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

From experience with various types of vagotomy in 3,102 patients and study of the late-term results, it was established that recurrent ulcer developed in 4.7%, dysphagia in 2.9%, incompetence of the esophagogastric junction in 9.7%, reflux esophagitis in 3.8%, dyskinesia of the duodenum in 2.6%, duodenostasis in 5.3%, the dumping syndrome in 5.4%, diarrhea in 6.1%, and hiatal hernia in 0.3% of cases. The surgical correction of disorders after vagotomy is marked by specific techniques which must be borne in mind to improve treatment.
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PMID:[The diagnosis and treatment of postvagotomy disorders]. 152 71

From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.
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PMID:Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. 154 Jan 2

Severe feeding troubles were recorded in five babies with long-gap esophageal atresia who underwent, between 1985 and 1990, a delayed primary anastomosis after spontaneous growth of their esophageal stumps. A comparison with 20 cases of direct esophageal anastomosis, operated on in the same period, was carried out by means of recorded esophagrams, pH monitoring and questionnaires charting the growth pattern and feeding habits of the patients. Bottle feeding, and, later on, the introduction of semi-solid foods was significantly retarded in the group of children with delayed primary anastomosis (labeled as group B) as well as height and weight parameters. Failure to complete feeds, dysphagia, vomiting, coughing, choking and recurrent respiratory symptoms were also significantly more common in this group than in the primary anastomosis group (labeled as group A) even in the absence of stricture. Variable degrees of disordered esophageal motility were present in all patients but pooling of the contrast medium, retrograde flow and delayed clearing of the esophagus were more frequent in group B. No patient was shown to have associated hiatal hernia. A 24 hour pH recording showed severe gastroesophageal reflux in 4 out of 13 cases of group A and in 3 out of 5 cases of group B. Clearing times were significantly delayed in all refluxing children. Our data suggest that the retarded start of oral feeding and swallowing coordination in patients with delayed primary anastomosis add further negative factors to their congenitally impaired esophageal motility, causing protracted dysphagia which represents a major problem for both family and hospital staff.
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PMID:Feeding troubles following delayed primary repair of esophageal atresia. 161 Jul 54

Twenty patients with the diagnosis of Zenker's diverticulum were studied clinically and manometrically. In 8 patients oropharyngeal clearance of liquid isotopic markers was done. In three, esophageal emptying of a marked meal was also studied. Clinically, sixteen patients had oropharyngeal dysphagia, while for remained asymptomatic. Dysphagia was severe in only five patients. In half of the patients there were signs of hiatus hernia and/or reflux. Pharyngo-sphincteric incoordination was present in 70% of cases with a mean resting pressure of the LES significantly lower than in controls. There were no differences among patients with or without reflux. Isotopic esophageal clearance was not useful as a test, as there were no significant differences with the control group. On the other hand, esophageal emptying of solid isotopic meals may show the persistence of food in the diverticular sac long time after the meal.
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PMID:[Oropharyngeal functional assessment in patients with Zenker's diverticulum. Manometric and isotopic study]. 161 37

From 1976 until April 1989, 31 intrathoracic total fundoplications were performed for reflux esophagitis and irreducible hiatus hernia. In the first 16 patients (group 1) the operation was complicated with acute perforation of the wrap in 4 cases, bronchogastric fistula in 1, and herniation of the wrap higher in the chest in 1. Technical modifications were applied to 15 more recent patients (group 2). These are enlargement of the hiatus, looseness of the wrap and its appropriate anchorage, avoidance of forceps when handling the stomach, care with the vagi, and efficient gastric decompression in the postoperative period. The postoperative course was always uneventful in group 2. Twenty-six patients, who still have their initial wrap, were considered for clinical evaluation: 11 from group 1 (mean follow-up, 81.5 months) and 15 from group 2 (mean follow-up, 32.8 months). All are free from any symptom of reflux; gas-bloat syndrome is infrequent and dysphagia is relieved. Twenty-four-hour pH monitoring, performed in 14 patients (3 from group 1 and 11 from group 2) (mean follow-up, 42 months), was normal in 13; a pathological upright reflux (time pH less than 4, 8.4%) was demonstrated in one symptom-free woman in whom endoscopy was unremarkable. Mechanisms of complications experienced in group 1 are analyzed in the light of the technical evolution of the procedure, and the place of the intrathoracic total fundoplication in the management of short esophagus is defined, considering the other available surgical techniques.
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PMID:Intrathoracic Nissen fundoplication: long-term clinical and pH-monitoring evaluation. 198 70

Barrett's esophagus, a condition in which the distal esophagus is lined by columnar epithelium, is almost always caused by gastroesophageal reflux and often occurs in conjunction with a sliding hiatal hernia. Patients are typically white men in their 50s who smoke and drink, and they present with complaints of regurgitation, heartburn, and/or dysphagia. Endoscopic biopsies are required to confirm the diagnosis. Complications, such as stricture, ulcer, dysplasia, and malignant degeneration, occur in many cases. Adenocarcinoma is the most serious complication. Medical treatment, including life-style changes as well as pharmacologic therapy, usually relieves symptoms and heals esophagitis, but when it fails, antireflux surgery is indicated. Patients without evidence of dysplasia should undergo endoscopy yearly; those with mild dysplasia require more frequent surveillance. If biopsies disclose severe dysplasia, esophagogastrectomy should be performed.
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PMID:Barrett's esophagus. A continuing conundrum. 206 52

Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.
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PMID:[False negatives in pH measurement. A retrospective study of 12 surgical cases]. 207 69

The indications for and findings in 431 consecutive patients who had upper gastrointestinal endoscopy in Zaria from June 1978 to August 1982 are reviewed. The major indications were dyspepsia (78.1%), upper gastro-intestinal bleeding (12.1%) and portal hypertension (4.2%). Other indications were persistent vomiting, dysphagia and abdominal masses. The mean age of the patients was 32 years. The male: female ratio (3:1) was not different from that in the hospital population. There were no abnormal findings in 32.7%. 26.6% had duodenal ulcers. Duodenitis was noted in 24.8%, oesophageal varices in 6.3%, gastritis in 6.3% and hiatus hernia in 4.6%. In those who presented with upper-gastrointestinal haemorrhage, oesophageal varices (34.6%) and peptic ulcer (17.3%) were the commonest findings. Complication seen commonly were soreness in the throat and thrombophlebitis at the site of valium injection. One death was recorded from the procedure over the period.
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PMID:Upper gastrointestinal endoscopy in Zaria, northern Nigeria. 208 5

Gastroesophageal reflux (GER) is a dysfunction of the distal esophagus causing movement of stomach contents into the esophagus. Patients may develop heartburn, regurgitation, dysphagia, odynophagia, and hemorrhage. Respiratory symptoms occur in 10-60 percent of patients with GER or hiatal hernia. Although there is evidence associating pulmonary symptoms and GER, causality has not been proven. The appropriate use of antireflux therapy or surgery to treat GER may consequently alleviate respiratory symptoms.
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PMID:Gastroesophageal reflux and respiratory symptoms: is there an association? Proposed mechanisms and treatment. 227 31

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


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