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

Symptomatic cytomegalovirus involvement of the gastrointestinal tract has become increasingly recognized in patients with acquired immunodeficiency syndrome. This may take varying forms, often mimicking more well known entities. This is a report of a male intravenous drug abuser with documented acquired immunodeficiency syndrome, who developed dysphagia and evidence of distal esophagitis. Although this was initially thought to be related to reflux peptic disease, he subsequently was documented to have cytomegalovirus esophagitis and gastritis. His course was further complicated by small bowel perforation with cytomegalovirus found here as well. Cytomegalovirus infection, in general, and its increasingly recognized role in the morbidity of patients with acquired immunodeficiency syndrome, is discussed.
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PMID:Cytomegalovirus esophagogastritis in a patient with acquired immunodeficiency syndrome. 298 29

Three hundred four patients have undergone cardiac transplantation at the University of Pittsburgh since 1980. Twenty patients have required 27 upper gastrointestinal (GI) endoscopic procedures. After heart transplantation the primary indications for endoscopy were epigastric pain (six patients with gastritis, one with multiple shallow gastric ulcers, and one with normal test results), mild upper GI bleeding (four patients with esophagitis, two with gastritis, and two with multiple shallow gastric ulcers), dysphagia and odynophagia (two patients with esophagitis), persistent nausea and vomiting (one with normal test results), lower GI bleeding (one with normal test results), and routine follow-up (one with normal test results). After heart-lung transplantation the primary indications for the endoscopy were massive upper GI bleeding (three patients with actively bleeding duodenal ulcers), dysphagia and odynophagia (one patient with esophagitis), mild upper GI bleeding (one patient with gastritis), and routine follow-up (one patient with normal test results). No complications resulted from endoscopy. The procedures were performed in the GI suite without cardiac monitoring. Prophylactic antibiotics were not routinely administered. No patient had a fungal infection of the upper GI tract--a finding attributed to the prophylactic use of nystatin in all patients. Opportunistic viral infections were identified histologically in six patients, including two patients with actively bleeding duodenal ulcers. The possibility of opportunistic viral infections in this immunosuppressed group required aggressive diagnostic techniques, including endoscopy and biopsy, which can be safely performed after cardiac transplantation.
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PMID:Upper gastrointestinal endoscopy after cardiac transplantation. 327 3

One hundred and fifty patients with various rheumatic complaints who were taking nonsteroidal anti-inflammatory drugs (NSAIDs) and required upper gastrointestinal endoscopy were compared with 150 patients, matched for age and sex, who were also referred for gastroscopy but who did not have rheumatic complaints and were not taking these drugs. A comparison was made between the indications for endoscopy and the endoscopic findings in the two groups. Significant differences were found. Fewer patients with rheumatic complaints had normal findings, more had chronic gastric ulcer, duodenal ulcer, gastritis or mucosal erosions. Patients with rheumatic complaints were referred more frequently for anaemia and less frequently for dysphagia or abdominal symptoms. The increased severity of gastric morbidity in patients with rheumatism is probably due to damage caused by NSAIDs. The frequency and severity of upper gastrointestinal lesions in patients with rheumatic complaints taking NSAIDs cannot be estimated from the patient's complaint rate, anaemia rather than pain being the most frequent finding. Upper gastrointestinal tract endoscopy is required to make a definitive diagnosis. This has important implications for the licensing policies of regulatory authorities when considering the licensing of new nonsteroidal anti-inflammatory drugs.
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PMID:Contrasting presentation and findings between patients with rheumatic complaints taking nonsteroidal anti-inflammatory drugs and a general population referred for endoscopy. 348 49

Records of 199 patients were analyzed retrospectively after upper gastrointestinal (UGI) series to assess its impact on patient management. Symptoms most predictive of an abnormal UGI series were dysphagia, UGI hemorrhage, abdominal pain, and chest pain. However, 23% of inpatients with seemingly trivial symptoms had shown abnormal results of the study. Overall sensitivity of the UGI series was 65%, which rose to 82% if esophagitis, gastritis, and abnormalities of the postoperative stomach were excluded. Effects on patient management included: serious pathologic change ruled out (53%), further studies ordered (21%), change of therapy (17%), existing therapy continued (16%), surgery performed (7%), and radiologic abnormality ignored (5%). In no case did the combination of initial screening by UGI series followed by endoscopy as indicated lead to subsequently reported morbidity or mortality due to a failure of diagnosis.
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PMID:Upper gastrointestinal series: patient management and a study of 199 cases. 402 44

Reflux is a common complication in patients who have undergone gastric surgery. These patients have bile reflux, often associated with gastric disease, and are resistant to conservative management. In this study the authors have reviewed 124 patients who were treated surgically for reflux that occurred after gastric operations. They were assessed preoperatively by history, radiologic investigation, manometry with pH and endoscopy. Seventeen patients were treated by Belsey hernia repair, 42 by partial fundoplication gastroplasty and 65 by total fundoplication gastroplasty. Thirty-seven patients required additional gastric surgery. Continued reflux was the commonest problem postoperatively; it was effectively corrected by total fundoplication gastroplasty. Of eight patients who had persistent bile gastritis, four had had bile drainage as part of their operation for reflux. From this study the authors conclude that total fundoplication gastroplasty is the most effective procedure to control reflux, but it must be carefully tailored to avoid overcompetence and dysphagia. Associated gastric problems should be treated simultaneously.
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PMID:Reflux control following gastric surgery. 646 96

Total fundoplication gastroplasty was designed to combine the low anatomic recurrence rate of gastroplasty with the effectiveness of reflux control obtained by total wrap. The problems requiring evaluation are anatomic recurrence, continued reflux, dysphagia, inability to belch or vomit, and gas bloat, all of which have been described in procedures employing a total wrap. Five hundred consecutive patients were analyzed 6 to 60 months following operation. There were no deaths and a 3.6% incidence of short-term operative morbidity. Follow-up was available clinically in 98.4% (495 patients), radiologically in 89.6% (448), and manometrically in 69.5% (347). Two patients have anatomic recurrence (0.4%) and none has reflux. Excellent results occurred in 93.4% (467), improvement in 5% (25), and poor results in 1.6% (eight). Repeat operation was necessary in 0.4% (two) for recurrence and in 0.8% (four) for severe dysphagia. The other problems were minor dysphagia in 2.2% (11), gastritis in 1.2% (six), late cholelithiasis in 0.4% (two), and continued pain with poor results in 0.4% (two). The length of the gastroplasty tube and the subdiaphragmatic position of the high-pressure zone (HPZ) did not affect the result of the operation. A long tube and unwrapped supradiaphragmatic HPZ was present in 18.8% (94); none had reflux or major dysphagia. Total length of the gastroplasty wrap was 3 to 4 cm in the first 200 and the incidence of major dysphagia was 5% (10). Reducing the length of fundoplication to 1.5 to 2 cm reduced the incidence of dysphagia to 1.7% (five). Other problems of gastritis and difficulty with belching and vomiting occurred in a random fashion. This procedure is effective in reflux control, prevents anatomic recurrence and, if the completed fundoplication is maintained at 1.5 to 2 cm, yields a low incidence of significant dysphagia.
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PMID:Total fundoplication gastroplasty. Long-term follow-up in 500 patients. 684 90

Acid corrosive gastritis is infrequently seen. It spares the esophagus and damages the antrum. It causes mucosal ulceration, damages the muscularis and ends in a typical antral stricture. The dynamic perpetuating pathophysiologic events, starting with coagulation necrosis, impose postponement of surgical intervention. Two cases of second degree acid corrosive gastritis are presented. Surgery was performed in both patients, only after dysphagia and vomiting became intractable.
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PMID:Acid corrosive gastritis. A plea for delayed surgical approach. 721 88

The authors reviewed 39 patients in whom bile reflux gastritis and esophagitis were diagnosed and treated. All had epigastric pain not relieved by antacids, 26 had heart burn, 13 dysphagia and 7 hematemesis. On endoscopic examination, all had reflux of bile into the stomach with gastritis, 14 had bile in the esophagus and 21 had esophagitis. Results of biopsy in 15 patients were consistent with gastritis or esophagitis. All but one patient had a history of peptic ulcer disease-gastric or duodenal-and 35 had undergone 48 gastric operationns. Treatment was medical but those refractory to medical management underwent operation. A Roux-en-Y diversion of bile was the most successful operative treatment, benefiting 9 of 12 patients. An adequate length of the efferent limb was found to be important as two patients were not improved until this length was increased to 45 cm. Successful treatment depends on the ability to distinguish this syndrome from recurrent acid peptic disease and esophageal reflux due to sphincteric incompetence.
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PMID:Bile reflux gastritis and esophagitis. 736 84

Esophageal candidiasis, along with gastritis caused by cytomegalovirus--CMV--, is a common opportunistic infection in immunodepressed patients. A clinico-pathological description is made of a human immunodeficiency virus-positive female (group IV-C-2) with a history of odynophagia and dysphagia resistant to treatment. The light microscopy and immunohistochemical study of an endoscopic esophago-gastric biopsy allowed the diagnosis of moniliasic esophagitis associated with CMV-induced gastritis. Emphasis is placed on the efficacy of immunohistochemical techniques over other methods in diagnosing CMV infection.
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PMID:[Candida esophagitis and cytomegalovirus gastritis: optic and immunohistochemical diagnosis in an HIV+ patient]. 772 66

Endoscopic experience in patients with acquired immunodeficiency syndrome (AIDS) has rarely been reported in Taiwan. We present our experience in 9 AIDS patients (8 male and 1 female, age from 26 to 63 years) with 12 examinations. The risk factor of these patients were bisexual in 3, homosexual in 2, hemophilia in 1, drug abuse in 1, and paid-sex in 2. Odynophagia or dysphagia was the major complaints. Oral ulcers or/and thrush were noted in 8 patients. Endoscopic findings included negative (6/12), candidiasis (3/12), erosions (1/12), ulcers (1/12) and ulcer scar (1/12) in esophagus; negative (8/12), gastritis (1/12), erosions (1/12), ulcers (1/12) and Kaposi's sarcoma (1/12) in stomach; and negative (11/12) and duodenitis (1/12) in duodenum. Patients with esophageal candidiasis always had oral thrush. Dysphagia was highly correlated with positive endoscopic findings in esophagus. It is important for an endoscopist to identify clinical symptoms and to examine patient's oral cavity before an endoscopic examination. The endoscopist must keep himself from being infected by exposure to contaminated blood and secretion and avoid dissemination of this horrible disease by undisinfected instruments.
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PMID:Endoscopic examination in patients with acquired immunodeficiency syndrome: Taiwan experience. 840 71


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