Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Secondary esophageal achalasia due to malignancy is a rare condition; only 53 such cases have been reported to date. Sixty-two percent of the cases were due to gastric adenocarcinoma. Mesothelioma of the peritoneum is an uncommon neoplasm. The usual presenting symptoms are abdominal pain, abdominal mass, or abdominal distention. The patient we are reporting had peritoneal mesothelioma which presented with dysphagia and weight loss, in addition to the radiological and manometric picture of achalasia. Secondary achalasia was suspected clinically, and was confirmed by computed tomography and laparotomy. The diagnosis of peritoneal mesothelioma was made only by histopathological examination. We are not aware of any other report documenting the association of peritoneal mesothelioma and achalasia.
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PMID:Peritoneal mesothelioma: an unusual cause of esophageal achalasia. 225 28

Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastro-esophageal reflux disease.
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PMID:Esophageal adenocarcinoma in a patient with surgically treated achalasia. 225 39

Achalasia secondary to malignancy is rare, with most cases associated with gastric adenocarcinoma of the gastroesophageal junction. This report describes the clinicopathologic features of a 64-year-old man found to have mesothelioma as the cause of secondary achalasia. To our knowledge, this is the first case of secondary achalasia produced by a mesothelioma. We reviewed the English literature in regard to achalasia induced by tumors.
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PMID:Esophageal achalasia secondary to mesothelioma. 275 76

Secondary or "pseudo" achalasia of the esophagus can mimic idiopathic achalasia radiographically and can be difficult to diagnose. Typically, it is due to invasive carcinoma involving the gastroesophageal junction, usually gastric adenocarcinoma. Occasionally, an achalasialike condition can be produced by tumors not involving the gastroesophageal junction. We report 2 cases, 1 of lung carcinoma and the other of hepatoma, in which the patients had radiographic and endoscopic changes compatible with achalasia. However, the onset of symptoms was abrupt and the patients were elderly; these are unusual features for primary achalasia. There have been several other reports of nongastrointestinal neoplasms producing a clinical and radiographic picture similar to achalasia. Although there are several theories as to the cause, our cases would support the concept that direct tumor involvement of the gastroesophageal junction is not necessary to produce significant esophageal dysmotility.
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PMID:Achalasia secondary to nongastrointestinal malignancies. 299 89

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.
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PMID:Early esophageal cancer. 348 67

Malignancies involving the gastric cardia or distal esophagus can result in a clinical syndrome termed pseudoachalasisa that mimics idiopathic achalasia. If not promptly recognized, pseudoachalasia can result in inappropriate pneumatic dilatation of the lower esophageal sphincter segment and delay appropriate treatment of the underlying malignancy. During the past 14 years, six patients with pseudoachalasia and 161 patients with primary idiopathic achalasia were encountered. Pseudoachalasia occurred mainly in the elderly and represented about 9 percent of these patients over 60 years of age with suspected achalasia. Five of the six pseudoachalasia cases were secondary to adenocarcinoma that originated in the gastric fundus, and one was caused by a squamous cell carcinoma of the distal esophagus. Conventional esophageal manometry did not discriminate achalasia from pseudoachalasia. On the other hand, esophagogastroscopy with biopsy resulted in a diagnosis of pseudoachalasia in five of these cases and in 24 of 32 cases reported previously. Ominous endoscopic findings are mucosal ulceration or nodularity, reduced compliance of the esophagogastric junction, or an inability to pass the endoscope into the stomach. Radiographic evaluation, particularly in conjunction with amyl nitrite inhalation, was also useful in discriminating pseudoachalasia from primary achalasia. It is concluded that pseudoachalasia generally mimics idiopathic achalasia imperfectly and can usually be diagnosed prior to surgery by fastidious endoscopic and radiographic examination.
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PMID:Comparison of pseudoachalasia and achalasia. 354 47

We describe a patient who developed an esophageal adenocarcinoma 25 years after esophagomyotomy for achalasia. The tumor arose in a Barrett's esophagus, suggesting gastroesophageal acid reflux following the Heller procedure.
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PMID:Esophageal adenocarcinoma following Heller myotomy for achalasia. 356 52

Computed tomography (CT) of the chest and abdomen has proved to be helpful in the preoperative staging of both esophageal and gastric carcinoma. The gastroesophageal junction however, is a difficult area to evaluate as variations in normal anatomy may mimic pathological processes. Pseudomasses at the gastroesophageal junction can be confused with neoplasm. The CT appearance of the GE junction was evaluated in 150 normal patients. CT scans were also performed on 15 patients with carcinoma involving the GE junction. Twenty cases of benign diseases of the GE junction were also studied by CT. Anatomy--The normal anatomy of the gastroesophageal junction will be illustrated with both line diagrams and CT images. The hepatogastric ligament and the caudate lobe of the liver will be demonstrated and their use in locating the GE junction will be shown. Technique--A short segment describing the appropriate technique for CT of the gastroesophageal junction will follow. The use of oral and intravenous contrast will be discussed. The need for distension of the stomach with effervescent agents and oral contrast as well as the use of decubitus and prone positioning will be emphasized when a mass-like density is seen at the GE junction. Examples will be provided. A pseudomass at the GE junction on a supine CT will be shown that disappears with distension and decubitus scanning. This will be used to lead into the next section on neoplasm in which the first example will have an identical appearance on supine CT images. Neoplasm--The relative incidence of gastric adenocarcinoma and esophageal squamous cell carcinoma at the GE junction will be briefly reviewed. The similar CT appearance of the neoplasms will be described and liberally illustrated. Metastatic involvement of lymph nodes adjacent to the GE junction will also be shown. The staging classification for CT evaluation of GE neoplasms will be reviewed. The utility of preoperative staging of esophageal and gastric neoplasms will be briefly reviewed and applied to the GE junction. Our series of patients with cancer of the GE junction will be discussed. The importance of the CT detection of criteria of inoperability will be demonstrated with examples of metastatic involvement of the liver and lymph nodes as well as direct invasion of adjacent organs. Benign Disease--Examples of benign stricture, hiatal hernia, and achalasia will be illustrated. Our cases where CT scans helped rule out a malignant process that had been suggested on barium studies will be reviewed. Summary and Conclusions--Important points of technique, normal anatomy, benign and malignant disease will be briefly reviewed.
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PMID:Computed tomography of the gastroesophageal junction. 637 68

Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbach's plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.
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PMID:[Megaesophagus secondary to carcinoma of the cardia: apropos of 4 cases]. 653 56

Three patients who were 8 to 30 years status postmyotomy for achalasia were shown to develop Barrett's columnar metaplasia of the esophagus. In one instance, the patient had multiple areas of severe dysplasia to carcinoma in situ. There have been only a few reports in the world literature of Barrett's metaplasia occurring in postmyotomy achalasia patients. Our experience would indicate it may be a more common complication than previously appreciated. Also, a possible causal relationship between surgical intervention, Barrett's epithelium, and adenocarcinoma in achalasia is suggested.
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PMID:Barrett's metaplasia and dysplasia in postmyotomy achalasia patients. 684 1


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