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)

1. A randomized, double-blind, placebo-controlled trial was carried out to determine the efficacy of isosorbide dinitrate (ISD) on dysphagia in patients with Chagasic achalasia. 2. Twenty-three patients with Chagas' disease and dysphagia entered the study and 20 (87%) completed the two 7-day treatment periods. Subjects were given either 5 mg ISD (12 patients) or placebo (11 patients) by the sublingual route for the first 7 days. On the 8th day, patients crossed over and began another 7-day period during which they received the opposite, identical-appearing tablets. 3. Scores attributed by uninformed investigators for the frequency and severity of dysphagia were significantly lower (P less than 0.05) following ISD treatment than after the placebo period or for the pretreatment condition. A significantly higher degree of improvement of dysphagia was experienced by the patients during ISD treatment than during the placebo period. Fourteen patients experienced meal-related headaches during ISD, but not placebo treatment. The extent of improvement in general well-being due to ISD was the same when the drug was given in the first or second test period. 4. Our results indicate that ISD, 5 mg by the sublingual route, is effective in alleviating dysphagia in patients with Chagasic achalasia but its usefulness is limited by the high rate of headache as a side effect.
 ...
PMID:Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas' disease achalasia. A double-blind, crossover trial. 182 97

Esophageal motility disorders consist of a complex array of disturbances in normal esophageal function associated with dysphagia, gastroesophageal reflux, and noncardiac chest pain. A thorough knowledge of normal esophageal anatomy and physiology is important to a full understanding of these motility derangements. Through a complicated interaction of neuromuscular and hormonal influences, the voluntary act of swallowing transforms into an automated sequence of peristaltic waves propelling food and liquids into the stomach in concert with coordinated relaxation of the sphincters. Anatomic and physiologic barriers exist within the esophagus protecting against gastroesophageal reflux and aspiration. With improvements in diagnostic tools such as barium contrast radiography, scintigraphy, pH measurements, and esophageal manometrics with provocative testing, motility disorders have become better defined and understood. Primary motility disorders consist of achalasia, diffuse esophageal spasm (DES), "nutcracker esophagus," hypertensive lower esophageal sphincter, and nonspecific esophageal motility dysfunction (NEMD). A host of secondary and miscellaneous motility disorders also affect the esophagus, including scleroderma and other connective tissue diseases, diabetes mellitus, Chagas' disease, chronic idiopathic intestinal pseudo-obstruction, and neuromuscular disorders of striated muscle. Gastroesophageal reflux disease (GERD) may also be promoted by associated motility disturbances. Treatment modalities include surgical myotomy; dilatation; and pharmacologic manipulations, including use of nitrates, calcium-channel blockers, H2-blockers, and psychotropic drugs where appropriate.
 ...
PMID:Esophageal motility disorders. 329 77

The purpose of this paper is to evaluate the experience acquired along a 15 years period (1971-1985) in the treatment of achalasia of the esophagus. One hundred and fifty six patients were evaluated. The average age was 50.8 years, and the M/F ratio 0.9/1. Dysphagia was present in 100%, regurgitation in 78.2%, weight loss in 61.5%, and chest pain in 50% of the cases, being the main symptoms. Serology for Chagas disease was positive in 21.2% of the patients. When classified by radiologic criteria the groups were: grate I 18.5%, grate II 53.8%, grate III 14.7% and grate IV 12.8%. The high pressure zone was X 23 mmHg (N 14.8 mmHg) pre dilatation. The incidence of vigorous achalasia was 5.7% and the urecholine test was positive in 61.1%. Only 95 patients were submitted to pneumatic dilatation, and this is the group that we shall analyze in detail. We performed 110 dilatations, since 80 patients were dilated once and 15 received 2 dilatations. The high pressure zone post dilatations was X 12.5 mmHg. We obtained good results in 82.1%, regular in 3.1% and bad results in 14.7% of the patients. The morbidity was 4.5% (3 perforations and 2 gastroesophageal reflux), and the mortality 0.9%. There was relapse in 26.3% of the cases. In 53.3% of the patients submitted to a second dilatation we obtained good results. The average hospital stay was 2.5 days, and the follow up X 32.4 months. Thirty nine patients were sent to surgery with good results in 82%, regular in 2.5%, and bad in 15.6%. The morbidity was 15.3% and the mortality 5.1%.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Esophageal achalasia: review of the results after 15 years' experience]. 344 84

A full-term infant developed dysphagia, vomiting, and regurgitation immediately after birth. On examination at 5 months of age, he was malnourished and had radiographically proven megaesophagus. On direct examination his blood was positive for Trypanosoma cruzi. Additionally an enzyme immunoassay for T. cruzi IgM antibodies was positive. He underwent corrective surgery for the megaesophagus but died post-operatively of aspiration pneumonia. At autopsy, the esophagus was markedly dilated. There was an extreme reduction of neurons in Auerbach's plexus, and inflammation of this plexus and the muscular layer of the esophagus. Nests of parasites were seen in the esophagus and bladder. It is suggested that this patient was not in the chronic phase of Chagas' disease but represents an acute digestive phase of this infection. This is the fourth case in the literature of congenital Chagas' disease with esophageal involvement and clinical signs, and the first in which megaesophagus was seen grossly at post-mortem examination.
 ...
PMID:Esophageal involvement in congenital Chagas' disease. Report of a case with megaesophagus. 642 Nov 81

The relationship of symptoms and radiographic abnormalities suggestive of esophageal motility disorders with electrocardiographic (ECG) alterations and seroreactivity to Trypanosoma cruzi was studied in a defined population in a rural area endemic for Chagas' disease in Bahia, Brazil. Between January and June 1981, 680 individuals 5 years of age or older were examined with serologic tests, ECGs and questionnaires for esophageal motility disorder. Of these, 39.9% were seropositive for Chagas' disease. Symptoms of dysphagia occurred 2.5 times more frequently among seropositive individuals than among seronegative individuals. Radiographic esophageal abnormalities were 3.6 times more frequent among seropositive individuals than among seronegative individuals in the symptomatic group. Symptoms and radiographic abnormalities were more common in men than in women although this was not statistically significant. Among seropositive individuals the percentage with symptoms of dysphagia increased with age, with a peak prevalence rate of 23.9% in the 45- to 64-year-old age group. Also, in the seropositive group, 41.7% with X-ray abnormalities of the esophagus and 26.3% with symptoms of dysphagia presented an abnormal ECG.
 ...
PMID:Megaesophagus and seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil. 643 62

The physiologic similarities between the megaesophagus of Chagas' disease and idiopathic achalasia are well documented. Therefore, it would seem reasonable that comparisons of controlled trials of therapy for the more common Chagas' megaesophagus could be applied to idiopathic achalasia, where the paucity of cases makes such a controlled comparison difficult. We had the opportunity to study 18 patients with achalasia secondary to Chagas' disease. All of the patients were from the mid central states of Brazil, all had symptoms of dysphagia and radiographic documentation of dilated esophagus and abnormal peristalsis (Rezende Groups II and III), as well as positive serologic evidence of Chagas' disease. Perfused intraluminal manometric studies were performed on all patients. Resting sphincter pressures ranged from 20-35 mm./Hg., mean of 25 (normal 5-12 mm./Hg.) with aperistalsis. Patients were randomly dilated with either bouginage (44-55 ff catheter) or pneumatic dilator (4-4.5 kg./6.5 cm.2 x 2 min.). Although all patients reported symptomatic improvement several days after either procedure, repeat manometric tracings demonstrated no change in the sphincter pressure in the bouginage group. The pneumatically dilated group, however, demonstrated a decrease in sphincter pressure to normal levels (mean 12 mm./Hg.). Follow-up studies one year after the procedure confirmed the persistence of normal sphincter pressure in the pneumatically dilated group but no change, as well as return of initial symptoms, in the bouginage group.
 ...
PMID:A clinical trial with pre- and post-treatment manometry comparing pneumatic dilation with bouginage for treatment of Chagas' megaesophagus. 678 91

A 67 years old man was admitted on July 1979 for nausea, dysphagia and rectal pain. At age 64 he had undergone radiotherapy on the lower lip for an epidermoid carcinoma. He remained then healthy. His medical history was negative with the exception of chronic bronchitis. He had never been exposed to toxic agents or drugs and had never left Europe. A few days after admission he suffered acute intestinal obstruction but at laparostomy no etiology was found. At the same time the patient complained of pain in all four limbs and he was found to have diffuse wasting of muscles, areflexia and distal sensory loss. No sign of dysautonomia was present. Physical examination was negative with the exception of a cervical lymphadenopathy. The lymph node biopsy showed an undifferentiated metastatic carcinoma. Negative investigations included: blood cells count; serum ionogram and immunoelectrophoresis; thyroid function tests; serological test for Chagas' disease. The following abnormalities were found: ESR: 55-105; CSF protein: 145 mg/100 ml and 1 cell mm3; whole blood folic acid: 1,7 mg/ml; Hbs antigen was present in blood; EMG showed evidence of denervation but motor conduction velocities were normal. By September the patient's weakness had increased and complete intestinal obstruction persisted. At oesophageal, gastric and duodenal fibroscopy no contraction was visible, and biopsies were negative. The patient died of peritonitis on October 5th, 1979. At necropsy peritonitis secondary to multiple perforation of the large bowel was found. No recurrence of the lip carcinoma or metastase or evidence of a primary carcinoma was found. Light microscopy showed no evidence of amyloidosis or scleroderma. Examination of the alimentary tract showed abnormalities restricted to the myenteric plexuses which varied from one level to another. In the small bowel there was hyperplasia of the smooth muscle and the myenteric plexuses were enlarged by marked proliferation of Schwann cells. Severe neuronal loss and nodules of Nageotte were also noted. Schwann cells proliferation was less marked in the stomach and large bowel. Lympho-histiocytic infiltration strictly confined to the region of the myenteric plexuses was present in oesophagus, stomach, large bowel and rectum. Mild chronic inflammatory lesions were also found in anterior and posterior spinal roots and semi-lunar ganglia. The striking feature of this case is the association of an undifferentiated carcinoma and a polyradiculoneuritis with a complete alimentary tract palsy of rapid onset, secondary to lesions restricted to the myenteric plexuses. The low folate level was insufficient to explain the neuropathy. Investigations showed no evidence of the usual causes of intestinal pseudo-obstruction: muscular, dysautonomic, toxic, plexic (idiopathic, familial, inflammatory), Chagas' disease). The clinical course, the pathological pictures of the alimentary tract and spinal roots and the association with a carcinoma suggest that our case may represent a paraneoplastic syndrome...
 ...
PMID:[Paralysis of digestive tract with lesions of myenteric plexuses. A new paraneoplastic syndrome (author's transl)]. 729 42

The aging process causes a progressive loss of the intrinsic esophageal innervation that may impair esophageal motility. Esophageal motility was studied by the manometric method in 30 symptomatic patients aged 70 to 83 years (median 72 years). The most frequent symptom was dysphagia, followed by chest pain. Eleven patients had Chagas' disease, with esophageal motility similar to that found in patients with the disease and of all ages. Thirteen patients had systemic diseases or esophagitis. Simultaneous contractions of low amplitude were found in five, normal motility in seven, and peristaltic contraction of low amplitude in one. The other six patients did not have systemic diseases or esophagitis. Esophageal motility was normal in two, the contractions were simultaneous in four, of low amplitude in three, and of high amplitude in one. These patients were interpreted to have presbiesophagus.
 ...
PMID:[Esophageal motility in the patient over 70 years old]. 757 82

A symptomatic megaesophagus was demonstrated in a three months old boy with Chagas disease. He had a difficult evolution with frequent aspiration pneumonias and progressive undernutrition. At 14 years old a cardiomyotomy (Heller's procedure) was performed, with good results that allowed a near normal life. At 27 years old, the patient started with progressive dysphagia due to an epidermoid esophageal carcinoma and died after surgery. Since a higher frequency of esophageal carcinoma is observed in achalasia, periodic endoscopic examinations are mandatory.
 ...
PMID:[A case of congenital chagasic megaesophagus: evolution until death caused by esophageal neoplasm, at 27 years of age]. 780 23

We measured the lower (LES) and upper esophageal sphincter (UES) pressure in 22 Chagas' disease patients with dysphagia and abnormal radiologic esophageal examination, and in 12 normal volunteers. We compared the station pull-through (SPT) and rapid-through (RPT) techniques of sphincter pressure measurement, using an infused round catheter 5 mm in outer diameter, and with four side orifices at the same level. The LES pressure was higher when measured by RPT than by SPT and at inspiration than expiration (P/0.05). In Chagas' disease patients, LES pressure was lower than in volunteers, with significance when measured by RPT at expiration (P/0.05). In normal volunteers, but not in patients, the UES pressure was higher when measured by RPT at expiration than when measured by SPT. When measured by RPT the UES pressure of Chagas' disease patients was lower than in volunteers. In conclusion, LES pressure was higher when measured at inspiration and by the RPT technique. There was a considerable overlap of LES individual pressures between patients and volunteers, but the pressure was lower in patients when we used RPT at expiration. In normal volunteers the RPT technique recorded higher UES pressures than the SPT, and higher pressures than in Chagas' disease patients.
 ...
PMID:Comparison of methods for recording esophageal sphincter pressures in Chagas' disease. 781 91


1 2 3 4 Next >>