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

Fifteen infants with congenital cricopharyngeal achalasia are reviewed. Although most of the patients had symptoms at birth, the diagnosis was frequently not confirmed until later in the first year of life. While four of the infants had only cricopharyngeal achalasia, 11 had associated diseases related to the central nervous system. Those patients without associated diseases improved spontaneously with conservative management; most of the infants with other abnormalities also improved, although their clinical progress was slower and more complicated. In three of the patients, the symptoms were persistent and there were two deaths related to associated diseases. Cricopharyngeal myotomy was performed on two children with only moderate improvement in symptoms. Congenital cricopharyngeal achalasia is more common than formerly recognized. When suspected, an esophagram with tele- or cineradiography is essential to confirm the diagnosis. Esophageal motility studies will quantify changes and also evaluate lower esophageal dysfunction not easily identified on esophagrams.
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PMID:Congenital cricopharyngeal achalasia. 91 Nov 35

Antireflux effect of various operations for achalasia of the esophagus was investigated with the use of the manometric study. Operative procedures subjected to the present comparative study were proximal gastrectomy with end-to-end esophagosgastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, each prepared in four mongrel dogs. Incidence of postoperative reflux with possible esophagitis was greatest in proximal gastrectomy followed by Wendel and Heller procedure. Fundic patch operation well prevented the reflux with greater values of pressure as well as dimension of the lower esophageal sphincter than those of the control series. In other series of experiments in dogs, an attempt was made to reveal the rationale of the effective valvular mechanism of the Fundic patch operation preparing various sizes of the valve. When compared by the manometric study, Fundic patch procedure with an incision of 6 cm in length, formation of the artificial mucosal valve and two thirds enclosure of the distal esophagus with the fundus like fundoplication sufficiently prevented the reflux. Preparation of the valve smaller in size accelerated the incidence of postoperative reflux.
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PMID:[Manometric studies on antireflux effect of fundic patch operation]. 91 41

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

Severe chronic constipation is an extremely rare disorder. Out of 39 370 patients seen in our hospital during the past two years only 309 children (=0,78%) were suffered from severe chronic constipation. Radiologic and electromanometrical examinations revealed as an organic cause anal sphincter achalasia or Hirschsprung's disease in 30,7% of these constipated children. In 54,9% however no pathomorphologic results could be found. Of all cases 14,4% examined were postoperative controls. Careful electromanometric and defecographic examination of every chronically constipated child is crucially important in determining the therapy as in most cases chronic constipation in childhood, is due to a functional asynchronism of the internal and external anal sphincter relaxation reflexes, it can most reliably be diagnosed by electromanometrical examinations. The accuracy and reliability of our electromanometrical method has been proved not only by comparison with radiologic and histologic techniques but also statistically by analysis of discriminance of the recorded parameters. The therapeutic approach depends on the underlying disease. Mechanical obstruction of the intestine, nervous dysregulation of colonic motility causing Hirschsprung's disease and organic anal sphincter achalasia require surgical treatment. In cases of achalasia myotomia of the internal anal sphincter gives excellent functional results. In 73 cases treated by myotomy no symptoms of anal incontinence were seen. Medical therapy includes administration of laxatives combined with high roughage diet, adjustment of living conditions including increased physical activity and bowel training in order to learn a conditioned defecation reflex. The matter can be more easily achieved by administering Dihydroergotamine and Lactulose initially.
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PMID:[Diagnosis and therapy of chronic constipation]. 96 5

A case of acute thoracic inlet obstruction presenting as a rare complication of achalasia is described. The probable mechanism, diagnosis, and management are discussed.
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PMID:Acute thoracic inlet obstruction in achalasia of the oesophagus. 96 4

A case of congenital suprabulbar paresis is reported. The associated severe dysphagia which presented soon after birth was shown by radiographic and cineradiographic studies to be due to cricopharyngeal achalasia. During four years of follow-up a clear tendency to spontaneous improvement was seen. It is therefore suggested that the condition may have a favorable outcome without resorting to surgical intervention.
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PMID:Cricopharyngeal achalasia associated with congenital suprabulbar paresis. 97 77

Achalasia of the esophagus is an unusual lesion in childhood and is quite rare under the age of one year. The case of a 3-month-old child with esophageal achalasia treated with a Heller esophagomyotomy is illustrated. Seven previously documented cases of achalasia in children under the age of one year are reviewed and the difficulties of diagnosing this lesion in childhood are discussed.
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PMID:Infantile achalasia. Brief clinical report. 97 22

Previous reports on the profile of lower oesophageal sphincter (LOS) pressures and swallow responses in achalasia have been conflicting. Both normal and high resting pressures have been reported. Many reports have noted a failure of relaxation of the LOS in response to swallowing. Manometric studies were performed on 17 untreated patients with achalasia, of whom 76% were found to have a resting peak end-inspiratory pressure significantly greater than normal (P = 0,001). Nine patients showed relaxation of the LOS in response to swallowing but this relaxation was usually inadequate and of brief duration. Contractions were premature in 16 patients. One patient showed a manometric pattern closely simulating a Mobitz type 1 atrioventricular block in response to repeated swallows. A common pathophysiological process is postulated. In one patient an injection of secretin reduced the high resting LOS pressure. This supports previous evidence that a hypersensitive sphincter in achalasia is due to a hypersensitivity to gastrin. Hyoscine-N-butylbromide (Buscopan) caused a significant reduction in LOS pressure in all patients in whom it was used.
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PMID:Lower oesophageal sphincter resting pressures in achalasia and the response of the sphincter to swallowing and drugs. 99 80

A survey of 108 patients with achalasia treated by cardiomyotomy is reported. All the operations were done by the abdominal approach and all the patients were followed up for a minimum of 4 years. Fifty-five patients had some form of hiatal reconstruction, 11 of these having a formal plastic repair as practised for oesophageal reflux problems. At 4 years after operation 71 patients (65-5 per cent) had entirely satisfactory results. Twenty-seven patients had recurrent dysphagia and 20 patients had symptoms of reflux oesophagitis. The group who had had a formal repair of the hiatus had no reflux symptoms after operation and also had better swallowing than the other groups. These results suggest that much of the dysphagia following Heller's operation is due to occult gastro-oesophageal reflux and can be avoided by a reflux-preventing procedure. Adequate hiatal repair after myotomy is strongly recommended.
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PMID:Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair. 100 44

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


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