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

We describe the results of pharyngeal and upper esophageal sphincter (UES) manometry, using new solid-state computerized technology in 19 patients with achalasia, compared with 14 healthy controls. The major manometric finding in achalasia is an increased residual pressure in the UES. Other differences seen in patients with achalasia include a reduction in the duration of UES relaxation with swallowing and a more rapid onset of pharyngeal contraction after UES relaxation. We review previous descriptions of suspected pharyngeal and UES abnormalities in achalasia and compare them to our own.
Am J Gastroenterol 1992 Dec
PMID:Abnormal upper esophageal sphincter function in achalasia. 144 31

From 1978 to 1983, 17 patients had an esophagocardiomyotomy with an added short total fundoplication as an antireflux procedure. Thirteen had achalasia and 4, diffuse esophageal spasm. All patients initially had the usual symptoms of these motor disorders. Early after the operation all became asymptomatic, but over the years of follow-up, symptoms reappeared in 14 of 17 patients, and 5 required reoperation. The distal esophageal transverse diameter showed progressive dilatation from 3.9 cm preoperatively to more than 6 cm after 10 years of evolution. Over the same period, deterioration in the esophageal emptying capacity caused esophageal stasis to increase from 32% to 75%. Manometric changes were significant after the operation: resting pressures in the esophageal body decreased from 10.5 to 4.4 mm Hg (p < 0.001) proximally and from 12.2 to 4.6 mm Hg distally (p < 0.001). Peak contraction pressures became significantly weaker: 38 to 30 mm Hg in the proximal esophagus (p < 0.001) and from 49.2 to 28.1 in the distal esophagus (p < 0.001). Tertiary contractions were unchanged distally, but peristalsis reappeared in more than 30% of all swallows in the proximal half of the esophageal body. The resting pressure gradient in the lower esophageal sphincter area was reduced from 25.5 to 7.4 mm Hg by the operation. This gradient remained stable over 10 years of follow-up. No significant acid exposure was documented in 8 patients undergoing 24-hour pH recordings after their operation. Endoscopy revealed dilatation and retention without evidence of reflux esophagitis damage. Total fundoplication when associated with esophageal myotomy results in improved symptoms in the early postoperative phase.(ABSTRACT TRUNCATED AT 250 WORDS)
Ann Thorac Surg 1992 Dec
PMID:Long-term effect of total fundoplication on the myotomized esophagus. 144 85

This prospective study investigates whether the effect of pneumatic dilation in patients with achalasia can be predicted on the basis of patient characteristics, type of treatment, or results of postdilation investigations. Over a period of 10 years, 54 consecutive patients with newly diagnosed achalasia were treated with pneumatic dilation and underwent pretreatment and posttreatment manometric, radiographic, and scintigraphic investigations. They were followed up every 2 years until the fall of 1991. Among the factors evaluated in the initial examination, only young age adversely affected outcome (P < 0.05). With the exception of the diameter of the dilating balloon, the treatment characteristics had a low predictive value. Postdilation lower esophageal sphincter pressure was the single most valuable factor for predicting the long-term clinical response (P < 0.0005). However, patients with high sphincter pressures and poor treatment results benefited from repeated dilations by having progressively longer remissions. It is concluded that young patients are poor candidates for pneumatic dilation, that treatment should be aimed at near complete inflation of the dilating bag, and that postdilation sphincter pressure may guide further treatment.
Gastroenterology 1992 Dec
PMID:Predictors of outcome in patients with achalasia treated by pneumatic dilation. 145 66

The long-term prognosis of expanding bag dilatation therapy using a Matsuo pneumatic bag dilator was evaluated in 163 cases of esophageal achalasia treated by this method over the 26-year period from 1964 to 1989. In all these cases, one year or more had passed since therapy. Practically no correlation was found between the efficacy of the therapy and the grade of esophageal dilation prior to therapy, the previous history of symptomatic distress or the number of dilatations performed. The efficacy of expanding bag cardial dilatation was most obvious in the increase of body weight, 59 cases (36.2%) showing an increase of 1-5 kg and 48 cases (29.4%) showing an increase of 6-10 kg. The therapy was rated "highly effective" in 61 cases (37.4%) and "effective" in 60 cases (36.8%), i.e. it was effective in a total of 121 cases (74.2%). It was rated as being "ineffective" in 16 cases (9.8%) including 4.3% of cases in which an operation had been performed. This indicated that surgical operation of esophageal achalasia should be performed in those cases in which good long-term results were not obtained even after expanding bag dilatation therapy had been carried out several times.
Gastroenterol Jpn 1992 Dec
PMID:Long-term prognosis of patients with achalasia treated by cardial dilatation therapy. 146 3

Primary cricopharyngeal achalasia is a rare cause of dysphagia in the pediatric population. In a review of the literature, only 11 well-documented cases were discovered. We report the case of a newborn with cricopharyngeal achalasia who was successfully treated with a myotomy of the upper esophageal sphincter. A review of the literature is presented and treatment options are discussed.
J Pediatr Surg 1992 Dec
PMID:Primary neonatal cricopharyngeal achalasia: a case report and review of the literature. 146 54

The effect of a bolus intravenous administration of secretin (2.0 U/kg) on resting lower esophageal sphincter pressure (LESP) was investigated in seven patients with esophageal achalasia. Basal LESP before secretin injection in the patients was 60.1 +/- 3.4 mmHg (Mean +/- SEM), which was significantly higher than 26.9 +/- 2.5 mmHg in normal controls consisting of eight healthy volunteers. LESP significantly decreased within 1 min after the injection both in the patients and the controls. The maximum pressure change from each basal LESP was 31.2 +/- 5.2 mmHg in the patients, which was significantly greater than 12.1 +/- 1.8 mmHg in the controls. The effect of secretin disappeared within 5 min in the controls. The effect in the patients, however, lasted throughout the investigation time of 30 min. It is concluded that secretin has a long-acting effect on muscular relaxation of the lower esophageal sphincter in esophageal achalsia patients.
Gastroenterol Jpn 1991 Dec
PMID:Effect of secretin on lower esophageal sphincter pressure in patients with esophageal achalasia. 176 45

Long myotomy (6-8 cm) + partial fundopexy + posterior fixation with intraoperative manometry of the esophagus was performed in 23 cases of esophageal achalasia. These cases ranged from 24-72 years of age (average 42), 11 were males and 12 females. There were 19 primary cases and 4 postoperative cases of recurrence, and the period of their clinical courses ranged from 2 months to 23 years. Concerning the operative procedure, in 22 cases the approach was via an upper midline incision and 1 case the approach was via left thoraco-abdominal incision. Intraoperative manometry was performed to help in judging the extent of each manipulation. With the operative manipulation, the LESP is reduced to 13.0 +/- 6.0 mmHg (39% of the average preoperative value) and HPZ is elongated to 60.9 +/- 14.1 mm (155% of the average preoperative value). Moreover, post-operative manometry data resembled intra-operative data. The effectiveness of the procedure is judged on the basis of the chief complaints, esophagography, endoscopic examination, esophageal manometry and 24-hr pH monitoring. Patients are followed up at 2 weeks, 3 months and 1 year from the operation. Results showed 22 excellent cases (96.65%), 1 fair case (4.34%). These are better results than those of other reports that showed 50-60% excellent results and 30% good results (remaining slight passage disturbance). The reason for this difference is that we obtain sufficient LESP decompression effect (myotomy + submucosal layer ablation) based on intraoperative manometry. In the only case that we judged as fair (a reoperated case after Heller's operation) showed severe EGR totalling 213 min. on 24-hr pH monitoring of the esophagus in the postoperative period and was erosion also seen in the lower esophagus endoscopically. In this case, the LESP was 6.0 mmHg and its HPZ is 27.0 mm, showing a higher HPZ than the non-reflux group. Among the non-reflux group, LESP was as low as 6.0 mmHg, and this case had a remarkable long HPZ of 57.0 mm. In conclusion, even though the LESP is low, it is possible to prevent reflux if the HPZ is sufficiently long.
Nihon Kyobu Geka Gakkai Zasshi 1991 Dec
PMID:[Follow-up study of patients with achalasia treated by long myotomy + partial fundopexy + posterior fixation based on intraoperative manometry]. 177 98

Surgical treatment of patients with achalasia of the esophagus results in dramatic and permanent relief in almost 90% of the patients. The abdominal approach seems to produce more reflux than the thoracic route. There is evidence that extending myotomy more than 10 mm onto the stomach increases reflux. The length of the hypertensive gastroesophageal sphincter is almost 4 cms and an anterior esophagomyotomy of 5 to 6 cms is long enough in these patients. Extending the section 7 to 10 cms proximally would seem to be unnecessary and may provoke more reflux. The mortality rate of the surgical procedure is very low--less than 0.2%. Postoperative complications can occur in almost 4% of them, esophageal leakage being the most dangerous. The most frequent late complication is gastroesophageal reflux, which can occur symptomatically in 10% of the cases and by objective studies in almost 20% of the patients. The addition of antireflux surgery is controversial. If performed, it must be ensured that no obstruction can occur; esophageal emptying in an aperistalsic esophagus can be seriously delayed. Comparative studies suggest that the addition of antireflux surgery gives better results than myotomy alone. Surgeons performing this operative technique should be specialized digestive tract surgeons and familiar with manometric studies.
Hepatogastroenterology 1991 Dec
PMID:Results of surgical treatment of achalasia of the esophagus. 177 73

Achalasia is the best known primary motility disorder of the esophagus. Dysphagia is the main symptom, intermittent at the beginning, but becoming more marked with evolution. Although some peculiarities are noted, they are not sufficiently characteristic to establish the diagnosis. Chest pain is often associated with dysphagia and may be the prominent complaint in the early stage of the disease. Dynamic investigations, mainly esophageal manometry, are needed for the diagnosis and follow-up after treatment. Three findings are commonly recorded: increase in lower esophageal sphincter pressure, lack of relaxation and absence of peristalsis, the latter being indispensable for the diagnosis of achalasia. On the basis of manometric findings, achalasia is easily differentiated from other primary motility disorders, i.e. diffuse esophageal spasm, nutcracker esophagus, but non-specific esophageal motility disorders are frequent. Manometry is also an objective method of assessing the effectiveness of treatment--i.e. surgical myotomy or balloon dilatation--of the lower esophageal sphincter.
Hepatogastroenterology 1991 Dec
PMID:Clinical aspects and manometric criteria in achalasia. 177 74

The present-day treatment of achalasia is palliative and is aimed at reducing the lower esophageal sphincter pressure. Drug therapy with nitrates and nifedipine is beneficial for short-term relief in patients with relatively mild symptoms or as a temporary measure before a more definitive form of therapy. Balloon dilatation is the traditional non-surgical treatment of achalasia. Balloon dilatation is a safe procedure that can be used even when the esophagus is widened and tortuous, or when the patient is cachectic. The method of balloon dilatation used by the authors is described in detail. The immediate and late clinical, manometric and radiographic results of such dilatation are excellent and compare favorably with those of surgery. With balloon dilatation improvement is immediate, complications are rare and the risks are low. Morbidity and costs and the occurrence of stenosing reflux are considerably less than after surgical cardiomyotomy. Balloon dilatation is considered the treatment of choice for most patients with achalasia.
Hepatogastroenterology 1991 Dec
PMID:Non-surgical treatment of achalasia. 177 76


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