ABSTRACT
RESULTS: Compared with the control group, the impacted subjects presented marked reduction in amplitude and duration of esophageal contraction in the proximal esophagus. CONCLUSIONS: These motor disorders could be responsible for the foreign body impaction in the esophagus. However, we believe this patient group should be further studied by 24-hour esophageal manometry to reach a more accurate diagnosis by studying each patient's entire circadian cycle.
Subject(s)
Esophagus/physiopathology , Foreign Bodies/etiology , Muscle Contraction , Peristalsis/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Endoscopy, Gastrointestinal , Esophageal Sphincter, Lower/physiopathology , Female , Humans , Male , Manometry , Middle Aged , Prospective Studies , Young AdultABSTRACT
Autonomic nervous system dysfunction has been implicated in the pathophysiology of irritable bowel syndrome (IBS). This study characterized the autonomic response to rectal distension in IBS using baroreceptor sensitivity (BRS), a measure of autonomic function. Rectal bag pressure, discomfort, pain, ECG, blood pressure and BRS were continuously measured before, during and after rectal distension in 98 healthy volunteers (34 +/- 12 years old, 52 females) and 39 IBS patients (39 +/- 11 years old, 35 females). In comparison with the healthy volunteers, IBS patients experienced significantly more discomfort (69 +/- 2.2% vs 56 +/- 3.6%; P < 0.05), but not pain (9 +/- 1.4% vs 6 +/- 2.4%; ns) with rectal distension despite similar distension pressures (51 +/- 1.4 vs 54 +/- 2.4 mmHg; ns) and volumes (394 +/- 10.9 vs 398 +/- 21.5 mL; ns). With rectal distension, heart rate increased in both healthy volunteers (66 +/- 1 to 71 +/- 1 bpm; P < 0.05) and IBS patients (66 +/- 2 to 74 +/- 3 bpm; P < 0.05). Systolic blood pressure also increased in both healthy volunteers (121 +/- 2 to 143 +/- 2 mmHg; P < 0.05) and patients (126 +/- 3 to 153 +/- 4 mmHg (P < 0.05) as did diastolic blood pressure, 66 +/- 2 to 80 +/- 2 mmHg (P < 0.05), compared with 68 +/- 3 to 84 +/- 3 mmHg (P < 0.05) in IBS patients. The systolic blood pressure increase observed in IBS patients was greater than that seen in healthy volunteers and remained elevated in the post distension period (139 +/- 3 mmHg vs 129 +/- 2 mmHg; P < 0.05). IBS patients had lower BRS (7.85 +/- 0.4 ms mmHg(-1)) compared with healthy volunteers (9.4 +/- 0.3; P < 0.05) at rest and throughout rectal distension. Greater systolic blood pressure response to rectal distension and associated diminished BRS suggests a compromise of the autonomic nervous system in IBS patients.
Subject(s)
Irritable Bowel Syndrome/physiopathology , Pressoreceptors/physiopathology , Rectum/innervation , Vagus Nerve Diseases/physiopathology , Adult , Blood Pressure/physiology , Dilatation, Pathologic , Female , Heart Rate/physiology , Humans , Male , Pain Threshold , Sensation/physiologyABSTRACT
We review the treatment of esophageal achalasia by means of pneumatic dilatation (PD), analyzing its results and comparing them with those of the literature. We conclude that our personal experience is similar to that of the literature: PD and surgery produce similar results (67-95%), morbidity (2-9.5%), and mortality (0.7-1%); and PD is cheaper than surgery. According to these conclusions, we believe that the decision of the appropriate treatment should be based on a combination of the choice of the properly informed patient and the operator's experience. However, we also conclude that surgery is mandatory in selected cases, such as achalasia associated with hiatus hernia, esophageal diverticula and neoplasia, history of previous PD failure (since in our experience the results after a second PD are very poor), postoperative relapse, and patients with grade IV mega-esophagus according to Resano-Malenchini's classification.
Subject(s)
Catheterization , Esophageal Achalasia/therapy , Argentina/epidemiology , Catheterization/methods , Chagas Disease/complications , Esophageal Achalasia/complications , Esophageal Achalasia/epidemiology , Esophageal Achalasia/etiology , Esophageal Perforation/complications , Esophageal Perforation/diagnosis , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/etiology , Humans , Incidence , Male , Megacolon/complications , Middle Aged , Prevalence , Retrospective Studies , Treatment OutcomeABSTRACT
We report the case of a 36-year-old man with a patch of heterotopic gastric mucosa in the upper esophagus complicated by an esophageal fistula.
Subject(s)
Choristoma/pathology , Esophageal Fistula/pathology , Esophagitis/diagnosis , Gastric Mucosa , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Adult , Biopsy, Needle , Choristoma/diagnosis , Drug Therapy, Combination , Esophageal Fistula/complications , Esophageal Fistula/diagnosis , Esophagitis/complications , Esophagitis/drug therapy , Esophagoscopy , Follow-Up Studies , Helicobacter Infections/complications , Helicobacter Infections/drug therapy , Humans , Immunohistochemistry , Male , Risk Assessment , Treatment OutcomeABSTRACT
In this paper we review the literature about regarding etiology, natural history, methods of study and treatment of Barrett's esophagus. Likewise we review our personal experience as well as the one at national level.
Subject(s)
Barrett Esophagus , Barrett Esophagus/diagnosis , Barrett Esophagus/etiology , Barrett Esophagus/therapy , Female , Humans , MaleABSTRACT
In this paper we review the literature about regarding etiology, natural history, methods of study and treatment of Barrett's esophagus. Likewise we review our personal experience as well as the one at national leve.
Subject(s)
Humans , Male , Female , Barrett EsophagusABSTRACT
In this paper we review the literature about regarding etiology, natural history, methods of study and treatment of Barretts esophagus. Likewise we review our personal experience as well as the one at national level.
ABSTRACT
In this paper we review the literature about regarding etiology, natural history, methods of study and treatment of Barretts esophagus. Likewise we review our personal experience as well as the one at national leve. (Au)
Subject(s)
Humans , Male , Female , Barrett EsophagusABSTRACT
UNLABELLED: We observed in our practice several cases of impaction with meat boluses without bony edges, in patients with patent esophageal lumen. The aim of this study was to search for eventual underlying motor disorders which could be responsible for this impaction. We included 19 patients who attended the endoscopy service for meat bolus impaction without organic esophageal stenosis. This group was compared with 18 control volunteers. Both groups underwent UGI series, UGI endoscopy and low-compliance perfusion standard esophageal manometry. RESULTS: Compared with the control group, the impacted subjects presented marked reduction in amplitude and duration of esophageal contraction in the proximal esophagus. CONCLUSIONS: These motor disorders could be responsible for the foreign body impaction in the esophagus. However, we believe this patient group should be further studied by 24-hour esophageal manometry to reach a more accurate diagnosis by studying each patient's entire circadian cycle.
Subject(s)
Esophageal Motility Disorders/complications , Esophagus , Foreign Bodies/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Esophagus/physiopathology , Female , Foreign Bodies/etiology , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A retropective study was perfomed to asses risk factors in patients with esophageal echalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4 percent). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. Conclusions: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4 percent risk of perforation and 0.6 percent mortality rate. 2) The risk of developping an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested.
Subject(s)
Adult , Middle Aged , Female , Humans , /adverse effects , Esophageal Achalasia/therapy , Esophageal Perforation/etiology , Analysis of Variance , Chi-Square Distribution , Retrospective Studies , Risk FactorsABSTRACT
A retropective study was perfomed to asses risk factors in patients with esophageal echalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4 percent). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. Conclusions: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4 percent risk of perforation and 0.6 percent mortality rate. 2) The risk of developping an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested. (AU)
Subject(s)
Adult , Middle Aged , Female , Humans , Comparative Study , Esophageal Perforation/etiology , Catheterization/adverse effects , Esophageal Achalasia/therapy , Chi-Square Distribution , Analysis of Variance , Retrospective Studies , Risk FactorsABSTRACT
UNLABELLED: A retrospective study was performed to asses risk factors in patients with esophageal achalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4%). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. CONCLUSIONS: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4% risk of perforation and 0.6% mortality rate. 2) The risk of developing an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested.
