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

Dysphagia with anterior osteophytosis of the cervical bone is a more and more reported affection, especially after the age of 60. However it remains a rare event. The cause to effect relationship between these two entities should be documented by a complete assessment. Surgical treatment is reserved for patients whose medical treatment has failed. We describe an original case of cervical bone osteophytosis which was diagnosed during an acute and febrile aphagia and review the literature about its assessment and treatment.
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PMID:[Dysphagia and cervical osteophytosis: case report and review of the literature]. 1190 42

Botulinum toxin (Botox) produced by Clostridium botulinum is a potent neuromuscular blocker agent that inhibits acetylcholine release from presynaptic nerve endings. This effect was confirmed in the smooth muscle of the gastrointestinal tract and led to clinical trials investigating the efficacy of Botox for treatment of several gastrointestinal disorders. Multiple controlled studies have shown that Botox is effective in short-term management of achalasia. Botox reduces lower esophageal sphincter pressure, improves esophageal clearance, and alleviates symptoms in up to 70% of patients; however, its long-term efficacy decreases to 30% and repeated injections are often necessary. Botox is reserved for older patients and with high surgical risk. The main predictors of a good response are older age and presence of vigorous achalasia. Biliary or pancreatic sphincter of Oddi dysfunction (SOD) has been another indication for Botox administration. Transendoscopic injection of Botox in the papilla of Vater has shown relief of symptoms in more than 50% of cases of SOD. Furthermore, a Botox clinical response in this condition can predict a long-term benefit with endoscopic sphincterotomy. Botox decreases resting anal pressure, has healing rates of approximately 80% at six months after injection in patients with chronic anal fissure, and has a better outcome than topic nitroglycerine. Case reports have shown good results with Botox administration in treatment of diffuse esophageal spasm, anismus, oropharyngeal dysphagia, anterior rectocele, and secondary achalasia. Administration of botulinum toxin has a low rate of adverse reactions and complications.
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PMID:[Usefulness of botulinum toxin in gastrointestinal disorders]. 1221 36

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.
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PMID:Malignant fibrous histiocytoma of the pharynx. 1264 57

The primary treatment goals in patients with gastroesophageal reflux disease are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis, and prevention of complications of esophagitis. In patients with reflux esophagitis, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H2-receptor antagonist [H2RA] taken on demand or a proton pump inhibitor IPPI] taken 30 to 60 minutes before the first meal of the day). The preferred empiric approach is step-up therapy (treat initially with an H2RA for eight weeks; if symptoms do not improve, change to a PPI) or step-down therapy (treat initially with a PPI; then titrate to the lowest effective medication type and dosage). In patients with erosive esophagitis identified on endoscopy, a PPI is the initial treatment of choice. Diagnostic testing should be reserved for patients who exhibit warning signs (i.e., weight loss, dysphagia, gastrointestinal bleeding) and patients who are at risk for complications of esophagitis (i.e., esophageal stricture formation, Barrett's esophagus, adenocarcinoma). Antireflux surgery, including open and laparoscopic versions of Nissen fundoplication, is an alternative treatment in patients who have chronic reflux with recalcitrant symptoms. Newer endoscopic modalities, including the Stretta and endocinch procedures, are less invasive and have fewer complications than antireflux surgery, but response rates are lower.
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PMID:Management of gastroesophageal reflux disease. 1456 83

Due to its prevalence, impact on quality-of-life and the associated significant health resource utilization, dyspepsia is a major healthcare concern. The available management strategies for uninvestigated dyspepsia include prompt endoscopy, the 'test-and-treat' strategy for Helicobacter pylori, and empiric antisecretory therapy. There is consensus that endoscopy should be reserved for patients with alarm features (e.g. symptom onset after 45 years of age, recurrent vomiting, weight loss, dysphagia, evidence of bleeding, anaemia), H. pylori-positive individuals who fail test-and-treat, and those with an inadequate response to empiric antisecretory therapy. Factors influencing the decision between test-and-treat and empiric antisecretory therapy in uninvestigated dyspepsia include the local prevalence of H. pylori and peptic ulcer disease and the proportion of ulcers attributable to H. pylori. For uninvestigated dyspepsia in patients without alarm features, test-and-treat is the preferred initial management method in Europe based on the relatively high prevalence of H. pylori/peptic ulcer disease whereas empiric antisecretory therapy is preferred in many parts of the United States, where the prevalence of H. pylori/peptic ulcer disease is relatively low. In patients with non-ulcer dyspepsia, H. pylori eradication and empiric antisecretory therapy result in comparable and small, but statistically significant, improvements in dyspepsia. Empiric antisecretory therapy is the preferred initial method of managing non-ulcer dyspepsia in Europe and the US. The test-and-treat approach would receive increased enthusiasm if H. pylori cure is shown to prevent development of gastric cancer in non-ulcer dyspepsia patients in a large Western trial.
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PMID:Review article: uninvestigated dyspepsia and non-ulcer dyspepsia-the use of endoscopy and the roles of Helicobacter pylori eradication and antisecretory therapy. 1472 72

Although gastroesophageal reflux disease (GERD) is frequently referred to as a continuous spectrum, it is more useful to consider GERD as 2 discrete entities with several subsets that differ in pathophysiology, clinical presentation, natural history, and therapy. One entity is classic severe acid reflux with erosive esophagitis and its complications. Barrett's esophagus is an important subset of this group, with markedly increased acid exposure and an increased risk of adenocarcinoma. The second entity is nonerosive reflux disease (NERD) with minimal or no esophagitis. Patients with NERD do not develop local mucosa complications, like stricture or Barrett's esophagus, but their symptom severity can equal that of erosive esophagitis. Acid is involved in the symptoms of many but not all NERD patients. This acid dependence is evident either as an increase in esophageal acid reflux or a hypersensitivity to acid, and both generally respond well to proton pump inhibitor (PPI) therapy. NERD patients who are not acid-dependent have what is called functional heartburn; GERD-like symptoms are present, but there is no obvious involvement of refluxed acid. An important subset of GERD is refractory GERD, which consists of patients who fail aggressive PPI therapy. Parallel findings with other refractory syndromes can be anticipated; however, there are indications that psychosocial factors play a major role in refractory GERD, and these patients may benefit more from an integrated biopsychosocial approach. Diagnosis of GERD is usually made on clinical grounds, often supplemented by a therapeutic trial with antisecretory agents. Endoscopy is reserved for patients with alarm symptoms, such as dysphagia, anemia, or weight loss, or to detect Barrett's esophagus. Endoscopy is not useful to exclude the diagnosis of GERD because it will be negative in 70% of cases in primary care. Ambulatory 24-hour esophageal pH monitoring is necessary only when the diagnosis is in doubt, the patient fails medical management, or surgery is contemplated.
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PMID:Gastroesophageal reflux disease: presentation and assessment of a common, challenging disorder. 1510 91

In the first part of the article we described diagnostic methods aiming to resolve the individual underlying pathomechanism of chronic swallowing disorders (dysphagia). From these, we deducted different therapeutic measures that can be applied either alone or in combination. Weakening of the upper esophageal sphincter with botulinum toxin is reserved for patients with structural stenosis or a relative hyperfunction of the sphincter. It can be tried to use the "Passy-Muir Valve" for tracheostomized patients that aspirate. Most cases benefit from a therapy that consists of specific exercises. "Restitution" relies on exercises to practice new movement patterns as well as improvement of muscle strength. "Compensation" is based on exercises to counteract structural and/or functional deficits. Through "adaptation" residual, therapy resistant disease can be alleviated through dietary planning of consistency, temperature, and nutrient content of food. In many cases it is necessary to combine "restitution", "compensation", and "adaptation".
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PMID:[The management of dysphagia -- part 2: therapy]. 1608 Feb 57

Surgical therapy (Heller myotomy) is the most effective treatment to relieve dysphagia associated with achalasia. The advent of minimally invasive techniques, specifically the laparoscopic approach, significantly reduced the morbidity of surgical therapy, making it the procedure of choice for most patients who have achalasia. Pneumatic dilatation is a viable alternative, though is associated with inferior results and a higher risk of esophageal perforation than surgical therapy. Pharmacotherapy and Botox provide inferior results and should be reserved for temporizing therapy, or for patients who are deemed too frail for surgical intervention. For best results, a laparoscopic myotomy should be carried at least 3 cm onto the stomach, and a partial fundoplication should be performed to reduce the incidence of postoperative GE reflux.
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PMID:Achalasia. 1592 45

The Stretta procedure is safe and effective for the treatment of GERD. There are well-documented clinical trial data supporting its use, including a randomized sham-controlled study, single- and multi-center prospective trials, and community practice reports. The complication rate is within the acceptable range for therapeutic endoscopic procedures and less than the published complication rate for laparoscopic fundoplication. The durability of effect also is established beyond 2 years in several studies. Stretta should be added to the GERD management algorithm specifically for patients considering an antireflux surgical procedure but who are not accepting of the risks of surgery and anesthesia. These patients typically present with incomplete GERD control, despite optimal antisecretory drug therapy, or intolerance to medical therapy. Stretta should be considered only for patients who fit the anatomic inclusion criteria, whereas antireflux surgery should be reserved for those who do not. The decision to undergo antireflux surgery or Stretta must be based on the relative risks and benefits of each procedure. Although antireflux surgery provides better control of esophageal acid exposure than Stretta, the outcomes for GERD symptoms, quality of life, and reduction in PPI use are comparable. Stretta has a low risk of acute adverse events, has no reported cases of long-term dysphagia, and obviates general anesthesia and hospitalization, whereas antireflux surgery has a reported adverse event rate of approximately 2%, a considerable incidence of dysphagia, and requires general anesthesia and 1 to 2 days in the hospital. Another advantage of the Stretta procedure is that antireflux surgery still can be performed in the case of failures. In conclusion, the Stretta procedure offers a minimally invasive, safe, and effective alternative to antireflux surgery for those patients who have GERD who are controlled unsatisfactorily on antisecretory medications, who are considering surgery, and who meet the anatomic criteria that make the procedure technically feasible and safe.
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PMID:Endoscopic antireflux therapy: the Stretta procedure. 1610 30

Eosinophilic esophagitis (EE) is an increasingly recognized disease of the esophagus with distinct clinicopathologic features. Adult and pediatric patients experience upper intestinal symptoms including food impaction, vomiting, abdominal pain, or dysphagia. Histopathologic analysis of the distal and proximal esophageal mucosa demonstrates dense eosinophilic infiltration despite proton pump inhibition. Few studies document the long-term outcomes of EE but current evidence suggests that EE is a chronic condition that can sometimes lead to esophageal strictures. Although the incidence of this complication is not yet known, it has sparked significant interest in defining safe, effective treatments. Once a diagnosis of EE is made, patients should seek the consultation of the allergist in an effort to identify possible food sensitivities. This is particularly important because the etiologic agent(s) that drive the eosinophilia are likely different for each patient. If the allergic evaluation identifies a specific food, this food should be strictly avoided as a first-line treatment. If a food is not identified, an elemental formula should be used to induce a remission. If an elemental diet cannot be used, topical steroids are effective in inducing a remission. The side effects associated with long-term steroid administration limit their use as a maintenance medication. Given the lack of prognostic data, the use of systemic corticosteroids should be reserved for severe cases when dietary elimination or topical steroids are ineffective. Most importantly, patients should remain under the care of a physician so that long-term outcomes can be identified. To date, diet restriction has been identified as the only effective maintenance treatment, but montelukast and topical cromolyn may also offer benefit. Anti-interleukin-5 antibody represents an emerging form of targeted therapy.
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PMID:Treatment of eosinophilic esophagitis in children. 1616 5


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