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)

Some patients with achalasia have been reported to develop airway obstruction from a massively air-distended esophagus, which may represent an abnormality in the upper esophageal sphincter belch reflex. When questioned carefully, 95% of our achalasia patients reported difficulty with belching. The upper esophageal belch reflex in 23 consecutive achalasia patients and 12 healthy controls was studied using an upper esophageal sphincter sleeve manometry catheter and rapid injection of 20-50 mL of air into the midesophagus. Compared with normal subjects, achalasia patients were significantly less likely to have an esophageal belch for all volumes tested and were more likely to have an increase rather than a decrease in upper esophageal sphincter pressure in response to air injection. This study systematically documents that many achalasia patients have an alteration in the upper esophageal sphincter belch reflex that may be a contributory mechanism for some of the chest and upper airway symptoms reported by some patients during acute esophageal distension.
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PMID:Alteration of the upper esophageal sphincter belch reflex in patients with achalasia. 142 88

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

The lower oesophageal sphincter (LOS) is a specialized segment of the circular muscle layer of the distal oesophagus, accounting for approximately 90% of the basal pressure at the oesophago-gastric junction. Together with the crural diaphragm, it functions as an antireflux barrier protecting the oesophagus from the caustic gastric content. During swallowing or belching, the LOS muscle must relax briefly in order to allow passage of food or intragastric air. These swallow-induced and prolonged transient lower oesophageal sphincter relaxations (TLOSRs) respectively result from activation of the inhibitory motor innervation of the sphincter. Both in man and animals, the main neurotransmitter released by the inhibitory neurones is nitric oxide. The two typical examples of dysfunction of the LOS are achalasia and gastro-oesophageal reflux disease (GORD). Achalasia is characterized by reduction or even absence of the inhibitory innervation to the LOS, leading to impaired LOS relaxation with dysphagia and stasis of food in the oesophagus. On the contrary, GORD results from failure of the antireflux barrier, with increased exposure of the oesophagus to gastric acid. This leads to symptoms such as heartburn and regurgitation, and in more severe cases to oesophagitis, Barrett's oesophagus and even carcinoma. To date, TLOSRs are recognized as the main underlying mechanism, and may represent an important target for treatment. More insight in the pathogenesis of both diseases will undoubtedly lead to new treatments in the near future.
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PMID:The lower oesophageal sphincter. 1583 51

Intraluminal impedance monitoring is a new technique that can be used to detect the flow of liquids and gas through hollow viscera. In combination with manometry, it is used for esophageal function testing and while manometry provides information on contractile activity, impedance provides information on esophageal bolus transit. This is especially useful in patients with nonobstructive dysphagia. However, impedance monitoring appears to be less suitable for the evaluation of patients with achalasia. When used in combination with esophageal pH monitoring, impedance monitoring makes gastroesophageal reflux monitoring more complete because it allows recognition of both acidic and weakly acidic reflux episodes. The results of several studies suggest that impedance-pH monitoring is useful in the evaluation of patients with PPI-resistant typical reflux symptoms, chronic unexplained cough, excessive belching, and rumination.
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PMID:Technology review: Esophageal impedance monitoring. 1710 Sep 61

Esophageal impedance monitoring and high-resolution manometry (HRM) are useful tools in the diagnostic work-up of patients with upper gastrointestinal complaints. Impedance monitoring increases the diagnostic yield for gastroesophageal reflux disease in adults and children and has become the gold standard in the diagnostic work-up of reflux symptoms. Its role in the work-up for belching disorders and rumination seems promising. HRM is superior to other diagnostic tools for the evaluation of achalasia and contributes to a more specific classification of esophageal disorders in patients with non-obstructive dysphagia. The role of HRM in patients with dysphagia after laparoscopic placement of an adjustable gastric band seems promising. Future studies will further determine the clinical implications of the new insights which have been acquired with these techniques. This review aims to describe the clinical applications of impedance monitoring and HRM.
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PMID:Clinical applications of esophageal impedance monitoring and high-resolution manometry. 2235 Sep 44

Modern functional laboratories provide various techniques for the evaluation of esophageal diseases. For proton pump inhibitor (PPI) refractory reflux symptoms the differentiation of non-erosive gastroesophageal reflux disease and functional heartburn is essential for the choice of further treatment. The differentiation of the two clinical entities is based on functional diagnostic methods, such as catheter-based and catheter-free pH measurement as well as combined pH measurement and intraluminal impedance. Combined pH measurement and impedance monitoring detects individual reflux episodes and permits the diagnosis of additional functional esophageal diseases, such as supragastric belching. The technical innovation of high resolution manometry has led to a better understanding of esophageal pathophysiology and motility disorders and resulted in a new classification system of esophageal motility disorders (Chicago classification). The diagnosis of achalasia by high resolution manometry differentiates three distinct subtypes which has a direct therapeutic impact on the clinical management.
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PMID:[Modern diagnostic tools for esophageal pathologies]. 2342 7

Esophageal high-resolution manometry (HRM) has advanced the understanding of esophageal motor function and the ability to diagnose and manage disorders of esophageal motility. In this review, we describe the indications for and the technical performance of HRM. The Chicago classification of esophageal motor function, now in its third iteration, streamlines and standardizes the nomenclature and basic interpretation of HRM data depicted as Clouse topographic plots. In clinical practice, HRM is an important diagnostic test for patients with dysphagia as well as patients with suspected gastroesophageal reflux disease (GERD), particularly in those patients with a suboptimal symptomatic response to antisecretory therapy. HRM can support diagnoses such as achalasia, as well as provide evidence for behavioral disorders such as rumination syndrome or supragastric belching with the assistance of postprandial HRM with impedance. Further, the GERD classification of motor function introduces a three-part hierarchical evaluation of esophageal motor function in GERD, highlighting the value of assessment of esophageal contractile reserve through provocative maneuvers during HRM such as multiple rapid swallows.
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PMID:Utility of Esophageal High-Resolution Manometry in Clinical Practice: First, Do HRM. 3027 71