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)

Patients with progressive or solid food dysphagia should be evaluated for the presence of an esophageal stricture. Barium esophagram and endoscopy can define strictures as benign or malignant. The majority of benign strictures are acid-related. Benign strictures are best managed by esophageal dilation with acid-suppressing medications if a peptic stricture is suspected. If dysphagia recurs, repeat dilation should be performed. There are a variety of interventions for refractory strictures which include injection of intralesional corticosteroids, temporary placement of self-expanding plastic stents and surgery.
Dis Esophagus 2005
PMID:Evaluation and management of benign esophageal strictures. 1633 4

A 54-year-old man presented to the ER with chest pain. He underwent an upper endoscopy revealing a large linear esophageal tear and a CT chest showed free air in the mediastinum. He was managed conservatively and was discharged 2 days later. An UGI series revealed a distal esophageal stricture. He was commenced on esomeprazole for gastroesophageal reflux symptoms and his dysphagia improved significantly. Upper endoscopy revealed multiple rings throughout the esophagus. Biopsies from the distal and mid-esophagus were normal. The underlying pathophysiology, in patients with dysphagia and a ringed esophagus has evoked debate in the literature. Opinions range from underlying gastroesophageal reflux disease (GERD) to eosinophilic esophagitis (EE). Our patient's symptoms of GERD and dysphagia resolved with proton pump inhibitor therapy. Normal histology excluded underlying EE. There have been a few case reports of esophageal perforation in patients with a ringed esophagus, and underlying EE, but none with spontaneous perforation occurring in a 'ringed esophagus'. Perforations in the upper and mid-esophagus can usually be managed conservatively, while those in the distal esophagus often need surgery due to the high risk of developing mediastinitis. However, our patient, despite sustaining a large tear in the distal esophagus, did well with conservative management. This case demonstrates that spontaneous perforation in the ringed esophagus, with normal underlying histology can occur in the distal esophagus and may not require surgery.
Dis Esophagus 2005
PMID:Spontaneous perforation in the ringed esophagus. 1633 13

Giant fibrovascular polyps are uncommon benign esophageal tumors almost always originating from the cervical esophagus, frequently from the upper esophageal sphincter. The case of a 74-year-old man with a long history of dysphagia and a weight loss of 9 kg is presented. Neither barium esophagogram, computed tomogram or magnetic resonance imaging correctly evidenced the lesion. Only fiberoptic endoscopy suggested the correct diagnosis because the mass fluctuated endoluminally with the spasm of vomiting. A left cervical exploratory incision with esophagotomy was performed following the experience of two previous similar cases. A giant fibrovascular polyp was observed and excised. If a malignant or benign extensive intramural tumor had been identified, a total esophagectomy would have been performed. In our opinion the possibility of the presence of a fibrovascular polyp should always be considered in the presence of an undetermined esophageal mass, and in these cases a left cervical incision is the preferred surgical access. Once the correct diagnosis is established, a major esophageal resection should always be avoided.
Dis Esophagus 2005
PMID:Giant fibrovascular polyp of the esophagus. 1633 14

A case of esophageal carcinosarcoma is described herein. A 58-year-old man presented with dysphagia and was admitted to our hospital. Imaging studies revealed a type 3 tumor in the upper intrathoracic esophagus with direct invasion to the left main bronchus. Analysis of a biopsy specimen revealed carcinosarcoma. The patient underwent esophageal bypass and chemoradiotherapy. Eight months after surgery, he died of esophago-bronchial fistula. Autopsy examination revealed liver metastasis, peritoneal dissemination and intramural metastasis. The sarcomatous component was predominant in the intramural and liver metastatic lesions.
Dis Esophagus 2006
PMID:Esophageal carcinosarcoma with intramural metastasis. 1664 82

Candida esophagitis in elderly patients is an entity that has not been investigated. We studied candida esophagitis in a population older than 65 years comparing them with an age and sex matched control sample. Diagnosis was made by histological identification of candida associated with inflammation from biopsy material taken during endoscopy. Fifty-six cases and 56 controls were analysed aiming to identify presentation, upper gastrointestinal pathologies associated with candida esophagitis, risk associations and to see whether it was a marker of poor outcome. Classical features clinically associated with esophageal disease were relatively uncommon: dysphagia 14%, oropharyngeal candidiasis 2%, dyspepsia 2%, while anaemia and loss of weight were the main indications for endoscopy (70%). No gastrointestinal pathologies were significantly associated with candida esophagitis. Malignancy, chronic obstructive pulmonary disease and antibiotic use were significantly associated, while there was no association between candida esophagitis and diabetes mellitus, stroke disease or dementia. Survival was significantly less in those with candida esophagitis with a mortality at 6 months of 47% compared to 5% in controls and a 1 year survival of 38% compared to 93% in the control sample. This was independent of disability measured by the modified Rankin scale and patients' residence.
Dis Esophagus 2006
PMID:A study of candida esophagitis in elderly patients attending a district general hospital in the UK. 1672 97

Laparoscopic Heller myotomy for achalasia has a 10-20% failure rate and may require re-operation to control persistent or recurrent symptoms. We report follow-up of 15 patients who underwent laparoscopic re-operation for failed Heller myotomy. Between 1993 and 2004, 15 patients underwent laparoscopic re-operation for failed Heller myotomy at our center. The mean duration between procedures was 23 months. Follow-up was completed at a mean duration of 30 months in 14 patients (93%) via a telephone questionnaire. Our overall failure rate for primary surgery (n = 106) was 5.6%. The mechanisms of failure were incomplete myotomy (33%), myotomy fibrosis (27%), fundoplication disruption (13%), too tight fundoplication (7%) and a combination of myotomy fibrosis and incomplete myotomy (20%). Significant symptom improvement was observed with postoperative symptom resolution seen in 71% of patients with dysphagia, 89% for regurgitation, 58% for heartburn and 40% for chest pain. Fifty percent reported excellent results and 79% would recommend the procedure to a friend. Subsequent dilations were performed in four patients (29%). Two patients required conversion to open surgery (13%). Three patients (20%) failed the re-operation and required further revisional surgery. Complications included intraoperative perforation in three (none of which resulted in postoperative morbidity) and a pneumothorax in one patient. Prior endoscopic therapies (pneumatic dilation or Botulinum toxin) were not associated with poor results. Laparoscopic re-operation for failed Heller myotomy is feasible and results are encouraging.
Dis Esophagus 2006
PMID:Laparoscopic re-operation for failed Heller myotomy. 1672 98

Benign tumors of the esophagus are a rare but diverse group of lesions. Although non-malignant in biology, their presence can cause significant morbidity, including dysphagia, bleeding, gastrointestinal obstruction, and even asphyxiation. Diagnosis is frequently made using radiographic and endoscopic means, even in the absence of definitive biopsy. If discovered early, endoscopic or minimally invasive techniques may be used to excise these lesions, with essentially 100% cure rates. However, if discovered late, open excision or even esophagectomy may be required. Angiolipoma represents perhaps one of the rarest of the benign entities to affect the esophagus, with only a few cases reported in the current literature. We present the case of an 85-year-old man who developed complete esophageal obstruction due to a large, pedunculated angiolipoma, requiring open surgical excision.
Dis Esophagus 2006
PMID:Angiolipoma of the esophagus: a rare clinical dilemma. 1672

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.
Dis Esophagus 2006
PMID:Surgical treatment and clinical course of patients with hypopharyngeal carcinoma. 1686 55

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.
Dis Esophagus 2006
PMID:Outcome and quality of life after open surgery versus endoscopic stapler-assisted esophagodiverticulostomy for Zenker's diverticulum. 1686 64

Thus far, there has been a paucity of studies that have assessed the value of the different gastroesophageal reflux disease (GERD) symptom characteristics in identifying patients with long-segment Barrett's esophagus versus those with short-segment Barrett's esophagus. To determine if any of the symptom characteristics of GERD correlates with long-segment Barrett's esophagus versus short-segment Barrett's esophagus. Patients seen in our Barrett's clinic were prospectively approached and recruited into the study. All patients underwent an endoscopy, validated GERD symptoms questionnaire and a personal interview. Of the 88 Barrett's esophagus patients enrolled into the study, 47 had short-segment Barrett's esophagus and 41 long-segment Barrett's esophagus. Patients with short-segment Barrett's esophagus reported significantly more daily heartburn symptoms (84.1%) than patients with long-segment Barrett's esophagus (63.2%, P = 0.02). There was a significant difference in reports of severe to very severe dysphagia in patients with long-segment Barrett's esophagus versus those with short-segment Barrett's esophagus (76.9%vs. 38.1%, P = 0.02). Longer duration in years of chest pain was the only symptom characteristic of gastroesophageal reflux disease associated with longer lengths of Barrett's mucosa. Reports of severe or very severe dysphagia were more common in long-segment Barrett's esophagus patients. Only longer duration of chest pain was correlated with longer lengths of Barrett's esophagus.
Dis Esophagus 2006
PMID:Correlation of gastroesophageal reflux disease symptoms characteristics with long-segment Barrett's esophagus. 1698 33


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