Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report their experience with 43 patients treated for achalasia of the esophagus in a general hospital between 1971 and 1986. Patients were divided into two groups according to the type of surgery performed: group 1--29 patients treated by Heller myotomy, performed by nine general surgeons between 1971 and 1983; and group 2--14 patients treated by transthoracic Heller myotomy with the addition of a Belsey Mark-IV fundoplication. Dysphagia was reduced postoperatively in 82.6% of patients in group 1 and 92.8% of patients in group 2. Three patients in group 1 and one patient in group 2 had persistent dysphagia. Ten patients in group 1 had symptoms of gastroesophageal reflux (5 of them required a second antireflux procedure). In group 2, one patient had symptoms of gastroesophageal reflux, but was treated successfully medically. There was no difference in the degree of relief of dysphagia between the abdominal and thoracic approach, or in whether the operation was performed by a general surgeon without specific experience in the treatment of achalasia. The addition of a fundoplication to a Heller myotomy appeared to lessen the problem of postoperative gastroesophageal reflux. Since the Heller myotomy is technically difficult and may lead to obstruction of the poorly emptying esophagus the authors recommend that it be used selectively and only by the experienced esophageal surgeon.
 ...
PMID:Surgical treatment of achalasia in a general hospital. 191 96

The achalasia is an uncommon pathology in childhood but the disturbances in growth, development and the severity of pulmonary symptoms are more severe than adults. In a period of twenty five years we have diagnosed three children of sixteen months, 4,5 and twelve years of achalasia and treating them with a modified Heller procedure as primary therapy adding anti-reflux procedure in the youngest. Literature review indicates excellent results following modified Heller's operation in more than 85 per 100 of cases. When an anti-reflux procedure is not performed the incidence of gastro-oesophageal reflux in childhood is 20 per 100.
 ...
PMID:[Esophageal achalasia in children]. 193 88

A series of six patients with congenital esophageal stenosis associated with esophageal atresia (EA) and distal tracheoesophageal fistula is presented. Three patients required only repeated dilatations, and have had good results. Two patients required limited resections of the distal esophagus, with excellent results. One patient died following a Heller myotomy. Tracheobronchial rests were present in the distal esophagus in the latter three patients. Diagnosis of congenital distal esophageal stenosis following repair of EA requires a high index of suspicion and a careful review of previous esophagrams. It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy, and esophageal pH monitoring. Once a congenital basis for distal esophageal stenosis is suspected, management consists of dilatation by bouginage followed by balloon dilatation. Resection is reserved for persistent stenoses from tracheobronchial rests, which usually do not respond to dilatations.
 ...
PMID:Distal congenital esophageal stenosis associated with esophageal atresia. 205 11

Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.
 ...
PMID:[Intraoperative esophageal manometry]. 206 83

The intraoperative esophageal manometry (IEM) has been used to improve results in operative management of gastroesophageal reflux and achalasia. The IEM pointed out the necessity to perform an antireflux procedure with an intraoperative sphincter pressure higher than normal, because the measured postoperative sphincter pressures were one-half the intraoperative values measured after repair. Nevertheless some authors failed to find any correlation between intraoperative and subsequent postoperative sphincter pressure measurements. The Authors, in their experience, achieved the same results with and without IEM in the surgical management of gastroesophageal reflux and achalasia. For this reason The IEM does not seem to be necessary when performing the standard Nissen or Heller procedure. It is probably useful in the surgical treatment of patients with motor disorders or sclerodermia associated with reflux and in patients who have had multiple prior operations for reflux or achalasia.
 ...
PMID:[Intraoperative esophageal manometry]. 206 84

The purpose of this investigation was to verify the suitability of intra-operative manometry in the course of functional surgery of the esophagus, especially with reference to the results obtained in terms of sphincter functionality, related to the overall changes in symptoms and pH-metry. The practice disclosed herein refers solely to the Heller-Dor operation for esophageal achalasia and to the Nissen Rossetti operation for gastro-esophageal reflux. The promising results obtained using this method to achieve a complete myotomy during Heller's operation, in our opinion testify in favor of its usefulness with this type of surgical procedure. On the contrary, for preparing a fundoplication we feel that method is of orientative value only, since there is no correspondence between the values obtained at the end of the fundoplication and those recorded 18 to 24 months after surgery. The predictive nature of the examination is thus denied.
 ...
PMID:[Intraoperative manometry during functional surgery of the esophagus]. 206 86

Esophageal disease has been reported in 70% to 90% of patients with scleroderma, of whom nearly 50% will have reflux esophagitis. The combined motility disorder of low LES pressure and aperistalsis of the esophageal body makes scleroderma patients especially susceptible to severe gastroesophageal reflux disease (GERD). Symptomatic GERD is a common problem in pregnancy, affecting 30% to 50% of women. Hormonal effects of estrogen and progesterone likely promote GERD by compromising LES function. Fortunately, the problem is usually relieved with delivery of the baby. Although difficult to quantitate, the reflux of both acid and especially alkaline material may be a common sequela of many types of gastric surgery. Medical therapy binding bile salts usually does not bring relief. The Rouxen-Y biliary diversion operation is the best solution for this problem. GERD complicates the treatment of achalasia after 10% of Heller myotomies and 2% of pneumatic dilatations. Nearly 50% of patients with the Zollinger-Ellison syndrome have esophagitis, which may be more difficult to treat than their ulcer disease.
 ...
PMID:Medical and surgical conditions predisposing to gastroesophageal reflux disease. 222 65

Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastro-esophageal reflux disease.
 ...
PMID:Esophageal adenocarcinoma in a patient with surgically treated achalasia. 225 39

This review describes our use of the Dor operation in the management of 22 patients with achalasia of the cardia over the period 1970 to 1989. There was a male to female ratio of 1.8:1. All presented with dysphagia of varying degree, with regurgitation (86%), weight loss (73%), pain (59%) and chest infections (14%) being associated symptoms. Two patients had undergone previous balloon dilatation, with temporary benefit. The morbidity was low and follow-up results were good in 94% of cases. None of the patients had symptoms of gastro-oesophageal reflux in the postoperative period. In our experience, the Dor modification of the Heller operation has yielded gratifying results.
 ...
PMID:Surgery for achalasia cardiae: the Dor operation. 233 94

We analyzed the course of 79 adult patients treated for achalasia between 1977 and 1988. Sixty-six patients (84%) had pneumatic dilatation as the primary therapy. Fifty-three patients (80%) had immediate improvement in swallowing. Three patients required immediate redilatation, 2 developed pulmonary aspiration, and 8 (12%) suffered esophageal perforation. Esophageal perforation was treated by closure plus Heller's myotomy in 3 patients, closure only in 3, chest tube in 1, and antibiotics and nasogastric suction in 1. At 4 years' follow-up, 50% of patients who had dilatation remained asymptomatic, 30% had symptoms of gastroesophageal reflux, and 20% had persistent dysphagia. Eight Heller myotomies were performed, with excellent results in 7 and 1 postoperative death from respiratory failure. Seven additional patients with disabling esophageal symptoms after multiple operations for achalasia were ultimately treated by esophagectomy (n = 5), hemigastrectomy and Roux-en-Y gastrojejunostomy (n = 1), and repeated myotomy (n = 1). All recovered and are able to eat solid food. Thus, our experience indicates that pneumatic dilatation remains unperfected (ie, the line between undertreatment and overtreatment is finer than generally recognized), and unless improvements can be made, the role for surgery may need to be reexpanded.
 ...
PMID:The treatment of achalasia. A current perspective. 275 5


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