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

From 1972 to 1977, the authors observed 156 patients with primary esophageal motility disorders which caused such a severe degree of dysphagia that treatment by pneumatic dilatation was deemed necessary. Before dilatation, 24% of the patients presented with motility disorders that did not fit well into the two classical disease entities, diffuse esophageal spasm and achalasia (absence of peristalsis with presence of lower esophageal sphincter (LES) relaxations or presence of peristalsis with absence of LES relaxations). After treatment with pneumatic dilatation, these "intermediate" forms constituted 45% of the motor disorders. This was due mainly to the reappearance, on manometric tracings, of peristaltic contractions and of LES relaxations. Radiologic and manometric observations suggest that in many patients, this "return of peristalsis" may be an apparent change in pressure pattern rather than a real change in motility. In 6 of the 156 patients, a deterioration of the esophageal motility disorder was observed, which was characterized by the loss of peristalsis and of LES relaxations over a period of a few months or years. The frequent occurrence of intermediate types of motility disorders and the transition from diffuse spasm to achalasia suggest that achalasia and diffuse esophageal spasm are part of a spectrum of related motor disorders.
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PMID:Achalasia, diffuse esophageal spasm, and related motility disorders. 42 3

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

None of the tests employed currently to investigate esophageal transit is quantitative. The purpose of this study was to evaluate normal subjects and patients with a variety of esophageal disorders using a scintigraphic technique to quantitate esophageal transit. After oral administration of a bolus of water labeled with 99mTc-sulfur colloid, isotopic count rates were measured over the esophagus employing a gamma-camera on line to a digital computer. Esophageal transit was expressed as the percent emptying for each of the first 15-sec after the initial swallow and for 15-sec intervals after serial swallows. Sixty-two subjects were studied, including: normal volunteers; patients with motor disorders of the esophagus such as achalasia, diffuse esophageal spasm, and scleroderma; and patients with symptomatic gastroesophageal reflux both with and without esophageal motor dysfunction on manometic testing. Esophageal transit was decreased significantly after single and multiple swallows in patients with motor disorders of the esophagus. In addition, esophageal transit was abnormal in patients with reflux disease accompanied by abnormal motor function. In contrast, esophageal transit was normal after a single swallow, but incomplete after serial swallows in patients with reflux associated with normal esophageal motor function on manometry. We conclude that esophageal scintigraphy may be used to evaluate esophageal transit.
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PMID:Esophageal scintigraphy to quantitate esophageal transit (quantitation of esophageal transit). 43 38

The effects of subcutaneous pentagastrin (6 microgram/kg) on esophageal motility were recorded in patients with achalasia, in patients with idiopathic diffuse esophageal spasm (IDES), and in healthy subjects. In achalasia and IDES, pentagastrin produced an increase in mean lower esophageal sphincter pressure, amplitude of contractions, esophageal pressure, and repetitive wave activity. Also, chest pain or dysphagia occurred after pentagastrin administration in 4 of 9 patients with IDES and in 7 of 12 patients with achalasia. After comparing these observations with those of healthy subjects, we tested the potential for pentagastrin-induced motility changes to improve our ability to diagnose IDES. This was done by administering pentagastrin to 22 patients with clinically "suspected" esophageal motor disease but in whom routine radiologic and manometric studies were nondiagnostic. In none of the 22 did symptoms or manometric changes develop to help establish the diagnosis of IDES. This was true despite additional studies in 10 patients that failed to provide an alternative to IDES as the diagnosis. These results do not support the use of pentagastrin as a provocative test for IDES.
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PMID:The effects of pentagastrin in achalasia and diffuse esophageal spasm. 45 41

Modified Heller's esophagomyotomy for achalasia of the esophagus was done in 145 patients at Henry Ford Hospital, Detroit, from 1951 to 1977. Information on current symptoms was obtained for 121 patients from a detailed questionnaire that was sent to all patients, from personal interviews, or from data obtained from patients' clinical records. Average period of follow-up was 85 months. Actuarial analysis of postoperative symptoms showed an incidence of reflux of 24% after one year and 48% after ten years; incidence of relief of dysphagia was 89% of all patients after one year and 81% after ten years. Continual surveillance of patients after esophagomyotomy must be stressed. Dissatisfaction with the results of this procedure prompted us to recommend that an antireflux operation be performed at the time of the initial procedure.
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PMID:Long-term results of esophagomyotomy for achalasia of esophagus. 46 8

4 cases of oesophageal achalasia, 2 primary and 2 recurrences following multiple oesophagomyotomy are reported. The superiority of oesophagomyotomy carried out by the left transthoracic route (according to Ellis) in cases of primary achalasia is stressed. On the basis of the literature and reported experience, it is concluded that this approach is also preferable in recurrences when the previous operation was done by the abdominal route and the recurrence occurred within 6 months. In all other cases, particularly in the presence of an achalasic megaoesophagus, partial oesophagogastric resection with interposition of a jejunal loop (Merendino's operation) is the procedure of choice and the satisfactory results of using it are reported.
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PMID:[Treatment of esophageal achalasia]. 48 63

Dysphagia of the newborn and the infant presents with many varied causes, neurological, malformative, turmoral or functional. Among the latter, cricopharyngeal achalasia is an exceptional entity open to discussion. Suspected as early as the first month, presenting with difficulty in swallowing with choking episodes and coughing up of food without any obvious etiology. Profile roetgengraphic studies will allow the diagnosis to be made. The characteristic sign is a round and regular posterior narrowing on the posterior wall of the esophagus (C4 - C5 level) with enlargement of the hypopharynx. This narrowing is a constant finding. This pathological entity, an absence of relaxation of the cricopharyngeus muscle during the third period of swallowing, well-known in the adult patient, has only exceptionally been described among newborn children. In the following case study, cure has only been obtained by an extra mucosal myotomy of the esophagus at the age of seven months. The discussion, considering the five cases reported in pediatric journals, covers the diagnostic elements, the physiopathology of the disease, the risks presented during evolution without treatment. Therapy must be precocious and surgical.
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PMID:[Cricopharyngeal achalasia, exceptional cause of dysphagia in newborn (author's transl)]. 48 99

Two cases of delayed esophageal perforation following a pneumatic dilatation for the treatment of achalasia are presented. Esophagrams obtained immediately after pneumatic dilatation failed to reveal a perforation. Increasing symptoms prompted repeat contrast studies, at which time an esophageal perforation was demonstrated. The occurrence of delayed esophageal perforation after pneumatic intrumentation is emphasized. An ischemic etiology for this delayed perforation is postulated.
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PMID:Delayed esophageal perforation after pneumatic dilatation for the treatment of achalasia. 48 7

Familial achalasia most often has been recorded in siblings, and only rarely (twice previously) in a parent and offspring. This report concerns a third case of achalasia in a parent and offspring (mother and son). Clinical and radiographic features of the esophageal achalasia are presented. The possibility that genetic factors may play a role in the etiology of this disorder is discussed.
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PMID:Familial achalasia of the esophagus in mother and son: a possible pathogenetic relationship. 48 60

We report the occurrence of achalasia and diffuse oesophageal spasm in brother and sister. The familial occurrence of these unusual disorders is consistent with the possibility that they share a common aetiology and indicates the potential importance of genetic predisposition.
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PMID:Achalasia and diffuse oesophageal spasm in siblings. 49 20


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