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

An unusual case of congenital lower oesophageal diaphragm (web) associated with achalasia is described. An 18-year-old nulliparous girl presented with severe cachexia and aphagia following progressive dysphagia. A barium swallow demonstrated the achalasia, and the oesophageal diaphragm with a central pinhole opening was seen at endoscopy. Parenteral hyperalimentation was required for ten weeks prior to surgery. Circumferential excision of the oesophageal diaphragm in conjunction with Y-V advancement oesophagoplasty gave a good result.
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PMID:Lower oesophageal diaphragm and achalasia in an adult. An unusual association. 652 77

A total of 538 dilations were performed upon 293 patients evaluated at our unit. Of these, 4.8 per cent had cervical webs, 3.0 per cent had cricopharyngeal dysfunction, 9.2 per cent had undetermined cause, 3.4 per cent had achalasia, 65.5 per cent had peptic strictures, 3.8 per cent had Schatzki's ring, 2.4 per cent had esophagitis, 6.1 per cent had postoperative strictures, 0.3 per cent had caustic stricture and 1.4 per cent had extrinsic compression. True dysphagia should always be investigated through a careful history, physical examination, barium study, endoscopy and, infrequently, esophageal manometry.
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PMID:Endoscopic evaluation of dysphagia in two hundred and ninety-three patients with benign disease. 669 9

In geographic areas where there is a high risk of esophageal cancer, analysis of cells obtained from the esophagus has been used effectively to detect early lesions. This has been demonstrated on a large scale in studies from China. Using abrasive balloon cytology techniques, 75% of the cancers detected were early lesions, where the 5-year survival after resection was in the range of 90%. Endoscopic followup studies indicate that dysplastic changes in the esophageal mucosa are a common precursor to malignancy. In many cases, the time course from dysplasia to carcinoma in situ to early invasive cancer may take place over many years, allowing a reasonable amount of time for screening. In low-incidence areas, such as the United States, most esophageal cancers are related to the excessive use of tobacco and alcohol. These factors are too common and the incidence of the disease too low, however, to justify screening on this basis. There are smaller groups at higher risk where selective screening by endoscopy with cytology and biopsy is recommended, usually every 1 to 3 years. These include patients with longstanding achalasia, lye strictures, and Plummer- Vinson syndrome. Patients with cancers of the head and neck region and patients with celiac disease may also be considered to be at increased risk. Tylosis is a rare inherited disease with a very high risk of esophageal cancer. There is an increased incidence of adenocarcinoma of the esophagus with Barrett's epithelium, and once identified such patients should be kept under endoscopic surveillance. The finding of severe dysplasia in any of these groups would indicate a shorter screening interval. Most patients with symptoms referable to the esophagus are first tested by barium esophagram. If negative, with persistent symptoms or if a suspicious lesion is identified, endoscopy with cytology and biopsy is recommended. Staging of the cancer is based on the size of the cancer both longitudinally and circumferentially and the presence of extraesophageal spread. At the present time, CT is the best noninvasive method for judging the extent of the cancer. Performance and nutritional status are also determinants of prognosis and should be considered in planning treatment.
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PMID:Screening diagnosis and staging of esophageal cancer. 672 90

Current methods to evaluate patients with esophageal disease include barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of radioisotopes has been useful in evaluation of esophageal reflux and the post-treatment of achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to acid in the esophagus include the acid infusion test, the standard acid reflux test, the acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or esophagitis and allows direct visualization of the esophagus. The treatment of reflux esophagitis is discussed. The differential diagnosis of dysphagia may include achalasia, diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs, strictures, and benign or malignant tumors. The evaluation of dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The Mallory-Weiss syndrome or bleeding from the mucosal tears of the gastroesophageal junction and Boerhaave's syndrome, spontaneous esophageal perforation, are two disorders associated with vomiting. The Mallory-Weiss syndrome usually resolves without specific therapy, but a high index of suspicion is required for patients with chest pain after vomiting, as spontaneous perforation necessitates immediate surgery. Most diverticula need no treatment, but the Zenker diverticulum, if symptomatic, should probably be surgically repaired.
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PMID:Evaluation and management of diseases of the esophagus. 703 70

Radiological features of the oesophagus of 7 normal horses and 13 with oesophageal lesions are described. The use of barium sulphate as a contrast agent and the techniqes of its administration are discussed. It is suggested that chronic intermittent oesophageal impaction with food material was a predisposing factor in the development of a localised oesophageal dilation in 3 horses and that one other probably resulted from an injury. A similar dilatation was seen which resulted from oesophageal constriction by a vascular ring. Megaoesophagus was seen in 2 ponies associated with grass sickness and a third case had a more localised ares of dilatation in the distal thoracic oesophagus. Other abnormalities recognised included slow passage of food material through the cranial oesophagus which was seen in 3 horses; one as a sequel to a laryngoplasty operation, the second was the probable result of chronic aerophagia and the third was a congenital abnormality. Oesophagoscopy was found to be a useful adjunct to radiography in the diagnosis of oesophageal disorders in horses.
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PMID:Observations on the potential role of oesophageal radiography in the horse. 708 83

Miniature Schnauzers maintained in a colony for 9 years were used to study the inheritance of esophageal dysfunction (canine achalasia, megaesophagus). All dogs were evaluated radiographically, using a barium swallow contrast technique which clearly distinguished normal and affected pups. At 4 to 6 months of age, all affected dogs had recovered clinically except one, and radiographic evidence of dysfunction was markedly diminished. None of the affected dogs required a special feeding regimen. Analysis of breeding pairs revealed a ratio of 9 affected/11 normal dogs when an affected male was mated with a normal female, and a 13/3 ratio was observed when two affected dogs were mated. These ratios were compatible with a simple autosomal dominant or a 60% penetrance autosomal-recessive mode of inheritance. Outbreeding to an affected Miniature Schnauzer/Poodle crossbred dog resulted in only two of 30 affected pups, indicating a polygenic mode of inheritance in outbred populations.
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PMID:Hereditary esophageal dysfunction in the Miniature Schnauzer dog. 718 91

Ten consecutive patients (ages 10 to 17) with achalasia of the esophagus diagnosed by radiographic, manometric, and endoscopic criteria were treated by forceful dilatations of the lower esophageal sphincter. A good to excellent response was seen in eight of the ten patients, manifested by disappearance of vomiting, improvement in dysphagia, and weight gain. A decrease in resting gastroesophageal sphincter pressure was documented in four patients tested. Short-term complications of fever or chest pain were seen following three of 18 procedures; however, barium swallow was negative for perforation and symptoms resolved spontaneously without treatment. Our findings suggest that pneumatic dilatation may produce similar results as surgical esophagomyotomy (Heller procedure) without the immediate operative morbidity, cost, and potential long-term effects.
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PMID:Successful treatment of achalasia in childhood by pneumatic dilatation. 725 67

A man with a mediastinal mass shadow detected on chest roentgenogram was diagnosed as having achalasia by barium swallowing study. Megaesophagus caused by achalasia produced airway obstruction. Maximum expiratory-inspiratory flow volume curve identified that peak flow rate decreased in early expiration, and the ratio of expired to inspired flow at 50 percent of vital capacity was below 0.9, aggravated by 250 ml water intake. Deformation of the tracheal shape was proved easily.
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PMID:Airway obstruction in achalasia. 739 31

Four cases of esophageal candidiasis complicating functional or mechanical obstruction are described. The causes of the obstruction included achalasia, scleroderma, and postoperative fundoplication. None of the commonly recognized conditions predisposing to esophageal candidiasis was present. The findings on barium study ranged from plaque-like filling defects to extensive nodularity and roughening of the mucosal surface, which must be distinguished from ingested debris. It is suggested that esophageal stasis of any cause can lead to candidiasis.
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PMID:Candidiasis in the obstructed esophagus. 747 Feb 15

Vagotomy is reported as a secondary cause of achalasia. Highly selective vagotomy, however, has rarely been reported to cause an achalasia-like syndrome. We suspect that periesophageal trauma accounted for the LES abnormalities seen at manometry in our patient but cannot explain the aperistalsis of the body of the esophagus. Pneumatic dilation improved his dysphagia only slightly but allowed him to maintain his nutrition with oral liquid enteral supplements. We recommend barium swallow, endoscopy, sounding the esophagus with a 50- to 60-French dilator, and manometry in evaluating patients with dysphagia after highly selective vagotomy. If an achalasia-like syndrome is demonstrated, then conservative management with observation and liquid nutritional supplements for four to eight weeks is appropriate. If this fails, pneumatic balloon dilation may be considered. Clearly, a preoperative history of dysphagia should prompt evaluation before highly selective vagotomy. This case represents a transient achalasia-like syndrome after highly selective vagotomy and signifies the importance of conservative management.
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PMID:Achalasia-like syndrome presenting after highly selective vagotomy. 755 68


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