Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe a patient who developed an esophageal adenocarcinoma 25 years after esophagomyotomy for achalasia. The tumor arose in a Barrett's esophagus, suggesting gastroesophageal acid reflux following the Heller procedure.
 ...
PMID:Esophageal adenocarcinoma following Heller myotomy for achalasia. 356 52

The therapeutic approach to children with achalasia of the esophagus is controversial. Both pneumatic dilatation (PD) and Heller esophageal myotomy (EM) are considered effective, while bougienage has been discarded by most authorities. To determine the best place for each in the therapy of achalasia, 19 cases treated since 1964 were reviewed. Ages ranged from 9 months to 17 years (median 11 years), and duration of symptoms ranged from 4 months to 8 years (median 1 year). Three patients had symptoms from infancy. Two patients underwent a successful EM as their sole procedure. Two underwent bougienage as their initial therapy. Dysphagia recurred quickly and both required operation. Fifteen underwent PD under intravenous sedation with a Brown-McHardy dilator placed under fluoroscopy. Seven underwent a single dilatation; seven underwent two; and one underwent four. Relief of dysphagia was achieved in 11 patients, but four required surgery. The patients who experienced adequate relief with dilatation alone were clinically identical to those in whom it failed with respect to age, race, sex, symptom duration, and manometric data. Those who required EM following PD experienced only a brief period of relief following PD (median 1 month) compared with those who enjoyed lasting results (median 18 months). Three patients suffered prolonged chest pain or fever following PD, but without esophageal leakage and with full recovery. Two of eight operative patients developed late postoperative reflux. There were no deaths. Both PD and EM are safe and effective treatments for achalasia. Our results indicate that dilatation is the logical first therapeutic step, but rapid recurrence of symptoms may identify those patients who will require operative myotomy.
 ...
PMID:Pneumatic dilatation and operative treatment of achalasia in children. 361 56

Forty-one (98%) of 42 patients with achalasia of the esophagus had pneumatic dilatation performed successfully using the Brown-McHardy dilator. One to four dilatations (mean, 1.9) were done on each patient with inflation pressures of 8-15 psi (mean, 11.1 psi). Immediately after the procedure, all patients were examined radiographically by injection of contrast material into the lower esophagus through a nasoesophageal tube. Two immediate and two delayed perforations occurred. Six intramural hematomas were noted, five of which resolved spontaneously. The luminal diameter at the esophagogastric junction increased from a mean of 4.2 mm before dilatation to 7.5 mm following treatment. Four patients with previous Heller myotomy were dilated without complications. Perforation was more common in patients with a minimal change in the esophagogastric diameter. Thirty-five patients (85%) improved symptomatically within several days following pneumatic dilatation. Excluding patients with perforation, the postdilatation appearance of the lower esophagus poorly correlated with clinical response.
 ...
PMID:Radiographic evaluation of esophagus immediately after pneumatic dilatation for achalasia. 362 90

A 23-year-old male was diagnosed as having idiopathic achalasia on the basis of clinical, radiologic, endoscopic, and manometric evaluation. He underwent a Heller's myotomy with 180 degrees posterior fundoplication as an antireflux procedure, and he did well subsequently. On reexamination one month later, return of peristaltic activity throughout the body of the esophagus was shown on manometric studies. Two years after the operation, peptic esophagitis was diagnosed by esophagoscopy, and the acid reflux test confirmed the existence of gastroesophageal reflux. To our knowledge, this represents the first reported case of return of esophageal peristalsis in idiopathic achalasia after surgical myotomy.
 ...
PMID:Return of esophageal peristalsis after Heller's myotomy for idiopathic achalasia. 369 71

Of 49 patients with achalasia treated surgically between 1975 and 1985, 12 (8 women, 4 men) had undergone transthoracic esophagomyotomy previously. Four had had concomitant upper gastrointestinal surgery. All 12 patients complained of dysphagia; other symptoms included regurgitation, nocturnal aspiration, heartburn, chest pain, vomiting, upper gastrointestinal bleeding and weight loss. The average time from initial operation to onset of symptoms was 9 months. Preoperative investigations and operative findings identified the cause of dysphagia as inadequate or healed esophagomyotomy with persistent or recurrent achalasia (eight patients--two had partially disrupted fundoplications contributing to their dysphagia), hiatus hernia with reflux esophagitis causing esophageal spasm or peptic esophageal stricture (two patients) and incorrect initial diagnosis and treatment (two patients). Treatment, with the aid of intraoperative manometry, included repeat Heller myotomy (five patients), Hill antireflux repair (four patients), takedown of Nissen fundoplication and extension of myotomy (two patients). The average follow-up was 16 months. Eight patients had good results, two required further operation and one underwent multiple dilatations postoperatively. The causes of recurrent dysphagia following surgery for achalasia are diverse and patients require individualized investigation and treatment. Remedial surgery for achalasia can correct postoperative dysphagia but results are less successful than those following an adequate initial operation.
 ...
PMID:Reoperation after failed esophagomyotomy for achalasia. 370 56

A case of hypertrophic osteoarthropathy associated with achalasia is reported. The signs and symptoms of hypertrophic osteoarthropathy abated after treatment of the patient's achalasia with Heller's myotomy. A review of the literature regarding the cause of hypertrophic osteoarthropathy is discussed briefly.
 ...
PMID:Hypertrophic osteoarthropathy associated with achalasia. 374 92

We describe a 65-yr-old man with achalasia, who had two previous Heller myotomies. He had a markedly dilated, tortuous esophagus, which defeated initial attempts at pneumatic dilatation. A method was improvised in which a Brown-McHardy dilator was attached by a string to a small caliber endoscope and both were successfully passed into the stomach. Pneumatic dilatation was then easily performed. Review of the literature and our experience with four patients suggests that pneumatic dilatation can be performed without substantial risk in patients after a failed Heller myotomy.
 ...
PMID:Pneumatic dilatation of the achalasic esophagus requiring the aid of an endoscope. 379 84

During a 20 year period we observed that in six patients with carcinoma of the esophagus associated with achalasia, four patients had had a prior Heller operation. Fifty patients with achalasia of the esophagus took part in endoscopic and histologic surveillance 5-15 years after cardiomyotomy. We have found a correlation between the severity of histologic changes and the duration of symptoms before the operation. It seems reasonable to advise early therapy to avoid the development of a dilated, poorly emptying esophagus. Our results suggest that long-term regular surveillance of the patient with achalasia is essential even after surgical treatment.
 ...
PMID:[Development of esophageal cancers in patients following cardiomyotomy]. 380 99

The clinical case of a 14-month-old girl with esophageal achalasia is described. Manometry revealed aperistalsis throughout the esophageal body and impaired relaxation of the lower esophageal sphincter. Six months after Heller's myotomy, manometric examination of the esophagus showed the return of peristalsis.
 ...
PMID:Return of peristalsis in a child with esophageal achalasia treated by Heller's myotomy. 394 39

Fifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in five and the abdominal route in ten. In three patients the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow-up period was 6.2 years. Nine patients had excellent results, three had good results, two had fair results and one had a poor result. Of the nine children who did not have an antireflux procedure, three developed symptomatic and radiologically proven gastro-oesophageal reflux. The results of myotomy in children with achalasia are satisfactory but a significant number may develop gastro-oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in children.
 ...
PMID:Achalasia of the cardia in children. 399 38


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>