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)

Achalasia of the esophagus is rare in children. The authors report eight cases and emphasize two atypical clinical records: The first one is a 3 month-old infant with respiratory distress and "near miss" Sudden Death Infant Syndrome. The second one is a ten year-old boy with association of achalasia of the esophagus, ACTH insensibility and alacryma. Theses cases are discussed.
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PMID:[Idiopathic achalasia of the esophagus in children. Report of 8 cases]. 221 98

We present a patient with a rare complication of achalasia. The principal complaint was a severe acute respiratory distress due to tracheal compression by an achalasic esophagus relieved by nasoesophageal tube aspiration.
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PMID:Acute upper-airway obstruction in achalasia of the esophagus. 356 45

Anginal pain is a common clinical finding during cardiospasm or during pneumatic dilatation of oesophagus to relieve cardiospasm. Thus the present work was taken up to find out any relationship between the oesophagus and the cardiovascular system during experimental distension of the oesophagus in dogs. Pneumatic distension of oesophagus was done in anaesthetised dogs and its effects on arterial blood pressure, E.C.G. and respiration were studied. A fall in arterial blood pressure was observed in almost all dogs during distension. E.C.G. changes like a reduction in the 'R' wave voltage, absence of 'R' wave and a shift in the isoelectric line were observed also during distension. Moreover, oesophageal distension produced a transient apnoea in almost all animals and they seemed to be in a respiratory distress. When the distension was continued, the arterial blood pressure instead of remaining low, came back to the control or even higher level inspite of the presence of distension. Bilateral vagotomy did not abolish the hypotensive effect and E.C.G. changes but abolished the increase of blood pressure during the later part of distension. The cardiovascular changes were considered to be of a reflex nature and besides the vagi, the sympathetics seem to play an important role in this.
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PMID:The effects of acute oesophageal distension on arterial blood pressure, E.C.G. and respiration in dog. 651 Oct 59

Acute airway obstruction associated with esophageal achalasia is an uncommon but life-threatening complication. The pathophysiology of this phenomenon has not been fully defined. A fully documented case of coexistent esophageal achalasia and upper esophageal sphincter relaxation abnormality presenting with airway obstruction is reported. The patient was initially treated with Heller's myotomy but had a recurrence of respiratory distress. She was successfully treated by cricopharyngeal myotomy. The causes of gas entrapment and respiratory distress are likely to be due to failure of both swallow- and distention-induced upper esophageal sphincter relaxation. Cricopharyngeal myotomy is an effective treatment for this complication, probably by facilitating esophagopharyngeal gas venting.
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PMID:Esophageal achalasia and coexistent upper esophageal sphincter relaxation disorder presenting with airway obstruction. 755 3

The most common presenting symptoms of achalasia are dysphagia, recurrent regurgitation, and gradual weight loss. Surprisingly, many achalasia patients tolerate considerable esophageal distention without complaint. In very few cases is respiratory distress the only presenting symptom of achalasia. We describe such a case.
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PMID:Acute upper-airway obstruction in a patient with achalasia. 914 Feb 55

We report a case of achalasia presenting as acute stridor and respiratory distress in an 87-year-old woman. A mega-oesophagus was decompressed by aspiration through a naso-oesophageal tube, stiffened with paediatric endoscopic biopsy forceps before placement. Subsequent barium swallow showed mega-oesophagus secondary to achalasia causing tracheal compression at the level of the thoracic inlet. There have been 28 previous case reports of mega-oesophagus due to achalasia causing tracheal obstruction and the literature is reviewed. Recognition and urgent treatment of this very rare complication of achalasia by naso-oesophageal decompression may avoid fatality.
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PMID:Achalasia presenting as acute stridor. 943 7

Achalasia presenting as acute airway obstruction is an uncommon complication. We report the case of an elderly woman with previously undiagnosed achalasia who presented with acute respiratory distress due to megaesophagus. Emergency endotracheal intubation and insertion of a catheter into the esophagus, with continuous aspiration was required. Upon introduction of the esophageal catheter an abruptand audible air decompression occurred, with marked improvement of the clinical picture. Endoscopic injection of botulinum toxin was chosen as the definitive treatment with good clinical result. The pathophysiology of the phenomenon of esophageal blowing in achalasia is unclear, but different hypothetical mechanisms have been suggested. One postulated mechanism is an increase in upper esophageal sphincter (UES) residual pressure or abnormal UES relaxation with swallowing in achalasia patients. We reviewed the UES manometric findings in 50 achalasia patients and compared it with measurement performed in 45 healthy controls. We did not find any abnormalities in UES function in any of our achalasia patients group, or in the case under study. An alternative hypothesis postulates that airway compromise in patients with achalasia results from the loss UES belch reflex (abnormal UES relaxation during esophageal air distension), and in fact, an abnormal UES belch reflex was evidenced in our case.
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PMID:Achalasia presenting as acute airway obstruction. 1111 88

Bilateral vocal cord paralysis is most commonly caused by trauma, malignancy, and neurologic disorders. Cases secondary to esophageal compression of the recurrent laryngeal nerves are rare. We report a patient admitted with an exacerbation of achalasia who developed acute respiratory distress from bilateral immobile vocal cords. Imaging studies revealed impressive dilation of the cervical esophagus causing compression of both recurrent laryngeal nerves. After securing the airway and decompression of the esophagus, mobility of the vocal cords returned within 1 week. This case shows the importance of a careful airway workup in patients with esophageal distention. Early decompression may prevent permanent recurrent laryngeal nerve injury and airway obstruction.
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PMID:Bilateral vocal cord paralysis secondary to esophageal compression. 1533 3

Systemic mycoses, especially pulmonary diseases and septicemia are observed increasingly at intensive care units. Essential risk factors for development of candidosis are the expanded use of antibiotics and immunocompromised patients, caused either as a result of a severe underlying disease or iatrogenically induced after organ transplantation. Candida albicans is the most frequent pathogen in microbiological findings. Blood cultures are only positive in massive fungemia. We report a 50-year-old patient with recurrent Candida-septicemia: rupture of the distal esophagus after dilatation because of cardiac achalasia with mediastinal emphysema and mediastinitis. Severe acute respiratory distress syndrome after aspiration with septic shock and acute renal failure at the beginning. Long-term mechanical ventilation, continuous renal replacement therapy and multifarious antibiotic therapy. Early microbiological samples of several positive blood cultures and bronchoalveolar lavages revealed the presence of Candida albicans. In the further clinical course, detection of Pseudomonas species in bronchoalveolar lavages and Staphylococci as well as Enterococci in a number of positive blood cultures. Later on development of a severe liver dysfunction with test results that showed an intrahepatic cholestasis. Because of coagulation failure commencement of artificial liver support with the MARS-system (molecule adsorbent recirculating system). Decrease of high bilirubin levels was accompanied by improvement of clinical condition of the patient. In the following course, repeated severe systemic infections with phases of septicemia or rather septic shock and detection of Candida in several positive blood cultures and bronchoalveolar lavages. In each case increasing bilirubin levels with signs of intrahepatic cholestasis and each time improvement with antimycotic therapy (voriconazol, caspofungin and fluconazol). The patient showed more and more signs of immunodeficiency in the sequel. The clinical appearance of candidosis is manifold. Systemic Candida infections are frequent in patients with immunodeficiency. A recurrent Candida septicemia with prolonged respiratory failure and severe liver dysfunction in form of cholestatic hepatosis, that improved several times with antimycotic therapy in combination with evidence based intensive care measures and artificial organ support is a comparatively rare event.
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PMID:[Recurrent Candida sepsis with prolonged respiratory failure and severe liver dysfunction]. 1582 96

Acute airway obstruction from mega-esophagus is a rare presentation of achalasia. Mega-esophagus is generally considered when the transverse width of the esophagus is more than 7 cm. A 78 year old lady presented with longstanding history of productive cough and nocturnal dyspnoea. She was seen in the emergency department with acute exacerbation of dyspnoea after a bout of vomiting, containing semi-solid food with foetid smell. Her respiratory status deteriorated rapidly with onset of stridor, and cyanosis. Chest x-ray showed widening of mediastinum due to dilated esophagus with air-fluid level. Prompt, repeated, upper respiratory tract suction was carried out. A wide bore nasogastric tube was introduced, esophagus was decompressed with a gush of air and fluid, relieving the respiratory distress. This case illustrates an unusual presentation of achalasia underscoring the need for urgent, life-saving esophageal decompression. Hypotheses, regarding the mechanism of airway compromise, as well as, treatment options are reviewed.
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PMID:Achalasia esophagus; presenting as acute air way obstruction. 1790 30


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