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)

Recurrent chest pain frequently results in significant disability and anxiety, even after cardiac disease has been excluded. A stepwise approach is recommended for the diagnosis of pulmonary conditions, musculoskeletal disorders and structural problems of the upper gastrointestinal tract that can produce chest pain. If a search for these disorders proves negative, an esophageal source of chest pain should be strongly suspected. Although gastroesophageal reflux disease is the most common and easily treated cause of esophageal chest pain, esophageal motility disorders should also be considered. Motility disorders include achalasia, diffuse esophageal spasm, nutcracker esophagus, hypertensive lower esophageal sphincter and nonspecific motility disorders.
Am Fam Physician 1989 Sep
PMID:Esophageal chest pain. 267 45

One hundred patients with achalasia of the esophagus were analyzed at a late follow-up by means of subjective and objective parameters. The surgical technique consisted of an anterior esophagomyotomy (6 cm long, not extending into the stomach more than 5 to 10 mm) with the addition of an anterior hemi-Nissen or Dor procedure, similar to the Thal serosal patch. No operative deaths occurred. The mean follow-up was 6.8 years, and only 1 patient was lost from this follow-up. Preoperative dysphagia, which was present in 100% of the patients, persisted only occasionally in 8%, and a significant gain in weight was recorded in 90% of the patients. In three patients epidermoid carcinoma developed 5 to 9 years after surgery. In one patient a severe gastroesophageal reflux with an esophageal ulcer developed. Radiologic studies demonstrated a significant increase in the diameter at the gastroesophageal junction and a decrease at the middle third of the esophagus (p less than 0.0001). The resting pressure of the lower esophageal sphincter showed a significant decrease, from 37 mm Hg to 10 mm Hg, after surgery (p less than 0.0001), when we analyzed 84 patients before and 68 patients after operation. The total length of this sphincter also decreased. The manometric evaluation of the lower esophageal sphincter pressure in the same 42 patients before, 2 months after, and 5 to 7 years after surgery demonstrated persistence of the low sphincter pressure. There was a significant increase in the amplitude of the esophageal waves, and the standard acid-reflux test demonstrated reflux into the esophagus in 19% of the patients. Final clinical evaluation showed excellent and good results in 92 of the 94 controlled patients.
Surgery 1988 Sep
PMID:Late subjective and objective evaluation of the results of esophagomyotomy in 100 patients with achalasia of the esophagus. 341 76

Chest pain is a major symptom of patients diagnosed with esophageal motility abnormalities. Motility disorders of the esophagus are also associated with elevated scores on measures of somatic anxiety and depression. In spite of this relationship between psychological characteristics and esophageal motility disturbances, few attempts have been made to treat complaints of chest pain in patients with esophageal motility disorders using psychological methods. This report describes the successful use of a behavioral pain management program for the treatment of persistent chest pain in a patient diagnosed with vigorous achalasia who was previously treated with pneumatic dilatation and a long Heller myotomy. This is the first report on the use of psychotherapy in treating chest pain associated with vigorous achalasia, and suggests that, in the etiology and treatment of chest pain in patients with esophageal motility disturbances, psychological influences may be more important than has generally been recognized. No long-term relationship between esophageal motility disturbances and complaints of chest pain was found.
Am J Gastroenterol 1988 Sep
PMID:Behavioral treatment of intractable chest pain in a patient with vigorous achalasia. 341 49

Forty-one (98%) of 42 patients with achalasia of the esophagus had pneumatic dilatation performed successfully using the Brown-McHardy dilator. One to four dilatations (mean, 1.9) were done on each patient with inflation pressures of 8-15 psi (mean, 11.1 psi). Immediately after the procedure, all patients were examined radiographically by injection of contrast material into the lower esophagus through a nasoesophageal tube. Two immediate and two delayed perforations occurred. Six intramural hematomas were noted, five of which resolved spontaneously. The luminal diameter at the esophagogastric junction increased from a mean of 4.2 mm before dilatation to 7.5 mm following treatment. Four patients with previous Heller myotomy were dilated without complications. Perforation was more common in patients with a minimal change in the esophagogastric diameter. Thirty-five patients (85%) improved symptomatically within several days following pneumatic dilatation. Excluding patients with perforation, the postdilatation appearance of the lower esophagus poorly correlated with clinical response.
Dig Dis Sci 1987 Sep
PMID:Radiographic evaluation of esophagus immediately after pneumatic dilatation for achalasia. 362 90

Forty-one women with achalasia diagnosed between the ages of 18 and 45 years were interviewed and 37 of them who had been married at some time were asked to provide details of their fertility and reproductive histories. Thirty-six agreed to do so and were compared with 36 healthy age-matched women. The mean age at the time of study was 44 and the women had been married, on average, for 21 years. The disease developed at a mean age of 27 years and was diagnosed and treated at a mean age of 32 years. For a mean period of 5 years the disease was untreated. There were no significant differences in the number of conceptions or live births before or after the onset of symptoms or during the period when the disease was untreated. In only three of the 20 women who became pregnant after the onset of disease did symptoms become worse. Achalasia during pregnancy is probably best managed by endoscopic dilatation and there is no reason to consider termination.
Br J Obstet Gynaecol 1987 Sep
PMID:Achalasia and pregnancy. 366 47

The contractile activity of the oesophageal body and of the upper and lower oesophageal sphincter (LOS) can reliably be portrayed by means of low compliance recording systems, either pneumohydraulic or with strain gauge force transducers, and at least two pressure sensors. LOS resting pressure can be assessed by both station and rapid pull-through techniques, or by the sleeve method. States of disordered LOS function, such as achalasia, can be diagnosed dependably only by manometric means. Manometry is of high diagnostic yield for motor disorders of the oesophageal body as well, although generally accepted diagnostic criteria are still lacking. In patients with angina-like chest pain, provocation tests can prove that oesophageal contraction abnormalities cause the symptoms. Edrophonium has been shown to be the most effective and best tolerated provocative agent. Transport of swallowed material through the oesophagus can reliably be recorded by radionuclide transit studies. Such studies are valuable in identifying patients with absent or impaired peristalsis and in evaluating treatment effects, e. g., the effects of mechanic dilatation in achalasia. Gastrooesophageal reflux should be recorded not only qualitatively but also quantitatively, although a definition of what is pathological and what is not has not been generally agreed upon. Recording of oesophageal intraluminal pH over longer periods of time, preferably 24 h, may have the best diagnostic yield. The advent of computer-aided analysis techniques will replace the cumbersome handscoring of motor and pH tracings and, hopefully, contribute to a better understanding and classification of oesophageal pathophysiology.
Z Gastroenterol 1986 Sep
PMID:[Methods for measuring the motor activity of the esophagus and gastroesophageal reflux]. 377 64

All treatment modalities of achalasia aim at reducing the resistance at the cardia sufficiently to allow easy aboral flow, but insufficiently to favour gastroesophageal reflux. This can be achieved either by powerful dilatation or by cardiomyotomy. Early and late results, morbidity and mortality rates and late complications of these different treatment modalities are discussed. The personal experience of the authors with progressive pneumatic dilatations in a series of 700 patients is described.
Z Gastroenterol 1986 Sep
PMID:[Treatment of primary motility disorders of the esophagus]. 377 65

Despite new techniques to investigate intestinal motility disorders the underlying etiologic and pathogenetic mechanisms remain uncertain in most cases. Years ago it was thought that in gastro-esophageal reflux disease the impairment of the lower esophageal sphincter is the only pathogenetic factor. In contrast to this recent studies ruled out that gastro-esophageal reflux disease seems not to be a monofactorial problem but has different pathogenetic mechanisms. The same problem has to be stated for the primary motility disorders of the esophagus. Although more often diagnosed in the last years due to more sophisticated diagnostic tools, the underlying mechanisms of the diseases are still poorly understood. In achalasia dilatation procedures seem to be the most promising therapeutic means, whereas the role of medical treatment in this disease has to be defined more clearly. Therefore a lot of work has to be done in the future to get a better basic knowledge of the motility problems of the gastrointestinal tract.
Z Gastroenterol 1986 Sep
PMID:[Esophageal motility]. 377 68

A patient with dysphagia initially diagnosed as achalasia but now thought to have spinocerebellar degeneration manifesting itself in the esophagus as achalasia, developed an intradiaphragmatic abscess, presumably as a complication of pneumatic dilation of the esophagus. This previously unreported complication occurred as a result of transmural spread of bacteria at the time of dilatation with seeding of the diaphragmatic muscle. An intradiaphragmatic abscess may be mistakenly diagnosed clinically and radiologically as a subphrenic abscess or loculated empyema. Management of intradiaphragmatic abscess is discussed briefly.
Dig Dis Sci 1985 Sep
PMID:Intradiaphragmatic abscess. An extremely rare complication of pneumatic dilatation of the esophagus. 402 15

Patients with achalasia, which had been treated in the Department of Surgery, University of Bonn, from 1953 to 1983 (n = 142), were examined by a detailed questionnaire (n = 90), endoscopy and biopsy (n = 47), esophagography (n = 53) and by gastric reflux scintigraphy (n = 12). The results of dilatation and surgical procedures are compared. Although the incidence of gastric reflux was very seldom, an esophagitis could be seen frequently. The dilatation of the esophagus is succeeded, if there is left any myogenic tone. Otherwise an esophagomyotomy by left thoracotomy should be performed without an antireflux operation.
Chirurg 1985 Sep
PMID:[Results of treatment of achalasia with special reference to gastroesophageal reflux]. 405 68


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