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

The purpose of this investigation was to verify the suitability of intra-operative manometry in the course of functional surgery of the esophagus, especially with reference to the results obtained in terms of sphincter functionality, related to the overall changes in symptoms and pH-metry. The practice disclosed herein refers solely to the Heller-Dor operation for esophageal achalasia and to the Nissen Rossetti operation for gastro-esophageal reflux. The promising results obtained using this method to achieve a complete myotomy during Heller's operation, in our opinion testify in favor of its usefulness with this type of surgical procedure. On the contrary, for preparing a fundoplication we feel that method is of orientative value only, since there is no correspondence between the values obtained at the end of the fundoplication and those recorded 18 to 24 months after surgery. The predictive nature of the examination is thus denied.
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PMID:[Intraoperative manometry during functional surgery of the esophagus]. 206 86

The article shows the results of diagnosis and treatment of achalasia of the esophagus in 21 children aged from 20 months to 15 years. Radiological examination with the use of the nitroglycerin test was highly informative and authentic in all cases. To evaluate the condition of the esophagus, additional endoscopic and esophagomanometric examination is necessary. From analysis of the results of drug therapy in all patients, operative in 13, and pneumocardiodilatation in 7 children it was found that treatment of achalasia of the esophagus in children should begin with forced pneumodilatation. Modified Heller's operation with fundoplication produces good results.
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PMID:[Diagnosis and treatment of esophageal achalasia in children]. 211 28

Esophageal disease has been reported in 70% to 90% of patients with scleroderma, of whom nearly 50% will have reflux esophagitis. The combined motility disorder of low LES pressure and aperistalsis of the esophageal body makes scleroderma patients especially susceptible to severe gastroesophageal reflux disease (GERD). Symptomatic GERD is a common problem in pregnancy, affecting 30% to 50% of women. Hormonal effects of estrogen and progesterone likely promote GERD by compromising LES function. Fortunately, the problem is usually relieved with delivery of the baby. Although difficult to quantitate, the reflux of both acid and especially alkaline material may be a common sequela of many types of gastric surgery. Medical therapy binding bile salts usually does not bring relief. The Rouxen-Y biliary diversion operation is the best solution for this problem. GERD complicates the treatment of achalasia after 10% of Heller myotomies and 2% of pneumatic dilatations. Nearly 50% of patients with the Zollinger-Ellison syndrome have esophagitis, which may be more difficult to treat than their ulcer disease.
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PMID:Medical and surgical conditions predisposing to gastroesophageal reflux disease. 222 65

Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastro-esophageal reflux disease.
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PMID:Esophageal adenocarcinoma in a patient with surgically treated achalasia. 225 39

Forty-eight patients with achalasia of the cardia were treated by Heller's myotomy with a posterior fundoplication of approximately 270 degrees, suturing the gastric fundus to the edges of the myotomy. The mean(s.d.) postoperative follow-up period was 5.4(2.8) years. The clinical results were good to excellent in 44 cases (92 per cent) and fair in four cases (8 per cent) (two with residual dysphagia and two with gastrooesophageal reflux). Barium studies showed a decrease in oesophageal diameter and disappearance of distal narrowing but normal oesophageal emptying did not occur. Postoperative manometric studies (29 patients) revealed a significant decrease in lower oesophageal sphincter pressure and a significant increase in the length of the infradiaphragmatic segment. In the oesophageal body a recovery of peristaltic waves in the proximal third was seen in ten of the patients (34 per cent). Twenty-four-hour pH monitoring showed pathological reflux in only three of 25 patients studied, and one of these was asymptomatic. This technique is effective, improving oesophageal symptoms and controlling long-term reflux.
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PMID:Achalasia of the cardia: long-term results of oesophagomyotomy and posterior partial fundoplication. 227 22

From 1972 to 1985, 101 consecutive patients underwent Heller's myotomy and Belsey repair (H + B) (n = 43) or Nissen fundoplication (H + N) (n = 58) for achalasia of the esophagus. There was no operative mortality after either operation; minor pulmonary complications occurred after H + B procedure in 9.3 per cent of the patients. Good to excellent long term results were achieved in 87 per cent of the patients after H + B repair and 83 per cent of the patients undergoing H + N. The failure rates were 2.5 and 11.3 per cent, respectively. The analyses of postoperative esophageal symptoms showed that the incidence of heartburn was greater after H + B repair and the incidence of obstructive symptoms was greater after H + N. The inability to vomit or belch, or both, was 10.2 per cent in the H + B group and 13.1 per cent in the H + N group. Finally, 56.4 per cent of patients after H + B repair and 41.0 per cent of those after myotomy and H + N were considered to be cured after the operative procedure was performed. Patients were improved in 41.0 and 47.3 per cent, respectively.
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PMID:Heller-Belsey and Heller-Nissen operations for achalasia of the esophagus. 230 47

The long-term results after Heller's myotomy for oesophageal achalasia were illustrated by questionnaire sent to 38 out of the original 47 patients submitted to operation during the ten-year period 1.7.1973-30.6.1983. Nine patients had died from other causes during the follow-op period. The minimum period of observation for the remaining patients was five years and the mean period of observation was 10.3 years. Thirty-six questionnaires were returned (95%). 75% of the patients were satisfied with the results of operation but only 25% were symptom-free. The commonest symptom was dysphagia (56%) followed by reflux problems (50%). Every third patient had discomfort from the scar. All of the 25% of the patients who were not satisfied with the result of operation had dysphagia. On the basis of these observations, the authors consider that Heller's myotomy should be reserved for patients on whom dilatation treatment has proved unsatisfactory.
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PMID:[Treatment of esophageal achalasia using Heller's method]. 230 50

This review describes our use of the Dor operation in the management of 22 patients with achalasia of the cardia over the period 1970 to 1989. There was a male to female ratio of 1.8:1. All presented with dysphagia of varying degree, with regurgitation (86%), weight loss (73%), pain (59%) and chest infections (14%) being associated symptoms. Two patients had undergone previous balloon dilatation, with temporary benefit. The morbidity was low and follow-up results were good in 94% of cases. None of the patients had symptoms of gastro-oesophageal reflux in the postoperative period. In our experience, the Dor modification of the Heller operation has yielded gratifying results.
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PMID:Surgery for achalasia cardiae: the Dor operation. 233 94

Thirty-three patients who have suffered with dysphagia to solids and liquids for a varying number of years are reviewed. They all had a history and radiologic findings suggestive of achalasia of the esophagus. Thirty-one of the cases who had uncomplicated achalasia benefited from a transthoracic modified Heller's procedure. Lower esophageal diaphragm and carcinoma arising in the proximal half of the distal third of the esophagus occurred in association with achalasia in two patients. Over 90 percent had symptomatic relief of their symptoms. The only mortality was recorded in a patient who had palliative esophagogastrectomy for associated carcinoma. A properly performed anterior extramucosal esophagomyotomy is the safest and most effective procedure available, even in places with minimal facilities.
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PMID:Achalasia of the esophagus: reflections upon a clinical study of 33 cases. 243 61

Over an 11-year period, 15 patients underwent surgery for achalasia (Heller's operation with added antireflux procedure). Thereafter due to the use of manometry 25 other achalasic patients were diagnosed and 17 of them underwent the same surgical procedure. Manometry was done by means of a triple-lumen catheter as described by Arndorfer. Surgical results in the first group were good in 80% and moderate in 20% with no recurrence or organic complications due to acid reflux, while in the second group good results were 95%. In 16 cases of the second group, diagnosis was based on manometric recordings, since the radiological findings were lacking. Early diagnosis enabled to operate on selected patients according to the motor findings of the esophageal body. Follow-up by manometry revealed in some cases an increase in post-deglutitory motor activity and in two cases a return of a coordinated peristalsis. Clinical and functional results are discussed and the role of manometric studies is stressed in order to improve the knowledge of the pathophysiology of functional diseases of the esophagus.
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PMID:Esophageal achalasia. Diagnostic and therapeutic implications. 262 86


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