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Achalasia Cardia

Manjunath Siddaiah-Subramanya, Rossita Mohamad Yunus, Shahjahan Khan, Breda Memon, Muhammed Ashraf Memon
BACKGROUND AND AIMS: Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures. MATERIAL AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed...
February 12, 2019: World Journal of Surgery
Thomas Frieling, Jürgen Heise, Christian Kreysel, Michael Blank, Bernhard Hemmerlein, Lothar Beccu, Rita Kuhlbusch-Zicklam
BACKGROUND:  Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review. MATERIAL AND METHODS:  A patient with dysphagia and eosinophilic infiltration referred to our clinic underwent standardized diagnostic work-up including symptom questionnaire, esophagogastroduodenoscopy (EGD) with esophageal biopsies, barium swallow, high-resolution esophageal manometry, and combined intraluminal 24-hour pH-impedance testing (pH/MII)...
February 2019: Zeitschrift Für Gastroenterologie
Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Santosh Darisetty, Rakesh Kalapala, Upender Shava, Manu Tandan, Rama Kotla, D Nageshwar Reddy
BACKGROUND AND AIMS: Achalasia cardia is rare in children and optimum endoscopic management options are not well known. Peroral endoscopic myotomy (POEM) is a novel treatment modality for achalasia with excellent results in adult patients. The long-term outcomes of POEM are not well known in children. In this study, we aim to evaluate the outcome of POEM in children with idiopathic achalasia. METHODS: We analyzed the data of children (≤ 18 years) diagnosed with achalasia from September 2013 to January 2018...
January 22, 2019: Surgical Endoscopy
Oliver Cousins, Elena Girelli, Sreedharan Harikrishnan
Neuromyelitis optica spectrum disorder (NMOSD) is a rare neurological condition infrequently associated with dysphagia on initial presentation. We describe the case of a 54-year-old woman who presented multiple times to healthcare professionals with severe vomiting, followed by sudden profound dysphagia. Her diagnosis was elusive, initially attributed to achalasia cardia and subsequently to stroke. A dorsal medullary lesion was revealed on MRI of the brain, which involved and extended beyond the area postrema...
January 14, 2019: BMJ Case Reports
Elisabeth Fabian, Andreas J Eherer, Carolin Lackner, Christian Urban, Freyja-Maria Smolle-Juettner, Guenter J Krejs
Pseudoachalasia is a condition in which symptoms, radiologic, endoscopic, and manometric findings mimick idiopathic achalasia. About 4% of patients with a typical constellation for idiopathic achalasia will turn out to have pseudoachalasia, posing a major diagnostic challenge. A large spectrum of underlying causes of pseudoachalasia has been described. However, in about 70% of affected patients, this condition is caused by a malignancy (mostly adenocarcinoma of the esophagogastric junction or cardia). We describe a 16-year-old high school student referred for management of achalasia who turned out to have pseudoachalasia due to adenocarcinoma of the cardia...
January 2, 2019: Digestive Diseases
Dario Biasutto, Sabine Roman, Aurelien Garros, Francois Mion
Background: Esophageal shortening (ES) might be observed during high-resolution manometry (HRM), in particular after the rapid drink test (RDT). We aimed to assess its diagnostic value in patients referred for HRM. Methods: HRM of patients without previous esophagogastric surgery or endoscopic treatment was retrospectively reviewed using the Chicago Classification v3.0. ES and pan-esophageal pressurization were analyzed during the RDT (200-ml free drinking in a sitting position)...
November 2018: United European Gastroenterology Journal
Uday C Ghoshal, Arun Karyampudi, Abhai Verma, Hemanta K Nayak, Samir Mohindra, Nakul Morakhia, Vivek A Saraswat
Pneumatic dilation (PD) is a cost-effective first-line treatment for achalasia. The most feared complication of PD is esophageal perforation (EP). As data on EP after PD for achalasia are not widely reported, we present the frequency, risk factors, and treatment-outcome of EP. Records of patients undergoing PD for achalasia (January 1995 to September 2015) were retrospectively reviewed. Of 433 patients (age 38 years, 13-88, 57% male), and 521 dilations, 12 were complicated by EP (2.7% of patients and 2.3% of PD)...
July 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Sumera Akram, Muhammad Ahmed Khan, Abdul Rehman
Allgrove syndrome is a rare autosomal recessive syndrome of unknown prevalence. The first case of Allgrove syndrome was reported in 1978 by Allgrove. It is characterized by triad of achalasia, alacrima and adrenal hypoplasia. There are also associated autonomic and neurological manifestations. We report the case of a 7 years old boy being treated for achalasia cardia, presented with fits and altered sensorium which on further investigations was found to be due to adrenal insensitivity (Raised ACTH level, low Cortisol level, and normal Aldosterone and Renin ratio)...
August 2018: JPMA. the Journal of the Pakistan Medical Association
Houda Meyiz, Mounia Elyousfi
Achalasia, also known as cardiospasm or megaoesophagus is a rare disorder of unknown origin. It is a primary motor disorder of the esophagus characterized by the absence of the esophageal peristalsis and by an incomplete or an absent relaxation of the lower oesophageal sphincter. Common symptoms include dysphagia, regurgitations and retrosternal pain. At an advanced level, fibroscopy can show a dilation of the lower esophagus and a shrinkage that can be easily passed through with a lifting at the level of the cardia...
2018: Pan African Medical Journal
Alexandr Evgen'evich Mashkov, Dmitrii Anatolèvich Pykchteev, Alexandr Viktorovic Sigachev, Andrei Viktorovich Bobylev, Johannes Michael Mayr
RATIONALE: Esophageal achalasia is characterized by impaired relaxation of the cardia and dilation of the intrathoracic part of the esophagus. We describe the late presentation of achalasia in an 11-year old girl. PATIENT CONCERNS: She suffered from recurrent pneumonia, obstructive bronchitis, and problems with swallowing solid food. Her family noted a wet pillow in the morning. DIAGNOSES: This case report describes the typical symptoms of achalasia in children in order to facilitate earlier diagnosis of this rare disease...
June 2018: Medicine (Baltimore)
Prince Gupta, Rajinder Parshad, Pavithra Balakrishna, Anoop Saraya, Govind K Makharia, Sanjeev Sachdeva, Raju Sharma
BACKGROUND: There is no consensus regarding the type of anti-reflux procedure to be used as an adjunct to laparoscopic Heller cardiomyotomy (LHCM). The aim of this study was to compare Angle of His accentuation (AOH) with Dor Fundoplication (Dor) as an adjunct to LHCM. METHODS: A total of 110 patients with achalasia cardia presenting for LHCM from March 2010 to July 2015 were randomized to Dor and AOH. Symptom severity, achalasia-specific quality of life (ASQOL), new onset heartburn, and patient satisfaction were assessed using standardized scores preoperatively, at 3, 6 months, and then yearly...
September 2018: Digestive Diseases and Sciences
Valter Nilton Felix
Forced pneumatic dilatation (PD) of the cardia is one of the most consecrated therapeutic measures for esophageal achalasia. The procedure only achieved better standardization with the appearance of the Rigiflex balloon. Results and predictive factors of success and failure of PD are reviewed, right after the description of the main technical aspects of the procedure. The success rates, providing control of dysphagia for about 1 year from the procedure using the Rigiflex balloon, are quite satisfactory, with success in more than 75% of patients...
December 2018: Annals of the New York Academy of Sciences
Samiullah Khan, Shuai Su, Kui Jiang, Bang-Mao Wang
RATIONALE: Retrograde gastroesophageal intussusception (RGEI) is a relatively rare gastrointestinal (GI) disorder in which a portion of the stomach wall invaginates into the esophagus. More recently, peroral endoscopic myotomy (POEM) has emerged as an endoscopic alternative to surgical myotomy for achalasia, and, to the best of our knowledge, our case is the first RGEI after POEM to be reported. PATIENT CONCERNS: A 22-year-old male was presented with a history of vomiting, intractable retching and hematemesis for 3 days...
January 2018: Medicine (Baltimore)
Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Rakesh Kalapala, Santosh Darisetty, D Nageshwar Reddy
Background and Aim: Peroral endoscopic myotomy (POEM) is a technically demanding procedure. Recently, a new triangular knife with integrated water jet function (TTJ) has been introduced. The present study was aimed to analyze and compare the operating time, efficacy, and adverse events (AEs) between the conventional (TT knife) and new knife (TTJ). Patients and Methods: All patients with achalasia cardia (AC) who underwent POEM between August 2015 and November 2016 were analyzed retrospectively...
January 2018: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Mohan Ramchandani, Zaheer Nabi, D Nageshwar Reddy, Rahul Talele, Santosh Darisetty, Rama Kotla, Radhika Chavan, Manu Tandan
Background and study aims:  Peroral endoscopic myotomy (POEM) can be performed via an anterior or posterior approach, depending on the operator's preference. Data are lacking on comparative outcomes of both approaches. Patients and methods:  This is a pilot randomized study comparing endoscopic anterior and posterior myotomy during POEM in patients with Achalasia cardia (AC). Patients were randomized into 2 groups (n = 30 in each group); anterior myotomy group (AG) and posterior myotomy group (PG) and were followed at 1, 3 and 6 months after POEM...
February 2018: Endoscopy International Open
Mohan Ramchandani, D Nageshwar Reddy, Zaheer Nabi, Radhika Chavan, Amol Bapaye, Shobna Bhatia, Nilay Mehta, Pankaj Dhawan, Adarsh Chaudhary, Uday C Ghoshal, Mathew Philip, Horst Neuhaus, Jacques Deviere, Haruhiro Inoue
Achalasia cardia (AC) is a frequently encountered motility disorder of the esophagus resulting from an irreversible degeneration of neurons. Treatment modalities are palliative in nature, and there is no curative treatment available for AC as of now. Significant advancements have been made in the management of AC over last decade. The introduction of high resolution manometry and per-oral endoscopic myotomy (POEM) has strengthened the diagnostic and therapeutic armamentarium of AC. High resolution manometry allows for the characterization of the type of achalasia, which in turn has important therapeutic implications...
August 2018: Journal of Gastroenterology and Hepatology
V Poornachand, K Kumarasamy, S P Karamath, V Seenivasan, Sumathi Bavanandam, Nirmala Dheivamani
Achalasia cardia is an esophageal motility disorder rarely reported in children and more so in young infants. Common clinical presentations include vomiting, dysphagia, regurgitation, recurrent pulmonary aspiration and failure to thrive. Diagnosis is made by barium swallow study and esophageal manometry, which is the gold standard test. Pharmocological management and endotherapy often fails and results in recurrence of symptoms. Laparoscopic Hellers myotomy, with or without anti-reflux procedure is the standard treatment of choice for children...
August 2018: Indian Journal of Pediatrics
Vaibhav Kumar Varshney, Subhash Chandra Soni, Manju Kumari, Pawan Kumar Garg, Ashok Puranik
Achalasia cardia is an oesophageal motility disorder characterised by aperistalsis and failure of relaxation of the lower oesophageal sphincter. The management is predominantly palliative with focus on addressing the sphincter that involves either pneumatic dilatation or Heller myotomy which relieves dysphagia in the majority of the cases. End-stage achalasia (ESA) is characterised by failed myotomy, massively dilated and tortuous oesophagus with nutritional deterioration due to progressive dysphagia and vomiting...
July 2018: Journal of Minimal Access Surgery
Zaheer Nabi, Duvvur Nageshwar Reddy
Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories...
March 2018: Clinical Endoscopy
Fanny Yeung, Ian Y H Wong, Patrick H Y Chung, Kenneth K Y Wong, Simon Y K Law, Paul K H Tam
BACKGROUND: Experience of peroral endoscopic myotomy (POEM) for treatment of achalasia in pediatric population is limited with varying techniques in different centers. The accurate extent of submucosal tunneling into the gastric cardia and the adequacy of myotomy are the important determining factors to success of POEM. A majority of studies in pediatric population have described using submucosal dye injection for assessing the adequacy of myotomy, however, this is a rather crude and inaccurate method...
March 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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