Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The combined Collis-Nissen operation has been performed in 353 patients. Forty-five percent had reflux esophagitis without stricture; 20%, peptic stricture; 72%, a sliding hiatal hernia; 17%, a paraesophageal hernia; 21%, previous antireflux operation; 15%, esophageal spasm; 8%, scleroderma; and 32%, marked obesity. There were 4 postoperative deaths (mortality rate, 1.1%). Complications occurred in 28 patients (8%) and included wound infection (2.2%), esophageal or gastroplasty tube leak (1.7%), bleeding (1.1%), splenic injury, gastric atony, and crural repair dehiscence (each less than 1%). Follow-up includes personal interview, esophageal manometry, and standard acid reflux testing. The average length of follow-up for 261 patients (74%) followed at least 12 months is 43.8 months. Fifty-eight percent have been followed at least 36 months; 41%, 48 months; and 29%, 60 months or longer. Subjectively, in these 261 patients, reflux has been eliminated in 75%, is mild in 11%, is moderate in 9%, and is severe in 5%. Eight percent have postthoracotomy pain; 3%, early satiety ("bloats"); and 1%, postvagotomy diarrhea. Seventeen percent require either periodic or regular esophageal dilations for dysphagia. Objectively, intraesophageal pH studies show good reflux control in 91% and poor reflux control in 9%. Twenty-six patients (10%) have required reoperation for recurrent reflux or dysphagia. These results substantiate satisfactory reflux control using the Collis-Nissen operation in patients at risk for recurrence after standard repairs, but also emphasize that, like other antireflux procedures, the Collis-Nissen operation is not without some degree of postoperative adverse symptoms.
 ...
PMID:Continued assessment of the combined Collis-Nissen operation. 291 6

Twenty patients with scleroderma of the esophagus were treated with esophageal dilation, an anti-reflux procedure, or colon interposition over a 12-year period. Antireflux procedures consisted of the following: six Belsey Mark IV, two Collis-Belsey, three Nissen, and one Collis-Nissen. Reflux esophagitis recurred in all patients at an average of 4 years postoperatively. Esophageal strictures were severe in 3 patients and necessitated partial esophagectomy and short-segment colon interposition. These patients had been on a regimen of long-standing high-dose steroid therapy, and none showed any wound healing problems or postoperative leaks. There was 1 death, which occurred fifteen days postoperatively as a result of pulmonary complications. Control of reflux and dysphagia can be achieved with antireflux procedures, but in our experience, all will ultimately fail in time. We believe esophageal replacement should be considered as the initial step in treatment of strictures of the esophagus in patients with scleroderma.
 ...
PMID:Surgery for scleroderma of the esophagus: a 12-year experience. 319 Mar 23

We studied 14 patients with PSS, 12 females and 2 males with a mean age of 43.6 and a medium of 8 years disease. All of the patients were selected for this study according to updated ARA criteria and were included in a prospective protocol to investigate digestive involvement. This protocol consists of a complete medical history, physical examination, radiologic and endoscopic studies, parasitological and microbial flora investigation. The symptoms more frequently seen were: pyrosis (78%), gastroesophageal regurgitation (50%), flatulence (50%), dysphagia (42%) and chronic diarrhea (21%). The radiologic findings commonly seen were: distal esophageal aperistalsis (78%), gastroesophageal reflux (57%), dilatation of intestinal loops (35%), changes of the mucosal folds (35%). A mild esophagitis was seen endoscopically in 64% of the patients, moderate and severe in 7% respectively. The study of the microbial flora showed contaminations with enterobacteria in 5 patients (35%). After statistical analysis we concluded that the digestive compromise by PSS is frequent, being the esophagus more commonly affected (80%), at the beginning in the form of reflux esophagitis and later in esophageal stenosis, the compromise of the small intestine (40%) is manifested by chronic diarrhea or dyspeptic flatulence, which correlates well the radiologic findings and the bacterial overgrowth in this organ. The colonic compromise generally is asymptomatic, and the common finding is dilatation os the colonic loops. Finally, the bacterial overgrowth in the small intestine is a secondary involvement to the intestinal compromise of Progressive Systemic Sclerosis.
 ...
PMID:[Digestive involvement in progressive systemic sclerosis]. 322 28

A follow-up study of 35 patients was performed 1.5 to 22 years after simple closure and drainage of the esophagus for nonmalignant intrathoracic perforation or rupture, with special attention to dysphagia. Of the seven patients with spontaneous rupture, only one required supplementary postoperative treatment, for severe reflux esophagitis. None of the eight patients with iatrogenic lesion and no prior esophageal disorder had any dysphagia postoperatively. Postoperative swallowing problems were absent in 13 of the 20 patients with perforation caused by examination or treatment of an already diseased esophagus. Four required repeated esophageal dilation and three underwent further surgery. Simple closure and drainage of nonmalignant intrathoracic perforation or rupture of the esophagus is concluded to be a safe procedure in regard to late postoperative dysphagia.
 ...
PMID:Long-term observation following perforation and rupture of the esophagus. 338 55

The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 +/- 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 +/- 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo-columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo-columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.
 ...
PMID:Barrett's esophagus: clinical, endoscopic, and histologic spectrum in fifty patients. 346 72

In the past 18 years the Nissen fundoplication has undergone a few modifications and changes in our institution and all over the world. The aim of this study is to review the long-term (up to 20 years) results of Nissen fundoplication in 350 patients and to evaluate the effect of major modifications in the technique of fundoplication in these patients. Three hundred fifty patients with symptomatic chronic reflux esophagitis have been treated with Nissen fundoplication in our institution since 1966. They were divided into four groups: patients who had a long, tight fundoplication; patients who had a short, floppy fundoplication; patients with crural approximation; and patients without crural approximation. The preoperative and postoperative findings of these patients were evaluated in each group. Group 1 had more immediate and long-term dysphagia compared with group 2. Also, "gas bloat" syndrome was more prevalent in group 1 than group 2. The location of Nissen fundoplication (chest or abdomen) or the addition of hiatal hernia repair did not change the outcome. In patients with intact Nissen fundoplications, their esophagitis healed, and their symptoms disappeared. The rate of recurrence of symptoms was 5%. Recurrence of symptoms was associated with disruption of the fundoplication, which usually happened within the first two years after operation.
 ...
PMID:Long-term follow-up for treatment of complicated chronic reflux esophagitis. 357 65

Healing of stenosing peptic esophagitis was proved by endoscopy and biopsy in 22 of 27 patients treated by transthoracic Nissen fundoplication and esophageal dilation during a follow-up period extending to 14 years. Four additional patients did not have follow-up endoscopy because three expired from intercurrent disease before endoscopy could be carried out and one refused to have the procedure because of lack of symptoms. Postoperative reflux has not been demonstrated in any patient either endoscopically or by contrast studies. Dysphagia, requiring repeat dilation, occurred in two patients after operation. Transthoracic fundoplication with intraoperative stricture dilation is a reasonable alternative in treating complicated esophagitis.
 ...
PMID:The surgical treatment of complicated peptic esophagitis. 363 61

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.
 ...
PMID:Reoperation after failed esophagomyotomy for achalasia. 370 56

Ulcerative peptic esophagitis may lead to the progressive replacement of squamous by columnar epithelium in the distal esophagus. A typical peptic ulcer (Barrett's ulcer) may develop in the columnar-lined segment, although this is a rare occurrence. Between 1975 and 1985 at Toronto General Hospital we treated 11 patients with penetrating peptic ulcer and acquired, columnar-lined esophagus. Presenting symptoms related to the ulcer were precordial and lower dorsal back pain in 4 patients, dysphagia in 6, and massive hemorrhage of the upper gastrointestinal tract in 4. None of the ulcers healed following a trial of medical therapy, and ultimately all 11 patients underwent antireflux procedures (gastroplasty and partial fundoplication). There was one operative death. Complete healing of the ulcer was observed in the 8 patients who underwent follow-up endoscopy between two and five months after operation. There has been no recurrence of symptoms resulting from ulcer in subsequent follow-up, which extends from 1 to 11 years (mean, 5 years). Adenocarcinoma developed in the columnar-lined segment in 2 of the 11 patients, which was diagnosed at 32 and 91 months following operation, respectively.
 ...
PMID:Peptic ulcer in acquired columnar-lined esophagus: results of surgical treatment. 382 68

The role of gastroesophageal reflux (GER) and reflux esophagitis in the pathogenesis of gastrointestinal hemorrhage was assessed in 13 male patients with chronic paralysis or neurologic impairment. Nine of the 13 patients initially presented for barium meal examination to evaluate anemia, hematemesis, heme-positive stools, or melena. Six of the 9 had radiographic evidence, confirmed by upper gastrointestinal (GI) endoscopy, of esophagitis with or without stricture without other upper GI tract lesions. Notably absent were antecedent symptoms of GER such as heartburn or dysphagia. Careful examination of the esophagus, although difficult, must be an integral part of the evaluation for anemia and/or gastrointestinal blood loss in paralyzed patients.
 ...
PMID:Gastrointestinal hemorrhage in paralyzed and neurologically impaired patients: contribution of reflux esophageal disease. 387 14


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>