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

We describe a technique for measuring the yield pressure at the cardia during upper gastrointestinal endoscopy. The test was applied to 47 patients with macroscopic oesophagitis and nine patients with achalasia. Controls were 123 patients from the routine endoscopy list in whom no abnormality was found and 21 healthy volunteers. Yield pressure was similar in both control groups, but was significantly higher in achalasia (p less than 0.001) and lower in oesophagitis (p less than 0.001). Yield pressures fell dramatically after pneumatic dilatation in the achalasia patients. The test was reproducible and yield pressure was not affected by age, sex, weight, or sedation. Measurement of yield pressure during endoscopy provides information which may reflect the function of the whole antireflux mechanism, and not just the lower oesophageal sphincter.
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PMID:Does measurement of yield pressure at the cardia during endoscopy provide information on the function of the lower oesophageal sphincter mechanism? 335 56

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

This study was performed because of the observation of unexplained esophageal dysfunction in patients with incomplete esophageal obstruction. A Gore-Tex band, measuring 110% of resting esophageal circumference, was placed about the esophagus at the gastroesophageal junction of 17 cats to produce incomplete obstruction by limiting the normal distention that occurs with swallowing. Esophageal manometry was performed before surgery and at 1 and 4 weeks after surgery. Lower esophageal high-pressure zone pressure was not influenced, but sphincter relaxation was impaired. Evaluation of esophageal body contractions showed that simultaneous contractions increased from 0% before surgery to 68% at 1 week and 85% at 4 weeks after surgery (p less than 0.001 versus preoperative for both comparisons). The incidence of repetitive contractions increased from 3.1% before surgery to 10.5% at 1 week and 10.9% at 4 weeks after surgery (p = NS). The average contraction pressure decreased from 22.5 mm Hg before surgery to 13.9 mm Hg at 4 weeks after surgery (p less than 0.05). Barium swallows showed esophageal dilatation, that was confirmed on gross examination. Histologic examination was remarkable only for retention esophagitis. Sham surgery in three cats with identical mobilization of the gastroesophageal junction did not affect motility. Motility returned to normal after the band was removed in three cats. Manometric evaluation of 15 patients with distal esophageal peptic strictures and 17 patients with excessively tight antireflux repairs showed a significantly increased (p less than 0.001) frequency of simultaneous contractions, 35% and 34%, compared with the 2.1% of 25 normal subjects. The following conclusions can be drawn: Partial obstruction alters feline esophageal body function and these achalasia-like changes are reversible on relief of the obstruction and similar motility aberrations occur in patients because of mechanical or functional distal obstruction; this suggests that dysmotility can synergistically contribute to dysphagia.
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PMID:Effect of incomplete obstruction on feline esophageal function with a clinical correlation. 373 63

In cases of mild symptomatic gastro-oesophageal reflux, standard antireflux surgery, such as fundoplication or the Angelchik prosthesis, produces satisfactory results. Duodenal diversion is recommended for use only in patients with severe oesophageal damage. This situation commonly arises where the gastro-oesophageal junction cannot be reduced into the abdomen, or where previous surgery has made reoperation at the hiatus difficult and hazardous. Fifty-seven patients with severe reflux oesophagitis have been treated by Roux-en-Y duodenal diversion and antrectomy. Thirty three patients had vagotomy in addition. Median follow-up after operation is 6.1 years. In 35 patients (61%), the technique was used as primary surgical treatment. These included 22 patients in a randomized trial of the method. Thirteen (23%) had previously had unsuccessful antireflux surgery. Nine (16%) had undergone previous operations for peptic ulcer or achalasia. There was no operative mortality. No patient in the series required stricture resection. Good or excellent overall results were achieved in 86% of patients. Eighteen of twenty seven patients with severe strictures required an average of three dilatations after operation before dysphagia was completely relieved. Heartburn was dramatically relieved and oesophagitis settled within an average period of 6 months. Poor or unsatisfactory overall results were observed in 8 (14%) patients. These included one tight fibrous stricture which required endoscopic intubation despite resolution of oesophagitis, and four patients who developed a stomal ulcer. No patients suffered from the dumping syndrome. Malignancy must be carefully excluded by biopsy in all cases of stricture.
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PMID:Duodenal diversion with vagotomy and antrectomy for severe or recurrent reflux oesophagitis and stricture: an alternative to operation at the hiatus. 378 11

Over the past 30 years, the authors reconstructed the esophagus with the right colon in 85 patients who had congenital and benign disease. The first individual operated upon in 1955 was asymptomatic. Nine patients had congenital tracheoesophageal fistula with atresia, four esophageal varices, 31 advanced obliterative esophagitis, and 23 corrosive destruction. In seven patients, severe esophagitis followed esophagogastrectomy, four had unsuccessful operations for achalasia, and seven had colon bypass following esophageal perforation. Eleven early nonfatal complications occurred. Remote nonfatal complications were seen in six patients. Three early deaths followed dehiscence of an intrathoracic esophago-colon anastomosis, and one patient died from peritonitis (4%). Four individuals died over the study period, and five patients were lost to follow-up. The late results in 72 patients show that 61 (84%) believe they have a satisfactory result, nine (13%) individuals are symptomatic, and two patients (4%) are classified as failures. Early complications have been minimized by employing preoperative intestinal angiograms and anastomotic stapling techniques, and by using the Doppler intraoperatively to prognosticate colon blood flow. Significant observations have been: Anastomosis in the neck is preferable; the transplanted colon dilates from loss of motor activity but is functionally adequate; an isoperistaltic segment is preferable, but antiperistaltic segments can be used; and colonic mucosa is relatively resistant to acid-peptic digestion.
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PMID:Unified approach for nonmalignant esophageal lesions using right colon and terminal ileum. A 30-year experience. 380 Jan 58

In 39 patients cardiospasm was associated with a hiatal hernia or the latter was formed in the process of treatment by cardiodilatation. An analysis of results of the treatment has shown that pneumocardiodilatation under control of esophagomanometry should be considered the method of choice in the treatment of such patients. The decreased gradient of the gastroesophageal pressure up to 12-14 mm of mercury is responsible for prevention of reflux-esophagitis. Operative treatment is indicated when cardiodilatation is ineffective or the manometric control is impossible. Cardiomyotomy in combination with an "incomplete" fundoplication is preferable. There are no good reasons for performing fundoplication after Nissen in patients with cardiospasm.
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PMID:[Surgical procedure in joint cardiospasm and cardial hiatal hernia]. 383 39

Patients with achalasia, which had been treated in the Department of Surgery, University of Bonn, from 1953 to 1983 (n = 142), were examined by a detailed questionnaire (n = 90), endoscopy and biopsy (n = 47), esophagography (n = 53) and by gastric reflux scintigraphy (n = 12). The results of dilatation and surgical procedures are compared. Although the incidence of gastric reflux was very seldom, an esophagitis could be seen frequently. The dilatation of the esophagus is succeeded, if there is left any myogenic tone. Otherwise an esophagomyotomy by left thoracotomy should be performed without an antireflux operation.
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PMID:[Results of treatment of achalasia with special reference to gastroesophageal reflux]. 405 68

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

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods.
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PMID:Pediatric esophageal scintigraphy. Results of 200 studies. 664 Oct 76

Over the past 28 years, one of us (W. E. N.) has reconstructed the esophagus with the right colon for congenital and benign disease in 84 patients. The first patient in the series, who was operated on in 1955, remains asymptomatic. Nine patients had congenital tracheoesophageal fistula with atresia; 4, esophageal varices; 30, advanced obliterative esophagitis; and 23, corrosive destruction. In 7, severe esophagitis followed esophagogastrectomy; 4 had unsuccessful operations for achalasia; and 7 had colon bypass following esophageal perforation. Eleven early nonfatal complications occurred. Late nonfatal complications were seen in 6 patients. There were 4 early deaths (4%): following dehiscence of an intrathoracic esophagocolic anastomosis and 1 due to peritonitis. Four individuals died over the years, and 5 patients were lost to follow-up. The late results in 71 patients show that 60 (84.5%) believe they have a satisfactory result. Nine (13%) individuals are symptomatic, and 2 (2.8%) must be classified as failures. Early complications have been minimized by using preoperative intestinal angiography, anastomotic stapling techniques, and the Doppler study intraoperatively to prognosticate colon blood flow. Several important observations have been made: anastomosis in the neck is preferable; the transplanted colon dilates from loss of motor activity but is functionally adequate; an isoperistaltic segment is preferable, but an antiperistaltic implant suffices; colonic mucosa is relatively resistant to acid-peptic digestion; and hyperalimentation is mandatory in very ill and debilitated patients.
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PMID:Colon replacement of the esophagus for congenital and benign disease. 665 76


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