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

A case of invasive gastric carcinoma mimicking idiopathic achalasia radiologically, endoscopically and manometrically is described. This is only the second case of tumor-associated achalasia with a positive mecholyl test where there was no demonstrable histological tumor involvement of the myenteric plexus in the body of the esophagus. The interpretation of the manometric findings including the positive mecholyl test are discussed in the light of these histological findings. The short duration of symptoms, the presence of anemia and guaiac positive stools, along with subtle radiologic abnormalities of the gastric fundus were aspects of this case which should increase the index of suspicion and lead to the correct diagnosis. In the evaluation of patients with the achalasic syndrome, a tumor-associated functional and organic disorder mimicking idiopathic achalasia in all respects has to be considered.
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PMID:Esophageal achalasia secondary to gastric carcinoma. Report of a case and a review of the literature. 43 88

In the light of three cases of esophageal carcinoma developing on a pre-existing idiopathic megaesophagus the authors examine etiopatological, clinical and terapeutic problems related to this association. They believe that carcinoma of the esophagus tends to be a complication of cardiospasm in patients inadequately treated for the primary condition. Early diagnosis and an adequate Heller operation for cardiospasm will lessen the chance of cancer developing in megaesophagus with stasis. When finally diagnosed, this variety of esophageal carcinoma has an extremely poor prognosis. An even more important claim upon the clinician is to be alert to the hazards of continued stasis in megaesophagus and to devise earlier techniques of recognition, including more frequent recourse to biopsy during esophagoscopy.
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PMID:[Association of idiopathic megaesophagus and carcinoma]. 54 Mar 69

Six cases of esophagogastric junction carcinoma are reviewed, with emphasis placed on differential diagnosis between achalasia and carcinoma. All six had abnormal motility with aperistalsis being the most common finding. Three patients demonstrated tapering of the distal esophagus simulating achalasia. Patients over 40 with recent onset of esophageal symptoms and radiographic signs suggesting achalasia should be suspected of harboring carcinoma.
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PMID:Secondary achalasia in esophagogastric carcinoma:re-emphasis of a difficult differential problem. 54 72

The use of endoscopic procedures in the evaluation of primary motor disorders, or functional diseases, of the esophagus is filled with both risks and benefits. Since both flexible and open-tube esophagoscopy carry a significant risk factor, it is necessary to have a clear concept of the indications and value of endoscopy in the management of functional diseases of the esophagus. A review of the literature reveals very little documentation on the value of endoscopy in diagnosing esophageal functional diseases other than Zenker's diverticulum and achalasia. Based on the current literature and the experience of the authors, observations and recommendations concerning the role of endoscopy in functional diseases of the esophagus are presented. These are: 1) In Phase I or upper esophageal sphincter dysfunctions, endoscopy contributes little to their understanding, is difficult to perform, and may be hazardous. In this group, esophagoscopy should be reserved for indications beyond the dysfunction itself. If endoscopy has to be performed, open-tube esophagoscopy should be performed by an experienced endoscopist. 2) In functional diseases of the esophageal body or Phase II dysfunction, endoscopy is frequently valuable. In spastic disorders, it helps to differentiate between primary spasm of neuromuscular origin and spasm secondary to esophagitis or an obstructive process. In scleroderma and pulsion diverticulum, endoscopy helps to identify such unsuspected complications as esophagitis, hiatal hernia, and carcinoma. 3) In Phase III or however esophageal sphincter dysfunctions, endoscopic examination is essential both to rule out organic lesions that stimulate functional disorders, and to determine the presence and extent of esophagitis.
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PMID:Functional diseases of the esophagus: role of endoscopy. 68 97

A case of symptomatic esophageal achalasia due to a slowly growing neoplastic infiltration of the esophageal wall by a mammary indifferentiated carcinoma operated ten years before is presented. At admission, the clinical history and the endoscopic appearance of the esophageal lumen and mucosa led to the diagnosis of idiopathic achalasia, while the esophageal manometry showed a rather long high pressure zone (6--8 cm), which did not relax with deglutition. Barium study confirmed the length of the achalasic tract. Only thoracotomy permitted a correct diagnosis. On the basis of this case achalasia is thus considered as a syndrome which can be either idiopathic or secondary to Trypanosoma cruzi, high troncular vagotomy, benign or malignant tumor infiltrating the esophageal wall. The difficult diagnosis of some cases from the clinical point of view is underlined. Stress is laid on the necessity that all findings (history, radiology, endoscopy, manometry) be carefully evaluated to reach a preoperative diagnosis.
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PMID:[Achalasia caused by infiltrating carcinoma of the esophagus. Clinical case and physiopathological considerations]. 69 94

The histopathology of 40 cases of achalasia of the cardia, 6 cases of oesophageal spasm-incoordination and 4 cases of scleroderma was examined. Three cases of carcinoma and 6 cases of reflux oesophagitis were used as a control group. A nearly complete loss of myenteric ganglion cells was found in the upper thickened segment in achalasia. Some surviving ganglion cells were found in the lower segments in half the cases of achalasia; in two cases counts were normal in this segment. The occurrence of neuronal chromatolysis in 9 biopsies of achalasia supports the view that an active disease process was involved. The preganglionic parasympathetic fibres in two cases of achalasia were normal in appearance and number; this somewhat limited evidence tends to count against a primary disorder of the preganglionic neurone in this condition. The 6 cases of oesophageal spasm-incoordination showed similar neuronal loss to that in the lower segment in achalasia. Possibly "oesophageal spasm" represent an early stage or incomplete expression of achalasia. One cases of scleroderma showed loss of ganglion cells, but the myenteric plexus was here involved by the disease process. None of the 9 cases in the control group showed any loss of ganglion cells or chromatolysis. Acute and chronic inflammation was not convincingly associated with loss of ganglion cells in either achalasia or oesophageal spasm.
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PMID:Ganglion cells in achalasia of the cardia. 82 85

The work-up of patients with benign diseases of the esophagus should start with a diagnostic evaluation. This includes a carefully taken history, radiologic and endoscopic examinations and, in suspected reflux disease, recording of intraesophageal pH. For the evaluation of functional troubles esophageal manometry is recommended. Patients with complicated reflux disease and failures of antireflux treatment should be operated upon. In high peptic stenoses, Barrett's syndrome should be carefully looked for. Achalasia is treated by pneumatic dilatations with more than 90% good or satisfactory results. But diffuse esophageal spasm is little responsive to therapy. There is a risk of secondary carcinoma in Barrett's syndrome, achalasia, caustic lesions and Plummer-Vinson syndrome. Therefore these patients should be seen at regular intervals. There is an urgent need for controlled studies evaluating the comparative results of medical and surgical therapy.
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PMID:[Benign diseases of the esophagus. An internist's view]. 96 Sep 12

Three cases of carcinoma infiltrating the esophagus and simulating achalasia are presented and the differential diagnostic problems discussed. The radiologic distinction between achalasia and carcinoma can be extremely difficult. Any rigidity, irregularity, nodularity, or ulceration of the distal-most esophagus or gastric fundus or symptoms of short duration in older patients should alert the radiologist to the possibility of carcinoma. It is suggested that all patients with suspected achalasia undergo esophageal and gastric endoscopy with biopsy and esophageal manometry to confirm the diagnosis, expecially if pneumatic dilatation is contemplated.
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PMID:Infiltrating carcinoma simulating achalasia. 105 66

Among 156 patients with achalasia who were treated during a 13 year period, two developed squamous cell carcinoma of the esophagus. The first, a 33-year-old man, developed a carcinoma of the upper third of the esophagus 2 years after the onset of symptoms of achalasia. He was treated by a Heller myotomy and radiation therapy and survived 16.7 months. The second, a 60-year-old man, had had symptoms of achalasia for 15 years. He is alive with suspected recurrence 6 months after undergoing esophagogastrectomy for a carcinoma of the middle and lower thirds. A summary of the literature regarding carcinoma complicating achalasia is presented. This indicates that carcinoma arises in at least 1 to 7 per cent of patients with achalasia. Delay in diagnosis is common. The treatment need not differ from that of carcinoma without a chalasia, but the prognosis is dismal. Since there is evidence that retention esophagitis is a premalignant condition, it should be possible to prevent the development of carcinoma in achalasia by early cardiomyotomy in cases in which hydrostatic dilatation is not completely effective. A plea is made for closer surveillance of patients with achalasia so that, if carcinoma supervenes, it may be detected at an early stage.
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PMID:The association of carcinoma of the esophagus with achalasia. 111 27

Achalasia of the esophagus occurred in association with gastric carcinoma involving the cardia. Except in a limited area subjacent to the squamocolumnar junction, the pathologic findings were unusual in that the myenteric plexus of the body of the esophagus was intact and apparently uninvolved. The hypothesis is advanced that, in this instance, the achalasia could be classified as a tumour-associated funnctional disorder due to distant neural involvement rather than to local invasion with plexus destruction.
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PMID:Esophageal achalasia associated with gastric carcinoma: lack of evidence for widespread plexus destruction. 112 59


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