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Query: UMLS:C0154059 (Esophagus)
 2,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 28-year-old man had been dysphagic for 9 months with a weight loss of 4 kg. A preliminary diagnosis of primary achalasia was made on the basis of typical radiological and manometric findings. Despite balloon dilatation of the cardia the symptoms did not improve and further diagnostic tests were performed. Ultrasound demonstrated a 4 cm tumour below the cardia. But its type and possible malignancy remained uncertain even at laparotomy. But as a malignant tumour was suspected a gastrectomy and omentectomy with removal of the local and regional lymph nodes were performed. After this the symptoms regressed and postoperative food intake was without problem. Histological examination of the surgical specimen revealed leiomyomatosis of the cardia and the gastric fundus, combined with a low-malignant B-cell lymphoma of the mucosa-associated lymphatic tissue. Oesophagus manometry 4 months postoperatively gave normal results. The patient has been free of symptoms and without evidence of recurrence for by now 18 months postoperatively.
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PMID:[Secondary achalasia in non-Hodgkin's lymphoma of low malignancy and leiomyomatosis of the cardia]. 150 59

The authors reported seven cases of megaesophagus by achalasia in children treated by transabdominal esophagomyotomy. There were five girls and two boys. Nor infantile neither familial forms were seen. Five children were cured clinically and radiologically at the third post operative month. Two failures were successfully treated by Thal's procedure. We concluded: (1) Infantile achalasia is not rare in recent literature; recurrent respiratory troubles and familial forms are frequent; prognosis is serious in this age groups. (2) Esophagus's width divided by thoracic vertebral corpus's height is a more objective criteria to appreciate megaesophagus's importance than esophagus's width alone. (3) Endoscopic biopsy is inadequate to detect tracheo bronchial remnants. (4) Appropriate treatment in children is surgical esophagomyotomy with fundoplication.
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PMID:[Megaesophagus by achalasia in children (seven cases) (author's transl)]. 707 22

A lateral esophagocardiomyotomy extending from the level of inferior pulmonary vein to 3 cm on to the fundus of stomach for achalasia of esophagus was combined with a flap-valve constructed at the gastroesophageal junction. A total of 69 consecutive patients of achalasia cardia were subjected to this procedure between 1980 and 1994. There was no mortality. In a follow-up of up to 14 years, 73.9% patients had excellent results and 26.1% had good results. Recurrence of dysphagia and hiatus hernia were not detected and clinical, radiological and endoscopic studies did not show evidence of any significant gastroesophageal reflux.
Dis Esophagus 1997 Jan
PMID:Incorporation of a flap-valve at cardia, with esophagocardiomyotomy, for achalasia of the esophagus. 907 73

Two cases of a rare combination of conditions, achalasia and adenocarcinoma in Barrett's esophagus are reported. Cancer developed 26 years after the onset of gastroesophageal reflux in one and 30 years after esophagomyotomy in the other. Twenty-one cases of Barrett's esophagus and achalasia have now been reported; adenocarcinoma developed in six patients. Only one has survived more than five years after treatment. Long-term surveillance of patients with achalasia is recommended.
Dis Esophagus 1997 Jan
PMID:Esophageal achalasia and adenocarcinoma in Barrett's esophagus: a report of two cases and a review of the literature. 907 76

Absence of the peristaltic contractions in the esophageal body and the failure of the lower esophageal sphincter (LES) post-deglutitive relaxation are the major motor disturbances in patients with achalasia. These alterations are usually evidenced by means of stationary esophageal manometry, which is able to record changes over a brief period. The aim of this work has been to study the circadian esophageal motor activity of the esophageal body in patients with achalasia, using a non-perfused ambulatory manometry system. Ten patients with untreated esophageal achalasia (dilatation < or = 5 cm) had a 24-hour ambulatory esophageal manometry. The portable recording system consisted of a computerized data logger and a probe with four microtransducers 5 cm apart, the distal one being positioned 5 cm above the LES. A microtransducer, positioned 1 cm below the upper esophageal sphincter, recorded the swallow activity. Contractions frequency (n/min), mean amplitude (mmHg), mean duration of contraction (sec), percentage of contraction > 7 sec, percentage of multipeaked, repetitive and isolated contractions, and percentage of peristaltic and simultaneous sequences were evaluated and analysed during the following periods: meal-time (MT); upright (UP); supine night-time (NT). On the basis of the relationship with swallows the contraction events were classified as post-deglutitive or spontaneous. The data out of a group of 65 normal subjects were used as control. Student's t-test and Wilcoxon's rank-sum test were used for statistical analysis. Peristaltic sequences were detected in all patients, 27.8 +/- 12.6% of the total, and the 19.5 +/- 11.06% of these were complete. Moreover primary peristaltic sequences were present in 33.1 +/- 23.4% of all peristaltic sequences. In contrast to current trends, our results show surprisingly the presence of peristaltic activity in patients with achalasia (27.9% MT; 26.9% UP; 28.1% NT). We believe these results are related both to the use of an ambulatory system, which allows 24-hour monitoring and to the use of microtransducers, which are able to detect motor events with great accuracy. These motor events are usually not detectable by stationary perfused systems.
Dis Esophagus 1997 Apr
PMID:24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus. 917 83

Pseudoachalasia is a rare entity with symptoms and radiographic and esophageal manometric findings that may mimic primary achalasia. Two such cases are presented, one of which was associated with gastric carcinoma and the other with carcinoma of the lung.
Dis Esophagus 1997 Jul
PMID:Pseudoachalasia: a report of two cases with comments on possible causes and diagnosis. 928 84

In order to improve the results of functional surgical procedures on the esophagus, the authors, after a number of experimental studies, proposed the use of intraoperative esophageal manometry (IEM). The technique was performed for the first time in 1972. IEM has been employed in the course of Heller's cardiamyotomies and Nissen-Rossetti (N-R) fundoplications, respectively, to document the ablation of the lower esophageal sphincter (LES) high-pressure zone (HPZ) and to calibrate the pressure of the fundal wrap between values ranging from 20 to 40 mmHg ('hypercalibrated Nissen'). This hypercalibration resulted from the retrospective evaluation of a former series when, at the beginning of our experience, we used to calibrate the fundoplication to pressure values similar to those of a normal sphincter ('normocalibrated Nissen': 10-20 mmHg). This experience, in fact, was followed by a high rate of gastroesophageal reflux (GER) recurrence (28.5%) in the first 12 months after surgery. Since 1985 to date, IEM has been employed in the course of 309 functional surgical procedures on the esophagus. This paper, however, reports on 281 patients: 144 with achalasia treated with Heller's myotomy + Nissen-Rossetti fundoplication and 137 with gastroesophageal reflux disease (GER-D) submitted to Nissen-Rossetti fundoplication. Our data suggest that IEM can be a useful tool in the field of functional surgery of the esophagus, and its routine use seems to be able to improve the postoperative results. In this series, in fact, IEM was able to detect the persistence of an HPZ in 15.2% of apparently complete myotomies, all performed with the aid of intraoperative endoscopy. As regards the manometric calibration of the n-HPZ, our results seem to confirm the validity of the technique, yet some findings still remain unexplained: i.e. two patients with a hypotonic n-HPZ and GER recurrence and two with an n-HPZ, exceeding 20 mmHg with postoperative persistent dysphagia. Finally, we would like to emphasize that the concept of a 'hypercalibrated Nissen' contrasts with the 'floppy Nissen' of Donahue and DeMeester; our wrap is also loose around the esophagus and does not impair the esophagogastric transit.
Dis Esophagus 1997 Oct
PMID:Intraoperative esophageal manometry: our experience. 945 52

Almost 10% of patients with Crest syndrome associated with severe gastroesophageal reflux and 5-10% of patients with failed cardiomyotomy for achalasia present with cardial or distal esophageal organic stricture. Some of these cases are poor risk patients for surgery and therefore the surgeon must offer a safe procedure with low morbimortality, keeping in mind the pathophysiological motor pattern of these patients. In order to treat the stricture to improve the esophageal transit we treated patients with esophagocardioplasty associated with vagotomy-antrectomy and Roux-en-Y gastrojejunostomy, thereby avoiding the potential acid or biliary reflux in poor risk patients in whom esophagectomy would be a very deleterious procedure. All four patients had a good postoperative evolution and late control demonstrated good esophagogastric transit with no postoperative esophagitis.
Dis Esophagus 1998 Jan
PMID:Esophagocardioplasty, vagotomy-antrectomy and Roux-en-Y gastrojejunostomy: indication in cases with severe esophageal motor disfunction. 959 36

In order to determine the endoluminal pressure force distribution, the pressure in the lower esophageal sphincter (LES) and esophageal body was recorded in healthy volunteers and patients with achalasia, using a new waterperfused circular four-channel-sleeve (FCS) manometry catheter. The median lower esophageal sphincter pressure (LESP) and interquartile range in healthy control subjects (group 1) was significantly higher in the left lateral quadrant: 37 (28-43) mmHg (channel III) (P < 0.001), in comparison to the right lateral: 24 (20-25) mmHg (channel I), anterior: 22 (18-30) mmHg (channel II), and posterior quadrant: 24 (22-28) mmHg (channel IV). The median LESP in achalasic patients (group 2) was significantly increased in channel I: 31 (27-36) mmHg, channel II: 35 (28-39) mmHg, and in channel IV: 29 (26-237) mmHg (P < 0.001) when compared to controls. The detected pressure of the left lateral quadrant of the LES was not found to be significantly different from controls: 38 (29-39) mmHg. The median contraction amplitude of healthy subjects was significantly higher when compared with achalasic patients (P < 0.001). In patients with achalasia (group 2) the median contraction amplitude of the proximal esophagus was significantly higher than the distal contraction amplitude. In contrast, healthy volunteers showed a reverse relationship. No asymmetric pressure force was detected with the FCS in the proximal or distal esophageal body in either group. In conclusion, the abolition of the normal manometric LES asymmetry in patients with achalasia might indicate regional variations of muscle functions in the high pressure zone of the gastroesophageal junction (GEJ).
Dis Esophagus 1998 Apr
PMID:Lower esophageal sphincter measurement in four different quadrants in normals and patients with achalasia. 977 69

We evaluated the relationship between radionuclide esophageal transit studies and barium swallow appearances in a group of patients following forceful balloon dilatation for the treatment of achalasia of the cardia. Paired erect radionuclide esophageal transit studies and erect barium swallows of a group of patients who had undergone pneumatic balloon dilatation for the treatment of achalasia were analyzed. Indices derived from the radionuclide transit study were the percentage of maximum activity remaining in the esophagus 30 s after swallowing a dilute volume of tracer (A30 s) and the percentage of retained activity remaining at 100 s after washout with a bolus of water (A100 s). Indices derived from the barium swallow were a subjective grading of the degree of esophageal dilatation on a 4-point scale and a similar grading of the maximum distensibility of the gastroesophageal channel. Twenty five pairs of radionuclide and barium studies in 18 patients were analyzed. There was statistically significant correlation between the amount of retained activity on the radionuclide studies and degree of esophageal dilatation on the barium studies (r = 0.69 for A30 s, r = 0.56 for A100 s, P = < 0.01). There was no correlation between the amount of retained activity on the radionuclide studies and the degree of distension of the gastroesophageal channel on barium studies. The relationship between the radionuclide esophageal transit curve and barium appearances of the esophagus following pneumatic balloon dilatation for the treatment of achalasia is complex. The transit study provides unreliable information about the distensibility of the gastroesophageal channel and should not be relied upon in isolation for assessment of the efficacy of treatment.
Dis Esophagus 1998 Jul
PMID:A comparison of barium swallow and erect esophageal transit scintigraphy following balloon dilatation for achalasia. 984 1


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