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

Patients with progressive or solid food dysphagia should be evaluated for the presence of an esophageal stricture. Barium esophagram and endoscopy can define strictures as benign or malignant. The majority of benign strictures are acid-related. Benign strictures are best managed by esophageal dilation with acid-suppressing medications if a peptic stricture is suspected. If dysphagia recurs, repeat dilation should be performed. There are a variety of interventions for refractory strictures which include injection of intralesional corticosteroids, temporary placement of self-expanding plastic stents and surgery.
Dis Esophagus 2005
PMID:Evaluation and management of benign esophageal strictures. 1633 4

Giant fibrovascular polyps are uncommon benign esophageal tumors almost always originating from the cervical esophagus, frequently from the upper esophageal sphincter. The case of a 74-year-old man with a long history of dysphagia and a weight loss of 9 kg is presented. Neither barium esophagogram, computed tomogram or magnetic resonance imaging correctly evidenced the lesion. Only fiberoptic endoscopy suggested the correct diagnosis because the mass fluctuated endoluminally with the spasm of vomiting. A left cervical exploratory incision with esophagotomy was performed following the experience of two previous similar cases. A giant fibrovascular polyp was observed and excised. If a malignant or benign extensive intramural tumor had been identified, a total esophagectomy would have been performed. In our opinion the possibility of the presence of a fibrovascular polyp should always be considered in the presence of an undetermined esophageal mass, and in these cases a left cervical incision is the preferred surgical access. Once the correct diagnosis is established, a major esophageal resection should always be avoided.
Dis Esophagus 2005
PMID:Giant fibrovascular polyp of the esophagus. 1633 14

This study compares the efficacy of porcine intestinal submucosa (SIS) patch graft versus SIS-tube graft in esophageal replacement, using a novel esophageal regeneration model. Clinical function, as well as macroscopic and microscopic morphology were evaluated in both SIS-treated groups. We performed semi-circumferential esophageal excision followed by repair of the defect using either a SIS-patch graft (group I) or segmental esophageal excision followed by a SIS-tube interposition graft (group II) in rats. The 28-day survival rate was significantly different between the SIS-treated groups (100% in group I vs. 0% in group II). Unlike the rats in group II, which died within the first postoperative month due to esophageal dysfunction, all surviving animals in group I resumed a normal solid diet within a few days after surgery, without signs of esophageal dysfunction and gained weight. Barium swallow studies showed no evidence of fistula, significant stenosis or diverticula. No hematological or serum biochemistry abnormalities were found. By day 150 the SIS patch was replaced by esophageal-derived tissues. In the rat model, a patch graft technique using SIS appeared to induce esophageal regrowth and provided an initial and long-term satisfactory function, while a tube-shaped graft technique using SIS was unsuccessful.
Dis Esophagus 2006
PMID:Esophageal replacement in rat using porcine intestinal submucosa as a patch or a tube-shaped graft. 1686 56

In this article we present our experience in the management of achalasia. From May 1988 through August 2005, 71 patients with achalasia underwent transabdominal esophagocardiomyotomy and partial posterior fundoplication. Barium swallow, manometry, and 24-h pH studies were performed in all patients preoperatively. Manometry and 24-h pH monitoring were only carried out in 58 patients at the third post-operative week and in 43 patients during follow-up, even though 52 patients were included in the follow-up. There were no operative deaths or complications. All the 71 patients were able to eat semifluid or solid food without dysphagia and heartburn at discharge. Esophageal barium studies showed that the maximum esophageal diameter decreased 2.2 cm and the minimum gastroesophageal junction diameter increased 8.4 mm after operation. Manometry examination in 58 patients revealed that the lower esophageal sphincter resting pressure decreased 15.0 mmHg in the wake of the procedure. Twenty-four hour pH monitoring demonstrated that reflux events were within the normal post-operative range. Fifty-five of the 58 patients had normal DeMeester scores. Among the patients with a mean 90-month follow-up, 49 patients had normal intake of food without reflux, the remaining three had mild dysphagia without requiring treatment. All the patients resumed their preoperative work and social activities. The manometry and 24-h pH studies in the 43 patients showed there were no significant changes between the third post-operative week and during follow-up. Transabdominal esophagocardiomyotomy and posterior partial fundoplication are able to relieve the functional outflow obstruction of the lower esophageal sphincter, obviate the rehealing of the myotomy edge and prevent gastroesophageal reflux in patients who have undergone myotomy alone.
Dis Esophagus 2006
PMID:Management of achalasia with transabdominal esophagocardiomyotomy and partial posterior fundoplication. 1698 38

Leiomyomas are rare esophageal disorders, although among the benign esophageal neoplasms, they are the most common. Multiple leiomyomas are distinguished from esophageal leiomyomatosis, an extremely rare condition, which is associated with Alport syndrome, showing deletions and rearrangements of the COL4A5/COL4A6 gene. There are only a few reports of diffuse multilocular lesions. A 19-year-old man presented with upper gastrointestinal bleeding and diffuse abdominal pain. On endoscopy multiple nodules covered with intact mucosa were present, the largest tumor arising from the gastro-esophageal border infiltrating the cardia. Barium swallow demonstrated narrowing of the middle and lower esophagus with the upper third of the stomach filled by the tumor. Thorax and abdominal CT scans revealed infiltration of almost the total aboral esophagus by the tumor with compression of left and right bronchi. The infiltration reached the whole lesser curvature of the stomach. Endosonography showed multiple encapsulated nodules. Due to the extended tumor growth with infiltration of the upper third of the stomach, a total esophago-gastrectomy with reconstruction by colon interposition was performed. On histopathological examination multiple esophageal leiomyomas with infiltration of the proximal third of the stomach was shown. Immunohistochemically the tumor stained positive for desmin and sm-actin and negative for CD34 and c-kit. Genetic analysis ruled out a deletion of the COL4A5/COL4A6 locus on chromosome X that is linked with Alport syndrome-diffuse leiomyomatosis. Extended mutations in the COL4A5 gene, associated with Alport syndrome, to the COL4A6 gene, are required for the development of leiomyomatosis. In young patients with diffuse multinodular infiltration by encapsulated tumors, esophageal leiomyomatosis should be considered. If the proximal third of the stomach is infiltrated by the tumor an extended resection is necessary. Reconstruction procedures include colon interposition.
Dis Esophagus 2006
PMID:Multiple giant leiomyomas of the esophagus and stomach. 1706 96

Short and medium term outcomes from laparoscopic antireflux surgery are generally excellent. A small number of patients suffer recurrent reflux or intolerable side-effects and may require reoperation. In this paper we describe our experience of 35 laparoscopic reoperations from a single center. Data on patients undergoing antireflux surgery in our unit has been prospectively collected and includes more than 600 primary laparoscopic antireflux operations since 1993. Laparoscopic reoperations have been performed between 1996 and 2005 for patients suffering recurrent reflux, dysphagia or severe gas bloat symptomatic despite medical treatment. All patients underwent preoperative barium studies and endoscopy with selective manometry and pH studies. Symptomatic outcomes were evaluated at 6 weeks and 12 months with Visick scores. Anatomical results were assessed with barium studies at between 6 and 12 months. Thirty-five laparoscopic reoperations were performed in 20 women and 13 men (median age 56 years). Primary surgery had been performed in our unit in 27 (77%) and elsewhere in eight (23%). Median time from primary surgery was 28.5 months (5-360). Two patients underwent a second reoperation. Indication was recurrent reflux in 28 (80%), dysphagia in five (14%) and gas bloat in two (6%). Thirty-two of the 35 reoperations (91.4%) were completed laparoscopically, median operating time was 120.5 min (65-210) and median hospital stay 2 days. There was no mortality and there were only five minor complications. Twelve-month follow-up was available for 32 reoperations (91%). Overall good symptomatic outcomes were obtained in 26 (74%) Visick I or II at 6 weeks and 24 of 32 (75%) at 12 months. In reoperations for dysphagia/gas bloat there was a relative risk of 4.26 of a poor symptomatic outcome (Visick III or IV) at 12 months compared to those for recurrent reflux (P < 0.05, Fisher's exact test). Laparoscopic reoperation is feasible with low conversion rates and minimal morbidity for patients who have undergone previous abdominal or thoracic hiatal repair. Symptomatic outcomes are generally good, particularly if the indication is recurrent reflux.
Dis Esophagus 2007
PMID:Results of laparoscopic reoperation for failed antireflux surgery: does the indication for redo surgery affect the outcome? 1761 84

The aim of this study was to determine whether attachment of the Bravo pH monitoring capsule alters esophageal motility. Twenty normal subjects were studied with 36-channel high-resolution manometry before and after Bravo capsule placement. Subjects performed 10 5-mL water-swallows in both upright and supine positions and two 5-mL barium-swallows under fluoroscopy synchronized with manometry recordings. There was no significant change in basal esophagogastric junction (EGJ) pressure, EGJ relaxation pressure or peristaltic function before and after Bravo placement in either position. However, a 2-cm focus of augmented peristalsis was found corresponding to the position of the Bravo capsule. Ten subjects were aware of the capsule (7 had a mild foreign body sensation, 1 had mild discomfort, and 2 had chest pain altering daily activity or diet) while nine subjects were unaware of the capsule. Subjects who were aware of the capsule's presence exhibited a greater augmentation of peristalsis than those who were not (P < 0.05). Neither EGJ function nor peristaltic performance were significantly altered by the presence of a Bravo capsule. However, capsule presence was associated with a locus of augmented peristalsis and this phenomenon was most evident in subjects who perceived the presence of the Bravo capsule.
Dis Esophagus 2007
PMID:Does the Bravo pH capsule affect esophageal motor function? 1776 Jun 54

Fibrovascular polyps of the esophagus are rare, with only 110 cases reported in the world literature to date. Dysphagia is the most common symptom. The diagnosis is usually made by barium swallow or upper endoscopy, but almost a third of cases can be missed with these studies. Treatment is surgical. Only four cases in the literature underwent esophagectomy for removal. We present a female patient with a fibrovascular polyp of the esophagus who required a transhiatal esophagectomy to safely remove this mass.
Dis Esophagus 2007
PMID:Fibrovascular polyp of the esophagus requiring esophagectomy. 1776 Jun 62

We hypothesize that the surface of the zone of air-liquid mixture in the esophagus after swallowing is the result of the esophageal gastric junction (EGJ) function or dysfunction. The aim of this study was to quantify the air-liquid components of the bolus in the esophagus and across the EGJ by means of digital videofluoroscopy sequences recorded in patients with gastroesophageal reflux disease (GERD). The patients were allocated to a Normo or a Hypo group, according to basal lower esophageal sphincter (LES) pressure. Two types of analysis were undertaken from the video sequences. For static analysis, maximal opening diameter of the LES and surfaces of air, air-barium mixture, and barium suspension were measured on two images extracted from each sequence. For dynamic analysis, transit times across the EGJ of the total bolus, air, mixture, and barium suspension were evaluated on a video sequence. For static analysis, the maximal opening diameter of the LES, air, and mixture surfaces were higher in the Hypo group. For dynamic analysis, transit time of total bolus, air, and mixture were longer in the Hypo group. The increase in mixture can be attributed to a defect in settling of both air and liquid phases in the esophagus in patients with low LES pressure and/or esophageal hypotonicity. Thus, these evaluations should provide information on the passage modalities of the bolus in esophagus and across the EGJ to assess differential diagnosis of GERD and hence to better select the most appropriate antireflux surgical procedure.
Dis Esophagus 2009
PMID:Impaired air-liquid settling during swallowing in gastroesophageal reflux disease. A digital videofluoroscopic study. 1884 54

Hiatoplasty is generally considered an essential part of antireflux operations. Posterior closure of an enlarged hiatus may lead to anterior displacement of the esophagus and it may be contributory to postoperative dysphagia. The aims of this study were to (i) measure the normal esophageal anteroposterior angulation, (ii) evaluate the variation of the angulation after laparoscopic hiatoplasty and fundoplication, and (iii) correlate the angulation with postoperative dysphagia. Normal esophageal anteroposterior angle determined by barium preoperative barium esophagram was evaluated based on the study of 100 patients. Postoperative angulation was evaluated based on the study of 32 patients who underwent barium esophagram after laparoscopic hiatoplasty and fundoplication. The results showed that the normal esophageal anteroposterior angle was 150.4 +/- 10.7 (range 119-169) degrees. There was no correlation between the angle and gender (P = 0.6) or age (P = 0.1). Postoperative angle averaged 146.6 +/- 11.7 (range 122-170) degrees. Normal and post-operative angle were not different (P = 0.1). The difference between post- and preoperative angle averaged 0.7 +/- 8.9 (range -15-14). There was no statistically significant difference when pre- and post-operative angles were compared (P = 0.6). De novo dysphagia was present in 31% of the 32 postoperative patients. There was no statistically significant difference when the angles in patients with and without de novo dysphagia were compared (P = 0.2). We concluded that (i) laparoscopic hiatoplasty and fundoplication does not significantly change the esophageal anteroposterior angle; and (ii) de novo dysphagia is not with the esophageal anteroposterior angle.
Dis Esophagus 2009
PMID:Esophageal angulation after hiatoplasty and fundoplication: a cause of dysphagia? 1901 48


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