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

The frequency and the possible age-related characteristics of gastro-oesophageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p less than 0.001). The occurrence of heartburn and regurgitation did not differ significantly between patients with or without oesophagitis, although the mean symptom scores were higher in those with oesophagitis. Dyspepsia and chest pain were not typical symptoms in oesophagitis. Of patients with oesophagitis 29% had no typical symptoms of GORD; only 24% of patients with regurgitation had oesophagitis. In 24-hour pH monitoring, a significant increase in the occurrence of symptoms was not seen until total reflux time pH less than 4 exceeded 10%. The occurrence of heartburn did not correlate with the extent of reflux in the pH study. In conclusion, typical symptoms of GORD in the aged were regurgitation, dysphagia, respiratory symptoms and vomiting rather than heartburn.
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PMID:Symptoms of gastro-oesophageal reflux disease in elderly people. 175 93

Despite the aging of our population, there remains a paucity of information about gastroesophageal reflux (GER) in the elderly. To assess the prevalence and characteristics of GER within this patient population, questionnaires evaluating symptoms associated with GER were administered to 313 consecutive patients 62 yr old or older from a primary care setting. Fourteen percent of these patients reported having at least weekly heartburn. Ambulatory 24-h esophageal pH monitoring was accomplished in 54 of the 313 patients surveyed. Twenty percent (11/54) of this subgroup exhibited increased acid contact time (pH less than 4 for more than 6% of the monitoring period). Twenty-two percent (12/54) complained of heartburn, yet only six individuals (11%) exhibited both symptomatic and objective indications of acid reflux. Surprisingly, 31% (17/54) of the patients studied exhibited significant alkalinity within the distal esophagus (pH greater than 8 for greater than 1.5% of the monitoring period). Whereas 29% of these patients (5/17) reported heartburn, 40% of those reporting heartburn (2/5) had acid GER as well as excessive alkalinity. In contrast to patients with acid GER--none of whom reported pulmonary symptoms--24% (4/17) of these patients with esophageal alkalinity reported wheezing, nocturnal cough, or paroxysmal nocturnal dyspnea. Of the four patients with significant distal esophageal exposure to both acid and alkali, two reported heartburn and a third reported dysphagia. In addition to the somewhat higher prevalence of acid reflux than anticipated, a surprisingly high prevalence of esophageal alkalinity was observed.
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PMID:Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. 185 62

Aspiration can lead to serious pulmonary disease and occasionally death. Substances aspirated commonly include bacteria or gastric contents or both, but may be as unusual as diesel oil or a variety of foreign bodies. Pulmonary symptoms range from a subtle cough, wheezing, or hoarseness to severe dyspnea or asphyxiation. We discuss the mechanism of pulmonary disease caused by aspiration as well as the appropriate treatment.
Dysphagia 1989
PMID:Pulmonary consequences of aspiration. 263 73

Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. There was no family history of vocal cord abnormalities. A year before the onset of symptoms, he suffered injury to his oral cavity with a loss of consciousness during a wrestling match. He denied dysphagia or dysphonia. He failed to respond to bronchodilators, cromolyn, or prednisone therapy during 4 weeks. On referral to our clinic, his physical examination and tape recording were characterized by harsh inspiratory stridor. His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. Fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." Sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.
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PMID:Bilateral abductor paresis masquerading as asthma. 337 24

Primary tumors of the esophagus are extremely rare in children. A common periesophageal mass in children is duplication. It constitutes only 0.5 to 2.5% of all esophageal lesions usually diagnosed in infancy or early childhood. Duplication of the esophagus may be diagnosed on examination by the emergency department (ED) physician when it produces symptoms or when it is inadvertently found on a chest radiograph. The duplication may produce acute gastrointestinal symptoms such as vomiting and dysphagia or respiratory symptoms such as cough, wheezing, or dyspnea. Currently the examination of choice for evaluation of esophageal duplication is a barium swallow. However, computed tomography (CT) has the advantage over conventional diagnostic procedures, since it demonstrates the cystic nature of the mass and its relationship to adjacent structures in a noninvasive manner. An esophageal duplication has a well-marginated spherical mass contiguous with the esophagus, with preserved surrounding fat planes, and numbers of 15 to 30 Hausenfield units (HU) on CT. We are reporting three cases of this anomaly as demonstrated by CT.
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PMID:Esophageal duplication in children: a report of three cases evaluated by computed tomography. 384 40

The atmosphere of a fire is deadly to breathe. Firefighters or building occupants may be victims of the heat, irritating smoke, depleted oxygen, carbon monoxide, and such other toxic gases as cyanide, hydrogen chloride, and acrolein. Increasing numbers of homes and public buildings are being built and furnished with highly flammable synthetic materials that give off copious smoke and toxic gases when burned. Whether or not there are cutaneous burns, the possibility of inhalation injury must be considered in any fire victim. All victims of a fire environment should be presumed to have CO intoxication and should be treated with 100% oxygen until the HbCO level is within normal limits. In an extreme situation, cyanide intoxication should be suspected and administration of sodium thiosulfate may be lifesaving. Upper airway occlusion may result from thermal damage or edema secondary to burns from soluble toxic gases. Chemical injury to the lower airway and alveoli may result from inhalation of insoluble irritant gases and toxic gases adsorbed on carbon particles. Upper respiratory tract obstruction may be suggested by the clinical presentation (eg, pharyngeal burns, stridor, hoarseness, dysphagia), but only by means of fiberoptic bronchoscopy can it be recognized or excluded with certainty. Intubation may be necessary. Lower respiratory tract injury may be manifest clinically by dyspneas, wheezing and chest tightness, as well as by hypoxemia and reduced FEV1 and FVC. Treatment is symptomatic, but close observation for progressive respiratory insufficiency is necessary.
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PMID:Inhalation of products of combustion. 662 65

Cardiac and aortic arch anomalies are a well-known cause of tracheal and esophageal compression producing stridor and dysphagia. We present a rarely encountered aortic arch anomaly in a 12-month-old infant who suffered from intermittent pulmonary wheezing. A discussion of the subsequent evaluation including an esophageal contrast study, computed tomography, angiocardiography, and bronchoscopy, will emphasize the diagnostic importance of these examinations. Preoperatively, a variant of Celoria type B aortic arch interruption was established by cardiac catheterization. The ascending aorta solely supplied both carotid arteries. Both subclavian arteries arose from the descending aorta, and all flow to the descending aorta was supplied via bilateral markedly enlarged vertebral arteries as a bilateral subclavian steal. Three areas of tracheal compression were noted at bronchoscopy. The patient's anomalous circulation was improved by the placement of a Gore-Tex graft connecting the ascending and descending aorta. A right-sided arterial ligament was divided in order to further relieve tracheal compression.
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PMID:Aortic wheeze: intermittent tracheal obstruction caused by a rare aortic arch anomaly. 688 44

Retrospective study of ten infants and young children in whom an unsuspected foreign body was found in the esophagus revealed that all had had wheezing of difficulty swallowing solid food. In four, stridor or wheezing had been ascribed to respiratory infection. All foreign bodies were in the upper esophagus. Their presence can cause prolonged, severe morbidity. They can be identified by radiography of the neck and chest, occasionally supplemented by barium studies.
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PMID:Unsuspected esophageal foreign bodies. 721 59

We studied 12 cases of right aortic arch (RAA) with MRI, and the anatomical relationship between right aortic arch and the esophagus and trachea were analysed. Three of 12 cases showed RAA with mirror-image branching. Nine cases were RAA with aberrant left subclavian artery. The proximal portion of the aberrant left subclavian artery in the retrotracheoesophageal space was expanded just like a pouch. The pouch was the 8th segment dorsal aortic root and the so-called aortic diverticulum. This was one of the causes of symptoms such as wheezing and dysphagia. We divided the configuration of aortic diverticulum into two types, bulging type and saccular type, on the basis of coronal images. Two cases were bulging type, seven saccular type. The axial images in two cases showed compressed esophagus, and in three cases showed displacement of the trachea, narrowing of the space like a triangle surrounded by the aortic arch, aortic diverticulum and aberrant left subclavian artery. We drew lines and measured the angle of the aortic arch with the aberrant left subclavian artery on the axial images of these cases. We found that cases with an angle of less than 60 degrees showed a high correlation with the causes of compression of the esophagus or displacement of the trachea. It was necessary to follow such patients with MRI.
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PMID:[Analytical evaluation of compression and displacement of the esophagus and trachea due to right aortic arch with MR imaging]. 872 31

From 1974 to 1995, 19 children with achalasia of the esophagus have been treated at our institution. Presenting symptoms included vomiting (n = 14), dysphagia (n = 13), failure to thrive (n = 6), and odynophagia (n = 1). Diagnosis was established by a barium swallow in 19, with eight also undergoing esophageal manometry. Six boys and 13 girls with an average age of 10 years (range, 1.3 to 17.6) underwent a transthoracic, modified anterior Heller esophagomyotomy (HM). Five underwent a concomitant, modified, Belsey fundoplication (BF). Follow-up ranging from 6 months to 21 years (mean, 9 years) was accomplished in all 19 patients by both office visits and telephone interviews. Early postoperative follow-up showed initial swallowing difficulty in two (14%) patients with a HM alone and in four out of five (80%) patients treated with a HM and BF. All patients (n = 5) with a HM and BF and one with a HM alone required one esophageal dilation during the first postoperative year. These initial swallowing difficulties resolved in all six patients during this first postoperative year. Late postoperative follow-up, however, indicates occasional, mild dysphagia in two out of five with an HM and BF resulting in complete relief of presenting symptoms in 17 of the 19 patients (90%). All patients rated their overall result as either excellent (68%) or good (32%) with none rating it as fair or poor. None of the 19 patients had clinical evidence of gastroesophageal reflux, although five patients had evidence of nonpathologic reflux noted during upper gastrointestinal x-ray. Recurrent vomiting, asthma, wheezing, or esophagitis symptoms have not been reported by any patients. No patients required reoperation, and there were no deaths or postoperative complications. Modified Heller esophagomyotomy is safe (0% mortality) and effective (90% relief of symptoms) in children with achalasia. A concurrent modified Belsey fundoplication results in early and late mild postoperative dysphagia that was responsive to esophageal dilation. The transthoracic, modified Heller esophagomyotomy without a fundoplication is currently our treatment of choice for achalasia in children.
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PMID:Efficacy of the transthoracic modified Heller myotomy in children with achalasia--a 21-year experience. 904 49


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