Cases reported "Esophageal Achalasia"

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11/50. Oesophageal achalasia causing respiratory obstruction.

    A patient with complete respiratory obstruction due to massive oesophageal dilatation is described. Immediate relief of symptoms and disappearance of the oesophageal swelling occurred after administration of sublingual glyceryl trinitrate. nitrates cause a reduction in the lower oesophageal sphincter pressure in patients with oesophageal achalasia and in this case it is presumed that spasm of the lower oesophageal sphincter had been a major factor preventing decompression of the dilated oesophagus.
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ranking = 1
keywords = obstruction
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12/50. life-threatening acute airway obstruction in achalasia.

    Acute airway obstruction from mega-esophagus is an extremely rare presentation of achalasia. We present the case of an 82-year-old woman without previously diagnosed achalasia who presented with shortness of breath. Her respiratory status deteriorated rapidly, with development of stridor. Prompt nasogastric tube placement decompressed the dilated esophagus and relieved airway obstruction. This case illustrates an unusual presentation of achalasia and underscores the need for emergent life-saving esophageal decompression. Hypotheses regarding the mechanism of airway compromise as well as treatment options are reviewed.
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ranking = 16.369924832762
keywords = airway obstruction, obstruction, airway
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13/50. Pseudoachalasia: a case series and analysis of the literature.

    OBJECTIVE: Pseudoachalasia frequently cannot be distinguished from idiopathic achalasia by manometry, radiologic examination or endoscopy. Mechanisms proposed to explain the clinical features of pseudoachalasia include a circumferential mechanical obstruction of the distal esophagus or a malignant infiltration of inhibitory neurons within the myenteric plexus. MATERIAL AND methods: Between January 1980 and December 2002, the clinical features of 5 patients with pseudoachalasia and 174 patients with primary achalasia, diagnosed in a single center, were compared. A literature analysis of the etiology of pseudoachalasia for the time period 1968 to December 2002 was performed. The search concentrated on the databases and online catalogues pubmed, Web of science, Cochrane Library and Current Contents Connect. RESULTS: In our case series, patients with pseudoachalasia reported a shorter duration of symptoms and tended to be older than patients with primary achalasia. Conventional manometry, endoscopy and radiologic examination of the esophagus proved to be of little value in distinguishing between the diseases. In the majority of cases only surgical exploration revealed the underlying cause. A coincidence of primary achalasia and disorders of the gastroesophageal junction was excluded by showing return of peristalsis following treatment. The analysis of the literature showed a total of 264 cases of pseudoachalasia in 122 publications. Most cases of were due to malignant disease (53.9% primary and 14.9% secondary malignancy), followed by benign lesions (12.6%) and sequelae of surgical procedures at the distal esophagus or proximal stomach (11.9%). In rare instances, the disease was an expression of a paraneoplastic process due to distant neuronal involvement rather than to local invasion with destruction of the myenteric plexus (2.6%). CONCLUSIONS: The diagnosis of pseudoachalasia is difficult to establish by conventional diagnostic measures. The main distinguishing feature of secondary versus primary achalasia is the complete reversal of pathologic motor phenomena following successful therapy of the underlying disorder.
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ranking = 0.2
keywords = obstruction
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14/50. Familial visceral neuropathy: a defined entity?

    Familial visceral neuropathy (FVN) is a heterogeneous group of disorders due to abnormalities of the myenteric plexus. FVN with neuronal intranuclear inclusions is one particular form of FVN with a variable phenotype that includes achalasia, gastro-esophageal reflux, intestinal dysmotility and pseudo-obstruction, dysarthria, peripheral neuropathy and pupillary defects, and the presence of intranuclear inclusions within the neurons of the enteric nervous system. We present a four-generation family in which 10 individuals (7 of whom have been examined) are affected with FVN. The family was previously reported as familial esophageal achalasia, an autosomal recessive condition (MIM200400). At that time, several individuals in a single sibship were affected and there were no manifestations in either parent. Since that report, two individuals have had affected children and the mother has developed symptoms and has abnormalities on electromyography, thus enabling us to reclassify the family. This family provides further evidence of autosomal dominant inheritance, with marked variation in expression.
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ranking = 0.2
keywords = obstruction
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15/50. cholangiocarcinoma presenting with severe gastroparesis and pseudoachalasia.

    Tumor-associated gastroparesis, though reported in association with various malignancies, is rare in patients with cholangiocarcinoma. We report a 55-year-old woman who presented with dysphagia and recurrent vomiting. Esophagogastroduodenoscopy revealed dilated stomach and excess residue without organic obstruction. 99mTc sulfur colloid solid gastric emptying study, radio-opaque marker gut transit study, and esophageal manometry showed features suggestive of gastroparesis and achalasia cardia; electrogastrography revealed bradygastria. cholangiocarcinoma was detected on CT scan performed after the patient developed jaundice two months later. The lesion was deemed surgically unresectable. She died four months later.
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ranking = 0.2
keywords = obstruction
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16/50. Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations.

    Pseudoachalasia is a difficult condition for the clinician to differentiate from idiopathic achalasia even by manometry, radiological studies or endoscopy. Its etiology is usually associated with tumors. In most cases, the diagnosis is made after surgical explorations. The proposed pathogenesis of the disease is considered as mechanical obstruction of the distal esophagus or infiltration of the malignancy that affects the inhibitory neurons of the meyenteric plexus in the majority of cases. Surgery has been reported as a cause of pseudoachalasia. We report a 70-year-old man who suffered from deglutination disorder caused by pseudo-achalasia after truncal vagotomy. The patient was symptom-free after a nine-year follow-up and complete recovery of esophageal motility status from pseudoachalasia after pneumatic dilations. We also reviewed the literature of pseudoachalasia.
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ranking = 0.2
keywords = obstruction
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17/50. Pneumatic dilation in patients with achalasia with a modified Gruntzig dilator (Levine) under direct endoscopic control: results after 5 years.

    From 1985 to 1990, 62 patients have undergone pneumatic dilatation with the modified Gruntzig (Levine) dilator in the treatment of achalasia. A single dilatation with a 30-mm balloon dilator was successful in 85% of the patients. Nine patients required additional procedures. One elected for operative surgical repair, and eight patients underwent a second dilatation with a 35-mm balloon dilator. One patient required a third procedure with a 40-mm dilator. Two patients developed dysphagia for solids after pneumatic dilatation, and did not demonstrate delay or obstruction to the passage of technetium on follow up study. We have described this syndrome as dysfunctional dysphagia, and believe that it is related to the rapid ingestion of a food bolus, and is relieved by eating smaller portions at a slower rate. This is to be differentiated from reflux esophagitis and/or stricture secondary to reflux. One patient required bougie dilatation of a stricture, and three other patients were treated with omeprazole, ranitidine, or antacids with relief of reflux symptoms. The safety and efficacy of the procedure of pneumatic dilatation under direct endoscopic control with the modified Gruntzig dilator has been demonstrated in patients from 8 to 93 yr old, and in patients who have had prior Heller myotomy.
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ranking = 0.2
keywords = obstruction
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18/50. airway obstruction in a child with esophageal achalasia.

    A 13-year-old Japanese boy who had respiratory symptoms and had been treated as a case of chronic bronchitis was found by us to have esophageal achalasia. He had complained of cough for one year and a half, and pulmonary function studies showed severe airway obstruction. The chest radiogram showed the trachea compressed by the dilated esophagus. After operation, the symptoms disappeared and marked improvement was found in the flow-volume curve. esophageal achalasia should be considered as one of the differential diagnoses of airway obstructive disease.
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ranking = 3.5820809800723
keywords = airway obstruction, obstruction, airway
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19/50. Mechanical and neurogenic factors in postvagotomoy dysphagia.

    Postvagotomy dysphagia (PVD) has been attributed to either periesophageal obstruction or failure of the lower esophageal sphincter (LES) to relax, presumably from interruption of preganglionic, contraction-inhibiting vagal fibers--a postvagotomy achalasia (PVA). This report describes a patient with periesophageal fibrosis which was successfully treated with dilation, and a second patient with an achalasia-like pattern on esophageal manometry after unilateral high, transthoracic vagotomy. The second patient is the first manometrically documented example of achalasia in a human subject related to proximal vagotomy. Most, if not all, PVD is due to esophageal obstruction and PVA is rare.
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ranking = 0.4
keywords = obstruction
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20/50. Acute airway obstruction in achalasia. Possible role of defective belch reflex.

    Achalasia presenting as an acute airway obstruction is a rarely reported phenomenon. The pathophysiology of this dramatic complication of achalasia remains an enigma. Our patient with achalasia presented with an acute airway compromise necessitating emergent endotracheal intubation. We review the available literature on this interesting yet rare complication of achalasia. We also add some information to help elucidate the possible pathophysiologic mechanism of this emergency, proposing that specific upper esophageal sphincter manometry may indicate abnormality of the "belch reflex."
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ranking = 13.652356062224
keywords = airway obstruction, obstruction, airway
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