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

The neuromotor disorders of the oesophagus are rare in childhood. The spectrum includes achalasia, vigorous achalasia and diffuse oesophageal spasm. The classical presentation in achalasia is vomiting, failure to thrive and recurrent chest infection. Diagnosis is confirmed on plain film of the chest and a barium swallow which shows the "bird beak" sign. Surgery is the preferred mode of management in children. Adjunctive procedures to surgery like Nissen fundoplication should be selectively performed.
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PMID:Childhood achalasia--a case report. 831 17

Megaoesophagus was observed in 82 Long-Evans rats aged 3-32 months. Clinically, the hair was coarse, the neck distended, the mouth opened, wetted by saliva and soiled by bedding material, and the respiration characterized by tachypnoea and inspiratory crackles. By radiography, after barium administration, the oesophagus was seen to be dilated and filled with impacted dry food in the precardial region. The size of the dilatation varied depending on the oesophageal region and reached a diameter of 12 mm in the most severe case. Histologically, the muscular layers of the dilated portions showed focal inflammation and single fibre necrosis. Each affected oesophagus had (1) an increased circumference and radius and a reduced number of myenteric ganglion cells in both the thoracic and abdominal portions, and (2) a decreased thickness of the muscular layers in the thoracic portion and at the level of the cardia. A simple geometrical model showed that the reduced ganglion cell number was not due to a change in shape of the dilated oesophagus. Since no sign of infectious disease was found in these animals, and rats of other strains kept at the same time under the same conditions were not affected, a hereditary aetiology is suggested.
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PMID:Megaoesophagus in rats: a clinical, pathological and morphometrical study. 831 55

The Cohen test has been recommended to evaluate the efficacy of pneumatic dilation of the lower esophageal sphincter in patients with achalasia. It consists of ingestion of 8 ounces of heavy barium. Upright radiographs are performed 5 minutes later to determine the height of the barium column in the esophagus in relation to the diaphragm. A column less than 1 cm above the diaphragm is a negative test indicating successful dilation and the high probability of dysphagia resolution. A positive Cohen test, a column exceeding 1 cm, is said to correlate with persistent symptoms and need for redilation. We evaluated this in a prospective manner for a 6-year period. Twenty-eight patients underwent standard technique pneumatic dilation at our institution. Achalasia was confirmed in all patients by way of upper endoscopy and manometry. A Cohen test was performed in all patients. Post-dilation symptoms and weight were analyzed at follow-up 6 weeks after dilation. Contrary to the original report, relief of dysphagia after dilation was not related to the results of the Cohen test (p = 0.77). A positive Cohen test was inversely correlated with both symptom duration (0.037) and lower esophageal sphincter pressure before dilation (p = 0.005). Weight gain after dilation was unrelated to Cohen test results (p = 0.67). We conclude that the Cohen test is not an accurate predictor of symptom relief after dilation and do not recommend its use to determine the end point of therapy in patients with achalasia.
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PMID:The Cohen test does not predict outcome in achalasia after pneumatic dilation. 849 36

A careful history can localize gastrointestinal motility disorders and suggest appropriate diagnostic tests. Dysphagia, odynophagia, heartburn and reflux have esophageal origins. The same symptoms occur in achalasia, a classic motor disorder of the lower esophageal sphincter, which can be diagnosed by barium swallow, endoscopy and esophageal motility studies. Nausea, vomiting, anorexia, bloating and abdominal pain are symptoms of motor disorders of the stomach and small intestine. When these symptoms are accompanied by unexplained right upper quadrant pain, elevated liver enzyme levels and unexplained recurrent pancreatitis, the diagnosis of impaired biliary motility is suggested. Colorectal motility disorders may present as abdominal pain, diarrhea, constipation and/or fecal incontinence. If symptoms do not resolve with dietary changes and appropriate medications and the anatomy is normal on lower gastrointestinal studies, colorectal motility studies may be indicated.
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PMID:Gastrointestinal motility disorders. 859 65

Pharyngo-oesophageal abnormalities are found in a high proportion of patients with globus sensation. This study compares the diagnostic value of static single- and double-contrast radiography of the pharynx and oesophagus with videofluoroscopy and with videofluoroscopy combined with static radiography in these patients. Pharyngeal and oesophageal morphology and motor function were studied in 130 consecutive patients with globus sensation (46 males, 84 females; mean age, 47 years) by means of static single and double-contrast radiography and by videofluoroscopy. Videofluoroscopy revealed significantly more functional and structural abnormalities compared to static radiography. Pharyngeal and/or oesophageal disorders were found in 89 vs. 47 patients (chi2 [1] = 19.82, P = 0.0001), pharyngeal abnormalities in 54 vs. 27 patients (chi2 [1] = 13.5, P < 0.0002), and oesophageal abnormalities in 72 vs. 27 patients (chi2 [1] = 28.13, P < 0.0001). Videofluoroscopy combined with static radiography revealed significantly more abnormalities than videofluoroscopy alone (chi2 [1] = 4.23, P < 0.05), and assessed mucosal details more reliably than videofluoroscopy alone. The most frequent abnormalities found were nonspecific oesophageal motor disorders, pharyngo-oesophageal sphincter dysfunction, pharyngeal stasis, achalasia, and laryngeal penetration or aspiration of barium. In most patients with globus sensation, pharyngeal and/or oesophageal abnormalities can be detected radiographically. Videofluoroscopy revealed significantly more functional but not morphological abnormalities than did static radiography. Videofluoroscopic studies combined with static radiography had a higher diagnostic value than videofluoroscopic studies alone.
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PMID:Globus sensation: value of static radiography combined with videofluoroscopy of the pharynx and oesophagus. 860 48

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.
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PMID:Diagnostic imaging in the evaluation of dysphagia. 862 36

Dysphagia is a common reason for radiographic examination of the oesophagus to assess structural or functional abnormalities. From February 1, 1989 to August 28, 1993, six hundred and sixty eight patients had barium swallow examination. Out of 668 patients complaining of dysphagia, 173 patients had either histologically confirmed diagnoses and/or surgical diagnoses or oesophagoscopic diagnoses. The histological, oesophagoscopic and surgical diagnoses were: malignant tumours of the oesophagus 137 patients, achalasia of the cardia 21 patients, diverticula of the oesophagus six patients, peptic structures, five patients and non specific oesophagitis, four patients. Barium swallow agreed with 166 (96%) histological, oesophagoscopic and surgical diagnoses. The Kappa statistic was high (> .8). The mean age for patients with malignant tumours of the oesophagus was 53.5 years (range: 32-75 years), and for achalasia of the cardia was 36 years (range: 14-58 years). Patients with malignancy are in higher age group categories in comparison to the non-malignant patients (OR = 0.07 (0.02, 0.17). The mean duration of dysphagia for achalasia of the cardia was 8.5 years. The major cause of dysphagia was found to be malignant tumour of the oesophagus. Further study is recommended to determine the pattern of oesophageal pathologies to substantiate the finding.
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PMID:Relative sensitivity of barium swallow examination in the diagnosis of oesophageal pathology. 869 23

Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition in which multiple small outpouchings are seen in the wall of the esophagus. Although EIPD is typically associated with esophageal narrowing, only a few cases have been described in which it was associated with esophageal dysmotility. We report the case of a 52-yr-old female who presented with dysphagia and who had EIPD protruding from a 5-cm-long concentric distal esophageal stricture, with a markedly dilated upper and middle third of the esophagus. The short segment of the esophagus between the stricture and the lower esophageal sphincter also was dilated. Barium column was held up above a nonrelaxing lower esophageal sphincter that opened after inhalation of amylnitrate. Esophageal manometry confirmed the presence of vigorous achalasia. Although EIPD has been associated with several other conditions, this is the first report of an association with achalasia.
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PMID:Esophageal intramural pseudodiverticulosis associated with achalasia. 879 18

We have been routinely performing laparoscopic cholecystectomy and antireflux procedures. Having this experience, we decided to assess the feasibility and safety of performing a laparoscopic esophagomyotomy and antireflux procedure. Here we present a case of a 37-year-old man with a history of progressive dysphagia and a diagnosis of achalasia, made on the basis of clinical, endoscopic, and manometric studies. Preoperative manometry reported a pressure of 52 mm Hg (normal, 15-25 mm Hg) for 4.5 cm (normal, > 3 cm). Laparoscopic esophagomyotomy and anterior fundoplication were performed. The esophagomyotomy included a 6-cm segment of distal esophagus and 2 cm of stomach; postoperative manometry was 18 mm Hg for 3 cm. Eight months postoperatively, a barium swallow demonstrated no reflux. Laparoscopic esophagomyotomy and antireflux procedure can be performed with efficacy and safety, with the advantage of a shorter hospitalization and an early recovery compared with the traditional procedure. Also, we emphasize the importance of the intraoperative manometry in the relevance of a concomitant antireflux procedure.
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PMID:Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry. 889 Apr 29

Two patients underwent a transabdominal laparoscopic Heller myotomy for achalasia. All patients had barium esophagograms. preoperative endoscopy, esophageal manometry. There were no surgical morbidity and the average hospital stay was 5 days. Excellent result was reported by one patients and good result by one. Laparoscopic Heller myotomy is a safe and effective treatment for achalasia.
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PMID:[Laparoscopic esophagomyotomy in cardial achalasia]. 892 96


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