Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

100 esophageal motility studies on 88 consecutive patients referred to the University of California Medical Center were analyzed. Diagnoses of achalasia, diffuse spasm of the esophagus, scleroderma, hiatal hernia and other conditions were made from the motility tracings. The motility tests have been found to be most helpful in differentiating various disorders of swallowing and thoracic pain of unknown cause.
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PMID:Evaluation of 100 esophageal motility studies at a university medical center. 564 Jan 87

Esophageal motor disorders may be clearly primary, as in achalasia or diffuse esophageal spasm (DES), or clearly secondary, as in scleroderma or intrathoracic malignancy. In patients with gastroesophageal reflux, abnormal motility of the esophageal body and stomach, and lower esophageal spasm (LES) appear to predispose patients to reflux. It is possible that esophagitis caused by refluxed gastric material then further impairs motility, propagating the injury. Therapeutically, appropriate use of recently available medications, such as calcium channel blockers and metoclopramide, and new applications of previously available agents, such as hydralazine and bethanechol, have improved our ability to relieve symptoms and at times restore more normal motility.
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PMID:Motor disorders of the esophagus: diagnosis and treatment. 646 93

We reviewed the radiographic findings in thirty patients with columnar-lined (Barrett's) esophageal mucosa. Gastroesophageal reflux was observed in 90%, hiatal hernia in 83%, stricture in 80% and esophageal ulceration in 33%. Superficial nodular mucosal changes were detected on 50% of the air contrast esophagrams. Prominence of this pattern may be associated with dysplastic or early malignant change. In addition, four conditions associated with secondary lower esophageal sphincter incompetence were identified in our patient group. These were scleroderma, previous myotomy for achalasia, previous gastric surgery and long-term indwelling nasogastric tubes.
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PMID:Barrett's esophagus: radiological and clinical considerations. 648 Jun 62

Autonomic dysfunction leads to a variety of clinical disorders involving all parts of the gut. These neural disorders are distinct from the four other recognised categories of disorders involving myogenic function, myoelectric activity, hormonal regulation and abnormal humoral factors. Criteria for establishing that a disorder has a neurogenic aetiology vary in different diseases. Absence of a neural mediated response with intact muscle function has been the major criterion used in most studies. Neural mediated responses of peristalsis, sphincteric relaxation and intestinal contraction following distension or feeding are the major parameters of assessment. Abnormalities in neural function have been demonstrated in achalasia, symptomatic diffuse oesophageal spasm, diabetes mellitus, amyloidosis, scleroderma and chronic idiopathic intestinal pseudoobstruction. The anatomical site and type of gut neurological disorder varies in each condition. Morphological studies have been helpful in demonstrating specific intranuclear inclusion bodies in some pseudoobstruction patients, and vagal and ganglionic lesions in achalasia. Intact muscle ad myoelectric function as well as normal responsiveness to drugs acting directly upon muscle may be established by morphological study. Advancement in basic technology should provide a rewarding area for future study of the pathogenesis and treatment of the gut neurological disorders.
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PMID:Clinical aspects of autonomic nerve dysfunction of the gut. 695 Dec 65

Twenty-two patients with a history of between one and four (average of two) unsuccessful prior esophageal operations for neuromotor dysfunction were treated with esophageal resection and replacement. Eleven (50%) had recurred reflux esophagitis in association with various disorders of motility: esophageal spasm in 4, achalasia in 3, scleroderma in 2, and esophageal atresia in 2. Eight (36%) had primary esophageal spasm and 3 (14%) had achalasia. Esophageal obstruction, regurgitation, and severe spasm were the most common manifestations of the inability to swallow normally. Transthoracic or transhiatal (blunt) esophagectomies were performed in 5 and 17 patients, respectively. The stomach, with a cervical esophagogastric anastomosis, was used for esophageal substitution in 15 patients. Six patients underwent a long-segment colonic interposition, and 1 patient with achalasia underwent a distal esophagectomy and short-segment colonic interposition. One patient undergoing transthoracic esophagectomy for achalasia died from unrecognized intraoperative bleeding into the opposite chest. There were no other operative deaths. Additional complications included transient hoarseness in 8 patients, chylothorax in 1, and anastomotic leak in 1. After an average follow-up of 25 months for the 21 surviving patients, ability to eat is regarded as good in 18 (85%), fair in 1 (5%), and poor in 2 (10%). In patients with incapacitating esophageal neuromotor disease, a more radical operative approach-esophagectomy--may be safer and more reliable than attempting another procedure and risking another failure. Esophagectomy ensures definitive elimination of the esophageal problem and as optimal an ability to eat as possible. Our experience suggests that the stomach, with a cervical esophagogastric anastomosis, offers a better functional esophageal substitute than does a colonic interposition.
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PMID:Esophagectomy: definitive treatment for esophageal neuromotor dysfunction. 711 44

Scleroedema adultorum Buschke is characterized by progressive hardening of the skin. In contrast to scleroderma the hardening occurs in the skin of the trunk while extremities remain largely free. Internal organs are said not to be involved in scleroedema adultorum Buschke. The full picture of the persistent form of scleroedema adultorum Buschke was observed in two patients. One patient complained of increasing dysphagia with regurgitation and aspiration. Manometry and X-ray cinematographic investigation showed inappropriate relaxation of the upper oesophageal sphincter. In the other patient who had not previously had swallowed difficulties manometry showed achalasia of the upper oesophageal sphincter. The functional disturbances of the upper oesophagus indicate the possibility of an involvement of internal organs in scleroedema adultorum Buschke. However, proof of an aetiological connection between disturbances of oesophageal motility and skin disease requires systematic investigations in a larger group of patients.
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PMID:[Cervical dysphagia in scleroedema adultorum Buschke (author's transl)]. 723 18

Optimum treatment of patients with esophageal strictures requires of the operating surgeon a wide repertoire of procedures suited to the individual circumstance. The Thal-Nissen procedure should be used in the patient with a longitudinal transmural stricture which cannot be easily dilated. When used in this setting, it widens the distal esophagus with a patch of well vascularized fundus and provides extremely effective protection against gastroesophageal reflux. Sixty-eight patients at the University of Florida underwent combined Thal-Nissen procedures for longitudinal peptic strictures. Operative mortality rate was 4%. The average length of follow-up was 68 months. Fifty-seven of 68 patients had an acceptable result (84%). Four per cent had an early recurrence of their stricture, while an additional 4% had late recurrence of their strictures, after an initially good response period of from two to 11 years. Four of the six patients with poor results had either achalasia, scleroderma, or diffuse esophageal spasm. The combined Thal-Nissen procedure represents the optimum therapy for the patient with an undilatable transmural stricture of the esophagus. When used in this setting, satisfactory results will be achieved in a large majority of patients with an extremely low operative mortality rate. Colonic or jejunal interposition should be reserved for those patients who either fail to respond to a combined Thal-Nissen procedure or who demonstrate sufficiently disordered peristalsis to render the esophagus an unsatisfactory conduit for the passage of food.
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PMID:Long-term follow-up of the combined fundic patch fundoplication for treatment of longitudinal peptic strictures of the esophagus. 724 34

Modern operative treatment of motor dysfunction of the esophagus began in 1949 with the recognition that anastomotic procedures that bypass or destroy the distal esophageal sphincter are associated with the development of reflux esophagitis and stricture. Thirty years later, reflux esophagitis related to esophagomyotomy or intrinsic esophageal disease remains the dominant concern and challenge. This review examines the current status of operative procedures for the management of three important primary disorders of esophageal motility: achalasia, diffuse esophageal spasm, and scleroderma. Relief of esophageal obstruction by esophagomyotomy or reconstruction is the common surgical goal. The addition of a fundoplication procedure to discourage esophageal reflux remains controversial in each disorder. Esophageal resection may become necessary when stricture persists or esophagomyotomy fails to provide lasting relief of dysphagia.
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PMID:Operation for motor dysfunction of the esophagus. 735 72

Four cases of esophageal candidiasis complicating functional or mechanical obstruction are described. The causes of the obstruction included achalasia, scleroderma, and postoperative fundoplication. None of the commonly recognized conditions predisposing to esophageal candidiasis was present. The findings on barium study ranged from plaque-like filling defects to extensive nodularity and roughening of the mucosal surface, which must be distinguished from ingested debris. It is suggested that esophageal stasis of any cause can lead to candidiasis.
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PMID:Candidiasis in the obstructed esophagus. 747 Feb 15

It has been shown that nasal continuous positive airway pressure (nasal CPAP) significantly reduces nocturnal reflux both in patients with sleep apnea and in patients without sleep apnea but consistent abnormal nocturnal reflux. The mechanism by which CPAP is thought to reduce reflux includes the elevation of the resting lower esophageal sphincter (LES) pressure. In this study, we tested the effect of nasal CPAP in two groups of patients with aperistaltic esophagus but with different resting LES pressure. Seven patients with scleroderma esophagus and six patients treated for achalasia were tested over a 48-h period. On the first night, the patients were untreated; on the second night, both groups received applied nasal CPAP at 8 cm H2O pressure. The percentage of time the pH < 4.0, the number of reflux events > 5 min, and the length of the longest reflux event were all significantly reduced in the patients with achalasia (p < 0.03), but not in the scleroderma group (p > 0.20). These results suggest that a residual resting LES pressure greater than that demonstrated by patients with scleroderma (> 10 mm Hg) may be necessary for nasal CPAP to affect nocturnal reflux.
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PMID:The effect of nasal CPAP on nocturnal reflux in patients with aperistaltic esophagus. 808 51


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