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 three main symptoms of esophageal disease or disorder are dysphagia, chest pain, and heartburn. Dysphagia in achalasia is mainly due to a non-relaxing lower esophageal sphincter (LES). The mechanism of dysphagia in diffuse esophageal spasm and related motor disorders is related to a combination of several factors including incomplete LES relaxation, failed or weak peristalsis (pressure less than 30 mmHg in the distal esophagus, and orad positive pressure gradient). Meal manometry and balloon distention may prove to be useful provocation tests. Chest pain of esophageal origin may be due to gastroesophageal reflux and esophageal motility disorders; it may also be a manifestation of an irritable esophagus, in which the esophagus is hypersensitive to various stimuli (chemical, mechanical, ischemic). Esophageal provocation tests may suggest the esophageal origin of the pain but do not give information on the nature of the esophageal disorder. Twenty-four-hour pH and pressure measurements may, however, yield this information. Heartburn and acid regurgitations are the most typical symptoms of gastroesophageal reflux. Transient relaxations of the LES are considered to be an important contributory mechanism of reflux. Absent basal LES pressure is another mechanism, which accounts for about one-fourth of the reflux episodes in patients with severe reflux esophagitis. During long-lasting inappropriate relaxations, swallows often produce deglutitive contraction waves that die out in the upper esophagus, suggesting that reflux often occurs during periods of inhibition of both LES tone and peristaltic esophageal activity.
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PMID:Recent studies of the pathophysiology and diagnosis of esophageal symptoms. 223 80

When esophageal disruption occurs in the presence of preexisting esophageal disease or is associated with sepsis or fluid and electrolyte imbalance, aggressive and definitive therapy often provides the only chance for patient salvage. Twenty-four adults (average age, 59 years) with intrathoracic esophageal perforations underwent esophagectomy: 15, transhiatal esophagectomy without thoracotomy; and 9, transthoracic esophagectomy. Restoration of alimentary continuity with an immediate cervical esophagogastric anastomosis was carried out in 13 patients. Eleven underwent a cervical or anterior thoracic esophagostomy, and 10 of them had a subsequent colonic (7) or gastric (3) interposition from 4 to 32 weeks (average time, 8.6 weeks) later. The perforations were due to esophageal instrumentation (9 patients), acute caustic ingestion (2), emesis (2), intrathoracic esophagogastric anastomotic disruption (2), and other causes (9). Preexisting esophageal disease in 20 patients included chronic strictures (10 patients), reflux esophagitis (3), esophageal cancer (3), achalasia (2), diffuse spasm (2), and monilial esophagitis (1 patient). Ten patients were operated on within 12 hours after the injury; 3, within 12 to 24 hours; and 11, within three to 45 days (average interval, 6.6 days). There were three hospital deaths (13%). Nineteen of the 21 survivors were able to swallow comfortably until the time of death or latest follow-up. Aggressive diagnosis and aggressive treatment of life-threatening esophageal perforations are advocated. Conservative procedures (repair, diversion, or drainage) for a perforation with preexisting esophageal disease often inflict more morbidity than esophageal resection, which eliminates the perforation, the source of sepsis, and the underlying esophageal disease. The decision to restore alimentary continuity in a single stage must be individualized.
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PMID:Esophagectomy for esophageal disruption. 229 75

Epiphrenic diverticula occur in association with motor disorders of the distal esophagus, including achalasia and diffuse esophageal spasm. Four patients with huge symptomatic epiphrenic diverticula are presented to emphasize the need for complete radiographic and manometric studies of the esophagus to document this motor dysfunction prior to performing combined diverticulectomy and esophagomyotomy. Each patient had achalasia with symptoms extending from 4 to 25 years. Diverticulectomy and esophagomyotomy were performed in every patient. One patient had previously undergone diverticulectomy alone, with prompt recurrence of the lesion. During a follow-up period extending from 2 to 10 years, three patients were alive and well. One patient developed recurrent dysphagia due to reflux esophagitis and stricture requiring dilatation. It is essential that esophagomyotomy be part of the initial operative procedure. In selected patients, an antireflux procedure may also be indicated.
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PMID:Management of huge epiphrenic esophageal diverticula. 249 4

Parietal cell vagotomy (PCV) was used for a variety of gastrointestinal conditions in 658 patients. Operative and late related deaths after PCV were 1.1% (3/273) in patients with intractable duodenal ulcers, 1.1% (1/91) in perforated ulcers, 0% (0/43) in Type I gastric ulcers, 0% (0/45) in pyloric and prepyloric ulcers, 3.2% (6/188) when combined with fundoplication, 8.7% (2/23) when combined with vascular surgery, and 4.2% (1/24) in ulcer patients with acute bleeding. The recurrent ulcer rate after PCV was 8.4% in patients operated on for duodenal ulcer, 6.4% for perforated ulcer, 5.3% for bleeding ulcers, 10% for Type I gastric ulcers, and 31% for pyloric and prepyloric ulcers. PCV was preferred to total gastrectomy in four patients in whom a gastrinoma could not be located. PCV was used in 188 patients with reflux esophagitis and in 12 patients with achalasia to facilitate fundoplication and placement of the myotomy, respectively. Based on the results of the study, PCV is contraindicated in patients with pyloric and prepyloric ulcers. PCV is not recommended when traumatic dilatation of the pylorus is required to overcome obstruction. PCV may have limited application in patients with bleeding ulcers and Type I gastric ulcers. In our experience PCV is not contraindicated in patients with ulcers resistant to H2 receptor antagonists. PCV may be contraindicated when acid hypersecretion exceeds an as-yet undetermined level. PCV is an ideal procedure for intractable duodenal ulcers and perforated ulcers.
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PMID:Indications for parietal cell vagotomy without drainage in gastrointestinal surgery. 274 12

Long-term results are presented in 60 patients (4 to 50 years old) who underwent a diaphragmatic graft procedure for relief of cardiospasm (achalasia) from 1962 through 1987. The operative technique involves construction of a pedicle flap of diaphragm. The muscular defect on the lower segment of the esophagus and the transplanted diaphragmatic pedicle that is sutured to the defect must be the same size. Immediate operative results were good. Only one complication developed, a case of pneumonia that was cured. The patients were followed up from 11 months to 25 years. Two patients were lost to follow-up, 55 had excellent results, and three patients still had nausea and heartburn but were better than before the operation. This procedure has three advantages: (1) It prevents the development of fistulas and diverticula at the site of the esophageal muscular defect; (2) it effectively eliminates both restenosis resulting from scar tissue and reflux esophagitis; and (3) it allows the cardia to recover its normal function and the esophagus to return to normal size at the site of the operation.
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PMID:Treatment of esophageal achalasia (cardiospasm) with diaphragmatic graft. Twenty-five years' experience. 292 62

The authors' and literature results concerning the peculiarities of a clinical course, diagnosis and therapy of the upper digestive tract in women during pregnancy were summed up. Exacerbation or first symptoms of diseases like cardiospasm, reflux esophagitis can often occur during pregnancy. Peptic ulcer in most pregnant women has a favorable course, exacerbations are rare. A conclusion has been made that measures aimed at the prevention of exacerbations and complications of these diseases, are recommended to women with chronic diseases of the digestive tract during pregnancy.
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PMID:[Diseases of the upper digestive system in pregnant women]. 306 59

Chylothorax is an unusual complication after transhiatal esophagectomy (THE) and in the past 10 years has occurred in 11 of 320 patients (3%) undergoing this operation for diseases of the intrathoracic esophagus. Four patients had benign esophageal disease: scleroderma reflux esophagitis (1), caustic stricture (1), and achalasia (2), and each had undergone at least one previous esophageal operation. Seven patients had intrathoracic esophageal carcinoma--two upper-third, two middle-third, and three distal-third lesions. Excessive chest tube drainage more than 72 hours after THE was the standard presentation, and the diagnosis of chylothorax was confirmed by the administration of cream through the jejunostomy feeding tube placed routinely at operation. The character of the chest tube drainage changed from serous to opalescent. Aggressive treatment of this complication was the rule, and every patient underwent a thoracotomy between 2 to 14 days (average, 6 days) after the diagnosis was established. Cream was administered through the jejunostomy tube before operation, and in each case the thoracic duct injury was readily identified and controlled with suture ligatures. There were no deaths in this group, and there was one recurrence of the fistula that required reoperation; all patients were discharged from the hospital within 3 to 29 days (average, 10 days) after thoracic duct ligation. It is concluded that early recognition of a chylothorax after transhiatal esophagectomy with prompt transthoracic ligation of the injured duct results in a shorter overall hospitalization and lower morbidity and mortality from this complication. The traditional conservative management of chylothorax with intravenous hyperalimentation and no or low-residue enteral feedings has little place in this nutritionally depleted patient population.
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PMID:Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. 317 69

We evaluated the use of total thoracic esophagectomy and replacement with stomach in a group of 21 patients between 1976 and 1986 who had undergone multiple unsuccessful esophageal operations. All patients had between one and four unsuccessful operations for benign esophageal disorders. Sixteen patients had primary motor disorders: achalasia in nine and esophageal spasm in seven. Of these patients, 11 also had recurrent gastroesophageal reflux and peptic esophagitis. Complicated reflux disease characterized by severe esophagitis, stricture, and impaired peristalsis without primary motor disorder occurred in five patients. In one patient a functionally impaired long-segment colon interposition was removed and replaced with stomach. Total thoracic esophagectomy and cervical esophagogastric reconstruction was done in all patients. The transhiatal approach was chosen for resection in 16 patients and thoracotomy was used in the other five. There was one perioperative death (5%), from massive aspiration 4 days after transhiatal esophagectomy. Other complications included transient anastomotic leak (three patients), tracheoesophageal fistula (one), recurrent nerve palsy (one), and transient hoarseness (two). Follow-up is complete between 1 and 10 years and reveals the following functional results: 12 patients good to excellent, seven fair, one poor. In this patient group in which multiple prior procedures have failed to improve severe incapacitating symptoms, we believe further attempts at hiatal reconstruction are unlikely to succeed. For this circumstance, we recommend total thoracic esophagectomy with the use of stomach as the replacement organ of choice.
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PMID:Esophagectomy for complex benign esophageal disease. 334 48

To address the controversy regarding the choice of operation for achalasia, the cases of 57 patients having operation, 38 for the first time (Group 1) and 19 with a previous procedure (Group 2), were reviewed. Surgical emphasis was on hiatal dissection to maximize exposure and use of the Belsey fundoplication to achieve cardiac competence without obstruction. Operative mortality was 1 (1.8%) of 57 patients. In group 1, 21 of the 38 had prior pneumatic dilations. All were treated with esophagomyotomy and a Belsey fundoplication. Clinical results are excellent or good in 30 (88%) of the 34 patients for whom follow-up is available, and are similar in patients with and without prior dilation. Lower esophageal sphincter (LES) pressure decreased from 22.3 to 7.7 mm Hg (p less than 0.001), and pH testing shows no reflux in any of 13 patients. In Group 2, previous operations were esophagomyotomy in 13, esophagomyotomy plus a Nissen fundoplication in 3, and a Nissen fundoplication only in 3. The initial operation failed because of inadequate myotomy in 6 patients, an obstructive Nissen fundoplication in 6, and reflux esophagitis in 7. In these 7 patients, acid reflux testing documented reflux due to cardiac incompetence and delayed clearance. Reoperations included takedown of a Nissen fundoplication in 6, esophagomyotomy and Belsey procedure in 15, Belsey procedure in 1, and resection plus colon interposition in 2. Clinical results are excellent or good in 12 (75%) of the patients with follow-up. These conclusions can be drawn. (1) Esophagomyotomy and Belsey fundoplication lowers LES pressure and provides good results with low risk, even after pneumatic dilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical treatment of achalasia: results with esophagomyotomy and Belsey repair. 336 39

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia (20), scleroderma (9), esophageal carcinoma (8), Barrett esophagus (5), and reflux esophagitis (27). We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.
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PMID:Esophageal scintigraphy: applications and limitations in the study of esophageal disorders. 340 2


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