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

A patient with complete respiratory obstruction due to massive oesophageal dilatation is described. Immediate relief of symptoms and disappearance of the oesophageal swelling occurred after administration of sublingual glyceryl trinitrate. Nitrates cause a reduction in the lower oesophageal sphincter pressure in patients with oesophageal achalasia and in this case it is presumed that spasm of the lower oesophageal sphincter had been a major factor preventing decompression of the dilated oesophagus.
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PMID:Oesophageal achalasia causing respiratory obstruction. 153 3

After a brief review of motility disorders of the oesophagus and oesophagogastric junction the authors present findings on the instability of the manifestations of impaired motility after a certain time interval in the same patient. These changes have an evolutional character and it is assumed that variants of the same pathological entity are involved. The picture of corkscrew oesophagus develops into a diffuse spasm of the oesophagus and finally into achalasia. In gastrooesophageal reflux the controversy concentrates on the finding of 24-hour continuous examination (pH-metry and manometry) and changes of the mucosal lining of the distal oesophagus. Changes of the lining are associated with therapeutic advances. In order to improve the therapeutic procedure we recommend dispensarization of the patients in gastroenterological centres.
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PMID:[New aspects of clinico-roentgenological evaluation of manifestations of motility disorders of the esophagus and esophagogastric junction]. 156 77

Achalasia of the cardia is an uncommon condition with an incidence of 0.1 cases per year per 100,000 population under 14 years. A review of experience at Booth Hall Children's Hospital over the past 10 years has revealed six cases of achalasia in children. This includes two cases of the rare syndrome of achalasia, alacrima and ACTH insensitivity (also known as Triple A syndrome) and its variants. There are 23 previously reported cases of Triple A syndrome and a further eight cases of its variants reported in the world literature. One-third of these cases (10 out of 31) have associated neurological abnormalities. The clinical and radiological features of achalasia are reviewed. The importance of barium studies in making the diagnosis is emphasized. However, early cases may show only spasm or incoordination, and manometry is required to confirm the diagnosis in these equivocal cases. In this series only three of the six barium studies were diagnostic and the remainder were diagnosed by manometry; all cases were subsequently confirmed by histology. Delay in diagnosis may result in severe lung damage due to repeated aspiration; this occurred in one of the six cases and was the cause of the child's death.
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PMID:Achalasia of the cardia in childhood and the syndrome of achalasia alacrima and ACTH insensitivity. 160 7

Esophageal spasm Teschendorf 's syndrome) is rarely distinguished among neuromuscular diseases of the esophagus, which leads to improper treatment. Primary esophageal spasm and secondary esophageal spasm should be distinguished, the latter developing in cardiospasm or achylia of the cardia. Retrosternal pain and dysphagia prevail in the clinical picture of ++esophageal spasm . X-ray and esophagomanometry are the most informative among the objective methods of examination. In a group of 106 patients 49 had primary and 57 had secondary esophageal spasm . A complex of measures should be applied in the management of esophageal spasm+. Primary esophageal spasm is treated only by nonoperative measures (spasmolytics, tranquilizers, vitamins, acupuncture reflex therapy and psychotherapy according to a suggested scheme), a course of pneumocardiodilatation (no more than 5 sessions) is included in the management of secondary esophageal spasm+. Such treatment produced good and satisfactory results in 100% of patients with primary and in 72% of patients with secondary esophagitis. The management of secondary esophagitis is a more difficult problem which calls for further study.
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PMID:[Clinical aspects, diagnosis and treatment of esophageal spasm]. 191 Sep 11

Patients with a prominent cricopharyngeal bar visible on radiography are generally considered to have spasm of the cricopharyngeus, which is the major muscle component of the upper esophageal sphincter. This condition has been termed "cricopharyngeal achalasia." The aim of this study was to determine the pathogenesis of cricopharyngeal bars. Concurrent videofluoroscopic and manometric examinations of the pharynx and upper esophageal sphincter were performed in a cohort of six patients with prominent cricopharyngeal bars and in eight control volunteers. In each subject, swallows of 2-30-mL barium boluses were recorded. The patients with cricopharyngeal bars showed (a) normal peristaltic contraction in the pharynx, (b) normal axial upper esophageal sphincter pressure and relaxation, (c) normal flow rate across the upper esophageal sphincter, and (d) normal duration of upper esophageal sphincter opening for different bolus volumes. The major abnormalities in the patients with cricopharyngeal bars were (a) reduced maximal dimensions of the upper esophageal sphincter during the transsphincteric flow of barium and (b) increased intrabolus pressure upstream to the upper esophageal sphincter. Thus, the increase in intrabolus pressure preserved normal transsphincteric flow rates even though the upper esophageal sphincter did not open normally. Overall, the constellation of findings in the patients studied suggests that the underlying pathogenesis of their cricopharyngeal bar was reduced muscle compliance wherein the relaxed cricopharyngeus did not distend normally during swallowing.
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PMID:Biomechanics of cricopharyngeal bars. 221 Feb 35

When esophageal disruption occurs in the presence of preexisting esophageal disease or is associated with sepsis or fluid and electrolyte imbalance, aggressive and definitive therapy often provides the only chance for patient salvage. Twenty-four adults (average age, 59 years) with intrathoracic esophageal perforations underwent esophagectomy: 15, transhiatal esophagectomy without thoracotomy; and 9, transthoracic esophagectomy. Restoration of alimentary continuity with an immediate cervical esophagogastric anastomosis was carried out in 13 patients. Eleven underwent a cervical or anterior thoracic esophagostomy, and 10 of them had a subsequent colonic (7) or gastric (3) interposition from 4 to 32 weeks (average time, 8.6 weeks) later. The perforations were due to esophageal instrumentation (9 patients), acute caustic ingestion (2), emesis (2), intrathoracic esophagogastric anastomotic disruption (2), and other causes (9). Preexisting esophageal disease in 20 patients included chronic strictures (10 patients), reflux esophagitis (3), esophageal cancer (3), achalasia (2), diffuse spasm (2), and monilial esophagitis (1 patient). Ten patients were operated on within 12 hours after the injury; 3, within 12 to 24 hours; and 11, within three to 45 days (average interval, 6.6 days). There were three hospital deaths (13%). Nineteen of the 21 survivors were able to swallow comfortably until the time of death or latest follow-up. Aggressive diagnosis and aggressive treatment of life-threatening esophageal perforations are advocated. Conservative procedures (repair, diversion, or drainage) for a perforation with preexisting esophageal disease often inflict more morbidity than esophageal resection, which eliminates the perforation, the source of sepsis, and the underlying esophageal disease. The decision to restore alimentary continuity in a single stage must be individualized.
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PMID:Esophagectomy for esophageal disruption. 229 75

We studied 85 patients with esophageal symptoms of a motor abnormality in whom esophagitis, achalasia or other organic lesions were ruled out by endoscopy. Main symptoms were dysphagia and severe retrosternal pain. Cardiac origin of the pain was ruled out by clinical and EKG evaluation in 72% of patients. Mean age was 43 years and female to male ratio was 3:1. Manometric study, performed in all patients, revealed diffuse spasm in 42, hypertensive sphincter in 16, nutcraker esophagus in 11 and nonspecific motor abnormalities in 16 patients. Only manometric studies can identify these esophageal disturbances. These studies should be performed in patients with non cardiac retrosternal pain.
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PMID:[Primary motor disorders of the non-achalasic esophagus: a manometric analysis]. 248 21

Primary motor disorders of the oesophagus have distinct manometric patterns but require full oesophageal investigation to exclude a secondary cause. Myotomy and forceful dilatation give good results in achalasia, though myotomy is superior in the long term. Indications for surgery are rare in diffuse spasm and nutcracker oesophagus. Non-cardiac chest pain may be related to reflux, diffuse spasm or nutcracker oesophagus, but correlation between motor abnormalities and symptoms is poor and psychological disturbances are frequent.
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PMID:Primary disorders of oesophageal motility. 268 1

To evaluate function of the normal and pathologic esophageal body under more physiologic conditions than those utilized for traditional laboratory testing, manometry was performed before and during eating using a catheter assembly containing three peripheral transducers. Studies were evaluated from seven normal volunteers, 18 typical achalasia patients (eight before and 10 after esophagomyotomy), and eight patients with diffuse esophageal spasm (DES) as characterized by frequent simultaneous and repetitive contractions. In the preprandial period, all had similar frequencies of esophageal contractions, although there was a wide range. During eating, the frequency of contractions increased in all groups; however, the contraction frequency in unoperated achalasia patients, 12.7 +/- 5.0 contractions/min, significantly exceeded the frequency in normal volunteers of 4.9 +/- 1.3 contractions/min, p less than 0.01. The frequency was lower in operated achalasia patients, 9.4 +/- 6.5 contractions/min, but still exceeded that of normal volunteers, p less than 0.01. Patients with DES also had more frequent contractions, 10.5 +/- 9.7 contractions/min, than did the normal volunteers, p less than 0.01. The mean pressure of esophageal contractions for both achalasia groups was similar and was significantly lower than for the normal volunteers. Pressure in the DES patients was intermediate. It is concluded that patients with achalasia have lower pressure but more frequent contractions than normal volunteers during eating, and this spasm-like activity may be a more important pathophysiologic factor in their dysphagia than previously recognized. Esophagomyotomy does decrease the frequency of these contractions. Frequency, but not pressure, of contractions differs from normal in patients with DES.
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PMID:Physiologic evaluation of esophageal function in patients with achalasia and diffuse esophageal spasm. 370 28

Before removing the diverticula (running suture for mucosa, interrupted stitches for the esophageal wall with resorbable material) a myotomy of the upper sphincter (pars inf. of the crycopharyngeal) muscle should be performed to restore the preoperative insufficient relaxation of the upper sphincter. The diffuse spasm shows a normal function of the LES; painful attacks can be treated by calcium antagonists or nitroglycerin. The achalasia can be treated either by endoscopic dilatation or myotomy to reduce the LES-pressure and restore the insufficient relaxation of the LES.
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PMID:[Reconstruction of esophageal passage in functional disorders (achalasia, Zenker diverticulum, spasms)]. 393 98


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