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)

The value of endoscopy in dysphagia is limited in the diagnosis of motility disorders and small structures, webs, and hiatal hernias. Endoscopy is of special use for the clarification of an organic cause of dysphagia. Intraluminal tumors can be seen and in a high percentage of cases be definitely diagnosed by taking biopsies; a malignant degeneration in Barrett's esophagus is detectable by endoscopy in 89.1% of cases. Gastroesophageal reflux disease can be diagnosed on endoscopy as it leads to an endoscopically visible inflammatory reaction; however, normal findings on endoscopy cannot exclude reflux disease. Endoscopy is the method of choice in the diagnosis of nonreflux esophagitis, especially Candida and viral esophagitis. A further advantage of endoscopy is the fact that a microscopic diagnosis can be obtained and endoscopic treatment can be performed simultaneously. Submucosal or extramural lesions can be missed by endoscopy. Endosonography, the combination of endoscopy and ultrasonography (EUS) yields additional information in diagnosing submucosal and extramural lesions of the esophagus which is missed by other imaging procedures. One of the main advantages of EUS is the detection of small and submucosal lesions. The most important indication is the local staging of esophageal carcinomas; the accuracy of endosonography in determining the depth of infiltration ranges between 79% and 92%. The detection of paraesophageal lymph nodes is successful in 60%-82%, although EUS cannot differentiate benign from malignant lymph nodes. Submucosal tumors can be visualized by endosonography and their size, echopattern, and the layers of origin can be determined with high accuracy. Further indications for EUS are the exclusion of focal lesions in achalasia or peptic strictures.
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PMID:The value of endoscopy and endosonography in the diagnosis of the dysphagic patient. 846 31

Fibreoptic endoscopy was performed on 5,086 consecutive patients with upper gastrointestinal tract disease (UGITD) symptoms, at two endoscopy centres in Khartoum over five years. Oesophageal disease was diagnosed in 559 patients (11%) comprising (20.5%) of all the positive findings. In 46% of all the endoscopies no abnormality was detected. The commonest oesophageal disease was varices occurring in 186 patients (3.7%) of the 5,086 endoscopies with a mean age of 33.5 +/- 12 and a male/female ratio of 3.4:1. Hiatus hernia occurred in 124 patients (2.4%) with a male/female ratio of 1.6:1, oesophagitis in 115 patients (2.3%) with a male/female ratio of 2:1. Carcinoma of the oesophagus was diagnosed in 108 patients (2.1%), with a mean age of 56 +/- 14 years and a male/female ratio of 1.4:1. Achalasia of the oesophagus occurred in 20 patients (0.4%), Mallory Weiss syndrome in 4 patients (0.08%) and benign strictures in 2 patients (0.04%).
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PMID:Oesophageal diseases in Sudan, diagnosed by fibreoptic endoscopy. 847 Mar 1

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.
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PMID:Diagnostic imaging in the evaluation of dysphagia. 862 36

Dysphagia is a common reason for radiographic examination of the oesophagus to assess structural or functional abnormalities. From February 1, 1989 to August 28, 1993, six hundred and sixty eight patients had barium swallow examination. Out of 668 patients complaining of dysphagia, 173 patients had either histologically confirmed diagnoses and/or surgical diagnoses or oesophagoscopic diagnoses. The histological, oesophagoscopic and surgical diagnoses were: malignant tumours of the oesophagus 137 patients, achalasia of the cardia 21 patients, diverticula of the oesophagus six patients, peptic structures, five patients and non specific oesophagitis, four patients. Barium swallow agreed with 166 (96%) histological, oesophagoscopic and surgical diagnoses. The Kappa statistic was high (> .8). The mean age for patients with malignant tumours of the oesophagus was 53.5 years (range: 32-75 years), and for achalasia of the cardia was 36 years (range: 14-58 years). Patients with malignancy are in higher age group categories in comparison to the non-malignant patients (OR = 0.07 (0.02, 0.17). The mean duration of dysphagia for achalasia of the cardia was 8.5 years. The major cause of dysphagia was found to be malignant tumour of the oesophagus. Further study is recommended to determine the pattern of oesophageal pathologies to substantiate the finding.
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PMID:Relative sensitivity of barium swallow examination in the diagnosis of oesophageal pathology. 869 23

We report a case of oesophageal disease as the first manifestation in a patient with CREST syndrome. A 46-year-old man with achalasia-like syndrome developed CREST syndrome 4 years later. A pneumatic dilatation of the cardia was performed. After pneumatic dilatation the dysphagia and regurgitation disappeared but the patient developed reflux oesophagitis. Four years after diagnosis of oesophageal disease he presented with a clinical picture of CREST syndrome. An acute ileus and constipation developed later. After receiving medical therapy with omeprazole and cisapride the patient is free of oesophageal symptoms and bowel movements are normal. Oesophageal disease is common in patients with limited and diffuse scleroderma, but to our knowledge achalasia-like syndrome has not been previously described as the first manifestation of the systemic disease.
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PMID:Achalasia-like syndrome as the first manifestation in a patient with CREST syndrome. 872 33

Dysphagia consists of various diseases, which all lead to an impaired quality of life. Besides a thorough case history and clinical examination, there is a need for objective diagnostic examinations to evaluate the extent of the disease. The present study includes 38 patients suffering from the most common causes of dysphagia such as benign or malignant strictures of the esophagus, esophagitis, achalasia cardiae, cricopharyngeal dysfunction and motility disorders. The patients were examined by endoluminal ultrasonography using a 2.7 mm-wide-probe. The present study clearly indicates the value of the method in evaluating the extent of the disease in patients suffering from the aforementioned diseases.
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PMID:Endoluminal ultrasonography: a new method to evaluate dysphagia. 873 56

Achalasia is a motor disorder of the oesopagus characterized by decrease in ganglion cell density in Auerbach's plexus. The cause of the lesion is unknown. This is to repeat on the occurrence of autoimmune phenomena in patients with achalasia, in particular circulating antibodies against Auerbach's plexus and its possible meaning. IgG-antibodies against Auerbach's plexus were determined by standard indirect immunofluorescence. Antibodies to the cytoplasm of Auerbach's plexus were found in 37 of 58 patients with achalasia at variable stages of the disease (I-IV) with a disease duration ranging from 1 to 20 years but only in 4 out of 54 healthy controls (specificity 93%, sensitivity 64%, p < 0.0001), and in none of 12 patients with Hirschsprung's disease as well as 12 patients with cancer of oesophagus and only in one of 11 patients with peptic oesophagitis as well as in one of 13 patients with myasthenia gravis. The present observations suggest that autoimmunity to Auerbach's plexus plays a role in the pathogenesis of achalasia, the mechanism of action is unknown.
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PMID:Autoantibodies to Auerbach's plexus in achalasia. 874 84

After a wide revision of the Literature, the most frequent causes of failure in the surgical therapy of esophageal achalasia are described. Above all there is the uncorrect execution of the Heller's myotomy as for its upward and downward extension or its deepness. An uncorrect myotomy, in fact, might cause the persistence or relapse of pre-operative symptoms, such as dysphagia and regurgitation. A correct myotomy, according to the authors, should be always carried out with the aid of intraoperative manometry (IEM), which allows the documentation of the alterations caused by surgery in the area of the high pressure zone, which corresponds to the sphincter (LES). A correct myotomy must produce the complete annulment of such a pressure. This technique creates the conditions sufficient to the genesis of gastroesophageal reflux (GER), which is one of the most frequent causes of failure in the surgery of achalasia. In fact, it causes a reflux esophagitis which can quickly evolve into a stricture with the reappearance of dysphagia. It is essential, therefore, to combine always the Heller's procedure with an antireflux procedure, which can protect the esophagus from GER and at the same time does not produce a mechanical obstacle to deglutition. The Authors report their last experience based on 114 primary operations of Heller's myotomy + Nissen fundoplication, performed since 1985 to date. IEM has been always used both for controlling the completeness of the myotomy and for the "calibration" of the Nissen's. Two patients, which had undergone elsewhere a Heller's myotomy alone, have been operated of re-myotomy + Nissen fundoplication. One patient, also operated elsewhere of myotomy of the esophageal body for diffuse esophageal spasm (DES), complained of dysphagia and had manometrical evidence of LES dischalasia; this patient has been reoperated of Heller's myotomy + Nissen fundoplication; another patient suffering from a reflux stricture after a Heller's myotomy without antireflux procedure, has been treated with a Roux esophago-jejunostomy. A last patient operated by Heller's myotomy + Dor fundoplication presented alkaline esophagitis without dysphagia; the treatment consisted in a Roux gastro-jejunostomy + bilateral troncular vagotomy. These data bring to the conclusion that the best treatment of achalasia relapses is their prevention, only obtainable by a good primary therapeutic approach and the routine use of IEM. The IEM avoids incomplete myotomies and inadequate antireflux procedures related to the incompetence (reflux) or hypercompetence (dysphagia recurrence) of the fundoplication.
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PMID:[Failure of surgical treatment for achalasia: diagnosis and treatment]. 894 95

From 1962 to 1992 sixtythree patients with esophageal achalasia underwent primary surgical treatment. The intervention performed was a cardiomiotomy according to Heller in 20 patients (Group A), a cardiomiotomy according to Heller with anti-reflux procedure according to Lortat-Jacob in 12 patients (Group B), a cardiomiotomy according to Heller with fundoplicatio according to Dor in 31 patients (Group C). Preoperative study was performed by radiological evaluation in patients of Group A, while patients of Group B and Group C were submitted also to endoscopy and esophageal manometry. Postoperative evaluation in Group A was performed by clinical and endoscopical controls, while in Groups B and C by clinical and radiological studies 6 months after the intervention and by clinical and endoscopical studies every two years. During the early two years after operation a functional study (esophageal manometry and esophagogastric pH-monitoring) was performed. The follow-up was complete for 13 patients of Group A, 10 patients of Group B and 28 patients of Group C. Good results (complete absence or slight dysphagia) have been obtained in 70% of Group A, in 90% of Group B and 90% of Group C. Esophageal manometry found a decrease of both resting pressure and length in every patient in Groups B and C. Gastro-esophageal reflux symptoms were found in 15% of Group A, 20% of Group B and 11% of Group C. A various degree of esophagitis was found by endoscopy in 40% of Group A, 50% of Group B and 18% of Group C. Esophago-gastric pH-monitoring, performed in Group C patients, showed pathologic refluxes in 22% of the subjects. The clinical and functional study demonstrates that Heller's cardiomiotomy, in the way it is performed nowadays (complete miotomy over 7 cm of the esophagus and 3-4 cm of the stomach), allows the complete disappearance of dysphagia. On the other side the anti-reflux procedures till now performed (including the 180 degrees fundoplicatio according to Dor) are not effective enough to avoid post-operative gastro-esophageal reflux.
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PMID:[Heller's intervention for esophageal achalasia]. 894 94

From 1974 to 1995, 19 children with achalasia of the esophagus have been treated at our institution. Presenting symptoms included vomiting (n = 14), dysphagia (n = 13), failure to thrive (n = 6), and odynophagia (n = 1). Diagnosis was established by a barium swallow in 19, with eight also undergoing esophageal manometry. Six boys and 13 girls with an average age of 10 years (range, 1.3 to 17.6) underwent a transthoracic, modified anterior Heller esophagomyotomy (HM). Five underwent a concomitant, modified, Belsey fundoplication (BF). Follow-up ranging from 6 months to 21 years (mean, 9 years) was accomplished in all 19 patients by both office visits and telephone interviews. Early postoperative follow-up showed initial swallowing difficulty in two (14%) patients with a HM alone and in four out of five (80%) patients treated with a HM and BF. All patients (n = 5) with a HM and BF and one with a HM alone required one esophageal dilation during the first postoperative year. These initial swallowing difficulties resolved in all six patients during this first postoperative year. Late postoperative follow-up, however, indicates occasional, mild dysphagia in two out of five with an HM and BF resulting in complete relief of presenting symptoms in 17 of the 19 patients (90%). All patients rated their overall result as either excellent (68%) or good (32%) with none rating it as fair or poor. None of the 19 patients had clinical evidence of gastroesophageal reflux, although five patients had evidence of nonpathologic reflux noted during upper gastrointestinal x-ray. Recurrent vomiting, asthma, wheezing, or esophagitis symptoms have not been reported by any patients. No patients required reoperation, and there were no deaths or postoperative complications. Modified Heller esophagomyotomy is safe (0% mortality) and effective (90% relief of symptoms) in children with achalasia. A concurrent modified Belsey fundoplication results in early and late mild postoperative dysphagia that was responsive to esophageal dilation. The transthoracic, modified Heller esophagomyotomy without a fundoplication is currently our treatment of choice for achalasia in children.
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PMID:Efficacy of the transthoracic modified Heller myotomy in children with achalasia--a 21-year experience. 904 49


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