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)

A total of 538 dilations were performed upon 293 patients evaluated at our unit. Of these, 4.8 per cent had cervical webs, 3.0 per cent had cricopharyngeal dysfunction, 9.2 per cent had undetermined cause, 3.4 per cent had achalasia, 65.5 per cent had peptic strictures, 3.8 per cent had Schatzki's ring, 2.4 per cent had esophagitis, 6.1 per cent had postoperative strictures, 0.3 per cent had caustic stricture and 1.4 per cent had extrinsic compression. True dysphagia should always be investigated through a careful history, physical examination, barium study, endoscopy and, infrequently, esophageal manometry.
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PMID:Endoscopic evaluation of dysphagia in two hundred and ninety-three patients with benign disease. 669 9

A Heller cardiomyotomy has been realized in 406 cases of achalasia. The indications for operation are defined. Surgery must be preferred to dilatation: the results are favorable in 96% of cases. The failures or so-called failures are detailed. In failures or recurrences due to an insufficient cardiomyotomy, a new myotomy is indicated. Gastro-esophageal reflux is frequently an indication for oesogastric resection. Failures have been observed in 70 cases. The insufficient initial myotomy was completed in 36 cases. The etiology of postmyotomy sclerosis (15 perioesophageal, 3 interstitial) is discussed. Severe peptic oesophagitis, observed in 15 cases, stresses the importance of restoring the anti-reflux mechanism, rather than using a thoracic approach with the risk of a myotomy too limited towards the stomach. Other causes of failures (atypical mega-oesophagus, limited peptic stenosis) are due to an erroneous interpretation of preoperative X-rays, endoscopy and manometric data: in such cases, the original treatment should have been adapted to the lesion. Finally, 8 postoperative oesophageal asystolias and 4 cancers stress the importance of an early myotomy, correctly realized through an abdominal approach.
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PMID:[Surgical treatment of failures or recurrences after Heller cardiomyotomy (author's transl)]. 681 Jun 4

Out of 90 patients with esophageal achalasia seen during the last decade, we found associated esophageal pathology in 46,6% of the cases. The esophagitis occurred with a frequency of 26,6%, whereas esophageal hiatus hernia was found in 14,4%, benign esophageal stenosis in 5,5%, diverticula in 2,2% and tumors in 2,2%. The role of the different ethiopatogeneic factors is discussed as well as the approach to the above mentioned entities.
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PMID:[Esophageal pathology associated with achalasia]. 681 41

Long-term follow-up of patients with achalasia has revealed recurrences many years following an initially successful cardiomyotomy. In three patients with recurrent achalasia, one previously operated on by us and another twice recurrent, we were confronted with an apparently previously complete myotomy at reoperation. We elected to perform a cardioplasty using the Y-V principle employed previously in duodenal stenosis. We added a Belsey type of partial plication. Five-year follow-up with history, esophagram, esophageal function studies, and endoscopy has revealed no recurrence of dysphagia and no symptoms of reflux or esophagitis.
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PMID:Y-V cardioplasty for recurrent achalasia. 684 62

Current methods to evaluate patients with esophageal disease include barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of radioisotopes has been useful in evaluation of esophageal reflux and the post-treatment of achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to acid in the esophagus include the acid infusion test, the standard acid reflux test, the acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or esophagitis and allows direct visualization of the esophagus. The treatment of reflux esophagitis is discussed. The differential diagnosis of dysphagia may include achalasia, diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs, strictures, and benign or malignant tumors. The evaluation of dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The Mallory-Weiss syndrome or bleeding from the mucosal tears of the gastroesophageal junction and Boerhaave's syndrome, spontaneous esophageal perforation, are two disorders associated with vomiting. The Mallory-Weiss syndrome usually resolves without specific therapy, but a high index of suspicion is required for patients with chest pain after vomiting, as spontaneous perforation necessitates immediate surgery. Most diverticula need no treatment, but the Zenker diverticulum, if symptomatic, should probably be surgically repaired.
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PMID:Evaluation and management of diseases of the esophagus. 703 70

Twelve patients underwent distal esophageal myotomy for achalasia. After denuding the esophageal mucosa over 50 percent of its circumference, a short (2 cm) total fundoplication was performed over a size 56 mercury bougie. Clinical evaluation showed marked symptomatic improvement. Obstructive symptoms are minimal, and no reflux symptoms were noted. Manometric documentation showed a significant decrease in resting esophageal and lower esophageal sphincter pressure. Contraction pressure was also lowered, and peristalsis returned in 36 percent of the waves in the proximal esophagus. Radiologic and scanning documentation revealed slow emptying without evidence of significant reflux. Endoscopic evaluation revealed no esophagitis after 19 months' follow-up.
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PMID:Effects of total fundoplication on function of the esophagus after myotomy for achalasia. 705 51

While Heller's myotomy has become the accepted operation for achalasia, still, there is no agreement about the indications for and choice of complementary procedures to minimize subsequent acid esophageal reflux. In the instances described in this investigation Heller's operation was accompanied by proximal gastric, or highly selective, vagotomy and anterior fundoplication. Dysphagia was abolished and normal alimentation restored in all but one patient, who was elderly and had an advanced megaesophagus. In every patient after the operation, results of pH-manometry, acid reflux tests and endoscopy demonstrated the absence of both acid reflux and esophagitis.
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PMID:Proximal gastric vagotomy and anterior fundoplication as complementary procedures to Heller's operation for achalasia. 711 62

The major postoperative complications of esophagocardiomyotomy (ECM) for achalasia are peptic esophagitis due to gastroesophageal reflux and recurrence. According to other authors, the incidence of postoperative esophagitis is 15% ot 25%. We report the results obtained in 40 patients treated by our own surgical technique, which is based on precise anatomic and physiopathological criteria. With this technique an ECM without esophagogastric mobilization is performed via a lower thoracotomy with partial perihiatal phrenotomy. There were no intraoperative or postoperative deaths. Two patients had postoperative basal pleurisy which was cured easily in a short time. In 36 of these patients, a follow-up ranging between 15 years and 6 months revealed a complete remission of dysphagia. The patients had significant and speedy improvement in their general condition. Seven patients had substernal pyrosis when lying down, but this was relieved in a few months in six of them. In only one patient did it persist for 4 years after the operation. Ph-manometric serial control studies performed in all the patients revealed, except in one case, normal pressure and pH values in the lower esophagus. Because of these results, we consider our ECM technique very effective in the treatment of achalasia.
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PMID:New approach to esophagocardiomyotomy: report of forty cases. 712 Oct 46

In most centers the myotomy described by Heller and Zaayer is presently the treatment of choice for achalasia. Scrutinised reports show that the results of this operation are marred by complications. The reason is obvious: an insufficient myotomy may fail to relieve the symptoms of dysphagia and an incision sufficient to relieve obstruction may result in reflex oesophagitis. The technique described by Belsey consisting of a long myotomy combined with an antireflux procedure seems to be superior. The rational of this operation and preliminary results are discussed.
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PMID:Preliminary results of a long myotomy with antireflux procedure for achalasia of the oesophagus. 741 97

To evaluate long-term efficacy and side effects after pneumatic dilation with low-compliance balloons, 40 patients with achalasia were prospectively studied during a 5-year period. All patients were investigated before, 4-6 weeks after, and at 28 +/- 15 months (final visit) after pneumatic dilation. Additionally, 12 patients underwent 24-hour esophageal pH-metry before and 26 +/- 14 months after dilation. Initial symptomatic success was obtained in 35 of 40 patients (87.5%). The remaining five and another seven patients with recurrent dysphagia underwent a second dilation, and two of these patients finally underwent esophagomyotomy. Effective dilation was reflected by a significant decrease of the symptom scores (p < 0.01) and an increase of the gastric cardia diameter both at 4-6 weeks after dilation and at the final visit (p < 0.01). Dilation reduced the lower esophageal sphincter pressure from 28.3 +/- 0.8 mmHg to 16.4 +/- 6.4 mmHg at the 4-6 weeks exam and to 14.7 +/- 5.5 mmHg at the final visit, respectively (p < 0.01). Neither the diameter of the esophageal body nor the motility of the tubular esophagus was affected by pneumatic. Esophageal pH-metry showed an increase of the number and duration of reflux episodes (pH < 4) after dilation (p < 0.05), whereas only one patient reported heartburn and another asymptomatic patient revealed esophagitis I0 at endoscopy. Therefore, pneumatic dilation with low compliance balloons proved to be safe and long lasting treatment of achalasia. Although prolonged esophageal acid exposure was measurable after dilation, clinically relevant gastroesophageal reflux occurred in only 5% (n = 2).
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PMID:Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation. 755 73


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