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)

It is suggested to use the medico-mathematical "decisive rules" for the differential diagnosis of esophageal cancer in non-specialized medical institutions. As the first step the examination cards were written, based on the data of 1195 patients with verified diagnosis. The "decisive rules" were worked out basing on the examination cards of 597 patients (in 267--esophageal cancer and in 330--benign lesions: cardiospasm, benign tumors, cysts, burn and scarring strictures, esophagitis, diverticulum). The suggested "decisive rules" using 63 and 87 clinical signs were tested elsewhere for a retrospective diagnosis in 167 patients. Using the "decisive rules" with 63 clinical signs esophageal cancer was recognized in 96% of cases, non-cancer--in 92%, while using 87 signs--in 92 and 94% accordingly. The rule comprising 63 signs-questions is recommended for practical purposes.
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PMID:[Differential diagnosis of esophageal cancer by using mathematical decision rules]. 38 64

The results from the 195 performed fibroesophagoscopies and 114 purposeful biopsies in different esophgus diseases are reported. In 65 of the examined -- cancer of the esophagus or cardia ventriculi was establised. The rest 122 patients are with non-malignant disease -- ulcers, polyps, diverticulums, varices, strictures, esophagitis, cardiospasm, etc. Cancer of esophagus and cardia ventriculi is proved in 93.93 per cent on the base of endoscopic data while another diagnosis was given in 29.30 per cent at the X-ray examinations of the same patients and at the clinical examinations of the patients in 40.1 per cent -- diagnostic errors were made. The purposeful biopsy gives 70.58 per cent of positive results and enables the differentiation of the tumor histological characterisitics.
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PMID:[Diagnostic possibilities of fibroesophagoscopy and target biopsy of the esophagus]. 122 12

Achalasia is believed to be a predisposing factor for the development of esophageal cancer. Small cell carcinoma of the esophagus is a rare neoplasm, with fewer than 150 cases having been reported in the world literature, and it has been described only once previously in a patient with longstanding achalasia. We describe a case of an 85-yr-old woman with long-term primary achalasia who developed primary small cell carcinoma of the esophagus. We hypothesize that this patient's recurrent, worsening dysphagia is related to a paraneoplastic phenomenon. We discuss this association and review the literature.
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PMID:Small cell carcinoma of the esophagus in a patient with longstanding primary achalasia. 131 72

In a follow-up study of 147 patients with achalasia of the esophagus treated by myotomy, 146 patients were traced (58 female and 88 male patients aged 4 to 83 years [median, 46 years]). The living persons were contacted in writing or by telephone. The mean follow-up time after the operation was 23.2 years (range, 6 to 41 years). The cause of death was established for 71 patients. There were three postoperative deaths and two deaths following recurrence. In comparison with the Danish population, the 66 remaining patients were found to have a relatively higher cancer mortality (33.8 percent). Contrary to the expected less than one, ten of 23 patients who died of cancer had a malignant tumor in the esophagus. The mortality rate after 30 years was 66.1 percent, 11.9 percent of the deaths caused by esophageal cancer. It is concluded that there is a connection between achalasia and cancer of the esophagus that ought to be considered in the treatment and follow-up of patients with achalasia.
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PMID:Does achalasia predispose to cancer of the esophagus? 139 35

From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.
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PMID:Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. 154 Jan 2

A review of the literature is done about the epidemiology and aetiology of esophageal cancer. Esophageal cancer is a relatively uncommon neoplasm in Western countries with a very poor prognosis. In industrialized countries alcohol and tobacco are the major risk factors. Nutritional factors play also an important role in the aetiology of esophageal cancer, particularly a diet rich in cereal but poor in fresh fruit and vegetables, accounts for some of the geographic differences. Several predisposing disorders for esophageal cancer are known and include Barrett's esophagus, achalasia, chronic strictures due to corrosive substances, tylosis, coeliac disease, and the Plummer-Vinson syndrome. The clinical manifestations are also discussed.
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PMID:Epidemiology and clinical aspects of esophageal cancer. 166 45

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

Smooth muscle specimens were taken from the lower esophageal sphincter of patients suffering from achalasia or hiatus hernia with gastro-esophageal reflux. The specimens were analysed for neurohormonal peptides using immunochemistry and immunocytochemistry. Control specimens were obtained from patients subjected to esophageal resection because of esophageal cancer. The concentration of vasoactive intestinal polypeptide (VIP) was higher and the VIP nerve supply greater in patients with hiatus hernia than in control patients. The VIP nerve supply and the content of this peptide was lower in patients with achalasia than in controls. The same tendency was observed for substance P and enkephalin although the changes in their concentrations were not statistically significant. Enkephalin fibers were few, both in specimens from control patients and from patients with hiatus hernia; they could not be detected in specimens from patients with achalasia. Never fibers containing somatostatin or gastrin/cholecystokinin could not be detected in any of the groups and somatostatin and gastrin/cholecystokinin could not be measured in extracts of the lower esophageal sphincter. We propose that changes in the concentration of neuropeptides may at least contribute to manifestations of achalasia and of decreased lower esophageal sphincter pressure and gastro-esophageal reflux.
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PMID:Regulatory peptides in the lower esophageal sphincter of man. 258 Dec 86

Thirty-one cases of esophageal achalasia were admitted to Chang Gung Memorial Hospital between 1981 and 1986. Eighteen male patients and 13 female patients, aged from 12 to 84 years old with an average of 39 years old, were included in this series. Their chief complaints were dysphagia (83.9%), postprandial vomiting (12.9%), and food regurgitation (3.2%). The symptoms are present for an average of 2.8 years (mostly between 0.5 and 2 years) before the diagnosis is made. The clinical signs and symptoms included dysphagia, postprandial vomiting, loss of body weight, food regurgitation, abdominal fullness, cough, chest pain, belching, and choking. The tentative diagnoses at admission were achalasia, esophageal stricture R/O achalasia, achalasia R/O esophageal cancer, and esophageal cancer. Laboratory examinations showed 90.3% with absence of the gastric air shadow in chest P-A view X-ray film. Typical birds-beat deformity in barium-meal esophagogram was seen in 100%, and during esophagoscopic examination, 25% (6/24) were without abnormal findings, 66.7% (16/24) had liquid and food stasis, 8.3% (2/24) had esophagitis. Manometry of esophagus was performed in 5 cases, all had positive abnormal patterns detected, such as aperistalsis of esophageal body and incomplete relaxation of lower esophageal sphincter, but only 60% showed hypertensive lower esophageal sphincter. In these 31 cases, 3 cases refused any treatment, 9 cases received medical therapy including drug therapy(9) and pneumatic esophageal dilatation(8), and 19 cases received surgical operations. Better swallowing improvement was obtained in the surgically treated group than in the medically treated patients during follow up period.
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PMID:[A clinical analysis of esophageal achalasia]. 277 66

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.
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PMID:Early esophageal cancer. 348 67


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