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

The authors performed Heller's myotomy using an endothoracoscopic technique on two patients with swallowing difficulties that were clinically demonstrated to be oesophageal achalasia. At 12 and 18 months' followup, respectively, both patients were asymptomatic. Extramucosal cardiomyotomy, as reported by Heller in 1913, is the most common approach to repair achalasia of the oesophagus. The advantages of the laparoscopic technique (less pain, small scars, reduced hospital stay) are given, as well as the disadvantages (possible mobilization of left lateral liver segment, possible splenic damage, difficulty retracting abdominal contents). More studies are needed to determine the rate of pulmonary complications caused by the extended degree of pulmonary collapse in the thoracoscopic approach and to compare the laparoscopic and thoracoscopic approaches to Heller's myotomy.
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PMID:Thoracoscopic Heller's cardiomyotomy: a new approach for achalasia. 816 69

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

Several treatment options are available in the management of achalasia of the cardia. Of a recent series of 14 children, 12 were treated by a modified Heller's myotomy combined with a floppy Nissen fundoplication. Symptoms were dramatically improved in nine during a mean follow up period of 3.9 years. Recurrent oesophageal pain was the most resistant symptom and continued to be moderately severe in three patients, two of whom obtained temporary relief by oesophageal balloon dilatation. Two patients treated by pneumatic dilatation alone have residual symptoms. These results support a primary surgical approach to the management of achalasia in children.
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PMID:Current results of surgery for achalasia of the cardia. 833 64

We treated 24 patients with achalasia using thoracoscopic (22 patients) or laparoscopic (2 patients) esophagomyotomy. The only operative complications were mucosal lacerations, which occurred in 3 patients and required conversion to an open procedure in 2. Twenty-two (91%) patients were eating by the second postoperative day. Analgesics were only required for the management of pain from the chest tube, which remained in place for a median time of 24 hours. The median postoperative hospital stay was 3 days (range, 20 to 14 days). The myotomy proved to be incomplete in the first 3 patients, who required a second myotomy; this was done laparoscopically in 2. One patient had a paraesophageal hernia repaired 6 months after the myotomy, and 1 patient required an esophagectomy 1 year after the myotomy for a large nonfunctioning esophagus. Late follow-up showed that swallowing was excellent in 17 (71%) and fair to good in 4 (17%). Sixteen (66%) of these 24 patients have regained their original weight. Thus, excellent to good results were ultimately obtained in nearly 90% of the patients. These results suggest that esophageal myotomy performed using minimally invasive techniques appears to be the treatment of choice for achalasia.
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PMID:Thoracoscopic esophageal myotomy in the treatment of achalasia. 837 70

Although concern about perforation has led physicians to perform pneumatic dilation for achalasia with routine contrast radiography immediately afterwards and with hospitalization, the need for these precautions has not been demonstrated. In contrast, we have routinely performed pneumatic dilations without contrast studies or hospitalization, and we hereby present our experience. During a recent six-year period, 110 pneumatic dilations were performed, and 71 of the last 73 were performed as outpatients with about 5-8 hr of clinical monitoring. Detailed review of 100 records showed that only 15 patients underwent contrast studies because of pain or fever. Perforation occurred in seven of the 15 patients, all of whom underwent surgery successfully. Short-term follow-up in patients who did not sustain perforation showed good or excellent results in 82%. Thus, it has been our experience that pneumatic dilation could be safely performed in achalasia without routine use of contrast studies or hospitalization.
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PMID:Achalasia. Short-term clinical monitoring after pneumatic dilation. 840 12

The aim of this paper is to describe a patient with severe postpolio problems who developed achalasia. A 66-year-old patient came to our observation for severe dysphagia. He had suffered from paralytic poliomyelitis at the age of 7 months and had severe residual deficits. At the age of 62 he presented with sudden pain localized in the distribution of the C4 and C5 dermatomes and an inability to abduct the left arm. At the time, he experienced only occasional and mild dysphagia; his esophagus was not dilated and emptied normally. Over the following months his muscular function improved, but dysphagia worsened. We found a megaesophagus with a sigmoid appearance and the manometric features of achalasia. Pneumatic dilatation produced good resolution of dysphagia. A year later manometry showed the reappearance of peristalsis after all wet swallows. In patients with postpolio dysphagia, the possible presence of achalasia must be considered.
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PMID:Achalasia. A possible late cause of postpolio dysphagia. 861 25

A laparoscopic Heller cardiomyotomy technique was used on five patients whose esophageal achalasia was diagnosed clinically, radiologically manometrically. The physiological principles and operational steps are the same as in open surgery. with the patient in an anti-Trendelenburg 30 degrees position and the surgeon between the patient's legs, a CO2 pneumoperitoneum was produced. Five trocars were used. the esophagus was freed by blunt dissection and an 8 cm longitudinal myotomy was made on the anterior surface of the thoracic esophagus starting a few centimetres above the cardias and parallel and to the left of the anterior vagus, the magnified operative field facilitated more precise myotomy. The myotomy incision ended 2 cm from the esophageal-gastric junction. We closed the angle of His before performing a Dor anterior fundoplication with anchorages to the diaphragmatic crura. Mean operation time was 2 hrs 45 min. Intraoperative blood loss was less than 100 ml. In comparison with open-surgery, patients had less postoperative pain, needed only non-narcotic analgesics for the first 12 hrs, and had no unsightly operation scar. patients tolerated liquids between 24 and 48 hrs. Hospitalization time was 3 to 5 days. Long-term follow-up transit studies, manometry, and 24 hrs pH measurements are needed to fully evaluate the technique. At two months, the symptoms of dysphagia had completely disappeared in three patients: the results were qualified as excellent. As some dysphagia for solids remained in the other two, they were qualified as good.
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PMID:Esophageal achalasia: laparoscopic Heller cardiomyotomy. 874 Jun 89

The relationship between the diameter of the esophageal body and the clinical profile of the disease and response to treatment was analyzed in 151 patients with idiopathic achalasia by pneumatic dilation of the cardias. Of the 151 patients, 46 presented an esophageal diameter < or = 3 cm (group I), 78 a diameter > 3 cm up to a maximum of 5 cm (group II) and 27 presented a diameter > 5 cm (group III). The result of pneumatic dilatation of the cardias under endoscopic control was analyzed in 117 patients with a minimum follow up of one year after the last dilatation session. Of all the clinical parameters studied, significant statistical differences were only found in group III in respect to the time of symptom evolution and the presence of regurgitation. Manometric data in basal pressure of the esophageal body and in contraction wave width were lower in groups I and III, respectively. The remaining variables were similar in the three groups although group III showed a trend to older age and the frequency of pulmonary complications with lesser thoracic pain and registry of a strict pattern. Endoscopic pneumatic dilation carried out in all the cases was effective in 83% of the patients and was similar in the three study groups. The rate of complications (perforation) was also similar. The therapeutic efficacy of pneumatic dilatation was accompanied by a significant reduction in esophageal diameter. It was concluded that the increase in esophageal diameter in idiopathic achalasia is associated with chronological, clinical and functional parameters which suggest greater disease evolution but do not determine significant changes in the therapeutic response to endoscopic pneumatic dilatation.
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PMID:[The clinical significance of the magnitude of esophageal dilatation in idiopathic achalasia]. 875 63

New and future indications for the treatment of disorders of the alimentary tract using local injections of botulinum toxin are reviewed. Clinical experience shows that overactive smooth muscle sphincters may be weakened to treat disorders such as achalasia or chronic anal fissure. By contrast, injections placed into the sphincter of Oddi have proven less effective for postcholecystectomy pain syndrome. Experimental evidence suggests that food intake may be reduced by weakening the distal stomach with botulinum toxin. This approach may possibly lead to the treatment of obesity. There are some new possible indications for the use of botulinum toxin on the alimentary tract, and infantile hypertrophic pyloric stenosis seems to be the most promising new development.
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PMID:Review article: the use of botulinum toxin in the alimentary tract. 882 46

Achalasia is characterized by absent or incomplete lower esophageal sphincter (LES) relaxation and aperistalsis in the smooth muscle esophageal body in response to swallowing. The esophageal and LES response to distention has not previously been studied. I aimed to characterize the responses to esophageal balloon distention in achalasia patients in comparison to controls. Sixteen consecutive achalasia patients and 11 healthy volunteers underwent standard esophageal manometry followed by graded midesophageal balloon distention during which LES (as measured by the Dent sleeve) and esophageal body pressures were monitored. Subject perception of distention was also recorded using a standardized scoring system. The LES relaxation response to esophageal balloon distention was markedly impaired in achalasia patients, irrespective of whether the patient had radiological evidence of a dilated or nondilated esophagus. However, phasic contractions proximal to the distending balloon were preserved. The esophageal body responses below the balloon were inconsistent in both groups, and not significantly different from one another. Pain-sensation scores were significantly lower in achalasia patients at the highest distending volumes, but this difference was attributable to the subgroup of patients with a dilated esophagus. Distention-induced LES relaxation is markedly impaired in achalasia patients in keeping with loss of intrinsic inhibitory innervation. Preservation of the proximal excitation suggests that extrinsic vagal reflexes are intact.
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PMID:Esophageal and lower esophageal sphincter response to balloon distention in patients with achalasia. 900 24


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