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

Chylothorax is an unusual complication after transhiatal esophagectomy (THE) and in the past 10 years has occurred in 11 of 320 patients (3%) undergoing this operation for diseases of the intrathoracic esophagus. Four patients had benign esophageal disease: scleroderma reflux esophagitis (1), caustic stricture (1), and achalasia (2), and each had undergone at least one previous esophageal operation. Seven patients had intrathoracic esophageal carcinoma--two upper-third, two middle-third, and three distal-third lesions. Excessive chest tube drainage more than 72 hours after THE was the standard presentation, and the diagnosis of chylothorax was confirmed by the administration of cream through the jejunostomy feeding tube placed routinely at operation. The character of the chest tube drainage changed from serous to opalescent. Aggressive treatment of this complication was the rule, and every patient underwent a thoracotomy between 2 to 14 days (average, 6 days) after the diagnosis was established. Cream was administered through the jejunostomy tube before operation, and in each case the thoracic duct injury was readily identified and controlled with suture ligatures. There were no deaths in this group, and there was one recurrence of the fistula that required reoperation; all patients were discharged from the hospital within 3 to 29 days (average, 10 days) after thoracic duct ligation. It is concluded that early recognition of a chylothorax after transhiatal esophagectomy with prompt transthoracic ligation of the injured duct results in a shorter overall hospitalization and lower morbidity and mortality from this complication. The traditional conservative management of chylothorax with intravenous hyperalimentation and no or low-residue enteral feedings has little place in this nutritionally depleted patient population.
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PMID:Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. 317 69

Malignant tumors, especially gastric adenocarcinomas infiltrating into the submucosa of the esophagus, can result in a clinical syndrome termed secondary or pseudo-achalasia that mimicks idiopathic primary achalasia. History, symptoms, radiology, esophago-gastroscopy with biopsy, and esophageal manometry do not discriminate secondary from primary achalasia at initial evaluation. The difficulty in establishing the diagnosis is demonstrated on the case of a 57-year old man presenting with dysphagia, vomiting, and weight loss. Fluoroscopically, the esophagus was moderately dilated and bird-beaked. The patient underwent two gastroesophagoscopies, in the second of which the endoscope could not be passed through the esophagogastric junction. Esophageal manometry revealed an only partial relaxation of the lower esophageal sphincter upon swallowing and nonpropulsive, repetitive contractions in the esophageal body, compatible with the diagnosis "vigorous achalasia". After two mechanic dilatations, a myotomy of the sphincter seemed indicated. At operation, a cardiac carcinoma infiltrating submucosally into the esophagus was found. The recognition of secondary achalasia is difficult, and signs such as older age, brief duration of symptoms, marked weight loss and the presence of vigorous achalasia, relatively rare in primary achalasia, are unspecific. Hence, in all instances in which secondary achalasia cannot be ruled out, it seems advisable to perform an explorative laparotomy with eventual sphinctermyotomy as primary therapeutic intervention instead of a mechanic dilatation, which potentially further obscures the underlying disease. To enable the recognition of undetected secondary achalasia, all patients with achalasia should be followed up thoroughly.
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PMID:[Secondary achalasia caused by diffuse infiltrating cardial cancer]. 321 64

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia (20), scleroderma (9), esophageal carcinoma (8), Barrett esophagus (5), and reflux esophagitis (27). We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.
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PMID:Esophageal scintigraphy: applications and limitations in the study of esophageal disorders. 340 2

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

Of 70 patients with achalasia and related motor disorders, 3 developed Barrett's esophagus 5, 8, and 15 years after esophagomyotomy. One of the three had dysplastic changes in the Barrett's mucosa. Although an increased incidence of gastroesophageal reflux, esophagitis, and stricture are well-known complications after esophagomyotomy, the development of Barrett's mucosa has been only recently recognized. Diagnosis of Barrett's esophagus in such patients is difficult and requires a high index of awareness by the radiologist and an endoscopic biopsy for definitive diagnosis. The cumulative effects of achalasia and Barrett's esophagus predispose these patients to higher risks of developing esophageal carcinoma.
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PMID:Barrett's esophagus complicating achalasia after esophagomyotomy. A clinical, radiologic, and pathologic study of 70 patients with achalasia and related motor disorders. 357

The incidence and clinical features of achalasia in Zimbabwe have not previously been documented. During a 10-year period (1974-1983) 25 cases were seen in Bulawayo and Harare. The estimated incidence is 0,03/100 000 members of the population per year, which is much less than the incidence in Europe and America. Achalasia occurred at any age and there was a preponderance of cases in males. Dysphagia was invariable and its duration varied from 2 weeks to 15 years. Parotid enlargement was found in 2 patients and respiratory infections occurred relatively frequently. The importance of excluding oesophageal carcinoma is emphasized.
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PMID:Achalasia in Zimbabwean blacks. 398 75

Abdominocervical (transhiatal) oesophagectomy was carried out in 8 patients. Five of 6 with oesophageal cancer were elderly (aged 75-88 years), and one was 59 years old. Two patients (aged 54 and 74 years) had recurrent achalasia and megaoesophagus 30 years after cardiomyotomy. Chest complications were common, but there were no anastomotic leaks and no deaths. In 2 patients with large paraoesophageal hiatal hernias oesophagectomy had not been planned; the procedure was undertaken for an unexpected carcinoma of the cardia and an oesophageal tear. Three patients have died of recurrent cancer at 12, 17 and 21 months. The 5 survivors are swallowing satisfactorily, although one has required two dilatations of an anastomotic stricture.
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PMID:Abdominocervical oesophagectomy in the elderly. 407 62

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

Carcinoma developed in a 67-year-old woman with achalasia of the esophagus 23 years after esophagomyotomy. Postoperative manometric and radiologic studies showed satisfactory relief of esophageal obstruction. The development of carcinoma after an unusually long interval after adequate surgical treatment emphasizes the need for lifelong surveillance for this complication.
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PMID:Carcinoma associated with achalasia. Occurrence 23 years after esophagomyotomy. 648 89

Achalasia has been purported to be a risk factor for the development of esophageal carcinoma. To test the validity of this association at the Yale-New Haven Hospital (YNHH) and its major affiliate, the West Haven Veterans Administration Medical Center (WHVA), two approaches were employed: (1) a prospective study identifying 100 subjects with manometrically documented achalasia for the development of esophageal cancer; (2) a retrospective review of esophageal cancer patients admitted to the YNHH and the WHVA from 1971 through 1981 for any evidence of achalasia. No cases of esophageal carcinoma were identified in the 91 evaluable achalasics. No case of achalasia was found or even suggested in association with the 153 cases of esophageal cancer reviewed. Our findings do not substantiate the association of achalasia and esophageal carcinoma. The clinical implications of this conclusion on surveillance and follow-up of achalasia patients are discussed.
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PMID:Achalasia as a risk factor for esophageal carcinoma. A reappraisal. 649 28


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