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

Fifty-three patients with scleroderma were evaluated by history, barium swallow, and esophageal function tests. The most common esophageal symptoms were heartburn and dysphagia. Abnormal motility was seen radiologically in 43 patients, gastroesophageal reflux in only 9. Esophageal function tests demonstrated: (1) abnormal motility in 51 patients and lack of a distal esophageal high-pressure zone in 18; (2) moderate to severe gastroesophageal reflux in 38; and (3) abnormal acid-clearing ability in 50. Eleven patients, including 8 with peptic stricture, underwent the combined Collis-Belsey operation. Symptomatically, reflux was abolished in all and dysphagia in 10. Roentgenograms showed that regression of strictures was complete in 5 and partial in 3. Postoperative esophageal function tests in 9 patients demonstrated a competent distal esophageal valvular mechanism in 7. Gastroesophageal reflux, not impaired motility, is the major cause of esophageal symptoms in scleroderma. Its effecitve operative control is not contraindicated by systemic disease in these patients.
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PMID:Gastroesophageal reflux in esophageal scleroderma: diagnosis and implications. 0 16

Primary repair of esophageal atresia restores gastrointestinal continuity, but does not ensure normal esophageal function. To date 22 patients, six to 32 (average 15) years after repair of their esophageal atresias, have been evaluated by personal interview and esophageal manometrics and acid reflux testing. Previous barium swallow examinations had demonstrated varying degrees of anastomotic narrowing (12 patients), abnormal esophageal motor function (11 patients), gastroesophageal reflux (two patients), and hiatal hernia (one patient). Ten patients experience intermittent dysphagia for solid foods. Seven have typical symptoms of gastroesophageal reflux. Esophageal function tests including manometry and intraesophageal pH recording, have demonstrated varying abnormalities of esophageal motility in 21 patients and moderate to severe gastroesophageal reflux in 13. Two patients have required reconstruction of the esophagogastric junction for control of severe reflux esophagitis. The unexpected high incidence of gastroesophageal reflux in these patients, coupled with their abnormal esophageal motility which impairs normal acid clearing, renders them more prone to reflux esophagitis. Careful long-term evaluation for gastroesophageal reflux and its complications is indicated following primary repair of esophageal atresia. Evaluation of esophageal function with intraesophageal pressure and pH recordings is a far more sensitive indicator of esophageal physiology than the barium swallow examination.
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PMID:Long-term esophageal function following repair of esophageal atresia. 2 Aug 56

The lower esophageal sphincter pressure has been measured intraoperatively in 200 patients with gastroesophageal reflux and in three patients with achalasia. Lower esophageal sphincter pressure is measured before and during repair. Calibrating the cardia during performance of the median arcuate posterior gastropexy allows a sphincter pressure between 50 and 57 mm. Hg to be obtained at operation. The postoperative pressures have ranged between 15 and 25 mm. Hg, or approximately half of the intraoperative pressure. No patient with a spincter pressure of 15 mm. Hg or greater has reflux according to postoperative pH and pressure studies. Correction of reflux correlates well with relief of symptoms. Three patients with achalasia had intraoperative manometrics during myotomy. The lower esophageal sphincter pressure was lowered and the length of the lower esophageal sphincter was shortened. Dysphagia was corrected without producing reflux. This is the first report of measurement of lower esophageal sphincter pressure in anesthetized patients. Intraoperative measurement of sphincter pressure is a safe, simple, and reliable technique which allows the surgeon, for the first time, to determine the status of the lower esophageal sphincter during the operation. This technique should be standard for all operations on the gastroesophageal junction.
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PMID:Intraoperative measurement of lower esophageal spincter pressure. 2 82

Twenty-four patients with gastro-oesophageal reflux were treated by Nissen fundoplication over a three-year period. In 22 patients the symptoms of heartburn, reflux, or dysphagia were abolished or dramatically improved. The operative technique, complications, and reasons for the less successful outcome in the remaining two cases are discussed.
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PMID:Nissen fundoplication for gastro-oesophageal reflux. 31 95

The authors undertook a retrospective study of a series of 17 cases of idiopathic megaoesophagus seen over a period of 25 years in two paediatric surgery departments. Age distribution was regularly between 20 months and 15 years. No neonatal nor familial forms were seen. Symptoms were dominated by regurgitation and dysphagia. Weight loss was an almost constant feature. Heller's operation, via an abdominal approach with retro-oesophageal valve of the tuberosity fixed to both edges of the myotomy, was the operation proposed. In one case of recurrent megaoesophagus operated upon elsewhere a Thal operation gave a good result with a follow up of 8 years. Immediate clinical and radiological results were favourable in the great majority of cases : 16 cases out of 17. Long term results (follow up of more than 5 years in 8 patients) were also favourable. However one patient was sometimes troubled by regurgitations due to persistent achalasia and a grave failure occured in a patient who five years after a Heller operation developed a peptic stenosis of the lower oesophagus. No recurrence of megaoesophagus was seen. The authors emphasise the importance of the prevention of gastro-oesophageal reflux and the value of oesophagoscopy and of manometry in cases where the result of a Heller's operation is imperfect.
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PMID:[Idiopathic megaoesophagus in the child. A series of 17 cases treated surgically (author's transl)]. 54 68

Although the lower esophageal ring is an important cause of dysphagia in adults, its pathogenesis is unknown. To better define the relationship between the lower esophageal ring and esophageal reflux, we analyzed, retrospectively, the records of 18 hospitalized patients with radiologically demonstrated rings (16 confirmed by endoscopy and/or surgery). In 16 of these patients, evidence of esophageal reflux including at least one of the following was present: overt esophagitis noted at endoscopy or surgery (14 cases), histologic evidence of esophagitis (3 cases), and/or symptoms of pyrosis or free reflux (13 cases). These findings suggest that 1. reflux is frequently associated with lower esophageal rings and may play a role in their pathogenesis; 2. the radiologic finding of a ring should serve as a clue to the possibility of esophageal reflux and 3. long-term control of dysphagia in these patients may depend upon control of the associated reflux as well as mechanical disruption of the ring.
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PMID:The lower esophageal ring and esophageal reflux. 68 61

Gastroesophageal reflux (GER) has been recognized with increasing frequency as the source of a wide variety of symptoms in infants and children. During the past 8 years at the UCLA Hospital, 74 patients under 18 years of age have been identified as having sufficiently severe symptomatic reflux to warrant gastroesophageal fundoplication. Although repeated emesis was the most common primary symptom, failure to thrive was a major symptom in 20 patients, repeated pneumonia in 18, asthma in five, and dysphagia owing to stricture in 12. Nine patients with previously repaired esophageal atresia had severe reflux. Serious neurologic disorders were present in 14 children. The diagnosis of reflux in the majority of symptomatic children was established by combining the findings of an abnormal esophagogram, Tuttle test, esophageal manometry, and esophagoscopy with biopsy. Six infants experienced repeated symptomatic GER although results of all diagnostic studies were normal. Each of the patients had undergone an unsuccessful trial of medical management before the decision to operate was made. Transabdominal Nissen fundoplication with gastrostomy was performed on each of the 74 children (28 under 1 year of age). Each of the strictures was successfully managed by postoperative dilatations. No death and no major complications occurred, but six patients experienced transient dysphagia and four had delayed gastric emptying. Every patient has been relieved of clinical reflux, and the pulmonary status in each, including the asthmatic children, has been markedly improved. On the basis of this favorable experience with 74 patients, we believe that an aggressive surgical approach should be taken in the management of symptomatic GER in infants and children who fail to respond to an adequate trial of medical management.
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PMID:Gastroesophageal fundoplication for the management of reflux in infants and children. 70 70

Achalasia is a neuromuscular functional disturbance with dystonia and dyscinesia of the entire tubular oesophagus of unknown aetiology characterised by loss of cardial opening reflex. In the usual functional state dysphagia and moderate stenosis are observed, but occasionally an organic form with marked mega-dolicho-oesophagus will develop. Therapeutically an attempt is made to reduce the hypertonus of the terminal oesophagus. In mild or moderate cases this may be achieved by dilatation alone. If conservative treatment fails or in severe forms an operative correction is mandatory, we advise preoperative dilatation together with an extramucous myotomy of the distal anterior oesophageal wall and a fundoplication to prevent the gastro-oesophageal reflux. This abdominal procedure demands great care but is not traumatising and ensures satisfactory early and late results even in patients with considerable surgical risks. Operative indication and technique in 63 cases are demonstrated.
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PMID:[Achalasia of the oesophagus. Operative treatment by abdominal myotomy and fundoplication (author's transl)]. 71 70

One hundred patients with complications of severe gastroesophageal reflux were treated surgically by the Thal fundoplication. In all patients the symptoms of reflux were eliminated by the operation, although 4 recurred within 8 months. Two of these were due to disruption of the fundoplication and two were due to hiatus hernia not recognized and repaired at initial operation. There were 8 deaths, none related to gastroesophageal reflux or the operation. Four patients required re-operation for intestinal obstruction. The Thal fundoplication is a simple procedure which fixes the distal esophagus within the abdomen and produces an acute angle of His. It is effective in prevention of reflux and the patient is able to burp and vomit if necessary. It has not been associated with dysphagia or "gas bloat" which may follow the Nissen fundoplication.
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PMID:Thal fundoplication: a simple and safe operative treatment for gastroesophageal reflux. 73 65

Food obstruction at the cricopharyngeal level is a common symptom of gastroesophageal reflux. In selected patients, cricopharyngeal myotomy is effective in relief of symptoms. We have used myotomy in patients whose only symptom was dysphagia, in patients too debilitated for major surgery, and in patients with persistent pharyngoesophageal dysphagia following hiatal hernia repair. All were studied by barium esophagogram, endoscopy, and manometry. Radiologic aspiration of barium was apparent in five of 19 patients. High-speed manometric tracings showed intermittent cricopharyngeal incoordination in the six consecutive patients most recently studied. This finding of incoordination has been shown to be present in 38 patients with reflux and in all with major cricopharyngeal symptoms. Myotomy was effective in relieving symptoms in patients in whom this was the only reflux symptom and in the five patients too debilitated for major surgery. Good symptomatic improvement was obtained in nine of the 12 with persistent dysphagia following hernia repair, but in three relief was partial, with persistent symptoms being secondary to distal esophageal obstruction. Investigation is necessary to exclude other causes of dysphagia. However, withcareful selection, myotomy has proved to be an effective method of treatment.
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PMID:Cricopharyngeal myotomy as a method of treating cricopharyngeal dysphagia secondary to gastroesophageal reflux. 91 11


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