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

During the period included between January 1970 and December 1990, we studied 242 patients with manometric and radiological diagnosis of esophageal achalasia. Eight of these patients (3.3%) developed during the evolution of their disease an esophageal carcinoma. Eight cases showed histologic type of epidermoid carcinoma: 3 differentiated, 3 semi-differentiated and 2 anaplastic. Therapy for achalasia was: one patient, Heller myotomy, 4 patients, dilatations with bougies in numerous opportunities, and the other two patients receive no treatment for achalasia. Two patients reported tracheobronchial fistulas as complication of carcinoma. Treatment received for carcinoma included: three patients, radiotherapy (4000 rads); one patient, chemotherapy; one patient, chemotherapy and radiotherapy, one resection surgery and two patients feeding gastrostomy. All of the eight patients died within the year of diagnosis of epidermoid carcinoma.
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PMID:[Achalasia and esophageal cancer]. 130 Aug 47

High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.
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PMID:Transnasal US of the esophagus: preliminary morphologic and function studies. 150 56

To determine the incidence of oesophageal carcinoma in patients with achalasia and to establish the efficacy of endoscopic surveillance, 195 consecutive patients with achalasia (90 men and 105 women, mean age 52 years), who were treated by pneumatic dilatation in our institution between 1973 and 1988 were prospectively studied. None of the patients had undergone cardiomyotomy. Follow up totalled 874 person years after pneumatic dilatation. In this period three patients developed an oesophageal squamous cell carcinoma. The mean age at diagnosis of the oesophageal carcinoma was 68 years (37, 77, and 89 years). The mean period between the onset of dysphagia and the diagnosis of the tumour was 17 years (19, 28, and 5 years); the mean interval between the diagnosis of achalasia and carcinoma was 5.7 years (5, 8, and 4 years). The incidence of oesophageal squamous cell carcinoma in this series (3.4/1000 patients per year) is significantly higher than the statistically expected incidence (0.104/1000 patients per year) using age and sex specific incidence data from the population of the Netherlands (Poisson statistics: p less than 0.001). The risk of developing oesophageal squamous cell carcinoma in patients with achalasia is therefore increased 33 fold. Periodic endoscopy showed the potential for detecting early stage oesophageal carcinoma in two cases but a larger study with a longer follow up is required to determine the efficacy of endoscopic screening in improving the prognosis for patients with achalasia who develop oesophageal squamous cell carcinoma.
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PMID:Achalasia complicated by oesophageal squamous cell carcinoma: a prospective study in 195 patients. 154 8

Metastatic breast carcinoma to the esophagus most often presents with a mid-esophageal stricture. Involvement of the gastroesophageal junction by breast carcinoma is distinctly unusual. The authors report the case of a 78-year-old woman who presented with clinical and radiologic features of achalasia secondary to breast carcinoma, metastatic to the gastroesophageal junction. Metastatic breast cancer to the gastroesophageal junction should be added to the list of conditions mimicking achalasia.
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PMID:Case report: esophageal metastasis from breast carcinoma presenting as achalasia. 158 Mar 22

Among 11,821 cases of esophageal carcinoma treated in a 32 year period, 7 were found to be associated with achalasia (0.059%). Five cases were proved by biopsy or cytology and 2 were diagnosed by esophagograms. There were 4 men and 3 women. The age ranged from 30-54 years with a median of 38. The age was younger than that of esophageal carcinoma unassociated with achalasia. Duration of achalasia was from 7 to 20 years. Three patients died within 1 year and 1 died 17 months after diagnosis. Three were lost to follow-up. The presenting symptoms were aggravating dysphagia in 4; and hoarseness, dyspnea and bloody regurgitation in the other two. Patients with achalasia should be treated energetically in the early stage. Double contrast esophagography and esophagoscopy should be done carefully during the followup. Preparation of the esophagus is most important when performing the X-ray examination of the esophagus.
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PMID:[Association of esophageal carcinoma with achalasia--report on 7 cases]. 161 81

From January 1, 1970 to April 1, 1990, we treated 32 patients with esophageal perforations. 19 patients underwent surgical repair by bilateral closing suture (n = 10), mucosal suture, extramyotomy and semifundoplication in the presence of achalasia (n = 6). Three patients had subtotal esophagus resection with esophageal graft. Four of these patients died postoperatively, the site of intervention being unremarkable. We lost 7 out of 13 patients from the group subjected to conservative therapy. These results suggest a low risk in the surgical treatment of esophageal perforations when carried out at early stage. The conservative approach on the other hand constitutes an uncalculable risk factor. It should be thus be employed with utmost precaution, e.g. in case of minor perforation only, or in patients with incurable carcinoma.
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PMID:[Esophageal perforation--indications for surgical therapy]. 176 60

A retrospective review of CT scans on patients referred with either a definitive or a tentative diagnosis of achalasia was undertaken. Twelve patients were identified, of whom nine had proven achalasia. The remaining three patients were later definitively diagnosed with pseudoachalasia, benign stricture, and leiomyomatosis, respectively. Findings in all nine achalasia patients were similar: moderate to marked esophageal dilatation (mean diameter 4.35 cm at carinal level) with normal wall thickness. Findings are in distinct contrast to the three patients with other diseases, in which the degree of esophageal dilatation and/or wall thickness was atypical. Complications in the patients with proven achalasia included secondary carcinoma (one), iatrogenic esophageal perforation (one), and pulmonary aspiration (three). Computed tomography may not be indicated as a routine study, but in complicated cases CT may be invaluable in confirming the diagnosis or in detecting atypical features that may indicate the presence of other diseases or superimposed benign or malignant processes.
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PMID:CT evaluation of achalasia. 202 5

In the period from 1980 to June, 1989 the authors conducted operations on 128 patients for extirpation of the esophagus with one-stage esophagoplasty by means of an isoperistaltic tube formed from the greater curvature of the stomach. Fifty-four of these patients had benign esophageal strictures, 74 had malignant lesions of the esophagus. The authors claim this operation to be the operation of choice in carcinoma of the lower third of the esophagus and in carcinoma of the cardia extending to the thoracic esophagus. It may be carried out in carcinoma of the thoracic esophagus at any level, in benign strictures of the thoracic esophagus, and in stage IV cardiospasm in patients in whom operations had been performed earlier on the cardia. The abdominocervical approach can be supplemented by right thoracotomy in carcinoma of the midthoracic part of the esophagus. Four patients (3%) died after the operation. The authors recommend wider use of the operation.
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PMID:[Esophageal extirpation with one-stage esophagoplasty]. 207 42

A perspective ultrasonographic study on 10 cases of achalasia showed characteristic ultrasonographic features: dilation and persistent water retention of the gastroesophageal vestibule, symmetrical parietal thickening, and delayed or intermittent opening of the cardiac orifice after drinking. We suggest that ultrasonography should play an important role in clinical management of achalasia. If the ultrasonographic features of achalasia were known, the misdiagnosis of achalasia for cardiac carcinoma could be avoided. When an infiltrating cardiac carcinoma found to be smoothly narrowing and difficult to distinguish from achalasia radiologically, an ultrasonogram may be helpful to make a correct diagnosis.
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PMID:Ultrasonographic diagnosis of achalasia. 211 43

Thirty-three patients who have suffered with dysphagia to solids and liquids for a varying number of years are reviewed. They all had a history and radiologic findings suggestive of achalasia of the esophagus. Thirty-one of the cases who had uncomplicated achalasia benefited from a transthoracic modified Heller's procedure. Lower esophageal diaphragm and carcinoma arising in the proximal half of the distal third of the esophagus occurred in association with achalasia in two patients. Over 90 percent had symptomatic relief of their symptoms. The only mortality was recorded in a patient who had palliative esophagogastrectomy for associated carcinoma. A properly performed anterior extramucosal esophagomyotomy is the safest and most effective procedure available, even in places with minimal facilities.
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PMID:Achalasia of the esophagus: reflections upon a clinical study of 33 cases. 243 61


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