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

We reviewed the hospital records of 36 patients who underwent modified Heller's myotomy for achalasia between January, 1961, and December, 1982. There were 18 male and 18 female patients ranging between 17 months and 75 years old. The most frequent symptom was dysphagia, followed by regurgitation of ingested food and weight loss. Modified Heller's myotomy was performed through a transthoracic incision in 35 patients and a transabdominal incision in 1. An antireflux procedure in addition to esophagomyotomy was performed in 20 patients. There was 1 postoperative death. Thirty-three patients were followed up for periods ranging from 9 months to 21 years. The results were considered good in 27, fair in 2, and poor in 4. One of the 4 underwent repeat esophagomyotomy 71/2 years after the initial operation with a good result. The remaining 3 had an antireflux procedure at the time of esophagomyotomy. Because of recurrence of symptoms, esophagogastrostomy was performed in 1 and colon interposition in 2. These results suggest that an antireflux procedure should not be added to modified Heller's operation in the treatment of achalasia.
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PMID:Two decades of experience with modified Heller's myotomy for achalasia. 647 42

In six patients with achalasia of the esophagus who previously underwent, one or more times, cardiomyotomy and had a failure of the procedure, we have done a new operation, an abdominal laterolateral anastomosis between the esophagus and the gastric fundus (Heyrowsky), wrapping it up with the stomach to form a genuine fundoplication. The six patients were preoperatively and postoperatively evaluated roentgenographically, endoscopically and manometrically, and the results were good with no reflux, and the drainage effect of the operation was excellent. This technique is a recourse for patients who have a recurrence of dysphagia after the Heller operation, because it has been ineffective, since it sometimes occurs in a rather large megaesophagus.
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PMID:The Heyrowsky operation associated with fundoplication for the treatment of patients with achalasia of the esophagus after failure of the cardiomyotomy. 663 17

To avoid gastroesophageal reflux which is reported to occur in about 4-25 per cent after Heller esophago-cardiomyotomy, a modified gastro-fundoplication was designed using a transabdominal approach. Forty patients with idiopathic esophageal achalasia were subjected to this surgery. There were no serious complications and suppression of dysphagia and gastroesophageal reflux manifestations were excellent.
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PMID:Cardiomyotomy and fundoplication for esophageal achalasia. 666 73

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.
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PMID:Achalasia: diagnosis, management, and clinical course in 16 children. 683 65

The symptoms of chest pain and dysphagia together with the typical radiological features of non-peristaltic segmental oesophageal contractions allowed the diagnosis of diffuse oesophageal spasm to be made in ten patients at The Prince Charles Hospital over the last six years. Eight patients have undergone long oesophageal myotomy with sparing of the lower oesophageal sphincter. All patients had immediate postoperative relief of symptoms, with postoperative cine radiographic examination in all patients demonstrating an inert oesophagus with adequate drainage and no gastro-oesophageal reflux. Two patients subsequently developed progressive dysphagia, one requiring a modified Heller's procedure. Because of the good result in six patients, sparing of the lower oesophageal sphincter with long oesophageal myotomy is recommended.
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PMID:Long oesophageal myotomy for diffuse spasm of the oesophagus. 695 65

During the past 20 months, 28 patients with symptomatic gastroesophageal reflux were treated with the Angelchik anti-reflux prosthesis. The patients ranged in age from 12 to 75 years, with symptoms present from one to 24 years. Vigorous medical management had failed with all patients prior to surgery. Before operation, 28 of 28 patients had upper GI x-rays, 27 of 28 fiberoptic esophagogastroscopy, 26 of 27 esophageal biopsy, eight of 28 Bernstein testing, and 24 of 28 lower esophageal sphincter pressure and motility. Eight patients had strictures requiring preoperative or postoperative dilatation. In four of 28 patients, a Nissen procedure had been previously done. In addition, two patients had metaplastic epithelium, and a single patient a previous Heller myotomy. Twenty-five of the 28 patients are completely asymptomatic eight to 20 months after Angelchik insertion. Fifteen patients had surgery more than one year previously. There are no recurrent hiatal hernias. Endoscopy and biopsy reveal resolution or marked improvement in the esophagitis. Seven patients complained of transient dysphagia lasting up to three months. One patient has persistent "gas bloat" syndrome. There were no technical or perioperative complications. Trouble with the prosthesis occurred in two patients; in one, the prosthesis disrupted and fell into the pelvis, and in the other the prosthesis migrated into the mediastinum. LES pressures preoperatively were 6.17 +/- 0.9 and 16.95 +/- 1.76 mmHg for the 19 patients studied after operation. The limited sample of patients who were studied with preoperative and postoperative acid-reflux tests have all shown improvement in their score. The Angelchik prosthesis in this series has been safe, simple, and reproducible, and can eliminate the symptoms and signs of gastroesophageal reflux.
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PMID:Treatment of symptomatic gastroesophageal reflux using the Angelchik prosthesis. 708 60

While Heller's myotomy has become the accepted operation for achalasia, still, there is no agreement about the indications for and choice of complementary procedures to minimize subsequent acid esophageal reflux. In the instances described in this investigation Heller's operation was accompanied by proximal gastric, or highly selective, vagotomy and anterior fundoplication. Dysphagia was abolished and normal alimentation restored in all but one patient, who was elderly and had an advanced megaesophagus. In every patient after the operation, results of pH-manometry, acid reflux tests and endoscopy demonstrated the absence of both acid reflux and esophagitis.
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PMID:Proximal gastric vagotomy and anterior fundoplication as complementary procedures to Heller's operation for achalasia. 711 62

Many previous studies have shown diffuse esophageal spasm (DES) to be an infrequent clinical disorder. Over a 15-month period, 122 patients were evaluated by low-compliance pneumohydrolic esophageal manometry. The patients were referred for obscure undiagnosed chest pain. Diffuse esophageal spasm or its variance was found in 22 patients (18%). All patients had chest pain and 77% had associated solid and liquid food dysphagia. Medical therapy included treatment with a combination of anticholinergic medications, short- and long-acting nitrates, mild sedatives, and dietary adjustments. Follow-up clinical evaluation have been obtained in 73% of patients: medical treatment alone has been successful in impressively relieving symptoms in 10 patients, two have benefited from repeat pneumatic dilatations, and one patient has improved after pneumatic dilatation and subsequent Heller myotomy. A combination of accurate clinical history, endoscopy, barium swallow, and esophageal manometry should allow a reliable diagnosis of DES with a good chance of successful medical therapy.
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PMID:Diffuse esophageal spasm in patients with undiagnosed chest pain. 717 46

Ten consecutive patients (ages 10 to 17) with achalasia of the esophagus diagnosed by radiographic, manometric, and endoscopic criteria were treated by forceful dilatations of the lower esophageal sphincter. A good to excellent response was seen in eight of the ten patients, manifested by disappearance of vomiting, improvement in dysphagia, and weight gain. A decrease in resting gastroesophageal sphincter pressure was documented in four patients tested. Short-term complications of fever or chest pain were seen following three of 18 procedures; however, barium swallow was negative for perforation and symptoms resolved spontaneously without treatment. Our findings suggest that pneumatic dilatation may produce similar results as surgical esophagomyotomy (Heller procedure) without the immediate operative morbidity, cost, and potential long-term effects.
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PMID:Successful treatment of achalasia in childhood by pneumatic dilatation. 725 67

In most centers the myotomy described by Heller and Zaayer is presently the treatment of choice for achalasia. Scrutinised reports show that the results of this operation are marred by complications. The reason is obvious: an insufficient myotomy may fail to relieve the symptoms of dysphagia and an incision sufficient to relieve obstruction may result in reflex oesophagitis. The technique described by Belsey consisting of a long myotomy combined with an antireflux procedure seems to be superior. The rational of this operation and preliminary results are discussed.
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PMID:Preliminary results of a long myotomy with antireflux procedure for achalasia of the oesophagus. 741 97


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