Esophageal Achalasia
Fundoplication
Esophagus
Laparoscopy
Anti-Dyskinesia Agents
Esophageal Sphincter, Lower
Esophagogastric Junction
Deglutition Disorders
Peristalsis
Barium Sulfate
Esophageal Motility Disorders
Catheterization
Leiomyosarcoma of the esophagus in a patient with chagasic megaesophagus: case report and literature review. (1/309)
Leiomyosarcoma constitutes approximately 0.5% of the malignant neoplasias of the esophagus and its association with megaesophagus has not been described. We report on a case of a woman with dysphagia that was slowly progressive from the age of 19 due to chagasic megaesophagus. The woman was subjected to cardiomyotomy at the age of 49. She presented a rapid worsening of the dysphagia due to leiomyosarcoma at the age of 61, and was subjected to subtotal esophagectomy with cervical esophagogastroplasty. She developed pulmonary and hepatic metastases 14 months after surgery and died six months later. (+info)Early experience with intrasphincteric botulinum toxin in the treatment of achalasia. (2/309)
BACKGROUND: Recent reports have suggested that intrasphincteric injection of botulinum toxin is effective and long-lasting in the treatment of achalasia. AIM: To report our experience of botulinum toxin injection in a prospective series of consecutive patients with achalasia. METHODS: Eleven consecutive patients with achalasia (eight male, mean age 55 years, range 20-87) were treated with 60 units of botulinum toxin (Dysport; Speywood Pharmaceuticals Ltd, UK) into each of four quadrants at the lower oesophageal sphincter. Patients were assessed pre-treatment and 1 month after treatment using a symptom score and oesophageal manometry. Median follow-up was 12 months (range 6-28). RESULTS: The injection procedure was simple to perform and free of adverse effects. Although treatment had a beneficial effect on dysphagia (median pre-treatment score 3 [interquartile range 3-3]; post-treatment score 2 [0-3]: P=0.03) 1 month following therapy, there was no significant improvement in chest pain or regurgitation scores. Similarly, no significant reduction in median lower oesophageal sphincter pressure was observed (29.5 mmHg [21-42] pre-treatment, 28.5 [17.5-55.5] post-treatment P=0.67). Four patients (36%) required further therapy within 3 months and the overall relapse rate was 73% (eight of 11) within 2 years. CONCLUSION: Although botulinum toxin injection was well tolerated, these results using Dysport at a dose of 240 mouse units question its efficacy as a treatment for achalasia. (+info)Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. (3/309)
BACKGROUND: Seven years ago, the authors reported on the feasibility and short-term results of minimally invasive surgical methods to treat esophageal achalasia. In this report, they describe the evolution of the surgical technique and the clinical results in a large group of patients with long follow-up. PATIENTS AND METHODS: Between January 1991 and October 1998, 168 patients (96 men, 72 women; mean age 45 years, median duration of symptoms 48 months), who fulfilled the clinical, radiographic, endoscopic, and manometric criteria for a diagnosis of achalasia, underwent esophagomyotomy by minimally invasive techniques. Forty-eight patients had marked esophageal dilatation (diameter >6.0 cm). Thirty-five patients had a left thoracoscopic myotomy, and 133 patients had a laparoscopic myotomy plus a partial fundoplication. Follow-up to October 1998 was complete in 145 patients (86%). RESULTS: Median hospital stay was 72 hours for the thoracoscopic group and 48 hours for the laparoscopic group. Eight patients required a second operation for recurrent or persistent dysphagia, and two patients required an esophagectomy. There were no deaths. Good or excellent relief of dysphagia was obtained in 90% of patients (85% after thoracoscopic and 93% after laparoscopic myotomy). Gastroesophageal reflux developed in 60% of tested patients after thoracoscopic myotomy and in 17% after laparoscopic myotomy plus fundoplication. Laparoscopic myotomy plus fundoplication corrected reflux present before surgery in five of seven patients. Patients with a dilated esophagus had excellent relief of dysphagia after laparoscopic myotomy; none required an esophagectomy. CONCLUSIONS: Minimally invasive techniques provided effective and long-lasting relief of dysphagia in patients with achalasia. The authors prefer the laparoscopic approach for three reasons: it more effectively relieved dysphagia, it was associated with a shorter hospital stay, and it was associated with less postoperative reflux. Laparoscopic Heller myotomy and partial fundoplication should be considered the primary treatment for esophageal achalasia. (+info)Comparison of two different formulations of botulinum toxin A for the treatment of oesophageal achalasia. The Gismad Achalasia Study Group. (4/309)
BACKGROUND: Intrasphincteric injection of botulinum toxin has been reported as a safe and effective alternative treatment in oesophageal achalasia, especially in high-risk and elderly patients. AIM: : To compare two formulations of botulinum toxin in the management of achalasia. PATIENTS AND METHODS: We randomly compared the efficacy and safety of 100 U of Botox (Allergan, Irvine, USA) and 250 U of Dysport (Ipsen, Milan, Italy), injected through a sclerotherapy needle at the level of the lower oesophageal sphincter, in 78 consecutive patients with achalasia. Symptom score, oesophageal manometry and 24 h pH-metry were recorded (before and 1 month after therapy). Symptom score was also obtained 6 months after treatment. RESULTS: One month after treatment, the effects of the toxin on symptoms and oesophageal tests were similar for both formulations. Lower oesophageal sphincter pressure decreased from 31 +/- 12 to 18 +/- 5 mmHg after Botox, and from 35 +/- 9 to 18 +/- 10 after Dysport. At the end of the follow-up period (6 months), symptom score decreased from 5 +/- 1.2 to 1.2 +/- 0.8 after Botox and from 5.2 +/- 1.5 to 1.5 +/- 1 after Dysport. Moreover, the percentages of patients who failed to respond to treatment (10% and 17.5%) and who relapsed during follow-up (12% and 24%) did not differ significantly. No patient complained of reflux symptoms after treatment, although abnormal acid exposure was documented in two subjects. CONCLUSIONS: Both formulations of botulinum toxin have comparable efficacy in the treatment of oesophageal achalasia, for up to 6 months of follow-up. (+info)Review article: pharmacological options in achalasia. (5/309)
Achalasia is a common primary oesophageal motor disorder. Treatment has been based traditionally on a surgical approach; however, there is new evidence that some medical strategies may be of benefit. The purpose of the present article was to review the current medical management of achalasia. A Medline search identified original articles and reviews published in the English-language literature between 1966 and 1998. This search has revealed that the pharmacological treatment of achalasia is limited to some subgroups of patients (for example, early stages of the disease and elderly patients), and that nitrates, nifedipine, and botulinum toxin are the best studied and most effective compounds. (+info)Complete lower esophageal sphincter relaxation observed in some achalasia patients is functionally inadequate. (6/309)
Generally accepted manometric criteria for the diagnosis of achalasia are absent peristalsis and incomplete lower esophageal sphincter (LES) relaxation. However, in some patients with otherwise typical features of achalasia, esophageal manometry shows complete LES relaxation during swallowing. To establish whether such apparently complete LES relaxations are functionally adequate, we quantified changes in resistance to flow at the esophagogastric junction (EGJ) during wet swallowing. We studied seven achalasia patients with manometrically complete (>80%) LES relaxation, eight achalasia patients with incomplete (<40%) LES relaxation, and eight healthy volunteers. Complete LES relaxation on standard manometry (open-tip catheters) was confirmed in five of the seven achalasia patients by a Dentsleeve. Changes in EGJ resistance to flow were quantified using a pneumatic resistometer. Manometrically, the relaxation time span was significantly longer in patients with complete LES relaxation than in those with incomplete relaxation (7. 3 +/- 0.5 vs. 4.4 +/- 0.7 s; P < 0.05). The fall in EGJ resistance from basal values during swallowing was markedly reduced in both achalasia groups (21 +/- 8% in those with manometrically complete relaxation and 4 +/- 2% in those with incomplete relaxation) by comparison with healthy individuals, in whom resistance fell by 90 +/- 3% (P < 0.05 vs. both achalasia groups). The duration of EGJ resistance drop was also much shorter in achalasia with (0.7 +/- 0.2 s) and without (0.2 +/- 0.1 s) complete LES relaxation compared with healthy control values (6.6 +/- 1.2 s). Our results reveal that the apparently complete LES relaxation observed manometrically in some patients with achalasia is functionally inadequate since it is not associated with the normal profound fall in EGJ resistance to flow. (+info)A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. (7/309)
BACKGROUND: Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment for oesophageal achalasia. However, the predictors of response and optimal dose remain unclear. AIMS: To compare the effect of different doses of Botx and to identify predictors of response. PATIENTS/METHODS: A total of 118 achalasic patients were randomised to receive one of three doses of Botx in a single injection: 50 U (n=40), 100 U (n=38), and 200 U (n=40). Of those who received 100 U, responsive patients were reinjected with an identical dose after 30 days. Clinical and manometric assessments were performed at baseline, 30 days after the initial injection of botulinum toxin, and at the end of follow up (mean 12 months; range 7-24 months). RESULTS: Thirty days after the initial injection, 82% of patients were considered responders without a clear dose related effect. At the end of follow up however, relapse of symptoms was evident in 19% of patients who received two injections of 100 U compared with 47% and 43% in the 50 U and 200 U groups, respectively. Using Kaplan-Meier analysis, patients in the 100x2 U group were more likely to remain in remission at any time (p<0.04), with 68% (95% CI 59-83) still in remission at 24 months. In a multiple adjusted model, response to Botx was independently predicted by the occurrence of vigorous achalasia (odds ratio 3.3) and the 100x2 U regimen (odds ratio 3.2). CONCLUSIONS: Two injections of 100 U of Botx 30 days apart appeared to be the most effective therapeutic schedule. The presence of vigorous achalasia was the principal determinant of the response to Botx. (+info)Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia. (8/309)
The most important component of the upper esophageal sphincter (UES) is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior) and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63) was higher than in normal volunteers (142.8 +/- 47.4 mmHg vs 113.0 +/- 46.0 mmHg, mean +/- SD, P<0.05). There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05). There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21) was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41), measured at the site with the highest pressure (109.3 +/- 31.5 mmHg vs 149.6 +/- 45.3 mmHg, P<0.01) and as the average of the four directions (64.2 +/- 17.1 mmHg vs 83.5 +/- 28.6 mmHg, P<0.05). We conclude that there is no difference in UES pressure between patients with Chagas' disease, primary achalasia and normal volunteers, except for patients with minor involvement by Chagas' disease, for whom the UES pressure at the site with the highest pressure was higher than the pressure of normal volunteers and patients with primary achalasia. (+info)Esophageal achalasia is a rare disorder of the esophagus, the tube that carries food from the mouth to the stomach. In this condition, the muscles at the lower end of the esophagus fail to relax properly during swallowing, making it difficult for food and liquids to pass into the stomach. This results in symptoms such as difficulty swallowing (dysphagia), regurgitation of food, chest pain, and weight loss. The cause of esophageal achalasia is not fully understood, but it is believed to be related to damage to the nerves that control the muscles of the esophagus. Treatment options include medications to relax the lower esophageal sphincter, botulinum toxin injections, and surgical procedures such as laparoscopic Heller myotomy or peroral endoscopic myotomy (POEM).
Dilation, also known as dilatation, refers to the process of expanding or enlarging a body passage or cavity. In medical terms, it typically refers to the widening of a bodily opening or hollow organ, allowing for increased flow or access. This can occur naturally, such as during childbirth when the cervix dilates to allow for the passage of a baby, or it can be induced through medical procedures or interventions.
For example, dilation of the pupils is a natural response to darkness or certain medications, while dilation of blood vessels is a common side effect of some drugs and can also occur in response to changes in temperature or emotional state. Dilation of the stomach or intestines may be necessary for medical procedures such as endoscopies or surgeries.
It's important to note that dilation can also refer to the abnormal enlargement of a body part, such as dilated cardiomyopathy, which refers to an enlarged and weakened heart muscle.
Manometry is a medical test that measures pressure inside various parts of the gastrointestinal tract. It is often used to help diagnose digestive disorders such as achalasia, gastroparesis, and irritable bowel syndrome. During the test, a thin, flexible tube called a manometer is inserted through the mouth or rectum and into the area being tested. The tube is connected to a machine that measures and records pressure readings. These readings can help doctors identify any abnormalities in muscle function or nerve reflexes within the digestive tract.
Esophagoscopy is a medical procedure that involves the visual examination of the esophagus, which is the tube that connects the throat to the stomach. This procedure is typically carried out using an esophagogastroduodenoscope (EGD), a flexible tube with a camera and light on the end.
During the procedure, the EGD is inserted through the mouth and down the throat into the esophagus, allowing the medical professional to examine its lining for any abnormalities such as inflammation, ulcers, or tumors. The procedure may also involve taking tissue samples (biopsies) for further examination and testing.
Esophagoscopy is commonly used to diagnose and monitor conditions such as gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal cancer, and other disorders affecting the esophagus. It may also be used to treat certain conditions, such as removing polyps or foreign objects from the esophagus.
Fundoplication is a surgical procedure in which the upper part of the stomach (the fundus) is wrapped around the lower esophagus and then stitched into place. This procedure strengthens the lower esophageal sphincter, which helps prevent acid reflux from the stomach into the esophagus. It is commonly used to treat gastroesophageal reflux disease (GERD) and paraesophageal hernias.
The esophagus is the muscular tube that connects the throat (pharynx) to the stomach. It is located in the midline of the neck and chest, passing through the diaphragm to enter the abdomen and join the stomach. The main function of the esophagus is to transport food and liquids from the mouth to the stomach for digestion.
The esophagus has a few distinct parts: the upper esophageal sphincter (a ring of muscle that separates the esophagus from the throat), the middle esophagus, and the lower esophageal sphincter (another ring of muscle that separates the esophagus from the stomach). The lower esophageal sphincter relaxes to allow food and liquids to enter the stomach and then contracts to prevent stomach contents from flowing back into the esophagus.
The walls of the esophagus are made up of several layers, including mucosa (a moist tissue that lines the inside of the tube), submucosa (a layer of connective tissue), muscle (both voluntary and involuntary types), and adventitia (an outer layer of connective tissue).
Common conditions affecting the esophagus include gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal cancer, esophageal strictures, and eosinophilic esophagitis.
Laparoscopy is a surgical procedure that involves the insertion of a laparoscope, which is a thin tube with a light and camera attached to it, through small incisions in the abdomen. This allows the surgeon to view the internal organs without making large incisions. It's commonly used to diagnose and treat various conditions such as endometriosis, ovarian cysts, infertility, and appendicitis. The advantages of laparoscopy over traditional open surgery include smaller incisions, less pain, shorter hospital stays, and quicker recovery times.
Anti-dyskinetic agents are a class of medications that are used to treat or manage dyskinesias, which are involuntary movements or abnormal muscle contractions. These medications work by blocking or reducing the activity of dopamine, a neurotransmitter in the brain that is involved in movement control.
Dyskinetic symptoms can occur as a side effect of long-term use of levodopa therapy in patients with Parkinson's disease. Anti-dyskinetic agents such as amantadine, anticholinergics, and dopamine agonists may be used to manage these symptoms.
Amantadine works by increasing the release of dopamine and blocking its reuptake, which can help reduce dyskinesias. Anticholinergic medications such as trihexyphenidyl and benztropine work by blocking the action of acetylcholine, another neurotransmitter that can contribute to dyskinesias. Dopamine agonists such as pramipexole and ropinirole mimic the effects of dopamine in the brain and can help reduce dyskinesias by reducing the dose of levodopa required for symptom control.
It is important to note that anti-dyskinetic agents may have side effects, and their use should be carefully monitored by a healthcare provider.
The lower esophageal sphincter (LES) is a specialized ring of muscle located at the junction of the esophagus and stomach. It functions as a physiological valve that regulates the direction of content flow between the esophagus and the stomach. Normally, the LES remains contracted to prevent the reflux of gastric contents into the esophagus, and it relaxes during swallowing to allow food to enter the stomach.
A dysfunctional lower esophageal sphincter may lead to gastroesophageal reflux disease (GERD), where stomach acid frequently backs up into the esophagus, causing symptoms such as heartburn, chest pain, and difficulty swallowing.
The esophagogastric junction (EGJ) is the region of the gastrointestinal tract where the esophagus (the tube that carries food from the mouth to the stomach) meets the stomach. It serves as a physiological sphincter, which helps control the direction of flow and prevent reflux of gastric contents back into the esophagus. The EGJ is also known as the gastroesophageal junction or cardia.
Deglutition disorders, also known as swallowing disorders, are conditions that affect the ability to move food or liquids from the mouth to the stomach safely and efficiently. These disorders can occur at any stage of the swallowing process, which includes oral preparation (chewing and manipulating food in the mouth), pharyngeal phase (activating muscles and structures in the throat to move food toward the esophagus), and esophageal phase (relaxing and contracting the esophagus to propel food into the stomach).
Symptoms of deglutition disorders may include coughing or choking during or after eating, difficulty initiating a swallow, food sticking in the throat or chest, regurgitation, unexplained weight loss, and aspiration (inhaling food or liquids into the lungs), which can lead to pneumonia.
Deglutition disorders can be caused by various factors, such as neurological conditions (e.g., stroke, Parkinson's disease, multiple sclerosis), structural abnormalities (e.g., narrowing or blockage of the esophagus), muscle weakness or dysfunction, and cognitive or behavioral issues. Treatment for deglutition disorders may involve dietary modifications, swallowing exercises, medications, or surgical interventions, depending on the underlying cause and severity of the condition.
Esophagoplasty is a surgical procedure that involves reconstructing or reshaping the esophagus, which is the muscular tube that connects the throat to the stomach. This procedure may be performed to treat various conditions such as esophageal atresia (a birth defect in which the esophagus does not develop properly), esophageal stricture (narrowing of the esophagus), or esophageal cancer.
During an esophagoplasty, a surgeon may use tissue from another part of the body, such as the stomach or colon, to reconstruct the esophagus. The specific technique used will depend on the individual patient's needs and the nature of their condition.
It is important to note that esophagoplasty is a complex surgical procedure that carries risks such as bleeding, infection, and complications related to anesthesia. Patients who undergo this procedure may require extensive postoperative care and rehabilitation to recover fully.
Peristalsis is an involuntary muscular movement that occurs in the digestive tract, including the esophagus, stomach, and intestines. It is characterized by alternate contraction and relaxation of the smooth muscles in the walls of these organs, which creates a wave-like motion that helps propel food, fluids, and waste through the digestive system.
The process of peristalsis begins with a narrowing or constriction of the muscle in one area of the digestive tract, followed by a relaxation of the muscle in the adjacent area. This creates a localized contraction that moves along the length of the organ, pushing its contents forward. The wave of contractions continues to move along the digestive tract until it reaches the anus, where waste is eliminated from the body.
Peristalsis plays a crucial role in maintaining proper digestion and absorption of nutrients, as well as in the elimination of waste products from the body. Disorders that affect peristalsis, such as gastrointestinal motility disorders, can lead to symptoms such as abdominal pain, bloating, constipation, or diarrhea.
Barium sulfate is a medication that is commonly used as a contrast material in medical imaging procedures, such as X-rays and CT scans. It works by coating the inside of the digestive tract, making it visible on an X-ray or CT scan and allowing doctors to see detailed images of the stomach, intestines, and other parts of the digestive system.
Barium sulfate is a white, chalky powder that is mixed with water to create a thick, milky liquid. It is generally safe and does not cause significant side effects when used in medical imaging procedures. However, it should not be taken by individuals who have a known allergy to barium or who have certain digestive conditions, such as obstructions or perforations of the bowel.
It's important to note that while barium sulfate is an important tool for medical diagnosis, it is not a treatment for any medical condition and should only be used under the direction of a healthcare professional.
Esophageal motility disorders are a group of conditions that affect the normal movement (motility) of the muscles in the esophagus, which is the tube that connects the throat to the stomach. The esophageal muscles normally contract and relax in a coordinated manner to help move food from the mouth to the stomach.
In esophageal motility disorders, this muscle movement is impaired, leading to difficulty swallowing (dysphagia), chest pain, heartburn, or regurgitation of food. Some common examples of esophageal motility disorders include:
1. Achalasia: a condition in which the lower esophageal sphincter muscle fails to relax properly, preventing food from passing into the stomach.
2. Diffuse esophageal spasm: a disorder characterized by uncoordinated contractions of the esophageal muscles, leading to difficulty swallowing and chest pain.
3. Nutcracker esophagus: a condition in which the esophageal muscles contract too forcefully, causing pain and difficulty swallowing.
4. Hypertensive lower esophageal sphincter: a disorder in which the lower esophageal sphincter muscle is too tight, making it difficult to swallow and leading to symptoms such as heartburn and regurgitation.
5. Ineffective esophageal motility: a condition in which the esophageal muscles have weak or disorganized contractions, leading to difficulty swallowing and other symptoms.
Esophageal motility disorders can be diagnosed through tests such as manometry, which measures the pressure and coordination of esophageal muscle contractions, or barium swallow studies, which use X-rays to visualize the movement of food through the esophagus. Treatment may include medications, lifestyle changes, or surgery, depending on the specific disorder and its severity.
Catheterization is a medical procedure in which a catheter (a flexible tube) is inserted into the body to treat various medical conditions or for diagnostic purposes. The specific definition can vary depending on the area of medicine and the particular procedure being discussed. Here are some common types of catheterization:
1. Urinary catheterization: This involves inserting a catheter through the urethra into the bladder to drain urine. It is often performed to manage urinary retention, monitor urine output in critically ill patients, or assist with surgical procedures.
2. Cardiac catheterization: A procedure where a catheter is inserted into a blood vessel, usually in the groin or arm, and guided to the heart. This allows for various diagnostic tests and treatments, such as measuring pressures within the heart chambers, assessing blood flow, or performing angioplasty and stenting of narrowed coronary arteries.
3. Central venous catheterization: A catheter is inserted into a large vein, typically in the neck, chest, or groin, to administer medications, fluids, or nutrition, or to monitor central venous pressure.
4. Peritoneal dialysis catheterization: A catheter is placed into the abdominal cavity for individuals undergoing peritoneal dialysis, a type of kidney replacement therapy.
5. Neurological catheterization: In some cases, a catheter may be inserted into the cerebrospinal fluid space (lumbar puncture) or the brain's ventricular system (ventriculostomy) to diagnose or treat various neurological conditions.
These are just a few examples of catheterization procedures in medicine. The specific definition and purpose will depend on the medical context and the particular organ or body system involved.
Esophageal diseases refer to a range of medical conditions that affect the esophagus, which is the muscular tube that connects the throat to the stomach. Here are some common esophageal diseases with their brief definitions:
1. Gastroesophageal reflux disease (GERD): A chronic condition in which stomach acid or bile flows back into the esophagus, causing symptoms such as heartburn, chest pain, and difficulty swallowing.
2. Esophagitis: Inflammation of the esophageal lining, often caused by GERD, infection, or medication.
3. Esophageal stricture: Narrowing of the esophagus due to scarring or inflammation, which can make swallowing difficult.
4. Esophageal cancer: Cancer that forms in the tissues of the esophagus, often as a result of long-term GERD or smoking.
5. Esophageal motility disorders: Disorders that affect the normal movement and function of the esophagus, such as achalasia, diffuse spasm, and nutcracker esophagus.
6. Barrett's esophagus: A condition in which the lining of the lower esophagus changes, increasing the risk of esophageal cancer.
7. Esophageal diverticula: Small pouches that form in the esophageal wall, often causing difficulty swallowing or regurgitation.
8. Eosinophilic esophagitis (EoE): A chronic immune-mediated disorder characterized by inflammation of the esophagus due to an allergic reaction.
These are some of the common esophageal diseases, and their diagnosis and treatment may vary depending on the severity and underlying cause of the condition.
Esophageal achalasia
Per-oral endoscopic myotomy
Farhad Manjoo
Neosaxitoxin
Myenteric plexus
Esophageal motility study
Hiatal hernia
Diverticulum
Achalasia microcephaly
Nutcracker esophagus
Esophagectomy
Greyhound
Dysphagia
Functional Lumen Imaging Probe
Eosinophilic esophagitis
False pregnancy
Stenosis
Occupational lung disease
Society of American Gastrointestinal and Endoscopic Surgeons
List of MeSH codes (C06)
Esophageal disease
Soft diet
Upper gastrointestinal series
Clostridium botulinum
Esophageal dilatation
Esophageal motility disorder
Therapeutic endoscopy
Esophageal dysphagia
Gastrointestinal disease
List of diseases (A)
Esophageal achalasia - Wikipedia
Apparent complete lower esophageal sphincter relaxation in achalasia
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Case report: Achalasia-like dysmotility secondary to oesophageal involvement of sarcoidosis | Gut
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Lower oesophageal sphincter hypersensitivity to opioid receptor stimulation in patients with idiopathic achalasia. | Gut
Esophageal Achalasia
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Manometry10
- Diagnosis is reached with esophageal manometry and barium swallow radiographic studies. (wikipedia.org)
- Seven of 23 patients (30%) seen in 2 yr with clinical and radiologic manifestations of achalasia underwent esophageal manometry demonstrating aperistalsis but apparent complete lower esophageal sphincter (LES) relaxation. (nih.gov)
- Apparent complete LES relaxation may be seen during manometry in achalasia and should not exclude its diagnosis. (nih.gov)
- High-resolution manometry of the oesophagus showed absent peristalsis in the oesophageal body and incomplete relaxation of the lower oesophageal sphincter. (bmj.com)
- The patient improved symptomatically and high-resolution manometry was repeated showing complete recovery of oesophageal peristalsis and a deeper relaxation of the lower oesophageal sphincter. (bmj.com)
- There is an increased risk of clinical relapse regardless of the treatment in patients with a sigmoid-shaped oesophagus or reduced oesophageal sphincter pressure assessed during pre-treatment manometry. (manchester.ac.uk)
- Functional lumen imaging probe (FLIP) was equivalent to high-resolution manometry (HRM) in predicting clinical response by Eckardt score 6 months or more after per oral endoscopic myotomy (POEM) for achalasia or esophagogastric junction (EGJ) outlet obstruction (EGJOO). (medscape.com)
- Those patients are going to probably still need manometry because if the esophageal body abnormalities are still present, then repeat testing might need to be performed," said DeWitt. (medscape.com)
- The GI Motility laboratory offers state-of-the-art diagnostic testing of the upper and lower GI tract, such as high-resolution esophageal manometry, pH-impedance monitoring, wireless Bravo pH testing, electrogastrography (EGG), endoFLIP distensibility testing of esophagus and pylorus, antroduodenal manometry, anorectal manometry/compliance and hydrogen breath test for SIBO and carbohydrate malabsorption. (iu.edu)
- when available, can be used to evaluate achalasia and can provide useful diagnostic information where manometry is nondiagnostic or if the patient cannot tolerate manometry. (msdmanuals.com)
Esophagus22
- Without a modifier, "achalasia" usually refers to achalasia of the esophagus. (wikipedia.org)
- The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in. (wikipedia.org)
- Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). (wikipedia.org)
- If enough food builds up, it triggers a need to purge what was swallowed, often described as not being accompanied with nausea per se, but an intense and sometimes uncontrollable need to vomit what was built up in the esophagus that, due to the excessive stretching of the esophageal walls, is easily released without heaving. (wikipedia.org)
- End stage disease, characterised by a markedly dilated and tortuous "burned-out" esophagus and recurrent obstructive symptoms, may require oesophageal resection in order to restore gastro-intestinal function, reverse nutritional deficits and reduce the risk of aspiration pneumonia. (wikipedia.org)
- True paraneoplastic causes of achalasia caused by the destruction of inhibitory innervation by tumor antibodies from distant tumors (e.g., lung cancer) are much rarer than local invasion of the EGJ by tumor or external compression of the distal esophagus by metastases. (abdominalkey.com)
- Achalasia, also known as oesophageal achalasia, is a condition in which the esophagus (a tube that carries food from the mouth to the stomach) is unable to move the food into the stomach. (katygastrodoctor.com)
- A lower oesophageal sphincter is a ring of muscle fibers that surrounds the lower-most end of the esophagus where it joins the stomach. (katygastrodoctor.com)
- In people with achalasia, the LES fails to relax during swallowing, resulting in the food moving backward into the esophagus. (katygastrodoctor.com)
- Achalasia cardia is a condition where the tube in our body that carries food from our mouth to our stomach, called the esophagus, does not work well. (agrawalgastrocarecenterindore.com)
- All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. (scielo.br)
- Note that increased soft tissue opacity in the area of projection of the caudal esophagus is still visible in panels B, C, and D (even though the radiographs were obtained in right lateral decubitus), but no gaseous esophageal distension is evident. (avma.org)
- POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy (LHM), not only for all types of esophageal achalasia [classical (I), vigorous (II), spastic (III), Chicago Classification], but also for advanced sigmoid type achalasia (S1 and S2), failed LHM, or other esophageal motility disorders (diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). (wjgnet.com)
- Other disorders such as diffuse esophageal spasm, jackhammer esophagus, and type III achalasia would not likely be candidates for FLIP. (medscape.com)
- Overview of Esophageal and Swallowing Disorders The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). (msdmanuals.com)
- Achalasia is thought to be caused by a loss of ganglion cells in the myenteric plexus of the esophagus, resulting in denervation of esophageal muscle. (msdmanuals.com)
- Increased pressure at the lower esophageal sphincter (LES) causes obstruction with secondary dilation of the esophagus. (msdmanuals.com)
- To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. (medlineplus.gov)
- Dr. Kothari has clinical expertise in interventional endoscopic ultrasound, diagnostic and therapeutic ERCP, intraluminal stent placement, esophageal endotherapy for Barrett's esophagus, Achalasia, Zenker's myotomy, and pancreatic-biliary disorders. (rochester.edu)
- The term 'achalasia' refers to the emptying of the esophagus which is the cardinal feature of this disorder. (spotpetins.com)
- Manometric evaluation of the esophagus in a patient with achalasia. (medscape.com)
- Pertinent findings include absence of propulsive peristalsis in the body of the esophagus (note simultaneous contractions), elevated resting lower esophageal sphincter (LES) pressure, and the absence of LES relaxation. (medscape.com)
Disorders8
- Functional causes include early-stage achalasia in which the nonrelaxing LES is not yet accompanied by severe motor disorders of the esophageal body (i.e., early achalasia). (abdominalkey.com)
- Peroral endoscopic myotomy (POEM) is an innovative, minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. (wjgnet.com)
- These disorders include esophageal achalasia, gastroparesis, intestinal pseudo-obstruction, Hirschsprung disease and slow transit constipation. (iffgd.org)
- It is primarily used to rule out esophageal disorders like achalasia. (covenanthealth.com)
- Faculty experts treat swallowing disorders, eosinophilic esophagitis, peroral endoscopic myotomy (POEM) for achalasia and gastroparesis, gastric electrical stimulation for gastroparesis, small bowel motility disorder, small intestinal bacterial overgrowth (SIBO), constipation and fecal incontinence. (iu.edu)
- POEM is a minimally invasive procedure performed under general anesthesia to help treat swallowing disorders such achalasia and diffuse esophageal spasm. (iu.edu)
- His clinical interests are dysphagia, esophageal disorders, motility disorders and functional gastrointestinal disorders, including irritable bowel syndrome. (iuhealth.org)
- There were no significant differences in the relative prevalence of achalasia or other motility disorders, peptic stricture, Schatzki's ring, esophageal cancer or unspecified diagnoses over the 10-year time period. (who.int)
Dysphagia7
- The main symptoms of achalasia are dysphagia (difficulty in swallowing), regurgitation of undigested food, chest pain behind the sternum, and weight loss. (wikipedia.org)
- citation needed] End-stage achalasia, typified by a massively dilated and tortuous oesophagus, may occur in patients previously treated but where further dilatation or myotomy fails to relieve dysphagia or prevent nutritional deterioration, and esophagectomy may be the only option. (wikipedia.org)
- Duration of dysphagia and weight loss were significantly less (p less than 0.05), whereas LES pressure was similar in the 7 patients compared with the 16 more traditional achalasia patients. (nih.gov)
- Laparoscopic re-operation with esophageal preservation is successful in the majority of patients with recurrent dysphagia after Heller myotomy. (sages.org)
- However, we show that treatment with prednisolone results in a completely disappearance of the symptoms of dysphagia and subsequently lead to a large improvement of oesophageal motility. (bmj.com)
- The diagnosis of achalasia and EGJOO is suspected in patients who have long-standing dysphagia to solids and liquids with regurgitation of undigested material that can include saliva. (abdominalkey.com)
- METHODS/BACKGROUND: Achalasia is an esophageal motility disorder characterized by dysphagia, regurgitation, reflux, recurrent vomiting, and weight loss. (jefferson.edu)
PATIENTS WITH ACHALASIA1
- A laparoscopic Heller myotomy may be the appropriate primary treatment of patients with achalasia. (spotpetins.com)
Sphincter12
- Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. (wikipedia.org)
- Untreated, mid-stage achalasia can fully obstruct the passage of almost any food or liquid - the greater surface area of the swallowed object often being more difficult to pass the LES/LOS (lower esophageal sphincter). (wikipedia.org)
- Lower oesophageal sphincter hypersensitivity to opioid receptor stimulation in patients with idiopathic achalasia. (bmj.com)
- It is a test that measures changes in pressure exerted by the oesophageal sphincter. (katygastrodoctor.com)
- Measures for clinical response following lower esophageal sphincter myotomy procedures include Eckardt Score, timed barium esophagram, HRM, and FLIP. (medscape.com)
- The study was limited to patients with hypertension in the lower esophageal sphincter. (medscape.com)
- POEM is a novel endoscopic procedure which involves cutting the lower esophageal sphincter to allow food to pass, and is considered a safe and effective management option for achalasia in non-pregnant individuals. (jefferson.edu)
- Achalasia is a neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and a lack of lower esophageal sphincter relaxation during swallowing. (msdmanuals.com)
- Achalasia can sometimes be treated with medication that helps the lower esophageal sphincter relax. (medlineplus.gov)
- Achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. (medscape.com)
- In 1929, Hurt and Rake realized that the disease was caused by a failure of the lower esophageal sphincter (LES) to relax. (medscape.com)
- The result is a hypertensive nonrelaxed esophageal sphincter. (medscape.com)
POEM3
- Certain medications or Botox may be used in some cases, but more permanent relief is brought by esophageal dilatation and surgical cleaving of the muscle (Heller myotomy or POEM). (wikipedia.org)
- The researchers conducted a retrospective, single-center study of 265 consecutive patients who underwent POEM for achalasia or EGJOO from 2016 through 2020. (medscape.com)
- RESULTS: We discuss the case of a patient with achalasia and a prior Heller myotomy who presented with recrudescence of severe symptoms prompting evaluation and treatment with POEM. (jefferson.edu)
Resection1
- 15 15 Hsu HH, Chen JS, Huang P. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. (scielo.br)
Dilatation3
- One hundred and twenty-five patients (59%) had prior esophageal dilatation and/or botulinum toxin injection and 19 (9%) had a prior myotomy. (elsevierpure.com)
- Does laparoscopic Heller's myotomy provide superior results compared to endoscopic dilatation for oesophageal achalasia? (manchester.ac.uk)
- If medication is ineffective, however, esophageal dilatation can correct the problem. (medlineplus.gov)
Esophagogastric Junction1
- Additionally, in patients undergoing interventions for achalasia (eg, surgery, peroral endoscopic myotomy), measurement of esophagogastric junction distensibility during and after the intervention accurately measures clinical response to interventions and can help guide therapy. (msdmanuals.com)
Peristalsis1
- The esophageal tissue refers to the hollow organ between the oropharynx and the stomach, which allows food to pass to the stomach through peristalsis. (nature.com)
Gastro-oesopha1
- Fundoplication during LHM is associated with reduced incidence of post-operative gastro-oesophageal reflux disease. (manchester.ac.uk)
Cancer4
- However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease (an infectious disease common in South America) or Triple-A syndrome. (wikipedia.org)
- The incidences of various esophageal diseases (e.g., congenital esophageal stenosis, tracheoesophageal fistula, esophageal atresia, esophageal cancer) are increasing, but esophageal tissue is difficult to be recovered because of its weak regenerative capability. (nature.com)
- Most people who experience occasional, mild heartburn will not develop esophageal cancer. (medlineplus.gov)
- A prospective of five cervical cancer screening tests assessed the risk of esophageal squamous cell carcinoma. (who.int)
Types of esophageal1
- The two types of esophageal tissue derived-decellularized extracellular matrix bioinks can mimic the inherent components and composition of original tissues with layer specificity. (nature.com)
Disorder3
- The symptoms and manometric pattern of this disorder mimics that of achalasia. (bmj.com)
- I eventually learned he suffered from esophageal achalasia, a rare throat disorder that makes it hard to swallow or eat. (mitchalbom.com)
- One disease that can cause heartburn is achalasia, a rare disorder that makes it difficult for food and liquid to pass into your stomach. (medlineplus.gov)
Gastroesophageal1
- Occult malignant infiltration of the gastroesophageal junction is a rare but important differential diagnosis that affects about 2% of patients evaluated for achalasia. (abdominalkey.com)
Diagnosis3
- The diagnosis of sarcoidosis with oesophageal involvement was made and treatment with prednisolone 30 mg OD initiated. (bmj.com)
- A- Image obtained at the time of diagnosis, with the dorsal and ventral esophageal walls indicated (arrowheads). (avma.org)
- See also the American College of Gastroenterology's 2020 practice guidelines on the diagnosis and management of achalasia. (msdmanuals.com)
Laparoscopic3
- We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia. (elsevierpure.com)
- Laparoscopic myotomy for achalasia is safe and effective in the majority of patients. (elsevierpure.com)
- Current evidence shows oesophageal perforation during LHM may be successfully managed intra-operatively but in ED usually requires further laparoscopic or open operative intervention. (manchester.ac.uk)
Squamous cell carc1
- risk of esophageal squamous cell carcinoma. (who.int)
Minimally invasive1
- A dual minimally invasive treatment approach was chosen, consisting of surgical diagnostic biopsies performed via lateral thoracotomy and transcardial placement of a self-expanding, covered, nitinol esophageal stent to palliate the obstruction. (avma.org)
Stomach2
- Achalasia Cardia is a rare but troublesome condition that affects the oesophagus, the tube connecting the throat to the stomach. (agrawalgastrocarecenterindore.com)
- It's characterized by the oesophagal muscles' inability to relax and allow food and liquids to pass into the stomach properly. (agrawalgastrocarecenterindore.com)
Dilation1
- Findings include upstream esophageal dilation and chronic stasis changes in the mucosa but no obstructing lesion. (msdmanuals.com)
Treatment of achalasia2
- Our study is an update of our center's experience with re-operative esophagogastric myotomy in the treatment of achalasia. (sages.org)
- He noted that the treatment of achalasia is evolving away from surgery, and the techniques to measure response are evolving along with it. (medscape.com)
Perforation2
- As technology improved, however, instrumental perforation became more common, and the pathophysiologies of rupture, perforation, and esophageal disruption (anastomotic leak) were elucidated, though the definitions of these entities became blurred. (medscape.com)
- Existing evidence shows that LHM is associated with improved post-operative symptoms and reduced clinical relapse rates compared to ED. Satisfactory clinical outcomes with ED often require repeat procedures performed over time and are associated with an increased risk of oesophageal perforation compared to LHM. (manchester.ac.uk)
Diseases1
- Achalasia can also manifest alongside other diseases as a rare syndrome such as achalasia microcephaly. (wikipedia.org)
Develop esophageal1
- Therefore, it is necessary to develop esophageal tissueengineering that enables regeneration of esophageal mucosa and muscle layers. (nature.com)
Regurgitation2
- Achalasia is characterized by difficulty in swallowing, regurgitation, and sometimes chest pain. (wikipedia.org)
- Lateral radiographic images of the thorax and cranial portion of the abdomen of a 10-year-old spayed female Rottweiler with a 2-month history of regurgitation and weight loss, despite no apparent changes in appetite, that was subsequently deemed to have esophageal leiomyoma. (avma.org)
Cardia1
- What is Achalasia Cardia? (agrawalgastrocarecenterindore.com)
Obstruction1
- Etiology of the denervation is unknown, but viral and autoimmune causes are suspected, and certain tumors may cause achalasia either by direct obstruction or as a paraneoplastic process. (msdmanuals.com)
Inhibitory2
- It is due to the failure of distal esophageal inhibitory neurons. (wikipedia.org)
- Persons with achalasia lack nonadrenergic, noncholinergic, inhibitory ganglion cells, causing an imbalance in excitatory and inhibitory neurotransmission. (medscape.com)
Relax1
- They coined the term achalasia, meaning failure to relax. (medscape.com)
Incidence1
- The incidence of achalasia is approximately 1 per 100,000 people per year. (medscape.com)
Clinical1
- Detailed clinical and laboratory evaluation suggests these patients may represent an early stage of achalasia. (nih.gov)
Reflux2
- But : Evaluer les resultats a mi-parcours de l'osocardiomyotomie de Heller par voie transthoracique avec la mise en place du systeme anti-reflux par un lambeau diaphragmatique pour le megaoesophage idiopathique. (bvsalud.org)
- Un systeme anti-reflux avait ete realise en utilisant un lambeau diaphragmatique sur toute la longueur de la myotomie de l'oesophage thoracique. (bvsalud.org)
Peroral endoscopic1
- Peroral endoscopic myotomy to treat achalasia. (cdc.gov)
Affects1
- Achalasia affects about one person in 100,000 per year. (wikipedia.org)
Methods1
- There are no commercialized off-the-shelf alternatives to current esophageal reconstruction and regeneration methods. (nature.com)
Surgery1
- Previous esophageal surgery for achalasia adversely affected functional results (p = 0.0139). (elsevierpure.com)