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

Laparoscopic Nissen fundoplication represents a minimally invasive surgical approach to symptomatic gastroesophageal reflux and may offer patients an attractive alternative to indefinite medical therapy. Fourteen patients with persistent gastroesophageal reflux and two with severe achalasia underwent a laparoscopically guided 360-degree or Nissen fundoplication. Both individuals with achalasia also had an extended distal esophagomyotomy. Two patients required conversion to open laparotomy because of difficulties in defining the anatomy of the posterior esophagus. All 16 patients reported complete relief of their symptoms. The average length of hospital stay was four days. These early results of laparoscopic Nissen fundoplication are encouraging and hopefully will stimulate further experience in this area.
Surg Laparosc Endosc 1992 Sep
PMID:Laparoscopic Nissen fundoplication. 134 29

The authors treated 17 patients with achalasia by a thoracoscopic (15 patients) or laparoscopic (2 patients) Heller myotomy. All patients had dysphagia and an upper gastrointestinal series demonstrating a dilated esophagus with a bird-beak deformity at the cardia. Manometry showed a mean lower esophageal sphincter (LES) pressure of 32 +/- 4 mmHg, incomplete sphincter relaxation on swallowing, and no primary esophageal peristalsis. After operation, mean LES pressure was 10 +/- 2 mmHg. Fifteen patients were fed on the second postoperative day. The average hospital stay was 3 days, and there were no deaths or major complications. In three early patients, the myotomy was not carried far enough onto the stomach, and dysphagia persisted until a second myotomy was performed (laparoscopically in two patients). The authors found that having an endoscope in the esophagus during the operation facilitated exposure and was vital to determine the appropriate length of the myotomy. With regard to dysphagia, final results were excellent in 12 patients (70%), good in two patients (12%), fair in two patients (12%), and poor in one patient (6%). Heller myotomy can be safely and reliably performed with minimally invasive techniques. Dysphagia is relieved, postoperative pain is minimal, hospital stay is short, and the patient can return quickly to normal activity.
Ann Surg 1992 Sep
PMID:Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. 141 78

Sixty-four patients with achalasia of the esophagus were surgically treated during the period 1973-1990. They were analyzed a late follow-up (mean = 78 months) by means of subjective and objective parameters. The Authors emphasize the efficiency of the diagnostic approach so that surgical treatment offers better results. The surgical technique of choice consists of an anterior esophagomyotomy (extending from 6 cm above the esophagogastric junction down to 1-2 cm below it) with the addition of an anterior Dor antireflux procedure through a laparotomy. The other therapeutic approach to achalasia is pneumatic dilatation of lower esophageal sphincter. A retrospective comparison of two different treatments is made through the analysis of the literature (medlars 1986-1990). Relief of dysphagia is reported in 92.78% of patients treated by myotomy and in 78.71% of those treated by forceful dilatation. The morbidity rate is greater after pneumatic dilatation (6% vs 5%) and the mortality rate is 1.1% after myotomy and 0.2% after dilatation. There are not rigorous criteria of choice between the two treatment methods but the Authors indicate that Heller's myotomy with an antireflux procedure achieve better and lasting results.
Minerva Chir 1992 Sep 30
PMID:[Esophageal achalasia: cardiomyotomy or pneumatic dilatation?]. 146 13

High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.
Radiology 1992 Sep
PMID:Transnasal US of the esophagus: preliminary morphologic and function studies. 150 56

Merits can be conferred upon S. S. Yudin not only in the improvement of the method of esophagoplasty with the small intestine suggested by C. Roux in 1907, but also in the development of reconstructive surgery of the esophagus on the whole. Although new methods for esophagoplasty have been suggested and new technical possibilities have appeared, many elements of surgical tactics, operative techniques, and instruments suggested by S. S. Yudin are still applied in reconstructive surgery of the esophagus. Among them are the detailed description of jejunal architectonics from the surgeon's point of view, the wide use of test compression of the mesenteric vessels to evaluate the adequacy of blood supply to the graft, description of the clinical signs of disturbed blood supply to the graft, etc. S. S. Yudin laid the foundations of scientific research into the morphological and functional reorganization of organs and tissues in prolonged existence under unusual conditions, which is of great theoretical importance. Twenty-year experience in reconstructive surgery of the esophagus allow the author of this article to appraise at their true worth the technical procedures and physiological approaches suggested by S. S. Yudin, which are being developed further under modern conditions. This applies to substantiation of the most reliable and physiological method of retrosternal esophagoplasty with the colon with isoperistaltic position of the graft, transpleural resection of a cicatricially deformed esophagus, surgical treatment of achalasia of the superior esophageal sphincter.
Khirurgiia (Mosk) 1991 Sep
PMID:[Role and significance of S. S. Iudin in the development of reconstructive surgery of the esophagus]. 175 34

Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs, and with the presence of chest pain. However, no study using current manometric techniques has compared manometric, radiographic, and clinical findings in vigorous and classic achalasia or questioned the usefulness of making this distinction. Fifty-four cases involving patients with achalasia whose radiographic and manometric studies were performed within 6 months of each other were available for review. Patients with vigorous achalasia (n = 17), defined by amplitude greater than or equal to 37 mm Hg, and patients with classic achalasia (n = 37), defined as amplitude less than 37 mm Hg, had substantial overlap in radiographic parameters of esophageal dilation, tortuosity, and tertiary contractions. Manometric properties of repetitive waves and lower esophageal sphincter pressure and clinical aspects of chest pain, dysphagia, heartburn, and satisfactory responses to pneumatic dilation were similar in both forms of achalasia. A separate analysis of patients with mean contraction amplitude greater than 60 mm Hg revealed similar findings. It is concluded that use of amplitude as a criterion for classifying achalasia is arbitrary and of dubious value.
Gastroenterology 1991 Sep
PMID:Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. 145 95

40 patients with achalasia underwent pneumatic dilatation. 25 were followed up for a mean duration of 3.96 years. Digestive symptoms disappeared in 32% of cases, were diminished in 40% and remained unchanged in 28%. In 8 patients oesophageal manometry after dilatation showed a significant reduction in lower oesophageal sphincter pressure. The patients showing improvement had a more marked drop in lower oesophageal sphincter pressure, lower residual pressure in the lower oesophageal sphincter measured by wet swallows, and negative pressure in the oesophagus. As complications 3 patients developed oesophageal perforation with one subsequent death, and 3 symptomatic gastro-oesophageal reflux. In view of these results, we regard pneumatic dilatation as the treatment of choice in achalasia.
Schweiz Med Wochenschr 1990 Sep 08
PMID:[Treatment of achalasia using balloon dilatation]. 221 51

Esophageal disease has been reported in 70% to 90% of patients with scleroderma, of whom nearly 50% will have reflux esophagitis. The combined motility disorder of low LES pressure and aperistalsis of the esophageal body makes scleroderma patients especially susceptible to severe gastroesophageal reflux disease (GERD). Symptomatic GERD is a common problem in pregnancy, affecting 30% to 50% of women. Hormonal effects of estrogen and progesterone likely promote GERD by compromising LES function. Fortunately, the problem is usually relieved with delivery of the baby. Although difficult to quantitate, the reflux of both acid and especially alkaline material may be a common sequela of many types of gastric surgery. Medical therapy binding bile salts usually does not bring relief. The Rouxen-Y biliary diversion operation is the best solution for this problem. GERD complicates the treatment of achalasia after 10% of Heller myotomies and 2% of pneumatic dilatations. Nearly 50% of patients with the Zollinger-Ellison syndrome have esophagitis, which may be more difficult to treat than their ulcer disease.
Gastroenterol Clin North Am 1990 Sep
PMID:Medical and surgical conditions predisposing to gastroesophageal reflux disease. 222 65

A report is given on a 14-year-old girl and a 13-year-old boy from a group of 83 patients who met the diagnostic criteria (MAS; DSM-III-R) for anorexia nervosa. The behavior therapy interventions did not have the expected effects in either child. On repetition diagnostic evaluations showed that the girl had esophageal achalasia within the scope of Turpin's syndrome (megaesophagus, bronchus deformation) and the boy Burkitt's lymphoma (malignant non-Hodgkins' lymphoma). The differential diagnostic and classification problems associated with the diagnosis anorexia nervosa are pointed out.
Z Kinder Jugendpsychiatr 1990 Sep
PMID:[How reliable is the diagnosis "anorexia nervosa"?]. 228 65

Nutcracker esophagus is essentially a manometric diagnosis characterized by high-amplitude, often prolonged duration of peristaltic contractions in the distal two thirds of the esophagus. Its association with noncardiac chest pain and/or dysphagia has been recognized and reported by numerous esophageal motility laboratories. There are very few long-term studies of the natural history of this abnormality. We report a patient who presented with dysphagia and, on initial investigation, was found to have classical nutcracker esophagus. On reinvestigation three years later, however, he had developed achalasia of the cardia. The transition from nutcracker esophagus to achalasia has not previously been reported.
Dig Dis Sci 1990 Sep
PMID:Transition from nutcracker esophagus to achalasia. 239 Sep 31


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