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)

Zenker's diverticulum is the single most common diverticular event arising in the esophagus. Its physiopathology is universally recognized. Lack of coordination between the propulsive pharyngeal contractions and the release of the upper esophageal sphincter creates abnormally high pressure in the pharyngeal chamber, resulting in the collapse of the posterior wall of the hypopharynx, i.e., the Laimer-Killian triangle (or Killian's dehiscence). The mucosal hernia that develops constitutes the diverticulum, which grows in volume and above all in length and is compressed between two rigid structures, namely, the spine posteriorly and the trachea anteriorly. Swallowing progressively fills the diverticulum, which in turn leads to compression of the esophagus and hence to the characteristic symptom of "delayed dysphagia" or "dysphagia of the 3rd bite". These physiopathological considerations underpin the rationale for surgical treatment, namely upper esophageal sphincter myotomy and diverticulectomy, which is the standard approach used in the 44 cases presented here. A diverticulopexy was performed only once due to the patient's advanced age. Myotomy alone was performed in only one case, given the small size of the diverticulum. In two patients the standard procedure was carried out following emergency therapy for iatrogenic perforation of the diverticulum. The patient with cancer underwent chemo-radiotherapy after futile surgical attempts. Complications included transitory salivary leakage (1 case), and a transitory laryngeal nerve deficit (1 case). Gastroesophageal reflux disease was present in two-thirds of the patients. A Nissen-Rossetti fundoplication was performed one year after treatment of the diverticulum in 5 patients. The following important aspects emerged: i) the incidence of neoplasia on the diverticulum; ii) the association and possible pathogenetic relationship with gastro-esophageal reflux disease iii) the validity of myotomy plus diverticulectomy as a treatment option in view of the negligible complications and the absence of relapse and/or persistence of dysphagia.
 ...
PMID:[Our experience with pharyngo-esophageal Zenker's diverticulum]. 1472 16

Esophageal diverticula are classified by location-phrenoesophageal (Zenker's diverticulum-70%), thoracic and mediastinal (10%), and epiphrenic (20%). Almost all esophageal diverticula are acquired pulsion diverticula. The most common symptoms are dysphagia, regurgitation, thoracic pain, and pulmonary manifestations related to aspiration. Barium swallow and upper endoscopy will help to establish the diagnosis while esophageal manometry may reveal underlying dysmotility. Diverticula should not be treated unless they are symptomatic. The treatment of Zenker's diverticulum is surgical and consists of either diverticulectomy or diverticular suspension with a myotomy of the cricopharyngeus muscle via cervical approach. Transoral endoscopic stapled diverticulostomy is a new and simple approach which may become the treatment of choice, particularly in elderly and high-risk patients. Treatment of diverticula of the mid and low esophagus must take into account any motor anomalies or associated lesions. Diverticulectomy with esophageal myotomy and an anti-reflux procedure through a left thoracotomy is the standard approach, but endoscopic approaches seem feasible, particularly for epiphrenic diverticula, and may become the norm in years to come.
 ...
PMID:[Esophageal diverticula]. 1513 31

A 90-year-old woman sustained a proximal esophageal perforation following transesophageal echocardiography. The perforation originated at the site of a Zenker's diverticulum and resulted in a false passage to the diaphragm. Initial management involved endoscopic placement of drains into the mediastinum in addition to bilateral chest drains and a gastrostomy. Following stabilization, the patient had repair of her Zenker's diverticulum and recovered uneventfully. We recommend that all procedures involving blind intubation of the esophagus should be preceded with specific pursuit of a background of cervical dysphagia.
 ...
PMID:Primary endoscopic management of esophageal perforation following transesophageal echocardiogram. 1523 61

Zenker's diverticulum is a protrusion of the posterior mucosal wall of the hypopharynx through the weakened muscular layer, between the oblique fibers of the inferior constrictor of the pharynx and the transverse fibers of the cricopharyngeal muscle (Killian's dehiscence). Pharyngoesophageal pulsion diverticulum is the most common of all the oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurling sounds in the neck and aspiration. The current principles of surgical management includes a pharyngoesophageal myotomy accompanied by a diverticulectomy or a diverticulopexy. The same principles apply in both open approach and the endoscopic methods.
 ...
PMID:[Zenker's diverticulum--surgical management in a series of six cases]. 1568 21

Oropharyngeal dysphagia is not a single disease but a symptom complex that is recognized by difficulty in transfer of a food bolus from mouth to esophagus or by signs and symptoms of aspiration pneumonia or nasal regurgitation. Its etiologies are legion, with the most common result of underlying neuromuscular disease, including cerebrovascular accidents, Parkinson's disease, multiple sclerosis, and muscular dystrophy. There are two methods of treatment for oropharyngeal dysphagia; one is specific and directed at the underlying disease and the other is general (supportive) and designed to preserve oral intake for nutrition while preventing aspiration pneumonia. Following a general discussion of the etiology and clinical presentation of orophyarngeal dysphagia, a description of the methods for supportive care is presented as well as the approach to the treatment of cricopharyngeal dysfunction and Zenker's diverticulum.
 ...
PMID:Oropharyngeal dysphagia. 1600 27

We report a case of a capsule endoscope lodged within a Zenker's diverticulum. The capsule was safely removed endoscopically. Safe re-insertion of the capsule was achieved using an overtube placed with a Savary dilator. While capsule endoscopy should be avoided in patients with large esophageal diverticula or dysphagia, this method may be used to deliver the capsule beyond the esophagus, allowing completion of the capsule endoscopy study.
 ...
PMID:Endoscopic retrieval of a capsule endoscope from a Zenker's diverticulum. 1619 36

Patients with Zenker's diverticulum (ZD) underwent surface electromyography (sEMG) evaluation to determine sEMG patterns specific for ZD. Group 1 comprised patients with proven long-standing ZD that refused surgical treatment (n = 11, age mean = 55.7 years). Group 2 comprised surgically operated on patients with ZD (n = 6, age mean = 61 years). The timing, amplitude, and graphic patterns of activity of the masseter, submental, and laryngeal strap muscles were examined during voluntary single water swallows ("normal"), single swallows of excessive amounts of water (20 ml, "stress test"), and continuous drinking of 100 cc of water. The muscle activity in pharyngeal and initial esophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. The data were compared with the previously established normative database. The main sEMG patterns of ZD are (1) duration of swallowing and drinking is longer than normal (p < 0.05), (2) electric amplitude of laryngeal strap muscles during swallowing activity is higher than normal (p < 0.05), and (3) regurgitation peaks immediately after swallow followed by secondary swallow of the regurgitated portion of a bolus as seen at the sEMG records are specific graphic patterns for the ZD. Zenker's diverticulum has its own specific sEMG patterns. Surface EMG, being an important screening method for patients with dysphagia, is a valuable additional diagnostic tool for ZD. Because it is noninvasive and nonradiographic, it can be used for monitoring of long-standing cases of the disease as well as monitoring of postsurgical recovery.
Dysphagia 2006 Jan
PMID:Surface electromyography in preoperative evaluation and postoperative monitoring of Zenker's diverticulum. 1654 90

Two techniques for treatment of Zenker's diverticulum, endoscopic stapler-assisted esophagodiverticulostomy and open cricopharyngeal myotomy by transcervical approach, were compared with regard to patient satisfaction and quality of life. Between January 1994 and December 2004 a total of 47 patients with Zenker's diverticulum underwent surgery in our department. Besides the usual retrospective evaluation of details of surgery, all patients were sent a questionnaire on their actual complaints and quality of life according to the Gastrointestinal Quality of Life Index (GIQLI). Twenty patients had the endoscopic procedure (Group A), and 27 the open procedure (Group B). The preoperative symptoms were dysphagia in 96%, regurgitation of undigested food in 60%, cough in 19%, and pneumonia caused by recurrent aspiration in 9%. The length of surgery was on average 32 min (range 5-70 min) in Group A and 106 min (range 45-165 min) in Group B, and the length of hospital stay was 5.5 days (range 1-10 days) and 12.3 days (range 7-25 days), respectively. The results of the questionnaire showed that the preoperative symptoms had disappeared in up to 83%, and 91% in Group A and 100% in Group B would be willing to undergo surgery again. The mean GIQLI was 123 points in Group A and 118 points in Group B (healthy volunteers in the literature, 125 points). Both techniques showed good results in a long-term follow-up with regard to relief of symptoms and patient satisfaction. Both groups had an excellent Gastrointestinal Quality of Life Index, comparable to that of a healthy standard population.
 ...
PMID:Outcome and quality of life after open surgery versus endoscopic stapler-assisted esophagodiverticulostomy for Zenker's diverticulum. 1686 64

One of the dysphagia causes may be pharyngeal or esophageal diverticula. Pharyngeal diverticulum (Zenker's diverticulum) is the most common among all upper digestive tract diverticula. It results from protrusion of the pharyngeal mucosa in Killian's area (triangle), at the border of two parts of the inferior pharyngeal constrictor muscle. Patients with Zenker's diverticulum complain about different types of dysphagia as a result of retention of freshly ingested food in diverticulum and its regurgitation. This problem may be present for years and has a progressive nature. The diagnosis of Zenker's diverticulum is based on anamnesis and radiological examinations with applied contrast medium of the upper digestive tract. There are two methods of the treatment: diverticulectomy from external cervical approach and endoscopic (with surgical laser) incision of the wall between diverticulum and pharynx or esophagus. Treatment results and number of postsurgical complications are similar for both methods. Treatment of Zenker's diverticulum is in field of interest of surgeons as well as otolaryngologists. Location of disease in the neck and in the upper digestive tract should make us well acquainted with this problem.
 ...
PMID:[Hypopharyngeal Zenker's diverticulum as a clinical and surgical problem]. 1698 39

In the diagnosis of diseases of the esophagus, conventional x-ray evaluation still plays a more important role than endoscopy in the visualization of stenoses. CT plays a major role in the staging of malignancies of the esophagus, while MRI plays does not play a major part in the diagnostic evaluation of the upper GI-tract but is equal to CT for the staging and evaluation of the extent of local infiltration. The main indication for the radiological examination of the esophagus by barium studies is dysphagia. The use of barium allows a functional examination of esophageal motility. Swallow motility disorders can be diagnosed by videofluorography using high frame rate imaging. Zenker's diverticulum and other pulsion diverticula should also be investigated by functional esophageal imaging. Candida esophagitis can be identified by its characteristic ulcerations using barium swallow. The extension of gastroesophageal hernias are more accurately evaluated with barium studies than with endoscopy. The diagnosis of gastroesophageal reflux disease should be made by barium studies, but discrete inflammation as well as epithelial dysplasia are best investigated by classic endoscopy and modern endoscopic techniques. In cases of esophageal carcinoma, radiology adds to the findings of endoscopy and endosonography.
 ...
PMID:[Radiological imaging of the upper gastrointestinal tract. Part 1. The esophagus]. 1711 93


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>