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

Intraoperative manometry can provide an objective means of determining the correct length of myotomy in patients with esophageal motility disorders. Of the patients in this series who underwent primary repair, 94 percent were relieved of pain and dysphagia. One patient required repeat myotomy for vigorous achalasia. After a mean follow-up period of 33 months, gastroesophageal reflux had not developed in any patient, indicating that myotomy with intraoperative manometry eliminates the need for an antireflux procedure. Such a procedure in these patients with poor esophageal motility can lead to dysphagia and obstruction, which is a very difficult problem to correct. We recommend intraoperative manometric be used routinely with myotomy for esophageal motility disorders.
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PMID:Intraoperative manometry: adjunct to surgery for esophageal motility disorders. 669 43

This study attempted to define the esophageal motor disturbances and pathogenesis of symptoms in patients with lower esophageal diverticulum. Sixty-five patients were investigated by manometry in addition to roentgenography and endoscopy. Fifty had manometric evidence of abnormal motility, most often diffuse spasm or achalasia. Of the 15 patients with normal esophageal motility, 13 had hiatal hernia, and five of these had a high grade distal esophageal stricture. Pressures in the lower esophagus and lower esophageal sphincter in patients with lower esophageal diverticulum and motor disturbance were the same as for those in matched patients with motor disturbances but no diverticulum. Dysphagia, chest pain and regurgitation were common presenting symptoms. Of 46 patients with dysphagia, only ten had mechanical obstruction to explain this symptom. Of 32 patients with chest pain, only two had ulceration in the diverticulum as a possible cause of pain. We conclude that the development of lower esophageal diverticulum and its symptoms are associated with a motor disturbance of the esophagus in the majority of patients and with an organic obstruction in the minority of patients. The diverticulum itself is usually not the sole cause of the esophageal symptoms, although diverticula can produce symptoms in the absence of other definable conditions. When surgical treatment is indicated, the diverticulum should be excised and the underlying motor or mechanical obstruction should be corrected to prevent serious postoperative complications and recurrence of the diverticulum and its symptoms.
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PMID:Physiopathology of lower esophageal diverticulum and its implications for treatment. 677 41

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.
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PMID:Achalasia: diagnosis, management, and clinical course in 16 children. 683 65

A patient who, eight years prior, had a Heller operation for achalasia developed hypertrophic osteoarthropathy possibly secondary to a leiomyoma of the esophagus with sarcomatous changes. No local invasion or metastases were found. Total esophagectomy completely cured the esophageal symptoms and relieved the swelling and pain of her knees and other joints. This case illustrates the hypertrophic osteoarthropathy syndrome, its marked diagnostic significance and its occurrence secondary to an esophageal leiomyoma and leiomyosarcoma.
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PMID:Hypertrophic osteoarthropathy with myogenic tumors of the esophagus. 742 77

The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy performed through a left thoracotomy gives better results than pneumatic dilatation, the fear of an operation with the associated postoperative pain and disability has kept patients away from this form of treatment. Minimally invasive surgery allows the same results obtained with open surgery, with a short hospital stay, minimal postoperative discomfort, and a fast recovery time. A thoracoscopic or laparoscopic Heller's myotomy should be considered today the primary form of treatment for esophageal achalasia.
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PMID:Thoracoscopic and laparoscopic Heller's myotomy in the treatment of esophageal achalasia. 757 74

Recent developments in video camera techniques, new instruments and advanced surgical techniques have increased the importance of thoracoscopy in both the diagnosis and therapy of diseases of the chest. Many diseases previously demanding open thoracotomy (i.e. spontaneous pneumothorax, biopsies of lung, pleura and mediastinum, several benign intrathoracic tumours, achalasia and reflux disease of the esophagus) can, today, be treated by video-assisted thoracic surgery with the same results as by using open procedures. The advantages of this technique compared to open thoracotomy include less operative trauma, less postoperative pain, good cosmetic results and shorter hospital stay. The drawbacks are the more difficult technique, demanding special education, the possibility of inadequate radicality in the treatment of malignant diseases and the necessity of longer operating time. The physician performing thoracoscopic surgery must also master the techniques of open procedures.
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PMID:The role of videothoracoscopy in the diagnosis and treatment of chest diseases. 769 64

A 13-year-old boy, with the diagnosis of congenital adrenocortical unresponsiveness to ACTH (ACTH insensitivity) at age 7, developed a steppage gait, when under glucocorticoid replacement therapy at age 13. The parents were healthy and not consanguinous. On general physical examination, a mild diffuse skin hyperpigmentation was noted. Neurological examinations revealed that all the muscle stretch reflexes of both limbs were absent without pathologic reflexes. Pes cavus was found bilaterally. A slight decrease of tactile sensation was noted distal to the ankle joints. Pain sensation was slightly decreased in the toes. On laboratory examination, the conduction velocities of the left ulnar and median motor nerves were 51 and 45 m/sec, respectively, which are normal. No M-wave responses were obtained by electrical stimulation of the tibial and peroneal nerves. The coefficient of the variation of the R-R interval from ECG recordings was normal. Orthostatic hypotension was not observed. Achalasia was negative on the barium swallow esophagram. Therefore, it was concluded that he had motor and sensory polyneuropathy, and a right sural nerve biopsy was performed. A 12-year-old girl, a sister of the boy described above, with the diagnosis of ACTH insensitivity at age 5, noted a pain on the medial aspect of the left sole after skating. On general physical examination, a mild diffuse skin hyperpigmentation was discovered. On neurological examination, a spontaneous pain with dysesthesia was noted on the plantar aspect of the 1st, 2nd and 3rd left toes and on the anterior and medial aspect of the sole. Otherwise she was normal. A diagnosis of the left tarsal tunnel syndrome was made.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two siblings with congenital adrenocortical unresponsiveness to ACTH showing peripheral neuropathy--morphometric evaluation of the sural nerve]. 792 65

Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum toxin was injected into the sphincter of Oddi, by a sclerotherapy needle passed through a duodenoscope. In the first patient, intrasphincteric injection of botulinum toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric botulinum toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.
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PMID:Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction. 795 45

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


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