Search

2018 DEC 22 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Hemolysis. According to news reporting out of [...]

Objective: Bronchogenic and esophageal duplication cysts are congenital anomalies of the tracheobronchial tree and foregut that are often asymptomatic at initial presentation in adults. Surgery is always recommended, even for [...]

CHARGE association describes a group of birth defects characterized by eye and heart defects, airway and esophagus abnormalities, retardation, small genitals, and ear and hearing defects. Children born with this condition will often have several defects which typify CHARGE, an acronym for the key disorders. The heart, respiratory and esophageal abnormalities may necessitate surgery to improve heart function, eating, and breathing. CHARGE patients will often have delayed and impaired motor and mental development. The condition appears to result from genetic mutation.

BACKGROUND: Recently, investigators have reported the use of endoscopic myotomy in the treatment of esophageal achalasia. As with the open operation, considerable disagreement exists regarding the appropriate length of the myotomy and the need for a concomitant antireflux procedure. METHODS: Patients presenting with symptomatic achalasia between 1993 and 1997 were included in this prospective study. Preoperative studies included barium upper gastrointestinal study, endoscopy, and esophageal manometry. Laparoscopic myotomy was completed in all 20 patients; 18 had concomitant Toupet fundoplication. RESULTS: Operative times ranged from 95 to 345 minutes (mean 216). Blood loss ranged from 50 to 300 cc (mean 100 cc). There were 7 minor complications (5 mucosal injuries repaired laparoscopically, 1 bile leak and 1 splenic capsular tear). Nine patients began a liquid diet on the first day postoperatively; 19 were tolerating liquids by postoperative day 3. Hospital stay ranged from 2 to 20 days (mean 5). Eighteen patients had complete relief of dysphagia, with less than one reflux episode per month. One individual continues to have mild persistent solid food dysphagia. Another patient initially did well but subsequently developed mild recurrent dysphagia and reflux. One patient required laparoscopic take-down of the wrap because of recurrent dysphagia and now has no problems swallowing, but does complain of mild reflux. Two other patients also have mild reflux, 1 of whom did not undergo fundoplication. CONCLUSlONS: Laparoscopic Heller myotomy can be performed safely with excellent results in patients with achalasia. Adding a partial fundoplication appears to help control postoperative symptoms of reflux. This procedure should be considered the procedure of choice in patients with symptomatic esophageal achalasia. Am J Surg. 1997;174:709-714. [C] 1997 by Excerpta Medica, Inc.

Since 1972, 17 patients have been surgically treated for double aortic arch at our institution. The procedure became necessary before 12 months of age in 11 patients and before 24 months in 16 patients. The major symptoms were respiratory distress, noisy breathing, and respiratory infections; four patients also had dysphagia. A high degree of clinical suspicion should warrant further investigation. Barium swarow and bronchoscopy were diagnostic and revealed extrinsic compression of the esophagus and trachea, respectively. Division of the anterior arch was performed in 16 patients; the right (posterior) arch was divided in the remaining patient. Kommerell's diverticulum was found in four patients and was resected in order to avoid recurrence of dysphagia by compression. A vascular suspension procedure was necessary in 13 patients to further release the trachea and eosphagus. There was no mortality in this series, and symptomatic improvement was achieved in all patients. A degree of tracheomalacia may be responsible for some residual symptoms in four patients.

Choking on food and liquids is a common occurrence that most of us have experienced to one degree or another. It can be a serious or even fatal event if the obstruction is not quickly removed. Little research has focused on deglutition (swallowing) in people who have experienced near-fatal choking episodes to see if any underlying abnormalities were responsible. This study examined swallowing with videofluoroscopy (internal X-ray technique with results imaged on a fluorescent screen) and static imaging to see if such abnormalities existed. Subjects examined were 75 adults who had near-fatal choking episodes. Normal results were found in 17 of the patients. Abnormalities were found in the swallowing process in the other 58 subjects. These abnormalities could be grouped into four stages of swallowing. Abnormalities were seen to occur during the oral stage in 32 patients, the pharyngeal stage in 19 patients, the pharyngoesophageal stage in 28 patients, and the esophageal stage in 23 patients. Aspiration (inhaling) or bolus misdirection (''going down the wrong tube'') was seen in 40 of the subjects. Structural abnormalities were found to arrest or delay transit of a barium pill in 17 of the 43 subjects who were able to take the pill. These results show a number of abnormalities in all four stages of swallowing in subjects who had near-fatal choking episodes. Forty-three of the subjects had abnormalities in more than one of the stages. These abnormalities appear to affect control and motility in swallowing rather than being specific obstructions. Radiologic evaluation of patients who have near-fatal choking episodes can be important in diagnosing and correcting abnormalities that affect swallowing and put the patients at increased risk for choking episodes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chest pain resulting from ischemic heart disease, or the lack of adequate oxygen supply to heart muscle, may be indistinguishable from chest pain caused by disorders of the esophagus. However, the two disorders have very different prognoses. Little attention has been paid to the prevalence of esophageal disorders among patients with cardiovascular disease, despite the fact that the chest pain in many such patients might respond to treatment. To investigate the prevalence of esophageal disorders among heart patients, 220 patients with confirmed heart disease and persistent chest pain were examined. A control group of 159 patients with chest pain but without evidence of cardiac disease were also examined. Positive indications for esophageal disorders included abnormal motility and esophageal spasms. Abnormal motility was common, and ranged from 24 to 37 percent among the patients. Negative results occurred in the groups with the following frequencies: noncardiac chest pain, 55 percent; coronary artery disease, 62 percent; mitral valve prolapse, 42 percent; and bypass/angiography patients, 59 percent. There were no distinct differences between the noncardiac chest pain group and the other patient groups. It has been suggested that in some patients esophageal pain may precipitate myocardial ischemia, and there is some suggestion that esophageal disorders may lower the threshold for cardiac chest pain. The relatively high prevalence of esophageal disturbances among the cardiac patients suggests that at least some pain may be effectively treated. It is important to exercise caution, as the results of failing to recognize true cardiac pain when it occurs could be serious. (Consumer Summary produced by Reliance Medical Information, Inc.)

As more infants with congenital diaphragmatic hernia (CDH) survive by means of extracorporeal membrane oxygenation (ECMO), new clinical observations are being made. We report anatomic and functional abnormalities of the esophagus in these infants. Twenty-two of 30 infants with CDH survived. Three of 7 non-ECMO-treated infants and 14 of 17 ECMO-treated infants had an air- or fluidfilled mediastinal mass that was confirmed by an upper gastrointestinal series as ectatic esophagus. Contrast studies demonstrated severe gastroesophageal reflux. intra-esophageal pH monitoring confirmed significant reflux (Euler scores greater than 50) in 69% of tested patients. Prolonged acid clearance in most patients implied abnormal peristalsis. Hydramnios was correlated to the observed esophageal abnormalities, being present in 13 of 16 infants with an available amniotic history. All patients had symptomatic gastroesophageal reflux managed without antireflux surgery and were discharged 36 +/- 2 days after initiation of feeding. Follow-up (range: 7 to 56 months; mean: 32 months) showed that weight gain in affected children was slower than in those not affected. All but one are asymptomatic. Repeat upper gastrointestinal series shows persistent ectasia but less gastroesophageal reflux. Gastroesophageal reflux/ectasia is a new observation with CDH. The associated hydramnios may result from proximal foregut obstruction by kinking the gastroesophageal junction with CDH. The radiographic appearance can be quite unusual. Clinical manifestations of gastroesophageal reflux are manageable without surgery but may account for the observed compromised growth., Today, increasing numbers of infants born with congenital diaphragmatic hernias (an abnormal protrusion of the stomach and sometimes the intestine up into the chest cavity) are surviving. This increased survival is due, in part, to the fact that more are being treated by means of extracorporeal membrane oxygenation (ECMO), in which the venous blood is diverted outside the body to a heart-lung machine to oxygenate the blood. Now that these babies are surviving, new abnormalities are being seen in association with congenital diaphragmatic hernia. Of 30 infants born with congenital diaphragmatic hernia and respiratory distress within four hours of birth, 22 survived; 15 had been treated with ECMO and 7 had not. There were 21 patients shown to have a mediastinal mass (mass in the chest between the lungs) on chest X-ray; further studies revealed that 20 of these infants had dilated ectatic (stretched) esophagus. Seventeen of these infants survived for further follow-up. A prenatal diagnosis of polyhydramnios (excess amount of amniotic fluid) was associated with dilated ectatic esophagus in 13 of 16 patients with prenatal history available. All study patients had symptoms of gastroesophageal reflux (backflow of the stomach contents into the esophagus) but were successfully treated without surgery. Follow-up (averaging 32 months) showed that these patients had slower weight gain than other children. (Consumer Summary produced by Reliance Medical Information, Inc.)

The signs and symptoms of gastroesophageal reflux disease are described along with various treatment options. Signs can include chronic coughing, hoarseness and chest pain in adults and frequent vomiting, low weight gain and irritability in infants and young children. Treatment options include lifestyle and diet changes, medication and surgery.

A white, diabetic, 72-year-old man with long-standing heartburn and globus came to the voice center with a 10-year history of dysphagia for solids and a several-year history of weight loss. [...]

Esophageal malposition is a potentially disastrous complication of attempted airway intubation. We report an unusual case in which a promptly recognized esophageal intubation aided detection of a perforated gastric ulcer. [...]

Barrett esophagus is a condition in which the epithelium, or outer cell layer, of the esophagus undergoes abnormal changes. These changes may result from a birth-related disorder or, more commonly, from gastroesophageal reflux, the backflow of stomach contents into the esophagus. Barrett esophagus has also been associated with chemotherapy in children. Cases are described of eight women who developed Barrett esophagus after chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) for breast cancer. Methotrexate and 5-fluorouracil can cause inflammation of the mouth, resulting in the development of lesions in the mucous membranes, which may extend to the esophagus. Inflammation of the esophagus may lead to disruption of the sphincter that prevents the backflow of stomach contents into the esophagus. Subsequent gastroesophageal reflux can cause changes in the cells of the esophageal epithelium. Chemotherapeutic agents can destroy the squamous epithelium of the esophagus, and recovery may involve the development of abnormal cell types in the esophageal epithelium. Although, in general, Barrett esophagus increases the risk of developing esophageal cancer, patients treated with CMF do not have a greater risk of esophageal cancer than untreated patients. It is possible that once chemotherapy is discontinued, a regression of the cell changes occurs. (Consumer Summary produced by Reliance Medical Information, Inc.)

A NEW primary care group REFORM (Reflux FORuM) has produced a set of practical guidelines for treating reflux disease. Reflux disease affects one in four of the population and costs [...]

An inlet patch is an area of heterotopic gastric mucosa in the cervical esophagus (figure). Unlike Barrett's metaplasia of the distal esophagus, its etiology is believed to be congenital rather [...]

Dysphagia: A web of clues CASE A 56-year-old man complained of episodic difficulty swallowing, which was of abrupt onset and accompanied by chest pain. He was rather distressed because this [...]