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

Between March 1990 and August 1997, outpatient endoscopic balloon dilation was performed for oesophageal strictures which developed secondary to malignancies, peptic strictures, post surgical narrowing, achalasia cardia, corrosive ingestion and other causes. A total of 169 dilations were performed in the 92 cases with an average of 1.8 dilation/case (Range 1 to 8). Dilation was possible in all 92 cases without the need for fluoroscopic monitoring. Twenty three (13.6%) of the dilations were performed using pneumatic balloon while in 146(86.4%) cases wire guided metal olives were used. There were nine minor complications which were treated with medication on an outpatient basis and four major complications which required inpatient care. Three of these had perforation of the oesophagus and one died. One other patient developed aspiration pneumonia and subsequently died.
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PMID:Outpatient experience with oesophageal endoscopic dilation. 980 35

Endoscopic ultrasound (EUS) of the esophagus has been used primarily in staging biopsy-proven cancers. Its use as a primary diagnostic modality for esophageal malignancy has not been previously described. We report our recent experience in four patients with dysphagia and endoscopic biopsies negative for malignancy, including one patient with clinical and manometric features suggestive of achalasia. In all cases, EUS revealed a large infiltrating tumor invading through the esophageal wall into the surrounding tissues, and in one case into the aorta. Computed tomography suggested the possibility of a tumor in only one of the cases. Two patients underwent esophagectomy and were found to have adenocarcinoma. Two patients underwent repeat biopsy with alternative aggressive biopsy techniques and were found to have squamous cell carcinoma. We conclude that EUS is useful in the diagnosis of esophageal cancer and should be performed in selected patients with esophageal strictures whose biopsies are negative for malignancy; i.e., those with suspicious endoscopic or radiographic appearance, atypical presentation (e.g., profound weight loss, short duration of symptoms, or advanced age), and failure to respond to treatment.
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PMID:Biopsy-negative malignant esophageal stricture: diagnosis by endoscopic ultrasound. 982 Apr 10

Modern diagnosis and treatment of esophageal disease is a result of progress in assessing the anatomy and physiology of the esophagus, as well as refinements in anesthetic and surgical techniques. Esophageal carcinoma spreads rapidly and metastasizes easily. The tendency for early spread and the absence of symptoms result in late diagnosis that reduces treatment options and cure rates. Lifestyle (i.e., use of alcohol and tobacco), nutritional deficiencies, ingestion of nitrosamines, and mutagen-inducing fungi are blamed for cancer of the esophagus. Other pathologic conditions (e.g., achalasia, Barrett's epithelium, gastric reflux, hiatal hernia) are potential contributors to the development of carcinoma. Nurses are in key positions to identify the existence of factors contributing to premalignant or malignant lesions and to educate patients and make the appropriate referrals.
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PMID:Anatomy and physiology of the esophagus. 1002 84

Synovial sarcoma is a rare malignancy occurring mainly in the extremities. Only seven cases have been described arising in the esophagus. All of them presented as a polypoid mass involving the upper third of the esophagus. A case of infiltrating synovial esophageal sarcoma simulating achalasia in a 63-year-old woman is reported. According to the literature, the location and the clinical pattern of this tumor are exceptional. The clinical features, pathologic findings, differential diagnosis, and management of this condition are discussed.
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PMID:Synovial sarcoma of the esophagus simulating achalasia. 1007 12

Malignant pseudoachalasia can be indistinguishable from primary achalasia on routine clinical evaluation, often resulting in a delay in diagnosis. To better define the clinical features and appropriate management of this disease, the course of five patients discovered to have pseudoachalasia after being referred for a minimally invasive Heller myotomy was reviewed, as were 67 cases of pseudoachalasia previously reported in the literature. Patients with an occult malignancy tended to present with shorter durations of symptoms, greater weight loss, and at a more advanced age than patients with primary achalasia. Since contrast radiography and endoscopy frequently failed to differentiate these two diseases, persons with presumed achalasia meeting these criteria who are referred for minimally invasive surgery should undergo additional imaging to rule out an occult malignancy, since this condition cannot be reliably detected during the course of a thoracoscopic or laparoscopic esophagomyotomy.
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PMID:Clinical presentation and evaluation of malignant pseudoachalasia. 1048

AIMS: The management and surveillance of achalasia remains controversial at the present time. The aim of this study was therefore to evaluate the results of endoscopic management and subsequent surveillance of patients with achalasia presenting to a specialist unit. METHODS: A prospective cohort of 40 patients with a radiological and manometric diagnosis of achalasia who presented to this unit between 1991 and 1998 were studied; the male : female ratio was 1 : 1 and the median age 38 (range 15-84) years. Twenty-one patients presented de novo, seven had previously undergone cardiomyotomy and 12 were referred following unsuccessful dilatation. RESULTS: Some 36 patients were treated with balloon dilatation (Microvasive achalasia balloon, 35/40 mm). Results were graded 1-4 (1, asymptomatic; 2, symptomatic but significantly improved; 3, symptomatic with no change; and 4, symptomatic but worse); 29 of 36 patients were grade 1 at subsequent follow-up and the remaining seven were grade 2 (median follow-up 17 (range 5-96) months). There was a single complication of oesophageal perforation which was treated conservatively with full recovery. Following intervention, patients were enrolled in a prospective surveillance programme of chromoendoscopy at 2-year intervals; in a total of 74 patient-years' follow-up, two superficial squamous cell carcinomas (SCCs) and one adenocarcinoma (following cardiomyotomy) were detected, giving a relative risk of one cancer in 25 patient-years. CONCLUSIONS: Balloon dilatation is a safe and effective treatment for achalasia even in patients who have had previous unsuccessful dilatations or cardiomyotomy. There is a high risk of SCC and the adenocarcinoma may have resulted from previous refluxogenic therapy, so all patients with achalasia should be followed up with surveillance endoscopy.
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PMID:Achalasia: management, outcome and surveillance in a specialist unit 1071 70

Endoscopic ultrasound (EUS) is one of the most significant advances in the history of gastrointestinal endoscopy. It is unsurpassed in local and regional staging of cancer of the esophagus, stomach, pancreas, and rectum. Recently, EUS has been applied to a number of benign conditions such as achalasia, difficult-to-diagnose gallbladder disease, and submucosal tumors. As EUS gains in popularity and increased clinical application in the United States, it is imperative that gastroenterology nurses and associates be aware of this ground-breaking technology and its indications.
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PMID:Endoscopic ultrasound: combining sight and sound for cancer and benign disorders. 1074 44

Endoscopic ultrasonography is recognized as an important tool in the diagnosis and staging of esophageal, gastric, colorectal, pancreatic, and biliary tumors. It also is a reliable method for the evaluation of submucosal tumors of the gastrointestinal tract, the differentiation between benign and malignant giant gastric folds, the evaluation of gastric ulcer healing, and the detection of common bile duct stones. The recent introduction of endoscopic ultrasonographic fine-needle aspiration provides for the cytologic and histologic diagnosis of gastrointestinal submucosal and extraluminal tumors and regional lymph nodes. This new technique may also be used for the intrasphincteric injection of botulinum toxin in the treatment of achalasia, for the steroid injection treatment of refractory esophageal strictures, for celiac nerve block, for pseudocyst drainage, and for drug delivery into pancreatic tumors. High-frequency thin ultrasonic probes can be used to make a more accurate diagnosis of superficial carcinomas of the gastrointestinal tract and for intraductal ultrasonography of the extrahepatic bile duct and pancreatic duct. In the future, three-dimensional imaging of gastrointestinal tumors will provide more accurate information regarding cancer extent. Endoscopic ultrasonography is a powerful tool which can be used in the diagnosis and treatment of a variety of gastrointestinal diseases.
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PMID:Recent advances in endoscopic ultrasonography. 1077 53

The authors report a case of primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophago-jejunostomy in a 76-years-old Caucasian woman. She was affected by esophageal achalasia and in another surgical department underwent gastric resection for adenocarcinoma 6 months before admission. A total gastrectomy performed was due to severity of achalasia symptoms conditioning a high degree of malnutrition. Two years after discharge the patient underwent surgery for total dysphagia, epigastric pain and inexorable weight loss. Histological response was adenocarcinoma of the long arm of Roux-en-y loop. Primary malignancies of the jejunum and ileum are extremely rare and many pathogenetic hypotheses were done but none of them received clinical or experimental demonstration. Symptoms are not specific and diagnosis is difficult and late, x-rays and endoscopy leading to it, US, CT and MNR are useful for differential diagnosis and staging. Prognosis is severe. Surgical therapy is large resection, if possible, but often it is only palliative.
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PMID:[Primary adenocarcinoma of the jejunum arising in the anastomotic loop of a Roux-en-Y esophago-jejunostomy: a case report]. 1081 73

The purpose of the present paper was to determine if pharyngeal or cervical oesophageal lesions may present with distal symptoms. All patients presenting for barium swallow underwent examination of the pharynx and oesophagus. The pharyngeal examination included spot films of the pharynx as well as views of the pharyngo-oesophageal segment filmed at three frames per second. During the 18-month period of the present study interrogations were carried out to identify patients without symptoms in the cervical or suprasternal region. One hundred and twelve patients were identified; 58 were male and 54 were female. The age range was 18-84 years. Examinations revealed abnormalities within the pharynx in 42 patients (38%); of this group of 42, 34 also had an oesophageal abnormality. The majority of the pharyngeal findings were minor. There were, however, three patients who each had a pharyngeal abnormality (pharyngeal carcinoma, obstructive cricopharyngeal narrowing, pharyngo-oesophageal junction stricture) as well as an oesophageal lesion (hiatal hernia, achalasia, reflux oesophagitis), either of which may have been the source of the symptoms. The remaining eight patients (7%) of this group of 42 with detected pharyngeal abnormality had normal oesophageal examinations. Most of these were again minor changes and were unlikely to be significant. There was, however, one patient in whom the only abnormality was an infiltrative cancer of the posterior wall of the pharyngo-oesophageal junction. In conclusion, the identification of patients in the present study with pharyngeal lesions and without distal abnormal findings indicates that a proximal lesion may present with downstream symptoms. Furthermore, there were also patients in whom the examination found abnormalities in multiple segments of the pharynx and oesophagus. We suggest that examination of the pharynx is warranted as part of the barium swallow in patients without cervical or suprasternal symptoms.
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PMID:Value of pharyngography in patients without suprasternal symptoms. 1110 36


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