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

In the present paper we have reviewed the results of forceful dilatation as compared with surgical esophagomyotomy in patients with achalasia. The review of 4 retrospective and uncontrolled studies revealed that in all, surgery produced a more effective late result than dilatation, with minimal side effects and very low or no mortality. In the only prospective randomized study comparing both treatments by the same group, good late results were seen after surgery in 95% of the cases, as compared with 65% after dilatation (p less than 0.001). The resting gastroesophageal sphincter pressure was predictive of the quality of the late results. Reflux occurred in 8% of the dilated and in 19% of the operated group as measured by standard acid reflux test. The old, classical concept that dilatation is the first choice and preferable method of treatment for patients with achalasia should be reviewed, and the idea that surgery should be reserved only for patients in whom dilatation has failed should be abandoned. We propose that surgical treatment should be the initial choice in the majority of patients with achalasia of the esophagus.
Hepatogastroenterology 1991 Dec
PMID:Comparison of forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. 177 78

Evidence is not available for a surgeon to be certain that one form of procedure is better than another in preventing reflux after myotomy of the lower esophageal sphincter in patients with achalasia. Therefore, each surgeon should choose the procedure and approach which he performs most competently. Well respected authorities in this field continue to advocate the performance of an antireflux procedure, or advocate that it is unnecessary to use a routine antireflux procedure. It is the author's own practice to add an antireflux procedure in the form of a partial fundoplication, in all patients having a myotomy of the lower esophageal sphincter. Sometimes there are factors which dictate one or other of the thoracic or abdominal approach, e.g. previous surgery, very obese patient, etc. When no such factors are present I favor the abdominal approach in the belief that an abdominal incision provides less morbidity than a thoracic incision.
Hepatogastroenterology 1991 Dec
PMID:Gastro-esophageal reflux following myotomy for achalasia. 177 79

Achalasia of the esophagus is a relatively rare problem in children, but it may be the cause of severe lung disease, growth retardation and respiratory death in young infants. Surgical esophago-cardio-myotomy remains the treatment of choice, and this article details 25 years of experience with 35 children with achalasia of the esophagus and their late post-operative follow-up. The occurrence of achalasia in the first six months of life, the existence of a familial factor, the prevalent possible association with genetic diseases (familial dysautonomia, glucocorticoid insufficiency, Rozycki syndrome) suggest that achalasia in childhood may in certain cases represent a congenital problem, somewhat different from the adult form, which is considered to be an acquired disease.
Hepatogastroenterology 1991 Dec
PMID:Achalasia of the esophagus in childhood. Surgical treatment in 35 cases, with special reference to familial cases and glucocorticoid deficiency association. 177 80

Thirty consecutive patients with globus sensation who were referred to a psychosomatic clinic prospectively underwent otolaryngological, videokinematographic, and manometric examinations of pharynx and esophagus to evaluate whether morphological abnormalities or motility disorders underlay their symptom. When indicated by findings, 24-hour pH-metry, scintigraphy of bolus transport, and esophagogastroscopy were performed. Seven patients were shown to have achalasia, 10 had "hypochalasia" (lower esophageal sphincter relaxation less than 75% with esophageal contraction abnormalities but no complete distal aperistalsis), and 1 had diffuse esophageal spasms; 2 patients had also hyperplastic lingual tonsils, 1 had tonsillitis, and 1 had a cervical spondylophyte. Nutcracker esophagus and nonspecific contraction abnormalities were found in 7 patients, and gastroesophageal reflux with esophagitis and a low lower esophageal sphincter resting pressure was found in 1; only 3 patients had normal esophageal motility. None had volunteered dysphagic symptoms at primary evaluation. Psychometric investigations in consenting patients showed no higher mean scores for state and trait anxiety, depression, hysteria, and hypochondriasis than in general medical outpatients. Esophageal motor disorders may, before giving rise to dysphagia, be sensed more vaguely and induce the globus sensation. However, only disappearance of the sensation after treatment allows inferring an etiological significance of such a disorder.
Gastroenterology 1991 Dec
PMID:High incidence of esophageal motor disorders in consecutive patients with globus sensation. 195 17

A case of secondary achalasia due to renal cell carcinoma is presented. The patient presented with typical clinical, radiologic, and manometric features of achalasia, and was found to have a renal cell carcinoma with metastases to lymph nodes in the region of the cardioesophageal junction. Direct esophageal involvement could not be demonstrated, however. Complete symptomatic remission was obtained with a single hydrostatic balloon dilatation of the cardioesophageal junction and was maintained until the patient's death 7 months later, perhaps as a result of regression of paraesophageal nodal metastases following radiotherapy, immunotherapy, and chemotherapy.
Am J Gastroenterol 1991 Dec
PMID:Achalasia of the esophagus in association with renal cell carcinoma. 196 28

Two patients were referred because of persistent dysphagia which developed for the first time after Nissen fundoplication. Investigations, including oesophageal manometry, demonstrated the presence of achalasia in one case, confirmed histologically, and aperistaltic oesophagus associated with an underlying connective tissue disorder in the other case. Our observations highlight the importance of assessing oesophageal motility before referring patients for anti-reflux surgery and illustrate the effect of such surgery on patients in whom oesophageal dysmotility was not suspected.
Postgrad Med J 1990 Dec
PMID:Aperistaltic oesophageal disorders unmasked by severe post-fundoplication dysphagia. 208 51

In two patients with achalasia we found intermittent, complete lower oesophageal sphincter (LES) relaxations at manometric evaluation. These patients had no weight loss, minimal oesophageal dilation, lower LES pressure and faster radionuclide oesophageal emptying when compared with other achalasia patients. Concurrent performing of radionuclide oesophageal emptying and manometry showed that the complete relaxations (CRs) were too short and functionally unsuccessful. Our findings suggest that these patients may be at an earlier disease stage and that intermittent CRs of LES may occasionally occur in achalasia.
Ital J Gastroenterol 1990 Dec
PMID:Are the lower oesophageal sphincter relaxations in achalasia always incomplete? A manometric and scintigraphic study. 213 52

A 4 month old girl with oesophageal achalasia was successfully treated with a single pneumatic dilatation. A subsequent barium swallow showed almost normal oesophageal caliber. During the following eighteen months, vomiting and feeding problems did not recur.
Ital J Gastroenterol 1990 Dec
PMID:Infantile achalasia treated by pneumatic dilatation. 213 54

An extremely rare clinical syndrome on a 7-year-old girl is presented. Besides isolated glucocorticoid insufficiency, achalasia and alacrimia disturbance of the lipid metabolism was also detected--this is a special feature of this case. The details of the endocrine workup is discussed, providing clues for the possible pathomechanism. The correct diagnosis and specific therapy is of utmost importance in the everyday life of the patient.
Orv Hetil 1990 Dec 16
PMID:[Simultaneous occurrence of selective ACTH deficiency , achalasia, alacrimia and hyperlipoproteinemia]. 217 79

A patient with a giant lipoma of the esophagus presented with progressive dysphagia and odynophagia, fever, and recurrent melena. Two years previously, when the symptoms were less pronounced, it had been misdiagnosed as achalasia. After surgical removal of the lipoma, the patient became symptom free.
Am J Gastroenterol 1990 Dec
PMID:Pedunculated giant lipoma of the esophagus. 225 27


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