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

Achalasia of the esophagus is an unusual lesion in childhood and is quite rare under the age of one year. The case of a 3-month-old child with esophageal achalasia treated with a Heller esophagomyotomy is illustrated. Seven previously documented cases of achalasia in children under the age of one year are reviewed and the difficulties of diagnosing this lesion in childhood are discussed.
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PMID:Infantile achalasia. Brief clinical report. 97 22

A survey of 108 patients with achalasia treated by cardiomyotomy is reported. All the operations were done by the abdominal approach and all the patients were followed up for a minimum of 4 years. Fifty-five patients had some form of hiatal reconstruction, 11 of these having a formal plastic repair as practised for oesophageal reflux problems. At 4 years after operation 71 patients (65-5 per cent) had entirely satisfactory results. Twenty-seven patients had recurrent dysphagia and 20 patients had symptoms of reflux oesophagitis. The group who had had a formal repair of the hiatus had no reflux symptoms after operation and also had better swallowing than the other groups. These results suggest that much of the dysphagia following Heller's operation is due to occult gastro-oesophageal reflux and can be avoided by a reflux-preventing procedure. Adequate hiatal repair after myotomy is strongly recommended.
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PMID:Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair. 100 44

In posterior fundoplasty, a derivative of Nissen fundoplication, the fundus is passed behind the abdominal esophagus and fixed to the anterior aspect of the stomach, thus modifying the angle of entrance of the esophagus, creating a posterior gastric reservoir relatively inaccessible to the cardia. In dogs, it was a successful as a Nissen fundoplication in reversing esophagitis caused by reflux and daily administration of histamine. In another group of dogs, a cylindrical resection of the last 4 or 6 cm of the esophagus and a posterior fundoplasty were performed simultaneously. In spite of the daily administration of 30 mg of histamine, none of the dogs developed esophagitis. Posterior fundoplasty has proved effective in 14 patients with hiatal hernia observed for three years. In five patients undergoing a Heller myotomy for achalasia, it was used successfully to prevent postoperative regurgitation.
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PMID:A new antireflux procedure at the esophagogastric junction: experimental and clinical evaluation. 109 Feb 81

Among 156 patients with achalasia who were treated during a 13 year period, two developed squamous cell carcinoma of the esophagus. The first, a 33-year-old man, developed a carcinoma of the upper third of the esophagus 2 years after the onset of symptoms of achalasia. He was treated by a Heller myotomy and radiation therapy and survived 16.7 months. The second, a 60-year-old man, had had symptoms of achalasia for 15 years. He is alive with suspected recurrence 6 months after undergoing esophagogastrectomy for a carcinoma of the middle and lower thirds. A summary of the literature regarding carcinoma complicating achalasia is presented. This indicates that carcinoma arises in at least 1 to 7 per cent of patients with achalasia. Delay in diagnosis is common. The treatment need not differ from that of carcinoma without a chalasia, but the prognosis is dismal. Since there is evidence that retention esophagitis is a premalignant condition, it should be possible to prevent the development of carcinoma in achalasia by early cardiomyotomy in cases in which hydrostatic dilatation is not completely effective. A plea is made for closer surveillance of patients with achalasia so that, if carcinoma supervenes, it may be detected at an early stage.
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PMID:The association of carcinoma of the esophagus with achalasia. 111 27

Results obtained with Heller's operation in the management of 27 cases of cardiospasm are presented. The probable causes of oesophageal achalasia leading to dilatation and elongation of the wall are examined. These, in association with nervous changes, form the most marked features of the syndrome. The soundness of the operation employed is confirmed by the results achieved. These are most satisfactory when the disease is at the initial stages and dilatation is not excessive.
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PMID:[Surgical treatment of cardiospasm]. 114 78

56 patients with achalasia of the esophagus were reviewed in a retrospective study to compare the results of a forceful pneumatic dilation with those of a Heller esophagomyotomy. 22 of 33 patients treated with forceful dilation (67%), showed relief of dysphagia and reduction in the average esophageal diameter by barium swallow during the follow-up period (mean = 6.5 years). In 2 patients (6%), forceful dilation was complicated by esophageal perforation, promptly diagnosed, and successfully treated at surgery in both patients. 21 out of 23 patients who underwent esophagomyotomy (91%) showed permanent relief of symptoms and improvement by endoscopic and radiographic criteria. There were no significant postoperative complications during the follow-up period ranging between 1.5 and 10.0 years. The results of this study indicate that esophagomyotomy constitutes a more effective therapeutic modality than forceful dilation (P less than 0.05). Although esophageal dilation has a place in the treatment of early achalasia, esophagomyotomy appears to be a safer and a more successful form of treatment, of particular value in advanced esophageal disease and in those instances where pneumatic dilation fails to result in immediate clinical improvement.
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PMID:Achalasia of the esophagus. A reappraisal of esophagomyotomy vs forceful pneumatic dilation. 116 19

Experience of 48 cases of achalasia of the cardia, treated by oesophagomyotomy, and of three cases of failed 'Heller' operation, treated by jejunal interposition, is recorded. Some technical details and the results are discussed.
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PMID:Oesophagomyotomy for achalasia of the cardia. 119 93

The treatment of achalasia at the present time is far from being ideal. The results of pneumatic dilatation have not always been impressive and the risk of esophageal perforation is real. Modified Heller operation has succeded in relieving obstructive symptoms in the majority of patients with achalasia. However, the reported incidence of reflux esophagitis following Heller myotomy is four to 37 per cent. In 25 patients with achalasia followed up to 10 years after Heller myotomy, nine patients had symptomatic reflux and three patients developed esophageal strictures. We believe the addition of an anti-reflux operation should be considered in all patients undergoing operation for achalasia and especially those patients with preoperative symptoms of reflux.
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PMID:A combined surgical approach in the management of achalasia of the esophagus. 125 51

During the period included between January 1970 and December 1990, we studied 242 patients with manometric and radiological diagnosis of esophageal achalasia. Eight of these patients (3.3%) developed during the evolution of their disease an esophageal carcinoma. Eight cases showed histologic type of epidermoid carcinoma: 3 differentiated, 3 semi-differentiated and 2 anaplastic. Therapy for achalasia was: one patient, Heller myotomy, 4 patients, dilatations with bougies in numerous opportunities, and the other two patients receive no treatment for achalasia. Two patients reported tracheobronchial fistulas as complication of carcinoma. Treatment received for carcinoma included: three patients, radiotherapy (4000 rads); one patient, chemotherapy; one patient, chemotherapy and radiotherapy, one resection surgery and two patients feeding gastrostomy. All of the eight patients died within the year of diagnosis of epidermoid carcinoma.
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PMID:[Achalasia and esophageal cancer]. 130 Aug 47

Fifty-eight patients with achalasia were evaluated by esophageal manometry. In the body of the esophagus, the resting pressure was elevated and the motor waves were typically of low amplitude and presented simultaneously. The LES was of normal or high tone with absent or reduced relaxation in response to deglutition. The authors noticed that the contraction pressure in the pharynx and the resting and closing pressures in the UES were markedly elevated. These features were not documented in the literature. Twenty-two patients were followed up by manometry 4 to 60 months after a Heller's myotomy. The resting pressures in the body of the esophagus and the LES were obviously reduced. We considered that esophageal manometry is an important method in the diagnosis of achalasia.
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PMID:[Esophageal manometry in patients with achalasia]. 130 37


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