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)

Fifty-three patients with scleroderma were evaluated by history, barium swallow, and esophageal function tests. The most common esophageal symptoms were heartburn and dysphagia. Abnormal motility was seen radiologically in 43 patients, gastroesophageal reflux in only 9. Esophageal function tests demonstrated: (1) abnormal motility in 51 patients and lack of a distal esophageal high-pressure zone in 18; (2) moderate to severe gastroesophageal reflux in 38; and (3) abnormal acid-clearing ability in 50. Eleven patients, including 8 with peptic stricture, underwent the combined Collis-Belsey operation. Symptomatically, reflux was abolished in all and dysphagia in 10. Roentgenograms showed that regression of strictures was complete in 5 and partial in 3. Postoperative esophageal function tests in 9 patients demonstrated a competent distal esophageal valvular mechanism in 7. Gastroesophageal reflux, not impaired motility, is the major cause of esophageal symptoms in scleroderma. Its effecitve operative control is not contraindicated by systemic disease in these patients.
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PMID:Gastroesophageal reflux in esophageal scleroderma: diagnosis and implications. 0 16

Twenty-four patients with gastro-oesophageal reflux were treated by Nissen fundoplication over a three-year period. In 22 patients the symptoms of heartburn, reflux, or dysphagia were abolished or dramatically improved. The operative technique, complications, and reasons for the less successful outcome in the remaining two cases are discussed.
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PMID:Nissen fundoplication for gastro-oesophageal reflux. 31 95

Nineteen patients with symptoms of upper gastrointestinal disease were assessed by endoscopy. Transmucosal potential difference (PD) in the lower oesophagus was recorded and suction biopsy specimens were obtained from the site of measurement and examined by light microscopy after haematoxylin and eosin staining. In 10 patients with normal histology, mean PD was--14.4 mV (SEM +/- 0.4 mV), whereas in nine patients with histological changes of reflux mean was +9.4 mV (SEM +/- 3.0 mV). In this latter group, polarity of the PD was reversed in all but one case. Good correlation was found between these objective indices of lower oesophageal disease and the presence of symptoms such as dysphagia and heartburn. The visual appearance at endoscopy was less reliable. It is suggested that measurement of PD is a simple, rapid, and sensitive method of detecting the presence of oesophageal mucosal damage.
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PMID:Transmucosal potential difference; diagnostic value in gastro-oseophageal reflux. 65 70

Although the lower esophageal ring is an important cause of dysphagia in adults, its pathogenesis is unknown. To better define the relationship between the lower esophageal ring and esophageal reflux, we analyzed, retrospectively, the records of 18 hospitalized patients with radiologically demonstrated rings (16 confirmed by endoscopy and/or surgery). In 16 of these patients, evidence of esophageal reflux including at least one of the following was present: overt esophagitis noted at endoscopy or surgery (14 cases), histologic evidence of esophagitis (3 cases), and/or symptoms of pyrosis or free reflux (13 cases). These findings suggest that 1. reflux is frequently associated with lower esophageal rings and may play a role in their pathogenesis; 2. the radiologic finding of a ring should serve as a clue to the possibility of esophageal reflux and 3. long-term control of dysphagia in these patients may depend upon control of the associated reflux as well as mechanical disruption of the ring.
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PMID:The lower esophageal ring and esophageal reflux. 68 61

Review of the world literature to the end of 1971 has provided data on 838 cases of esophageal leiomyomata, including our own 19 surgically removed lesions. Although esophageal leiomyoma is the most common of the benign tumors of the esophagus, it is still rare compared with carcinoma. It occurs in more men than women, by a ratio of 1.9 to 1. Over 50% of the patients with leiomyoma of the esophagus are asymptomatic. Dysphagia and vague pain are the most frequent symptoms. Pyrosis is mentioned in the literature as present in 40% of the cases, but it is considered mainly as symptom of coexistent hiatal hernia. Diagnostic problems often arise, as the smooth muscle tumors may mimic mediastinal neoplasms, cysts, or even aneurysms, or complicate coexisting hiatal hernia and esophageal diverticulum. Operative management by transthoracic enucleation is the procedure of choice, although resection of the esophagaus may be required in few cases. Postoperative morbidity is minimal and results are excellent.
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PMID:Leiomyomata of the esophagus. An analysis of 838 cases. 99 Nov 29

A series of 8 patients with severe oesophageal strictures secondary to reflux oesophagitis who have been treated by antrectomy with Roux-en-Y anastomosis is described. There was 1 postoperative death. The remaining patients have been completely relieved of heartburn and all have had a dramatic improvement in their dysphagia. This method of treatment is strongly recommended for patients who have had prior surgery to the hiatus which has failed, and for those who are too elderly or frail to withstand a direct attack on their oesophageal stricture.
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PMID:Antrectomy with Roux-en-Y anastomosis in the treatment of peptic oesophagitis with stricture. 117 98

Ten patients with documented scleroderma were assessed before and after antireflux operations over a twelve year period. The approach was through the left chest in 9 of 10 patients (7 short Nissen, 1 Collis Nissen, 1 Collis Belsey) and through the abdomen for 1 (vagotomy, antrectomy and Roux en Y). Clinically, 5 of 10 patients still mention episodes of heartburn. Dysphagia, which was present in 8 patients before the operation, has been replaced by a slow emptying impression in five. Endoscopically five patients had a columnar lined esophageal mucosa. Four more were considered to have ulcerative esophagitis and stricture which proved to be also Barrett's esophagus in the postoperative assessment. Three patients had preoperative 24 h pH assessment when the technique became available. Their postoperative control studies revealed persistent acid exposure but to a lesser degree. All ten patients had 24 h pH studies in their postoperative assessment and 5 out of 10 still show abnormal exposure to acid. Esophageal motility studies did not reveal significant changes to the hypomotility of the distal esophageal body and to the decreased tone of the Lower Esophageal Sphincter area. Both radiologically and using esophageal transit scintigrams the esophagus shows atony and poor emptying before the operation. Retention is increased following the creation of an antireflux technique at the esophagogastric junction. The success rate of antireflux operations in scleroderma patients is limited. The ideal procedure to use in this condition remains unclear.
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PMID:[Scleroderma and esophageal reflux, surgical monitoring]. 129 56

Granular-cell tumors (GCT), also called Abrikossof's tumors, are generally benign, ubiquitous tumors. An original case of granular-cell tumor of the esophagus is reported. The symptoms included dysphagia and pyrosis. Fiberendoscopy showed a peptic esophageal stenosis with ulcerations confirmed by biopsy. CT showed a round thickening of the esophageal wall, localized in height. This lesion had previously been the object of several dilatation attempts. Esophagectomy with esogastric anastomosis in the thorax was performed. The histological study allowed diagnosing a granular-cell tumor, though one of a very peculiar type: misleading symptoms, tumor infiltrating the whole height of the esophagus and a circular area. Ninety cases of granular-cell tumors are reported in the literature; they are associated with a cancer of the air passages or of the digestive tract in 11% of cases. The cancer often appears secondarily, which requires lengthy surveillance. We do not know if this association is directly related or accidental. We have found no identical case of such a lesion, involving both the whole circumference and the whole height of the esophagus, in the literature.
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PMID:[Abrikossof's tumor of the esophagus. An original case. Review of the literature]. 133 16

The physiologic abnormalities and management of patients with diffuse esophageal spasm are controversial. We evaluated the symptomatic and functional results of surgical therapy in 19 patients with diffuse esophageal spasm who were incapacitated with dysphagia and chest pain and unresponsive to conservative management. A long esophageal myotomy with an antireflux procedure was performed in 15 patients, and four patients with multiple previous esophageal procedures had an esophagectomy. Eleven patients had increased esophageal exposure to gastric juice on preoperative 24-hour esophageal pH monitoring. The severity of dysphagia, chest pain, regurgitation, and heartburn was scored on a scale of 0 to 3 before and a mean of 24 months (range 8 months to 13 years) after the operation. After myotomy, each of these symptoms and the overall symptom score improved significantly (p < 0.01). The improvement in the symptom scores in the patients who had esophagectomy were comparable with the improvement after myotomy. On self-assessment, 90% of the patients would have the operation again if again faced with the decision. Standard and ambulatory 24-hour manometry showed a significant reduction in the amplitude of the esophageal body contractions, a decrease in the frequency of simultaneous contractions, and the elimination of multi-peaked waves after the myotomy. Despite the addition of an antireflux procedure, lower esophageal sphincter pressure, overall length, and abdominal length were reduced markedly after the myotomy. This was associated with persistent or emerging heartburn or regurgitation in four patients. These data indicate that a long esophageal myotomy is a valid treatment alternative in appropriately selected patients with diffuse esophageal spasm. Esophagectomy and colon interposition is the procedure of choice in patients with multiple previously failed myotomies.
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PMID:Physiologic assessment and surgical management of diffuse esophageal spasm. 140 82

Forty-five patients with histologically proven Barrett's columnar-lined oesophagus (CLO) were treated in one unit over a 9-year period. Patients were studied prospectively as part of a surveillance programme; all initially received standard conservative treatment including high-dose H2-receptor antagonists. A satisfactory initial response was seen in 21 patients, but in 24 the symptoms were unchanged or progressed; 19 patients in the latter group were considered suitable for antireflux surgery and underwent fundoplication. Symptoms of heartburn or dysphagia persisted or recurred in 88 per cent of patients receiving medical treatment alone and complications developed in 38 per cent, including nine strictures and one adenocarcinoma. In patients undergoing antireflux surgery, symptoms persisted or recurred in 21 per cent and complications developed in 16 per cent (P < 0.01). Complete regression of Barrett's CLO occurred in two patients (11 per cent) after antireflux surgery. The results of this study suggest the superiority of antireflux surgery over pharmacological acid suppression in the control of symptoms and prevention of complications in patients with Barrett's CLO.
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PMID:Barrett's oesophagus: effect of antireflux surgery on symptom control and development of complications. 142 17


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