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)

A 9-month-old infant suffering from dysphagia to solids presented with esophageal bolus obstruction. Using an adult fiberoptic esophagoscope, a congenital web was found at the junction of the middle and distal thirds of the esophagus. Previous direct rigid esophagoscopy and roentgenologic examination had not visualized the web. The web was successfully ruptured and dilated by inserting a guide wire under fiberscopic control and then inserting metal olives, followed later by blind mercury bougienage. This report illustrates the use of adult fiberoptic instruments for diagnosis and treatment in pediatric patients.
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PMID:Fiberoptic endoscopic diagnosis and treatment of a congenital esophageal diaphragm. 115 17

Three hundred patients underwent 1,177 esophageal dilations over a nine-year period. There were 164 men and 136 women. Mean age was 63 years. Etiology of stricture was peptic (160), Schatzki's ring (124), cancer (8), post-surgical (3), post-radiation (2), caustic ingestion (1), and esophageal web (2). Dilators used were Maloney red-rubber mercury weighted (78.1%), Savary wire-guided (15.2%), Eder-Puestow (6.3%) and Balloon (0.4%). Fluoroscopy was used in 98% of cases. One hundred and two of the 111 patients with peptic strictures observed for longer than six months had successful dilation. Forty-five of these patients (40.5%) required 54 redilations to maintain relief of dysphagia. Nine patients were refractory to dilation, two needing serial dilation and seven surgery. All Schatzki's rings were treated successfully. Ten of 82 patients followed for greater than six months needed redilation (12%). Morbidity was 0.2% with two complications occurring, an esophageal perforation and one case of hematemesis. There was no mortality.
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PMID:Esophageal stricture: results of dilation of 300 patients. 140 61

A 3-year-old child with cricopharyngeal dysfunction is reported. Swallowing difficulties, nasal regurgitation, and gagging developed at 2 months of age. Repeated aspirations and over 40 episodes of pneumonia necessitating multiple hospitalizations occurred up to 2 years of age, along with pharyngeal pooling of saliva and inability to swallow solid food. Barium was held up at the cricopharyngeal level, and a prominent esophageal impression was seen at the same level. Symptoms were completely alleviated after two esophageal dilatations by mercury dilators, and the relief persisted for the 6 months of follow-up. The diagnosis of cricopharyngeal dysfunction is discussed, and the necessity for manometric studies, in the face of often misleading radiologic appearance, is emphasized. It is suggested that early use of esophageal dilatations might prevent prolonged morbidity and afford long-term symptomatic relief.
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PMID:Cricopharyngeal dysfunction in childhood: treatment by dilatations. 369 45

Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.
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PMID:Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation. 400 34

A force transducer has been developed to measure peristaltic propulsive force (;pull') in the oesophagus. Utilizing a mercury-in-Silastic strain gauge to which a sphere has been attached, this transducer can be calibrated to measure value for force, work, and power. Variability in force values were found between different peristaltic waves at the same site, between different sites in the same subject, and between different control subjects. Control subjects' patterns did not change when the subjects were studied on separate occasions. Patients complaining of dysphagia, who had normal radiographs and manometric tracings, revealed force values that were significantly different from control values. This device should prove useful in the quantitation of oesophageal muscle function.
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PMID:Intraluminal force transducer measurements of human oesophageal peristalsis. 504 Aug 33

A wide variety of therapies have been suggested for patients with painful esophageal motility disorders. In a prospective, double-blind, cross-over clinical trial, we evaluated the effectiveness of mercury bougienage ("placebo," 24 F; "therapeutic," 54 F) in eight symptomatic patients with the nutcracker esophagus (NE). There were no significant differences between the placebo or therapeutic dilators in relation to chest pain, dysphagia, lower esophageal sphincter pressure, or amplitude. Chest pain scores after completion of this trial were significantly lower than baseline scores, irrespective of the sequence of dilators used. No subjective or objective improvement could be demonstrated when "therapeutic bougienage" was compared with "placebo bougienage" in patients with the NE. The improvement in symptoms at the completion of the study may result from the close physician-patient interaction, suggesting that this may be more important than the actual size of the bougie.
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PMID:Esophageal bougienage in symptomatic patients with the nutcracker esophagus. A primary esophageal motility disorder. 637 33

Postvagotomy dysphagia is typically a temporary phenomenon but a small subgroup of patients appear to develop irreversible motility disorders of the esophagus. Two patients are reported with persistent symptomatic esophageal dysfunction demonstrated by modern hydraulic infusion technics. Both initially lost weight rapidly and then stabilized. The distal esophagus of both was greatly dilated but in one patient, lower esophageal sphincter pressure was normal. Aperistalsis with diminished motor activity was present throughout the body of the esophagus. Dysphagia and objective esophageal abnormalities were refractory to dilations with simple mercury bougies in one patient whose condition was improved by treatment with pneumatic dilation. The cause of this unusual complication is unknown but may involve a nonneoplastic form of secondary achalasia.
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PMID:Irreversible esophageal motor dysfunction in postvagotomy dysphagia. 732 47

An 86-year-old man presented ambulatory with acute dysphagia. Radiologic examination and endoscopy revealed a swallowed postauricular hearing aid. The earmold of the hearing aid became visible in the hypopharynx after mucus and saliva were removed. It could be extracted without effort once the connecting tube was disconnected from the coupling device lodged in the upper esophageal sphincter. The hearing aid itself was impacted in the proximal esophagus and was extracted without any problems. The postoperative phase was uneventful with normal swallowing and discharge. Technical inspection revealed that the hearing aid no longer worked. Diffusion of toxic substances (zinc, mercury) from the impacted batteries is not to be expected.
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PMID:[Case report: swallowed hearing aid]. 856 24

Peptic strictures of the esophagus are a common sequelae of long-standing reflux esophagitis. They occur in approximately 10% of patients with gastroesophageal reflux disease seeking medical evaluation. Factors predisposing to stricture formation are poorly understood; however, stricture patients are typically older, have a longer duration of reflux symptoms, and more frequently display abnormal esophageal motility than reflux patients without strictures. Diagnosis can usually be made with a careful history but should be confirmed with a barium esophagram followed by endoscopy with biopsies to exclude malignancy. Relief of dysphagia, which is the initial goal of therapy, can be readily accomplished in most patients using polyethylene or mercury-filled dilators or balloons. An equally important therapeutic objective should be the complete healing of associated esophagitis using proton pump inhibitors. Surgical treatment is reserved for the subset of patients with intractable esophagitis, irreversibly damaged esophagus, or extraesophageal manifestations.
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PMID:Diagnosis and management of peptic esophageal strictures. 895 96

Esophageal dilation, a technique developed four centuries ago, continues to be an important method of treating the symptom of dysphagia in patients with luminal narrowing of the esophagus. Dilation is safe, with < 0.5% chance of perforation and bleeding and a 0.01% risk of death. Mercury bougienage (Maloney dilators), hollow polyvinyl dilators (Savary-Guillard), and balloon dilators (Through the Scope) are the principal types of dilators in use today. Few trials have compared the differing dilating methods. The results of these trials are mixed, and further randomized trials are necessary to determine if any technique has advantages in efficacy and cost. Although most patients successfully treated with dilation suffer with peptic strictures, those with nonpeptic strictures due to lower esophageal mucosal rings, corrosive injury, and radiation injury can also be treated effectively with dilation. By reviewing the current literature, effective treatment algorithms can be used with patients suffering from dysphagia due to various types of strictures.
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PMID:Esophageal dilation. 953 Nov 11


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