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)

Most operations performed for peptic ulcer disease in the United States include vagotomy as part of the surgical procedure. This paper reviews the complications associated specifically with or increased in frequency and severity by this procedure. Included in this review are technical complications, gastric retention, recurrent ulceration, postvagotomy diarrhea, postvagotomy dysphagia and achalasia, postvagotomy biliary disease and nutritional problems. The frequency of these complications, their pathophysiology and therapeutic modalities available are reviewed. The main emphasis is on postvagotomy syndrome that can be treated medically and on the various treatment forms that have been suggested.
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PMID:Complications of vagotomy. 69 13

During the last 12 years, 1489 vagotomies were performed at the Chirurgische Poliklinik of Munich University; 1339 of them were selective proximal vagotomies (SPV). The main indication was duodenal ulcer (n = 915) and gastric ulcer (n = 188), including emergency operations for extensive bleeding. Further indications were: sliding hiatal hernia, erosive gastritis and achalasia of the cardia. The SPA was combined in all cases with a pyloroplasty based on form and function. The results are shown in detail related to mortality (elective 0.5%), recurrency (1.6%) and functional results (good 88.2%, fair 7.2%, poor 4.6%). The combined operation of SPV with pyloroplasty is, in our opinion, an operative procedure which allows non resectioning surgical treatment of GDU without selection, i.e. based on form and function.
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PMID:[Non-resecting surgery for gastroduodenal ulcer. III. Clinical results (author's transl)]. 81 6

A patient is presented with true duplication of the pylorus and concomitant achalasia of the esophagus. This patient has never had peptic ulcer disease and is suspected to have a double pyloric anomaly as a congenital abnormality rather than the result of peptic disease and scarring.
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PMID:Duplication of the pylorus found concomitantly with achalasia: congenital or peptic etiology? 90 99

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

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

There is renewed interest, particularly by head and neck surgeons in the pathophysiology of swallowing. Some of the reasons for this are an increased number of patients in the following categories who have swallowing problems: 1) patients postoperative from procedures in the head and neck, e.g., partial laryngectomy, partial or complete excisions of the tongue, pharynx, or mandible; 2) patients with peptic ulcer, hiatal hernia, esophageal diverticula, and cardiospasm; 3) patients who survive severe central nervous system problems such as stroke, brain tumors, aneurysms, or degenerative disease; and 4) patients who survive serious accidents with severe neck trauma. This paper reviews the pathophysiology of swallowing and the methods of diagnosing and treating dysphagia and its complications.
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PMID:The patient who aspirates -- diagnosis and management. 678 50

Acupuncture has been used for various gastrointestinal (GI) conditions. Voluminous data support the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have also shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture has also been used for a variety of other conditions including postoperative ileus, achalasia, peptic ulcer disease, functional bowel diseases (including irritable bowel syndrome and nonulcer dyspepsia), diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few prospective randomized clinical studies, the well-documented physiological basis of acupuncture effects on the GI tract, and the extensive history of successful clinical use of acupuncture, makes this a promising modality that warrants further investigation.
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PMID:Acupuncture for gastrointestinal and hepatobiliary disorders. 1010 29

Laparoscopic surgery of the upper gastrointestinal tract is nowadays associated with little morbidity and mortality. Cardiomyotomy with semifundoplication for management of achalasia and the various forms of fundoplication for treatment of reflux syndrome have proved beneficial and have largely replaced conventional surgery. Independent of the operative approach, it has not yet been established with certainty whether gastroesophageal reflux can best be prevented by 360 degrees fundoplication or semifundoplication. A perforated peptic ulcer can be treated effectively by laparoscopic overstitching of omental patch-plasty, although the superiority of the laparoscopic method has yet to be proved. Benign lesions and early malignancies are currently resected laparoscopically, but the role of laparoscopy in the curative treatment of advanced gastric carcinoma remains to be clarified. Diagnostic laparoscopy is used to avoid unnecessary laparotomy in inoperable cancer and to ascertain whether neoadjuvant therapy is indicated in advanced gastric carcinoma.
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PMID:[Laparoscopic surgery of the upper gastrointestinal tract]. 1135 25

In peptic ulcer, ulcerative colitis and achalasia of the esophagus there is usually an important emotional component, the significance of which in the etiology of these diseases is not yet known, but which has a profound effect on the course and severity of symptoms. None of these diseases can successfully be treated without consideration of this aspect and it must be dealt with by a general physician rather than a psychiatrist, in most instances. Eighty per cent of the purely functional disorders of the gastrointestinal tract are manifestations of neurosis. The results of treatment in these cases should be good if correctly undertaken early in the course of the disease. The author believes that many gastrointestinal neuroses which have become intractable are such because of improper treatment at the onset, and are thus iatrogenic.
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PMID:Emotional component in gastrointestinal disorders. 1316 Aug 16

Patients who are unresponsive to 4-8 weeks' treatment with PPIs twice daily might have so-called refractory GERD. The first investigation these patients should undergo is upper endoscopy to exclude a diagnosis of peptic ulcer disease or cancer and identify the presence of esophagitis. The presence of esophagitis in these patients is suggestive of a pill-induced injury, an autoimmune skin disease involving the esophagus, eosinophilic esophagitis or, less likely, a hypersecretory syndrome or a genotype that confers altered metabolism of PPIs. Refractory reflux syndromes associated with normal endoscopy findings are more problematic to diagnose and further testing may be required, including prolonged 48 h pH testing, impedance measurements (for nonacid reflux), esophageal manometry and gastric function tests. For patients with refractory GERD who do not have esophagitis, possible etiologies include nocturnal gastric acid breakthrough, nonacid GER, missed GER or other diseases such as achalasia, gastroparesis or functional heartburn.
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PMID:How to manage refractory GERD. 1804 75


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