patients with esophagitis and not in patients with esophageal dysmotility. These data strongly suggest that acid in the distal esophagus frequently triggers the sensation of dysphagia in esophagitis patients, but not in patients with esophageal motility disorders. Combined ambulatory intraesophageal motility and pH monitoring may further elucidate the mechanism of dysphagia in these patients.
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PMID:Nonobstructive dysphagia in reflux esophagitis. 272 32

This report describes a series of 553 flexible upper gastrointestinal (GI) endoscopies performed on 382 children in two surgical centers between 1975 and 1987. Indications included abdominal pain (180), reassessment of known disease (149), upper GI bleeding (99), foreign body ingestion (77), vomiting (14), dysphagia (10), and miscellaneous (24). Findings were chronic peptic ulcer (47), gastritis/duodenitis (63), healing disease (92), nonhealing disease (22), recurrent disease (32), foreign body impaction (22), stricture (9), esophagitis (7), varices (7), mass (6 [3 polyp, 1 lymphoma, 1 fungus ball, 1 inflammation]), normal (209), and miscellaneous (37). Endoscopic diagnosis was uniformly correct except on two occasions, when the presence of recurrent tracheoesophageal fistula in small infants was missed due to use of an inadequate instrument. A pathologic lesion is likely to be identifiable in GI bleeding (84.8%). Endoscopic surveillance for progress of known disease was found to be valuable, particularly in peptic ulcer management, as both incomplete healing after standard therapy as well as recurrence are frequent. The recent practice of routine antral biopsy in children with severe "nonspecific abdominable pain" enabled four cases of Campylobacter pylori colonization in the stomach to be diagnosed, thus allowing appropriate treatment. Endoscopy was therapeutic on 61 occasions: injection sclerotherapy (32), foreign body removal (20), polypectomy (3), and stricture dilatation (6). Endoscopy-guided bougienage, in particular, represents a recent major advance. There was no morbidity or mortality in the entire series. It is concluded that pediatric upper GI endoscopy performed by experienced surgeons is safe and effective. As a result of better understanding and technological advances, a changing trend of wider and more rational applications of the procedure is now evident.
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PMID:Pediatric upper gastrointestinal endoscopy: a 13-year experience. 273 8

Gastroenteric changes in patients suffering from connectivitis observed consecutively between 1977 and 1986 have been examined: of the 24 patients (20 f, 4 m) aged between 13 and 76 yrs observed, 12 suffered from rheumatoid arthritis, 8 systemic lupus erythematosus, 2 sclerodermia, 2 mixed connectivitis. 14 reported gastroenteric disturbances, particularly dyspepsia, rarely dysphagia, diarrhoea, melena. Gastroenteric lesions, gastroesophageal reflux, erosive oesophagitis, oesophageal diverticulum, congestive gastritis, duodenitis, duodenal ulcer, diverticular colonopathy were observed, confirming the frequency of gastroenteric changes in connectivitis.
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PMID:[Connectivitis and diseases of the digestive system]. 276 49


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