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)

A patient is described who suffered from prolapse of the lower oesophageal mucosa in the presence of a Schatzki ring. There was variable dysphagia culminating in total aphagia. The clinical symptoms disappeared without any treatment once the patient had overcome several years of psychological stress. The radiological appearances gave rise to a discussion of the radiological anatomy of the terminal oesophagus with a Schatzki ring since numerous similar appearances illustrated in the literature have been interpreted as axial hiatus hernias. A comparison of manometric and radiological fingings has shown that a hernia did not exist. The advantages and errors inherent in diagnosing hernias with the help of the "three rings", as described by Hafter, are discussed. The mucosal prolapse during the stage of aphagia is demonstrated and compared with cases from the literature showing prolapse at the upper and lower vestibular margins. The mechanism leading to these appearances is discussed.
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PMID:[Invagination of the oesophageal mucosa in the presence of a Schatzki ring (author's transl)]. 15 Oct 7

Twenty-nine patients who underwent Nissen fundoplication for the treatment of symptomatic, sliding, esophageal hiatal hernia are reported. Fourteen of these patients also underwent parietal cell vagotomy (PCV) without a drainage procedure. Simulatenous cineradiography and manometric studies, esophagoscopy and gastric analysis were performed pre- and postoperatively. Esophageal acid clearing and pH reflux studies were performed postoperatively. All but 3 patients had reflux and/or esophagitis preoperatively. Cineradiography and the pH reflux test were the most reliable tests for diagnosis of reflux. There was no operative mortality. The mean followup period was 20 months. Dysphagia occurred in 5 patients. Correction of dysphagia in one patient required operation. The dysphagia in the remaining patients was temporary and mild, responding to dilatation. Two patients had mild diarrhea. One patient who had had a previous gastric resection developed severe diarrhea after bilateral truncal vagotomy. No patient developed the "bloat syndrome". A close correlation did not exist between reflux and preoperative sphincter pressure. The mean LES pressure increased 10 mmH2O postoperatively and the two patients with persistent reflux postoperatively had normal LES pressure. Correction of reflux after Nissen fundoplication is probably due to some mechanism other than increased LES pressure. Recurrent or persistent hiatal hernia was diagnosed in 4 patients by cineradiography. Two of these patients had reflux but only the patient who had undergone PCV was without symptoms or esophagitis. The technical performance of the Nissen hiatal hernia repair was greatly facilitat ed by PCV. This procedure also provided adequate treatment for patients with concomitant duodenal ulcer disease. PCV, unaccompanied by a drainage procedure, was not associated with increased morbidity, mortality or the adverse effects usually attributed to vagotomy. In the event of recurrent hernia and reflux, PCV may prevent the development of esophagitis.
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PMID:Evaluation of the Nissen fundoplication for treatment of hiatal hernia: use of parietal cell vagotomy without drainage as an adjunctive procedure. 23 37

The lower esophageal ring, or Schatzki's ring, consists of a thin, submucosal, circumferential scar which forms a thin incomplete diaphragm in the lower esophageal lumen. The symptoms may be either episodic aphagia or progressive dysphagia, and the severity of symptoms is related to the diameter of the ring. Between 1970 and 1978, we saw 24 patients with lower esophageal rings and complaints of episodic aphagia or progressive dysphagia. Symptoms of esophagitis were present in 20 of the 24. Twenty were treated surgically by interrupting the rings and repairing the sliding hiatal hernias. Two were treated by dilatation and two received no treatment to the ring. Hiatal hernias have recurred in two patients. In one, there is a recurrent ring and in the other, an acid peptic stricture. The ring has responded to dilatation and the peptic stricture to dilatation and repair of the recurrent hernia. Two patients without symptoms of esophagitis, treated by dilatation, are doing well but the follow-up period is so far too short to draw any conclusion.
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PMID:Symptomatic lower esophageal ring: treatment of 24 patients. 47 13

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

Intussusception of the distal esophagus into a reducible hiatus hernia is described in nine female and three male patients. The main radiographic feature is demonstration of a lobulated fundal mass of changeable size and configuration surrounding the narrowed distal esophageal segment. This pseudotumor is produced by inversion of the hiatus hernia into the stomach, and may be mistaken for a neoplasm. Disinvagination invariably occurs when maneuvers directed toward demonstration of a sliding hernia are utilized during upper gastrointestinal fluoroscopy. It is emphasized that esophago-gastric invagination frequently accounts for masses shown in the cardia of older women with intermittent dysphagia and crampy epigastric pain.
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PMID:Esophago-gastric invagination in patients with sliding hiatus hernia. 105 68

The authors report a case of Zenker's giant hypopharyngeal diverticulum in an elderly patient who underwent surgery due to the severity of symptoms. This diverticulum, which is both juxtasphincteric and epiphrenal, has a pulsion pathogenesis: the presence of a hernia on the esophageal side (jato?), with which Zenker's diverticulum is frequently associated and which is often followed by reflux esophagitis, is enough to cause motor asynchronism of the crico-pharyngeal muscle which, in the presence of hypertonic conditions during deglutition, leads to the formation of a high-pressure pouch which is then responsible for the formation of the diverticulum itself. It is therefore important to check whether an associated esophageal pathology exists once Zenker's diverticulum has been diagnosed: X-ray examinations of the upper digestive tract are undoubtedly capable of identifying the presence of the diverticulum as well as other pathological associations. In the present case it was not possible to perform a sufficiently exhaustive X-ray examination in order to exclude associated esophageal pathologies. Endoscopy may be superfluous and contraindicated in cases of large diverticular pouches. Symptoms vary depending on the size of the diverticulum. A feeling of dysphagia may precede the appearance of the diverticulum, even by several years, before the onset of symptoms related to the ingestion of food: initially the patient may experience the sensation of a foreign body while eating due to the accumulation of ingested food in the diverticulum; this is followed by halitosis, sialorrhea, noisy deglutition, regurgitation of undigested food especially during sleep, and frequently bronchopulmonary symptoms "ab ingestis".(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Zenker's diverticulum in the elderly. Description of a case and surgical treatment]. 128 56

Patients with an uncomplicated sliding hiatal hernia frequently experience dysphagia. The present study shows, using video barium contrast esophagograms, that the cause of dysphagia in 60% of these patients is an obstruction to the passage of the swallowed bolus by diaphragmatic impingement on the herniated stomach. Manometrically this was reflected by a double-hump high pressure zone (HPZ) at the gastroesophageal junction, and specifically to the length and amplitude of the distal HPZ and the length of the intervening segment between the two HPZs. The former represents the degree of the diaphragmatic impingement on the herniated stomach and the latter the size of the supradiaphragmatic herniated stomach. Surgical reduction of the hernia resulted in relief of dysphagia in 91% of the patients.
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PMID:The cause of dysphagia in uncomplicated sliding hiatal hernia and its relief by hiatal herniorrhaphy. A roentgenographic, manometric, and clinical study. 232 35

During a 25-year period, 40 patients with paraoesophageal hiatus hernia were operated on by narrowing of the hiatus and gastropexy. The main symptoms were: epigastric pain (40%), reflux symptoms (25%), cardiac symptoms (20%), dysphagia (20%) and dyspnea (8%). Six patients were free of symptoms. Anaemia was present in 33%, gastric ulcer in 15%. Six patients (18%) had to be operated on as emergencies because of gastric ulcer complications in 4 (3 perforations, 1 severe bleeding) and incarceration in 2 patients. Considering the important risk of acute complications in paraoesophageal hernia an elective gastropexy seems generally advisible--also in patients with few or no symptoms, provided there are no contraindications.
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PMID:[Paraesophageal hiatal hernia--risks and surgical indications]. 277 98

Diffuse esophageal spasm (DES) is a rare disease, and its surgical management is controversial. There are seven major reported series totaling 148 patients and six operative variations depending on the extent of myotomy and whether or not a hernia repair should be added. There are no five-year follow-up reports. In the present study of 34 patients followed for at least five years, all had a myotomy from the apex of the chest through the high-pressure zone and all had a total fundoplication hernia repair, 16 with gastroplasty and 16 with a standard Nissen fundoplication. The length of the completion fundoplication is reduced to less than 0.5 cm to avoid problems of overcompetence. There were no operative deaths. Follow-up is 100% by clinical history, 82.4% by radiology, and 61.8% by manometry. Radiological follow-up showed no recurrence or reflux, although 1 patient had esophageal mucus retention. Thirty patients (88.2%) are eating normally without dysphagia or spontaneous pain. Two patients (5.9%) have mild dysphagia, and 1 of them also has mild spontaneous pain. One patient has major residual dysphagia, which is being treated conservatively, and 1 has required colon interposition. Good-quality results have been achieved in 94% of patients now followed 5 to 10.7 years.
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PMID:Extended esophageal myotomy and short total fundoplication hernia repair in diffuse esophageal spasm: five-year review in 34 patients. 354 14

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


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