Pedunculated liposarcoma of the esophagus.

Polypoid tumours of the esophagus present diagnostic and therapeutic problems. Liposarcomas are infrequent among them. We report a recent case. A 73-year-old male patient was seen in May 1995 in the Ear, Nose and Throat (ENT) Department, Clinica Modelo de Morón, with intermittent dysphagia and dyspnoea due to recurrent vomiting. A laryngeal lineal tomography showed a subglottic obstruction due to extrinsic compression. The patient was referred to the Gastroenterology Department, where an upper gastrointestinal (upper GI) series demonstrated mega-esophagus with abundant retained food. Endoscopy showed a large intraluminal mass covered by normal mucosa which arose on the posterior wall. Videofluoroscopy and chest CT diagnosed a probable polypoid lipoma due to its densitometric characteristics. The tumour was resected by left cervicotomy and left esophagotomy. The patient's progress to date is favourable. Pathology studies showed a well-differentiated liposarcoma. According to the literature, the first case was reported in 1983, and ours is only the seventh case in the world to be documented.

Foreign body impaction in the esophagus: are there underlying motor disorders?

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.

Prevalence, clinical spectrum and atypical symptoms of gastro-oesophageal reflux in Argentina: a nationwide population-based study.

BACKGROUND: Population-based data on gastro-oesophageal reflux in Latin America are lacking. AIM: To assess gastro-oesophageal reflux symptom prevalence, clinical spectrum and association with the atypical symptoms in our country. METHODS: Gastro-oesophageal reflux self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-80 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census. RESULTS: The overall prevalence of any typical gastro-oesophageal reflux symptom experienced in the previous year was 61.2% (95% CI, 57.9-64.6), the prevalence of frequent gastro-oesophageal reflux symptoms was 23.0% (95% CI, 20.1-25.9) and the prevalence of gastro-oesophageal reflux disease was 11.9% (95% CI, 9.6-14.1). Frequent gastro-oesophageal reflux symptoms were associated with dysphagia (OR 2.12, 95% CI, 1.27-3.54, P < 0.01), globus (OR 2.22, 95% CI, 1.35-3.66, P < 0.01) and non-cardiac chest pain (OR 1.55, 95% CI, 1.04-2.31, P < 0.05). CONCLUSIONS: In Argentina, typical symptoms of gastro-oesophageal reflux are highly prevalent at the national level, and frequent gastro-oesophageal reflux symptoms are significantly associated with dysphagia, globus and non-cardiac chest pain.

Pneumatic dilatation in achalasia of the esophagus: a report from Argentina.

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.

Heterotopic gastric mucosa in the upper esophagus: report of a case with a fistula.

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.

[Barrett s epithelium: clinical review]. / Epitelio de Barrett: revisión clínica.

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.

Epitelio de Barrett: revisión clínica. / [Barrett s epithelium: clinical review]

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.

Foreign body impaction in the esophagus: are there underlying motor disorders?

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.

Pedunculated liposarcoma of the esophagus.

Polypoid tumors of the esophagus present diagnostic and therapeutic problems. Liposarcomas are infrequent among them. We report a recent case. A 73-year-old male patient was seen in May 1995 in the Ear, Nose and Throat (ENT) Department, Clínica Modelo de Morón, with intermittent dysphagia and dyspnoea due to recurrent vomiting. A laryngeal lineal tomography showed a subglottic obstruction due to extrinsic compression. The patient was referred to the Gastroenterology Department, where an upper gastrointestinal (upper GI) series demonstrated mega-esophagus with abundant retained food. Endoscopy showed a large intraluminal mass covered by normal mucosa which arose on the posterior wall. Videofluoroscopy and chest CT diagnosed a probable polypoid lipoma due to its densitometric characteristics. The tumour was resected by left cervicotomy and left esophagotomy. The patient's progress to date is favourable. Pathology studies showed a well-differentiated liposarcoma. According to the literature, the first case was reported in 1983, and ours is only the seventh case in the world to be documented.

[Esophageal achalasia: what to do, the balloon or the scalpel?]. / Acalasia del esófago: que hacer, el balón o el bisturi?

In this paper we review the different options published in the world literature regarding the treatment of achalasia of the esophagus. It is concluded that pneumatic dilatation and Heller's operation are the only valid possibilities for primary treatment of the disease. The specific indications for each procedure are also being set. The cost analysis in our country is determined, arriving to the conclusion that pneumatic dilation has a direct cost of A$968 (expectant cost up to A$1.144); and laparoscopic Heller's operation A$2.250. Our personal experience on 120 pneumatic dilatations is analyzed and compared with that of the literature, arriving to the conclusion that our results are similar to the ones of the main available papers.

[Gastroesophageal reflux disease refractory to medical treatment. Which approach: the pill or the scalpel?]. / Enfermedad por reflujo gastroesofágico refractaria al tratamiento medico. Qué conducta adoptar: la píldora o el bisturí?

We analyze the modern literature regarding natural history, clinical picture and treatment of gastroesophageal reflux disease. The characteristics of a small group of patients with tendency to relapse are emphasized, analyzing the possibilities offered by pharmacological as well as surgical treatment. Finally, we analyse the current literature of our country situation.

[Predictive factors in the treatment of esophageal achalasia]. / Factores Predictivos en el Tratamiento de la Acalasia del Esófago.

With aim of determining if there are predictive factors in the treatment of achalasia of the esophagus, we analyzed in a group of 119 patients variables such as age, gender, X-Rays, Chagas' disease serology and esophageal manometry before and after treatment. The only significant factor was the LES pressure post-treatment but, since the sampling was heterogeneous, and the differences where the same between bad and good results, we believe it has no predictive value in the treatment of achalasia of the esophagus.

Factores Predictivos en el Tratamiento de la Acalasia del Esófago. / [Predictive factors in the treatment of esophageal achalasia]

With aim of determining if there are predictive factors in the treatment of achalasia of the esophagus, we analyzed in a group of 119 patients variables such as age, gender, X-Rays, Chagas disease serology and esophageal manometry before and after treatment. The only significant factor was the LES pressure post-treatment but, since the sampling was heterogeneous, and the differences where the same between bad and good results, we believe it has no predictive value in the treatment of achalasia of the esophagus.

[Esophageal achalasia: 20 years' experience with non surgical treatment]. / Acalasia del esófago: veinte años de experiencia en el tratamiento no quirúrgico.

The purpose of this paper is to report the experience acquired in pneumatic dilatation in achalasia of the esophagus up to 1990. Two hundred and six patients were studied in that period (X 50, 7 years, M/F 1:1). According to X Rays the distribution was: grade I 17.4%, grade II 54.8%, grade III 14% and grade IV 13.5%. The associated esophageal pathology was: hiatus hernia 9.7%, esophagitis 5.8%, benign stenosis 2.4%, cancer 1.4%, ulcer and diverticula 0.9% and Schatzki's ring and leiomyoma 0.4% respectively Serology for Chagas disease was positive in 23% Chagasic megacolon was more frequent than chagasic heart disease (4.3% Vs. 1.4%). Out of these, one hundred and twenty patients were treated by pneumatic dilatation. To this group we shall refer in more detail. One hundred ant two patients were dilated once and the remaining 18 twice. Esophageal manometry showed a vigorous pattern in 7.7%. The LES' pressure pre-treatment was 24.5 mm Hg and post-dilatation 13.7 mm Hg in 75.8% of the cases the result was good. The morbidity was 5% and the mortality 0.7%. Relapse was seen in 25.8% of the cases. The follow-up was X 38 months. We conclude that pneumatic dilatation is the election procedure in the treatment of achalasia since it offers good results with low morbimortality. Surgery is indicated after failure of 2 dilatations, in children, and association with esophageal neoplasms, hiatus hernia and esophageal diverticula.