Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Various gastroenteric surgical procedures have been attempted laparoscopically. Laparoscopic esophagomyotomy (LE) with or without fundoplication, performed for achalasia, has gained popularity. In our clinic, LE (Heller's myotomy) was performed on six patients with achalasia. All patients underwent barium esophagography, endoscopy, and esophageal manometry for diagnosis. Extramucosal myotomy was started 6 cm above the cardioesophageal junction on the left anterolateral aspect of the esophagus and continued 1 cm below this area. Endoscopic control of the distal esophageal mucosa and the stomach was carried out under direct laparoscopic visualization following the completion of myotomy during the operation. LE was completed without complication in five patients. In one patient (16%), mucosal perforation occurred after myotomy during endoscopic control and was repaired with endostitches. There were no postoperative complications. The average hospital stay was 3 days. Three of the six patients agreed to 24-h pH monitoring, the results of which showed no evidence of reflux. All patients were completely symptom free in the postoperative period. The average preoperative lower esophageal sphincter pressure was 44 mm Hg, whereas in the early postoperative period and 6 months later, it was 11 mm Hg. There was no dysphagia or reflux esophagitis during the follow-up period (range 12 to 24 months). LE is associated with low morbidity and a high success rate, comparable with an open procedure, and can be done without an antireflux procedure.
 ...
PMID:Laparoscopic esophagomyotomy without an antireflux procedure for the treatment of achalasia. 991 94

Barium esophagograms of 89 patients out of 110 with manometrically proven achalasia were reviewed. Only four (4.4%) patients showed association of hiatal hernia, indicative of its rare occurrence. Presence of hiatal hernia, is said to have less likelihood of associated achalasia but this association does exist as per our report and that of others.
 ...
PMID:Hiatal hernia in achalasia. 1006 21

Surgical myotomy is the mainstay of treatment for oesophageal achalasia. Minimally invasive surgical techniques, if feasible, reduce patient morbidity and mortality. In this study we review our experience of thoracoscopic Heller's myotomy. Thoracoscopic myotomy was undertaken in 9 patients (male = 3; female = 6, mean age = 37). All patients presented with dysphagia of 1 to 8 yr duration. Diagnosis was based on barium swallow and manometry. Two patients had previous dilatations and 1 had a transabdominal myotomy. All patients had a 5 port thoracoscopic technique. Thoracoscopic Heller's myotomy was completed in 8 out of 9 patients. In 1 patient extensive oesophagitis and peri-oesophagitis precluded both a thoracoscopic and an open myotomy, and oesophagectomy was subsequently performed. The mean duration of surgery was 142 min. Completion of myotomy and mucosal integrity was confirmed by intraoperative gastroscopy. All patients had an uneventful post-operative recovery. The mean hospital stay was 4 days. All patients are now asymptomatic, with documented weight gain. No patients have reflux oesophagitis symptoms. Our preliminary experience would suggest that thoracoscopic Heller's myotomy is a safe alternative to open surgery, with satisfactory results and reduced hospital stay.
 ...
PMID:Thoracoscopic Hellers myotomy for oesophageal achalasia. 1009 35

A variety of therapeutic options exist for the treatment of achalasia. This case study explores these options and follows an individual's experiences as he undergoes these treatments from a barium swallow to botulinum toxin injection.
 ...
PMID:Botulinum toxin: a case study. 1038 13

Treatment of achalasia cardia by pneumatic dilatation is an established method. However, data on results of pneumatic dilatation in Indian patients with achalasia cardia are scarce. We report our experience with treatment of achalasia cardia by pneumatic dilatation in 38 patients. The diagnosis of achalasia cardia was based on clinical examination, barium swallow and upper gastrointestinal (GI) endoscopy. Twenty nine (76.3%) patients improved with first dilatation, 8 (21%) patients had to undergo second dilatation and 1 (2.6%) required a third. Most of the patients remained asymptomatic during a follow-up of 6 months to 6 years. Immediate and late complications occurred in 5 (13%) and 2 (5.2%) patients, respectively. Thus, pneumatic dilatation is a simple, safe and effective method for treating Indian patients with achalasia cardia.
 ...
PMID:Balloon dilatation in achalasia cardia. 1048 90

We performed a randomized prospective study of pneumatic dilatation comparing a 30-mm and 35-mm Microvasive balloon dilator inflated for either 15 or 60 sec in patients diagnosed with idiopathic achalasia who were previously untreated. Twenty-four patients, 11 men, 13 women, mean age 45, range 18-81 years), were prospectively randomized for dilatation. History and physical examination, esophageal manometry, and barium swallow were performed before dilatation. Symptom self scores were assessed before dilatation, and one month and six months after dilatation. Pneumatic dilatation was successfully completed in all 24 patients, with one patient experiencing a confined perforation. Conservative treatment was employed, and the patient recovered fully. Two patients experienced a recurrence of symptoms and required a second dilatation. Evaluation of posttreatment symptom self scores indicates no difference between the 30-mm and 35-mm Microvasive balloon or inflation durations of either 15 or 60 sec. These data indicate that the more conservative 30-mm dilator inflated for just 15 sec delivers a symptom response equal to a more aggressive approach with the larger dilator inflated over longer duration.
 ...
PMID:Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. 1050 25

Stationary manometry is the gold standard for the evaluation of patients with suspected esophageal motility disorders. Comparison of videoesophagram in the evaluation of esophageal motility disorders with stationary motility has not been objectively studied. Two hundred two patients with foregut symptoms underwent stationary motility and videoesophagram. Radiographic assessment of esophageal motility was done by video recording of five 10-cc swallows of barium. Abnormal esophageal body function was defined by stasis of barium in the middle third of the esophagus on at least four swallows or stasis on at least three swallows in the distal third. Stationary manometry was performed using a five-channel water perfused system. Contraction amplitudes <25 mm Hg in any of the last two channels or the presence of simultaneous or interrupted waves in 10 per cent or more were considered to be abnormal. Sixty-two patients had abnormal manometry. Thirty-four patients also demonstrated abnormal videoesophagrams for an overall sensitivity of 55 per cent. The positive predictive value was 53 per cent; specificity was 79 per cent; and negative predictive value was 80 per cent. Sensitivity was greatest in patients with achalasia (94%) and scleroderma (100%) and in patients presenting with dysphagia (89%). Sensitivity was poor for nonspecific esophageal motility disorders. A videoesophagram is relatively insensitive in detecting motility disorders. It seems most useful in the detection of patients with esophageal dysfunction, for which surgical treatment is beneficial, and in those patients presenting with dysphagia.
 ...
PMID:Abnormal esophageal body function: radiographic-manometric correlation. 1051 33

In patients with achalasia, it has been suggested that pneumatic dilatation could make cardiomyotomy more difficult to perform, diminishing its efficacy and safety. Our aim was to evaluate the efficacy and safety of elective cardiomyotomy after failure of pneumatic dilatation in achalasia. During 14 years, 32 of 276 consecutive patients with achalasia have been operated on because of failure of dilatation therapy. Twenty patients have been followed-up for at least one year after surgery. After failure of dilatation, Heller's cardiomyotomy and 180 degrees anterior fundoplication were performed. Clinical status was evaluated before and after surgery. Lower esophageal sphincter pressure and esophageal body basal pressure were measured by manometry, esophageal diameter by barium meal, and gastroesophageal reflux by endoscopy and 24-hr esophageal pH monitoring. No technical difficulties were found during operation. Postoperative morbidity was infrequent and mortality was absent. Cardiomyotomy improved clinical status in 19 of 20 patients. The results of surgery were considered excellent or good in 16 patients (80%; CI: 56-94%). The pressure of the lower esophageal sphincter was significantly reduced, falling in most patients to under 10 mm Hg. Gastroesophageal reflux appeared after surgery in eight patients, four of them with endoscopic esophagitis, but it was controlled in all patients with medical therapy. In conclusion, cardiomyotomy is a safe and effective therapy in achalasia after failed pneumatic dilatation.
 ...
PMID:Efficacy and safety of cardiomyotomy in patients with achalasia after failure of pneumatic dilatation. 1057 74

Cricopharyngeal achalasia is a rare cause of neonatal dysphagia. Its treatment is based on surgical myotomy, which is to be avoided in the presence of prematurity and neurological diseases. The authors report a case of cricopharyngeal achalasia in a full-term four-month-old female baby. Coughing and choking during feeds were the major symptoms. The diagnosis was made peroperatively although barium meal and endoscopic findings were suggestive. After cricopharyngeal myotomy, symptoms took several weeks to disappear. Seven months after surgery, she feeds normally and weighs 7,700 g. Neonatal cricopharyngeal achalasia could be a foregoing state to cricopharyngeal diverticula in adult. Some cases may remain undiagnosed either due to lack of symptoms or sudden infant death.
 ...
PMID:Cricopharyngeal achalasia--a cause of major dysphagia in a newborn. A case report. 1066 53

We report the case of a patient with a gastric remnant relapse of an antral carcinoma resected 5 years before and presenting with the clinical feature of a secondary achalasia (pseudoachalasia). In spite of the patient's 4-month history of dysphagia and weight loss that suggested a malignant lesion, barium swallow, repeated endoscopic biopsies and computed tomography (CT) scan of the upper abdomen did not reveal any abnormalities to indicate a recurrence. However, in the following months, because of worsening symptoms, a further CT scan was performed and revealed thickening of the cardia and gastric wall. The patient underwent an exploratory laparotomy that showed an unresectable lesion involving the gastric fundus, the diaphragm and penetrating into the mediastinum, and therefore a palliative jejunostomy was performed.
 ...
PMID:Recurrent gastric carcinoma causing pseudoachalasia: case report. 1100 39


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>