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

One hundred consecutive patients underwent esophageal motility testing at the Gastroenterology Section of the University Hospital for symptoms of esophageal dysfunction. These were dysphagia (55), non cardiac chest pain (11), gastroesophageal reflux (32), and other (2). Fifty five studies were abnormal. The most frequent findings were achalasia in fourteen patients and nonspecific esophageal motility disorder in fourteen. When the clinical presentation was correlated with the results of the study, 35 of the 55 patients with dysphagia had an abnormal study, as compared with 5 of 11 with chest pain and only 12 of 32 with reflux symptoms. These findings compare with those reported elsewhere and suggest that esophageal motility studies are most useful in the diagnosis of patients presenting with dysphagia or non cardiac chest pain.
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PMID:Esophageal motility patterns in a Puerto Rican population. 801 92

The main aim of the study was to determine prospectively, in patients referred for oesophageal manometry, whether certain combinations of oesophageal symptoms are more likely than others to predict the presence of oesophageal dysmotility or a positive response to acid perfusion testing. In 524 consecutive patients, presenting predominantly with (non-cardiac) chest pain (n = 277), dysphagia (n = 186), or heartburn (n = 61), a standardized symptom assessment was completed before oesophageal manometry and acid perfusion testing. Half the patients in each group reported additional ('secondary') oesophageal symptoms as well as the predominant symptom. Oesophageal dysmotility was categorized in accordance with standard manometric criteria for achalasia, diffuse oesophageal spasm, nutcracker oesophagus, hypertensive lower oesophageal sphincter, or non-specific oesophageal motility disorder. In the predominant chest pain group, the prevalence of abnormal manometry was 33%; in the presence of secondary symptoms, especially dysphagia rather than heartburn, however, the prevalence was significantly (p < 0.01) increased. Also in the predominant chest pain group the prevalence of positive acid perfusion testing (44%) was significantly greater (p < 0.05) in those with than in those without secondary symptoms. In the predominant dysphagia group, the prevalence of abnormal manometry was higher than in the other two groups (56%; p < 0.001) but was not affected by the presence or absence of secondary symptoms; this latter finding was also true for the predominant heartburn group. The distribution of specific manometric disorders in any group was not related to the presence or type of secondary symptoms, although a combination of dysphagia and chest pain discriminated achalasia from other manometric disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Predictive value of symptom profiles in patients with suspected oesophageal dysmotility. 803 53

The management of oesophageal motility disorders has been unsatisfactory due to the lack of effective pharmacological treatment. Endoscopic surgical myotomy offers an effective long-term therapy without the disadvantages of a thoracotomy. After characterization by oesophageal manometry 12 patients with achalasia and 23 patients with non-cardiac chest pain were considered suitable for myotomy. For achalasia, the laparoscopic approach was preferred to the thoracoscopic route. Fundoplication was not performed unless a hiatus hernia was present or as a buttress protection following suture of an iatrogenic perforation of the oesophageal mucosa. For patients with non-cardiac chest pain a thoracoscopic long myotomy was performed from the left side with the patient operated on in the postero-lateral position. Three perforations (all sutured endoscopically) were encountered: two during cardiomyotomy, one during long myotomy. Complete or substantial relief of chest pain was encountered in 18 patients, with five patients having no relief of their pain. Our experience indicates that long myotomy is successful but longer term follow-up is required to assess its therapeutic role.
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PMID:Endoscopic oesophageal myotomy for specific motility disorders and non-cardiac chest pain. 808 98

At present, an esophageal origin can be identified in as many as 50% of patients with non cardiac chest pain. In about 1/3 of these patients, gastroesophageal reflux can be documented. In the remaining 2/3 of patients, various disorders of esophageal motility have been described. Abnormal esophageal motility may be classified as nutcracker esophagus, diffuse esophageal spasm, achalasia, hypertensive lower esophageal sphincter, and nonspecific esophageal motility disorders. Simultaneous recording of intraesophageal pH, pressure, and symptoms (combined 24-h pH-metry and manometry) makes it possible to test the temporal association between pain, reflux, or abnormal motility. This review describes the diagnostic evaluation and therapeutic options in patients with non cardiac chest pain. Identification of the esophageal origin of chest pain should improve the therapeutic results.
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PMID:[Esophageal thoracic pain: what can be done?]. 815

Esophageal diseases frequently cause symptoms such as heartburn, epigastric pain and dysphagia. This article discusses the indications, techniques and limitations of currently available diagnostic procedures. Investigation of symptoms should proceed in a logical stepwise manner, beginning with endoscopy to exclude esophagitis or neoplasia. Symptoms due to acid reflux can be identified by 24h esophageal pH-metry to document a temporal association between symptoms and episodes of esophageal acidification. Stationary or ambulatory manometric recording of esophageal pressures can be used to diagnose esophageal motor disorders such as achalasia, nutcracker esophagus, diffuse esophageal spasm, or dysfunction of the upper or lower esophageal sphincter. Combined 24 h pH-manometry should be used to test the temporal association between pain, reflux, or abnormal motility in patients with non-cardiac chest pain. Video-fluoroscopy is the most appropriate technique to diagnose swallowing disorders. Pulmonary aspiration of gastro-esophageal reflux can be documented with scintigraphy.
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PMID:[Motility disorders and assessment methods of the esophagus]. 821 Oct 52

The aims of this study were to investigate a group of patients with achalasia prospectively to determine (1) the relationship between changes in symptoms and esophageal motor function in response to pneumatic dilation and (2) the effects of the balloon size as well as the frequency and duration of inflation on the outcome of treatment. Fourteen patients with achalasia who were symptomatic for a median duration of 27 months participated in the study. The patients were randomized to one combination of the following pneumatic dilation conditions: a 30- or 35-mm balloon dilator, one or two balloon inflations, and 20, 40, or 60 seconds per balloon inflation. A comprehensive assessment of their symptoms and esophageal motility, transit, and diameter were performed before and 3 months after pneumatic dilation. Pneumatic dilation provided significant relief of dysphagia (P < 0.01), but other symptoms (heartburn, regurgitation, and chest pain) remained unchanged. Pneumatic dilation also caused a significant decrease in lower esophageal sphincter pressure and esophageal diameter and improved esophageal emptying of a solid bolus. Nevertheless, no significant association was detected between changes in the symptom score for dysphagia and changes in objective response measures as a result of pneumatic dilation. Changes in the symptom score for dysphagia or objective responses were similar regardless of the size of the dilator used or the frequency and duration of the balloon inflations.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. 823 Dec 71

The technique of laparoscopic and thoracoscopic esophageal myotomy is described. The laparoscopic Heller procedure was performed in a patient with manometrically diagnosed achalasia and the thoracoscopic long esophageal myotomy in another with diffuse esophageal spasm. Both operations were performed in the same fashion as during open surgery, using standard laparoscopic surgical instruments. Antireflux procedures using the Dor and modified Belsey fundoplications protected patients from iatrogenic reflux. Complete relief of dysphagia in the first case and chest pain in the second has been confirmed after 2- and 4-month follow-up, respectively. Laparoscopic Heller myotomy and thoracoscopic long esophageal myotomy are technically feasible and reduce surgical trauma, hospitalization, and postoperative recovery. They offer a viable alternative for the definitive management of primary esophageal motor disorders comparable with that of open surgery.
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PMID:Laparoscopic Heller cardiomyotomy and thoracoscopic esophageal long myotomy for the treatment of primary esophageal motor disorders. 826 Dec 79

A diagnosis of diffuse esophageal spasm (DES) based on radiological and manometric studies was made in a 70-year-old man who presented with severe dysphagia, vomiting, and spontaneous chest pain. The manometric studies revealed a simultaneous onset of high amplitude contractions and a hypertensive lower esophageal sphincter (LES) that was well relaxed in response to deglutition, in contrast to the incomplete relaxation seen in achalasia. Because his dysphagia was so severe and did not respond to pneumatic dilatation, the patient was treated by a long esophageal myotomy with a full thickness incision through the LES and mucosa, adding a Thal-Hatafuku procedure. The patient made a good postoperative recovery and has since been eating normally without any further dysphagia or chest pain. Good manometric and radiological results have been obtained in this patient during 5 years of follow-up.
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PMID:Long esophageal myotomy with a fundic patch procedure for treating diffuse esophageal spasm: report of a case. 831 91

This oesophageal laboratory serves a population of 1.5 million. The study aimed to review referral patterns and assess the cost effectiveness of oesophageal manometry in clinical practice. All 276 consecutive manometry studies performed between 1988 and 1991 were reviewed. Reasons for referral in the 268 first referrals were: dysphagia 50.4%, non-cardiac chest pain 23.1%, gastro-oesophageal reflux disease 14.2%, connective tissue disease 11.2%, and 'other' 1.1%. Manometry was normal in 49.3%, showed achalasia in 17.9%, diffuse oesophageal spasm in 13.4%, connective tissue disease in 7.8%, hypertensive lower oesophageal sphincter in 4.5%, nutcracker oesophagus in 2.6%, and 'other' in 4.5%. A positive diagnosis was significantly more common if dysphagia was the reason for referral (65.9% v 35.3%, p < 0.01). A positive diagnosis was established in 60% of patients referred with connective tissue disease, 30.6% with non-cardiac chest pain, and 21.1% with gastro-oesophageal reflux disease. A positive diagnosis was significantly more common in connective tissue disease when symptoms were present (85% v 10%, p < 0.05). Management was changed in 48.9% of all patients because of manometry findings. The cost of each oesophageal manometry study was calculated to be 63.00 pounds: every change in patient management cost 129.00 pounds. In conclusion, oesophageal manometry changed management in over 20% of patients with non-cardiac chest pain or gastro-oesophageal reflux disease and in over 60% of those with dysphagia. It is, therefore, a useful and cost effective test in patients with these symptoms.
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PMID:Audit of the role of oesophageal manometry in clinical practice. 840 45

Achalasia is a primary esophageal motor disorder that is characterized by dysphagia, regurgitation, and chest pain. The diagnosis is suggested by narrowing with the classic "bird's beak" appearance of the distal esophagus. Esophageal manometry showing aperistalsis confirms the diagnosis. Pseudo-achalasia must be excluded with endoscopy. Pneumatic dilatation is the treatment of choice. Surgical myotomy is reserved for patients in whom repeated pneumatic dilatation fails.
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PMID:Coping with achalasia. 846 81


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