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

Videofluoroscopic evaluation of both liquid barium and barium soaked kibble was performed in 11 adult, clinically normal dogs of varying breeds. Each examination was digitized and evaluated frame by frame to establish the normal timing sequence of the pharyngeal phase of swallowing. Closure of the epiglottis was considered the onset of swallowing. The time to each of the following events was recorded: (1) Maximum pharyngeal contraction, (2) Opening of the epiglottis, (3) Opening of the cranial esophageal sphincter, and (4) Closure of the cranial esophageal sphincter. These values were found to be consistent both intra and interpatient. Retrospective analysis of 3 videofluoroscopic examinations from dogs that met the subjective criteria defining cricopharyngeal achalasia was then performed. A statistically significant delay in the time to opening and closure of the cranial esophageal sphincter was found employing both liquid barium and barium soaked kibble in the dogs with cricopharyngeal achalasia.
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PMID:Quantitative videofluoroscopic evaluation of pharyngeal function in the dog. 1105 62

Achalasia is characterized by the absence of peristalsis in the distal two thirds of the esophagus, failure of receptive relaxation of the lower esophageal sphincter, and dysphagia to both solids and liquids. Diagnosis is confirmed by barium swallow, esophageal manometry, and flexible endoscopy. Treatment is based primarily on disruption of the lower esophageal sphincter, which can be achieved by forceful dilation of surgical esophagomyotomy. Esophagomyotomy produces relief of symptoms in more than 90% of patients.
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PMID:Thoracoscopic esophagomyotomy for achalasia. 1105 16

The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.
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PMID:[Primary cricopharyngeal achalasia and its dilatation with balloon catheter]. 1107 94

The purpose of the present paper was to determine if pharyngeal or cervical oesophageal lesions may present with distal symptoms. All patients presenting for barium swallow underwent examination of the pharynx and oesophagus. The pharyngeal examination included spot films of the pharynx as well as views of the pharyngo-oesophageal segment filmed at three frames per second. During the 18-month period of the present study interrogations were carried out to identify patients without symptoms in the cervical or suprasternal region. One hundred and twelve patients were identified; 58 were male and 54 were female. The age range was 18-84 years. Examinations revealed abnormalities within the pharynx in 42 patients (38%); of this group of 42, 34 also had an oesophageal abnormality. The majority of the pharyngeal findings were minor. There were, however, three patients who each had a pharyngeal abnormality (pharyngeal carcinoma, obstructive cricopharyngeal narrowing, pharyngo-oesophageal junction stricture) as well as an oesophageal lesion (hiatal hernia, achalasia, reflux oesophagitis), either of which may have been the source of the symptoms. The remaining eight patients (7%) of this group of 42 with detected pharyngeal abnormality had normal oesophageal examinations. Most of these were again minor changes and were unlikely to be significant. There was, however, one patient in whom the only abnormality was an infiltrative cancer of the posterior wall of the pharyngo-oesophageal junction. In conclusion, the identification of patients in the present study with pharyngeal lesions and without distal abnormal findings indicates that a proximal lesion may present with downstream symptoms. Furthermore, there were also patients in whom the examination found abnormalities in multiple segments of the pharynx and oesophagus. We suggest that examination of the pharynx is warranted as part of the barium swallow in patients without cervical or suprasternal symptoms.
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PMID:Value of pharyngography in patients without suprasternal symptoms. 1110 36

Although adenocarcinoma of the cardia is extremely rare in adolescent patients, the endoscopist should be alert to this disease in patients of any age with dysphagia, even if symptoms, and results of a barium study, upper endoscopy, and esophageal manometry are suggestive of primary achalasia, especially if family history is negative for achalasia. In addition, secondary achalasia should be suspected in patients who do not respond to therapy with botulinum toxin within 2 months. Because none of the mentioned tests can distinguish between primary achalasia and secondary forms due to carcinoma of the cardia, biopsy specimens should be obtained. It appears that, although there is a minimal risk for complications, a diagnostic procedure such as biopsy would be appropriate when the information obtained could be essential. In some cases EUS can be an additional diagnostic tool, because lesions of the submucosa and the surrounding area can be identified by EUS.
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PMID:Gastric adenocarcinoma mimicking achalasia in a 15-year-old patient: a case report and review of the literature. 1117 37

The optimal treatment of achalasia includes several options and presents a challenge for most gastroenterologists. There are numerous patient variables that must be assessed including age, degree of symptoms, duration of disease, desires of each patient, and related comorbidities. Treatment includes both medical and surgical options, with medical therapy further subclassified into pharmacologic and pneumatic dilation. Pneumatic dilations with a polyethylene dilator (sizes of 3.0, 3.5, and 4.0 cm) and laparoscopic myotomy represent the most common forms of therapy. A graduated increase in dilator size, based on symptomatic response, minimizes complications and is successful in more than 90% of patients. Further dilations or adjustment of pharmacologic therapy should be based on symptoms, weight gain, and a timed barium meal. Referral for myotomy should be considered for patients who do not respond to medical therapy or individuals that do not desire pneumatic dilations. Most patients responding to botulinum toxin (Botox; Allergan, Irvine, CA) injections will require repeat treatment at 3- to 6-month intervals. Due to cost constraints, Botox therapy should be reserved for patients who are at an increased risk from possible complications of a dilation or surgery, or those with less than 2 years of life expectancy. The most cost-effective course of therapy per patient cured over a 5-year period is pneumatic dilation, then Botox, and finally laparoscopic myotomy.
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PMID:Achalasia. 1117 86

Apart from gastroesophageal reflux disease, achalasia, non-cardiac chest pain and functional dysphagia are the most important manifestations of disturbed esophageal motility. Achalasia is characterized by esophageal aperistalsis and impaired deglutitive relaxation of the lower esophageal sphincter. The morphological correlate is a degeneration of nitrergic neurons in the myenteric plexus. Diagnosis is based on barium esophagram or esophageal manometry with the latter setting the gold standard. Endoscopic exclusion of a tumor at the gastroesophageal junction is mandatory. Appropriate therapeutic interventions are pneumatic dilatation or (laparoscopic myotomy) of lower esophageal sphincter. In patients unfit for these procedures endoscopic injection of botulinum toxin into the lower esophageal sphincter is appropriate. Non-cardiac chest pain may be of esophageal origin. Gastroesophageal reflux, spastic motility disorders and visceral hypersensitivity are arguable underlying mechanisms. The most important diagnostic procedure is 24 h esophageal pH metry correlating symptoms and reflux episodes. Proton pump inhibitors and tricyclic antidepressants serving as visceral analgesics are appropriate therapeutic approaches. Functional dysphagia defines the sensation of impaired passage without mechanical obstruction or a neuromuscular disease with known pathology, e.g. scleroderma. Impaired transit is proven by esophageal scintigraphy or radiogram both using solid boluses. Manometry assesses the underlying mechanisms.
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PMID:[Diagnosis and treatment of esophageal motility disorders]. 1130 49

Diagnostic evaluation for achalasia in patients with dysphagia begins with barium esophagography to evaluate for an anatomic lesion of the esophagus or the gastric fundus. Most of the patients with achalasia can be detected with an initial radiologic approach. Esophageal manometry, however, remains the gold standard for the diagnosis of achalasia and is important for patients for whom a correct diagnosis is uncertain or essential. The article reviews these and other diagnostic tests that may be used in evaluating patients suspected of having achalasia.
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PMID:Diagnostic modalities for achalasia. 1131 63

Determining success after achalasia therapy is an important aspect of treating this disease. Esophageal manometry, scintigraphy, and barium esophagram are the most commonly employed techniques. Recent data suggest that barium esophagram may be most practical and informative compared to manometry and scintigraphy in predicting treatment success in achalasia patients after therapy.
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PMID:Quantitative methods to determine efficacy of treatment in achalasia. 1131 70

We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgitation, cough, and 10-kg weight loss caused by an epiphrenic diverticulum associated with esophageal achalasia managed with a laparoscopic approach. A preoperative barium swallow showed a dilated sigmoid esophagus with a 6-cm epiphrenic diverticulum. Esophageal manometry confirmed the absence of peristalsis in the esophageal body. We performed a laparoscopic diverticulectomy and a 7-cm distal esophageal myotomy with a Dor fundoplication. The postoperative course was uneventful. On the third postoperative day a barium swallow showed no leak, and the patient started oral intake. She was discharged home 5 days after the operation free of symptoms and tolerating a soft diet. Sixteen months after surgery, she was asymptomatic and had gained 8 kg. A barium swallow showed a normal-size esophagus with regular emptying. We reaffirm the feasibility, safety, and efficacy of the laparoscopic diverticulectomy and distal myotomy with Dor fundoplication to manage epiphrenic diverticula resulting from esophageal achalasia.
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PMID:Laparoscopic approach for esophageal achalasia with epiphrenic diverticulum. 1133 Mar 75


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