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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laparoscopic procedures have begun to replace many conventional operations because of the avoidance of major surgery and the rapid recovery of the patient. The majority of these traditional operations will be performed laparoscopically in the future. For example, patients who suffer from achalasia will be able to undergo laparoscopic cardiomyotomy and patients with non-cardiac chest pain of esophageal origin will be able to undergo thoracoscopic myotomy. Likewise, a viable alternative to long-term medication with H2 blockers or omeprazole will be laparoscopic posterior vagotomy and anterior lesser curve seromyotomy. As methods are developed to deal with the extraction of large specimens, many ablative procedures will be undertaken by the laparoscopic route. Extraction techniques must not compromise the need for histopathological examination of the resected specimen in cancer resections. The ultimate spectrum of laparoscopic surgery will be determined by the progress in remote handling technology, overcoming the manipulative restrictions inherent in the current instrumentation. Research evaluating the efficacy of new methods will be essential.
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PMID:The spectrum of laparoscopic surgery. 145 78

A 28-year-old man had been dysphagic for 9 months with a weight loss of 4 kg. A preliminary diagnosis of primary achalasia was made on the basis of typical radiological and manometric findings. Despite balloon dilatation of the cardia the symptoms did not improve and further diagnostic tests were performed. Ultrasound demonstrated a 4 cm tumour below the cardia. But its type and possible malignancy remained uncertain even at laparotomy. But as a malignant tumour was suspected a gastrectomy and omentectomy with removal of the local and regional lymph nodes were performed. After this the symptoms regressed and postoperative food intake was without problem. Histological examination of the surgical specimen revealed leiomyomatosis of the cardia and the gastric fundus, combined with a low-malignant B-cell lymphoma of the mucosa-associated lymphatic tissue. Oesophagus manometry 4 months postoperatively gave normal results. The patient has been free of symptoms and without evidence of recurrence for by now 18 months postoperatively.
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PMID:[Secondary achalasia in non-Hodgkin's lymphoma of low malignancy and leiomyomatosis of the cardia]. 150 59

A 42 year old woman had undergone a Heller myotomy for achalasia of the cardia at age 28. Thereafter, she had become asymptomatic but reported for endoscopic follow-up examinations at three-yearly intervals. Fourteen years after surgery, endoscopy and biopsy revealed "carcinoma in situ" in the proximal esophagus and surgery was recommended. In the resected specimen, a circumscribed area of cancer was demonstrated that invaded the lamina propria but was confined to the mucosa. With the exception of mild and transient postoperative dysphagia, she had an uneventful postoperative course and remains well 16 months following surgery. This case demonstrates that endoscopic surveillance may detect early malignant changes in the achalasic esophagus and may possibly lead to an improvement in survival.
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PMID:Superficial esophageal carcinoma in achalasia, detected by endoscopic surveillance. 163 73

The purpose of this paper is to report the experience acquired in pneumatic dilatation in achalasia of the esophagus up to 1990. Two hundred and six patients were studied in that period (X 50, 7 years, M/F 1:1). According to X Rays the distribution was: grade I 17.4%, grade II 54.8%, grade III 14% and grade IV 13.5%. The associated esophageal pathology was: hiatus hernia 9.7%, esophagitis 5.8%, benign stenosis 2.4%, cancer 1.4%, ulcer and diverticula 0.9% and Schatzki's ring and leiomyoma 0.4% respectively Serology for Chagas disease was positive in 23% Chagasic megacolon was more frequent than chagasic heart disease (4.3% Vs. 1.4%). Out of these, one hundred and twenty patients were treated by pneumatic dilatation. To this group we shall refer in more detail. One hundred ant two patients were dilated once and the remaining 18 twice. Esophageal manometry showed a vigorous pattern in 7.7%. The LES' pressure pre-treatment was 24.5 mm Hg and post-dilatation 13.7 mm Hg in 75.8% of the cases the result was good. The morbidity was 5% and the mortality 0.7%. Relapse was seen in 25.8% of the cases. The follow-up was X 38 months. We conclude that pneumatic dilatation is the election procedure in the treatment of achalasia since it offers good results with low morbimortality. Surgery is indicated after failure of 2 dilatations, in children, and association with esophageal neoplasms, hiatus hernia and esophageal diverticula.
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PMID:[Esophageal achalasia: 20 years' experience with non surgical treatment]. 181 99

Eighteen patients with cancer-induced or secondary achalasia (SA) were compared to 421 patients with idiopathic or primary achalasia (PA). The aim of the study was to detect any differences in clinical presentation between the two groups. Mean age of patients with SA was 57.1 (range 15-78) and 47.1 (range 1-90) in patients with PA (p = 0.02). Three patients with SA were 15, 24, and 36 yr old, respectively. Symptom frequency was comparable in SA versus PA. Mean duration of symptoms in SA was 4.5 months, with 15 of the 18 patients experiencing symptoms for six months or less. Weight loss occurred in 88.2% of patients with SA and 57.3% of patients with PA (p less than 0.05). Cancer was at the gastroesophageal junction in 16 patients, duodenum in one, and breast in one. Endoscopy showed tumor in 12 (67%). The esophagram was suspicious for tumor in only 25%. We conclude that patients with SA are older, more likely to lose weight, and have a short duration of symptoms. However, SA may occur in younger patients, and endoscopy with biopsy is necessary in any newly diagnosed case of achalasia.
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PMID:Features distinguishing secondary achalasia from primary achalasia. 222 Jul 23

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

To determine the value of endoscopy, manometry, and scintigraphy in predicting the severity of achalasia, 25 patients with primary achalasia of the esophagus were posprectively studied; 17 patients could be examined prior and post pneumatic dilatation. According to the symptoms, the severity was graded from I to IV. While endoscopic findings did not well correlate with the symptom score, the lower esophageal sphincter pressure and the resting pressure in the esophageal body were significantly correlated with the severity of the disease (p less than 0.01). The esophageal retention of radioactivity rose parallel to the symptom score (p = 0.07). Both manometric and scintigraphic findings changed significantly after therapy (p less than 0.01). Manometry and scintigraphy of the esophagus can be used to measure treatment related effects in patients with primary achalasia. Endoscopic findings are not related to subjective complaints, but an endoscopic examination should always be performed to exclude malignancies of the esophago-gastric junction.
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PMID:[Diagnosis of achalasia--comparison of methods for the evaluation of severity]. 260 6

Achalasia is a chronic illness that can be treated effectively in 65 to 90 per cent of patients with either pneumatic dilatation or Heller esophagomyotomy. Prior to institution of therapy, clinicians must rule out secondary achalasia, especially malignancy-associated achalasia, with upper endoscopy, and if the clinical history is worrisome for malignancy, with a computerized tomography scan of the chest and abdomen. Medical therapy with isosorbide dinitrate or nifedipine is occasionally useful for temporary control of dysphagia prior to a more definitive treatment or for the elderly or medically complicated patient who has increased risks for surgery. Complications of pneumatic dilatation, though rare, can be recognized with the use of postprocedure contrast studies of the esophagus and monitoring the patient for 6 hours after the dilatation. The appropriate long-term management of the patient must include personal support and a clear understanding of the potential for developing complications.
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PMID:Achalasia. 266 68

In the US, the cumulative lifetime risk of developing carcinoma of the upper gastrointestinal tract is less than 1 per cent, premalignant conditions are uncommon, and esophageal and gastric malignancies are rarely curable even when identified early. Endoscopic screening of the upper gastrointestinal tract in asymptomatic persons thus cannot be justified. Surveillance of persons with certain uncommon conditions associated with a higher risk of upper gastrointestinal cancer may be of benefit. These conditions include achalasia, Barrett's esophagus, chronic atrophic gastritis with intestinal metaplasia, familial polyposis coli, gastric polyps, lye stricture, Plummer-Vinson syndrome, and tylosis. In the lower gastrointestinal tract, however, the lifetime risk of developing carcinoma is 5 per cent, premalignant conditions and lesions are common, and carcinoma is curable when detected at an early stage. Sigmoidoscopic screening of asymptomatic adults has been advocated by the American Cancer Society but has not become widely practiced because of its cost, required physician effort, low overall yield, and poor patient compliance. Surveillance by flexible sigmoidoscopy is recommended for persons at slightly increased risk of colorectal carcinoma who have prior breast or gynecologic malignancy or a family history of colorectal malignancy. Colonoscopic surveillance is recommended for patients with high risk of colorectal cancer who have had prior colorectal carcinoma or adenoma or who have inflammatory bowel disease or a ureterosigmoidostomy.
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PMID:Endoscopic screening and surveillance for gastrointestinal malignancy. 268 51

Over a 5-year period 82 patients underwent 244 fibreoptic endoscopic dilatations for oesophageal stricture. A total of 55 patients had benign peptic oesophageal stricture caused by reflux oesophagitis. Two-thirds of these patients had good symptomatic relief with dilatation combined with medical treatment of reflux, whereas one-third had an unsatisfactory result. The practice of endoscopic dilatation in benign stricture proved to be safe and was cost-effective as the procedure was carried out under intravenous sedation on a day-care basis. Three patients underwent dilatation for achalasia with good results in two cases. There were 16 patients with malignant oesophageal stricture and, in this group, fibreoptic endoscopic dilatation had little role to play in relieving dysphagia and its practice was associated with a substantial morbidity and mortality. Dilatation of malignant strictures facilitated biopsy and was used prior to oesophageal intubation. The virtues of the Atkinson or Celestin tube put in with the Nottingham introducer are summarised. Eight patients developed anastomotic stricture after resection of carcinoma of the oesophagus and dilatation provided only very transient relief of dysphagia in this group. Most anastomotic strictures represented recurrent malignancy and the difficulty in gaining biopsy proof endoscopically is emphasised. We advocate the early use of a CT scan in this situation to make the diagnosis of recurrent malignancy so that, if appropriate, palliative treatment can be instituted while the patient's general condition is good enough to benefit from it.
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PMID:A review of the practice of fibreoptic endoscopic dilatation of oesophageal stricture. 270 18


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