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

Recent developments in video camera techniques, new instruments and advanced surgical techniques have increased the importance of thoracoscopy in both the diagnosis and therapy of diseases of the chest. Many diseases previously demanding open thoracotomy (i.e. spontaneous pneumothorax, biopsies of lung, pleura and mediastinum, several benign intrathoracic tumours, achalasia and reflux disease of the esophagus) can, today, be treated by video-assisted thoracic surgery with the same results as by using open procedures. The advantages of this technique compared to open thoracotomy include less operative trauma, less postoperative pain, good cosmetic results and shorter hospital stay. The drawbacks are the more difficult technique, demanding special education, the possibility of inadequate radicality in the treatment of malignant diseases and the necessity of longer operating time. The physician performing thoracoscopic surgery must also master the techniques of open procedures.
Ann Med 1994 Dec
PMID:The role of videothoracoscopy in the diagnosis and treatment of chest diseases. 769 64

In the framework of an epidemiologic study we collected data on all the 162 patients with achalasia in central Israel. The mean (+/- SD) follow-up was 9.9 +/- 8.7 years (range 1-52). At the last, as compared to the initial examination, the clinical condition of the patients had improved: 38% were without dysphagia as compared to 0% initially, 67% did not vomit and 92% did not complain of aspiration as compared to 17% and 68% initially, and 67% did not complain of chest pain as against 36% initially. In contrast, X-ray examinations, endoscopy as well as manometry did not show major changes. Esophageal retention of a semisolid radiolabeled meal 10 min after ingestion was 46 +/- 25% initially and 34 +/- 26% at last examination (NS). Medical therapy was given to 99 patients and a beneficial response was initially noted in 65% of them. About 88.7% had a beneficial response to surgery and 82.7% to pneumatic dilatations which were associated with a 7.3% perforation rate. Overall the clinical course of this unselected, regional group of patients was better than expected.
Isr J Med Sci 1994 Dec
PMID:Achalasia in central Israel, 1973-83: clinical aspects. 800 68

This article presents the normal physiology of esophageal peristalsis. It discusses current approaches to the diagnosis and treatment of primary disorders of the esophagus, including achalasia, nutcracker esophagus, diffuse esophageal spasm, as well as the secondary disorder, scleroderma.
Surg Clin North Am 1993 Dec
PMID:Esophageal physiology and pathophysiology. 824 29

We have reported a rather extreme instance in which achalasia was misdiagnosed as a primary eating disorder. Our patient spent 2 months in a psychiatric institution before the correct diagnosis was made. Misdiagnosis in this case could have been avoided (1) if the symptoms of dysphagia had been elicited as part of her history, (2) if it had been recognized that the vomiting (her dominant symptom) was involuntary and not self-induced, (3) if the absence of disturbed body image had been appreciated, or (4) if it had been recognized that she did not meet accepted criteria for anorexia nervosa or bulimia. Our case and others like it in the literature also illustrate that achalasia frequently remains an elusive diagnosis.
South Med J 1993 Dec
PMID:Achalasia mistakenly diagnosed as eating disorder and prompting prolonged psychiatric hospitalization. 827 22

Achalasia is a motility disorder of the esophagus characterized by total loss of esophageal peristalsis and by defective lower esophageal sphincter function. The etiology of achalasia is poorly understood. Achalasia occurs across the lifespan, but is uncommon in children. Most patients have progressive dysphagia for both liquids and solids. This article describes the symptoms of achalasia, its diagnosis, and treatment. The emphasis is on primary achalasia. Case studies illustrate common findings in patients with achalasia. The importance of patient education for effective management of this chronic illness is discussed.
Gastroenterol Nurs 1993 Dec
PMID:Managing esophageal achalasia: medical and nursing implications. 828 27

Vigorous achalasia has been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the whole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients with vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS) were analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or good in all cases. Surgery induced a significant decrease (P < 0.01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be treated surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.
Br J Surg 1993 Dec
PMID:Short myotomy for vigorous achalasia. 804 73

This study evaluated the efficacy and safety of endoscopic pneumatic balloon dilatation as the initial treatment for achalasia of the cardia. 15 patients with achalasia underwent a total of 19 dilatations using the new polyethylene dilator (Microvasive Rigiflex Balloon Dilator) over the last 6 years. An overall treatment success rate of 93% was achieved. 11 patients (73.3%) have not required a further dilatation and 3 patients (20%) required between 1 and 2 further dilatations. Elective surgery was necessary in 1 patient. The mean follow-up period was 31.5 months. There was no complication or death attributable to the procedure. Endoscopic pneumatic balloon dilation is a safe and effective treatment for achalasia and should be considered as the initial treatment of choice in most patients with achalasia.
Med J Malaysia 1995 Dec
PMID:Endoscopic pneumatic balloon dilatation for achalasia of the cardia. 866 54

Achalasia is a motor disorder of the oesopagus characterized by decrease in ganglion cell density in Auerbach's plexus. The cause of the lesion is unknown. This is to repeat on the occurrence of autoimmune phenomena in patients with achalasia, in particular circulating antibodies against Auerbach's plexus and its possible meaning. IgG-antibodies against Auerbach's plexus were determined by standard indirect immunofluorescence. Antibodies to the cytoplasm of Auerbach's plexus were found in 37 of 58 patients with achalasia at variable stages of the disease (I-IV) with a disease duration ranging from 1 to 20 years but only in 4 out of 54 healthy controls (specificity 93%, sensitivity 64%, p < 0.0001), and in none of 12 patients with Hirschsprung's disease as well as 12 patients with cancer of oesophagus and only in one of 11 patients with peptic oesophagitis as well as in one of 13 patients with myasthenia gravis. The present observations suggest that autoimmunity to Auerbach's plexus plays a role in the pathogenesis of achalasia, the mechanism of action is unknown.
Cell Mol Biol (Noisy-le-grand) 1995 Dec
PMID:Autoantibodies to Auerbach's plexus in achalasia. 874 84

Achalasia is a primary esophageal motor disorder characterized by lack of esophageal peristalsis and poor lower esophageal sphincter (LES) relaxation. Clinically, achalasia manifests as progressive dysphagia to solids and liquids and mild weight loss. Predisposition to esophageal cancer is not prevalent, but certain tumors may mimic achalasia. The diagnosis of achalasia is relatively easy to make with a good history, radiography, and esophageal motility testing. The esophagogram reveals a typical bird-beak narrowing of the esophagogastric junction and esophageal dilation, the degree of which depends on the stage of the disease. Esophageal manometry reveals poor LES relaxation, aperistalsis, and often elevated intraesophageal pressure. Endoscopic examination is important to rule out malignancy as the cause of achalasia. The traditional treatment of achalasia is forceful dilation of the LES. Bougienage may be helpful in some cases. Pharmacological agents, such as nitroglycerin and calcium channel blockers, provide some relief by decreasing LES pressure. However, they are not a viable, long-term choice. Surgical myotomy offers slightly better results than pneumatic dilation, but it is accompanied by some increased gastroesophageal reflux. Laparoscopic and thoroscopic myotomy are in their infancy, and, if successful, they will make surgical treatment much more attractive. Intrasphincteric botulinum toxin injection is the newest form of therapy. Its safety and ease of administration are very encouraging, but long-term results are not available.
Gastroenterologist 1995 Dec
PMID:Achalasia. 877 90

New and future indications for the treatment of disorders of the alimentary tract using local injections of botulinum toxin are reviewed. Clinical experience shows that overactive smooth muscle sphincters may be weakened to treat disorders such as achalasia or chronic anal fissure. By contrast, injections placed into the sphincter of Oddi have proven less effective for postcholecystectomy pain syndrome. Experimental evidence suggests that food intake may be reduced by weakening the distal stomach with botulinum toxin. This approach may possibly lead to the treatment of obesity. There are some new possible indications for the use of botulinum toxin on the alimentary tract, and infantile hypertrophic pyloric stenosis seems to be the most promising new development.
Aliment Pharmacol Ther 1995 Dec
PMID:Review article: the use of botulinum toxin in the alimentary tract. 882 46


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