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

Four cases of H-type tracheoesophageal fistula are reported. The patients all had chronic aspiration from the esophagus. Although serious symptoms were present in all, definitive diagnoses were not made until the patients had reached 1, 6, 12, and 50 years of age, because ordinary radiologic methods failed to establish the diagnosis. The angulation of the fistula usually prevents contrast medium in the esophagus from entering the trachea, especially with the subject upright. On the other hand, air easily passes from the trachea to the esophagus, eventually producing megaesophagus which may be confused with the picture of achalasia. An ill-advised Heller esophagomyotomy was done on 1 patient. All 4 patients eventually had successful closure of the fistulas. Three operations were by the transthoracic route, and 1 high fistula in an infant was closed through a cervical approach.
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PMID:Diagnosis and surgical treatment of "H-type" tracheoesophageal fistulas. 51 80

In the light of three cases of esophageal carcinoma developing on a pre-existing idiopathic megaesophagus the authors examine etiopatological, clinical and terapeutic problems related to this association. They believe that carcinoma of the esophagus tends to be a complication of cardiospasm in patients inadequately treated for the primary condition. Early diagnosis and an adequate Heller operation for cardiospasm will lessen the chance of cancer developing in megaesophagus with stasis. When finally diagnosed, this variety of esophageal carcinoma has an extremely poor prognosis. An even more important claim upon the clinician is to be alert to the hazards of continued stasis in megaesophagus and to devise earlier techniques of recognition, including more frequent recourse to biopsy during esophagoscopy.
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PMID:[Association of idiopathic megaesophagus and carcinoma]. 54 Mar 69

The authors present their experience with manometric studies, before and after Thal's fundic patch operation, in patients with Chagas' megaesophagus. The preoperative studies showed in the majority of the patients synchronous, waves of normal duration, that had low peak pressure and were repetitive (vigorous achalasia). The postoperative studies showed disappearance of the vigorous achalasia in over half the patients and increase of the contraction peak pressure in one patient.
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PMID:Chagas' megaesophagus: manometric studies before and after Thal's fundic patch operation. 82 76

Achalasia of the esophagus is combination of dysfunction of the lower esophageal sphincter and disorder of the peristaltic movement of the esophageal body. Both components influence one another in a negative way, but the first usually prevails. That is why satisfactory and long-term results can be obtained in most of patients with non-advanced achalasia by Heller's myotomy. In a small group of patients with disease of megaesophagus-type (disorder of the motility of the esophageal body prevails) and in patients in which their disease reach for various reasons the stage of advanced (decompensated) achalasia, the resection-surgery is etiopatogeneticly justified. At the Ist and IInd surgical clinic in Olomouc 331 patients with achalasia have been operated so far. 29 patients treated by resection of a shorter or longer portion of the aboral esophagus, in 2 patients the whole thoracic esophagus was extirpated without thoracotomy. Resection was in principle indicated as secondary treatment. To substitute the esophagus the stomach in various operative modifications was used in two thirds of the patients, in the remaining patients interposition by a segment of the small or large intestine was carried out.
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PMID:[Resection therapy of advanced achalasia]. 184 Mar 57

Three surgical complications of Chagas' disease--megaesophagus, achalasia of the pylorus, and cholelithiasis--were evaluated within the framework of the experience acquired in the management of 840 cases of megaesophagus--722 in the nonadvanced stage of the disease and 118 with advanced disease (dolichomegaesophagus). In the group of the 722 patients with nonadvanced disease, achalasia of the pylorus was present in 140 (19.4%), and in the total of 840 patients, uncomplicated cholelithiasis without chagasic involvement of the gallbladder and/or papilla was observed in 58 (6.9%). The 722 subjects with nonadvanced megaesophagus were submitted to wide esophagocardiomyectomy performed at the level of the anterior esophagogastric junction, combined with an antireflux valvuloplasty procedure. We recorded no mortality, and 95% excellent and good results in long-term follow-up. On the other hand, dolichomegaesophagus required esophageal resection with reconstruction by means of an esophagogastroplasty placed in the esophageal bed. The mortality rate was 4.2% (5/118); the main postoperative complications were pleural effusion (22%) and fistulas of the esophagogastric anastomosis (8.4%). Postoperatively, the patients adapted well to their new anatomy and gained weight. Achalasia of the pylorus was confirmed by delayed gastric emptying time. This entity was managed by concomitant antropyloromyectomy without mortality. Cholelithiasis was managed by cholecystectomy and radiologic exploration of the bile ducts.
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PMID:Surgical complications of Chagas' disease: megaesophagus, achalasia of the pylorus, and cholelithiasis. 190 32

A report is given on a 14-year-old girl and a 13-year-old boy from a group of 83 patients who met the diagnostic criteria (MAS; DSM-III-R) for anorexia nervosa. The behavior therapy interventions did not have the expected effects in either child. On repetition diagnostic evaluations showed that the girl had esophageal achalasia within the scope of Turpin's syndrome (megaesophagus, bronchus deformation) and the boy Burkitt's lymphoma (malignant non-Hodgkins' lymphoma). The differential diagnostic and classification problems associated with the diagnosis anorexia nervosa are pointed out.
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PMID:[How reliable is the diagnosis "anorexia nervosa"?]. 228 65

Although esophagomyotomy is highly effective as the initial surgical treatment of most patients with achalasia, those with either recurrent symptoms after a previous esophagomyotomy or a megaesophagus do not respond as well to esophagomyotomy. Total thoracic esophagectomy was performed in 26 patients (average age, 49 years) with achalasia. Eighteen had a history of a previous esophagomyotomy, and 18 had a megaesophagus (esophageal diameter of 8 cm or larger). In 24 patients, a transhiatal esophagectomy without thoracotomy was the operative approach; 2 patients required a transthoracic esophagectomy because of intrathoracic adhesions from prior operations. The stomach was used as the esophageal substitute in all patients; it was positioned in the posterior mediastinum, and a cervical anastomosis was performed. Intraoperative blood loss averaged 765 mL. Major postoperative complications included mediastinal bleeding requiring thoracotomy (2), chylothorax (2), and anastomotic leak (1). There were no postoperative deaths. The average postoperative hospital stay was ten days. Follow-up is complete and ranges from 3 to 91 months (average duration, 30 months). All but 1 patient with severe psychiatric disease eat a regular, unrestricted diet without postprandial regurgitation. Early postoperative anastomotic dilation was required in 10 patients. Dumping syndrome has occurred in 5 patients. It is concluded that esophagectomy provides the most reliable treatment of esophageal obstruction, pulmonary complications, and potential late development of carcinoma in the patient with a megaesophagus of achalasia or a failed prior esophagomyotomy and that it is a far better option in these patients than esophagomyotomy, cardioplasty procedures, or limited esophageal resection.
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PMID:Esophageal resection for achalasia: indications and results. 264 31

Intramural denervation confirmed anatomopathologically and by means of a pharmacological test is the main factor responsible for achalasia of the cardia and for the absence of peristalsis in the esophageal body in Chagas' disease. The resulting difficulty in transit and stasis cause the main symptoms and complications of megaesophagus. Among the recent phenomena observed in the physiopathology and pharmacology of megaesophagus by the manometric method, we may mention: delayed pharyngo-esophageal time, concomitance of peristalsis and aperistalsis and abnormal responses of the lower sphincter to caerulein, atropine, nifedipine and isosorbitol dinitrate. Gammascintillography was shown to be useful in the study of esophageal transit in megaesophagus by permitting the detection of unsuspected abnormalities, especially when deglution is done with the patient lying down, and by affording a dynamic and quantitative view of the changes in esophageal emptying.
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PMID:[The esophagus in Chagas' disease: physiologic, pharmacologic and clinical studies]. 314 64

Pneumatic dilation of the lower esophageal sphincter was accomplished by endoscopic visualization and positioning of a modified polyurethane dilator (90 F diameter) without fluoroscopy in 17 consecutive patients with advanced symptomatic achalasia. All patients were monitored for completeness of dilation by pre- and postdilation radionuclide scintiscan. Despite advanced megaesophagus, prior dilatations, or complicating disease, all patients showed prompt relief of symptoms.
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PMID:Pneumatic dilatation in achalasia under endoscopic guidance: correlation pre- and postdilatation by radionuclide scintiscan. 356 34

Forty-six patients with esophageal achalasia required reoperation between January 1970 and January 1986. Three of these patients required a second reoperative procedure, for a total of 49 reoperations. Indications for reoperation were inadequate myotomy, 17; gastroesophageal reflux, 14; concomitant antireflux operation, six; incorrect diagnosis, four; carcinoma of the esophagus, four; megaesophagus, three; and paraesophageal hernia, one. Various procedures were employed at the time of reoperation, including revision of the myotomy, takedown or revision of a previously performed wrap, fundoplication, and resection. Of the 48 patients available for follow-up study over an average postoperative period of 5 years, the condition of 38 (79%) was considered to have been improved by reoperation. The best results were obtained by revision or takedown of a previous wrap (an improvement rate of 88.9%) and radical resective procedures (89% to 100%). We conclude that for good results to be achieved after reoperative achalasia procedures, the preoperative diagnosis must be accurate, the operation should be performed early before the development of megaesophagus, and a short but complete esophagomyotomy must be performed, preferably without the addition of an antireflux procedure. Elimination or revision of a previously performed fundoplication can be expected to be followed by good results. The precise indications for radical resective procedures have yet to be defined clearly, but their wider application to carefully selected patients with postoperative achalasia seems justified.
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PMID:Reoperative achalasia surgery. 377 41


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