Difference of achalasia subtypes based on clinical symptoms, radiographic findings, and stasis scores. / Diferencia de subtipos de acalasia basados en síntomas clínicos, hallazgos radiográficos y puntajes de estasis.

INTRODUCTION: Three subtypes of achalasia have been defined through high-resolution esophageal manometry: subtype i shows no pressurization with swallows, subtype ii has increased isobaric panesophageal pressure, and subtype iii has distal esophageal spastic non-isobaric contractions. Studies describing the subtypes based on radiographic findings, clinical symptoms, and stasis scores are limited. AIM: To determine the differences in clinical symptoms, radiographic findings, and stasis scores for the 3 achalasia subtypes. METHODS: Patients undergoing high-resolution esophageal manometry received a questionnaire about current symptoms and previous treatments. The questions included the presence of symptoms and their severity. Barium swallow tests were performed before the high-resolution esophageal manometry study to evaluate the maximum esophageal diameter. Stasis scores were calculated using the transit patterns on high-resolution esophageal manometry. RESULTS: One hundred and eight patients with high-resolution esophageal manometry diagnosis of achalasia (n=8, subtype i; n=84, subtype ii; n=16, subtype iii) within the time frame of 1/2012-6/2015 were included in the study. Sex distribution was similar between the subtypes. Patient age was younger for subtype i (38±16 years), compared with subtypes ii (55±17 years) and iii (63±17 years) (P=.03). Esophageal symptoms did not differ between subtypes regarding the severity of nausea, chest pain, coughing, and heartburn, except for increased vomiting severity in subtype i (2.8±1.4 vs. 1.4±1.4 vs. 1.2±1.2, P<.01). A significant radiographic difference in esophageal dilation was seen between subtypes ii and iii (35.1±14.4 vs. 24.0±7.2mm, P=.023). Stasis scores did not significantly differ between the subtypes. CONCLUSIONS: Achalasia subtypes had similar clinical symptoms, except for increased vomiting severity in subtype i. The maximum esophageal diameter in subtype ii was significantly greater than in subtype iii. Esophageal stasis scores were similar. Thus, high-resolution esophageal manometry remains essential in assessing achalasia subtypes.

Esofagograma: imágenes que valen más que mil palabras / Esophagograms: Images Worth a Thousand Words

Resumen El estudio de las enfermedades esofágicas requiere de múltiples exámenes diagnósticos, ya que ninguno, por sí solo, provee total información sobre la funcionalidad y la anatomía del tracto digestivo superior. Para los cirujanos generales y gastrointestinales, el esofagograma constituye una herramienta esencial que, además de sugerir un diagnóstico, ofrece una idea de la anatomía del órgano y nos permite esbozar un mapa de fácil evaluación (sin la necesidad de un radiólogo), para establecer o definir un plan quirúrgico. El objetivo del presente artículo es mostrar al lector la utilidad del esofagograma en centros de referencia en el estudio y el tratamiento de las enfermedades esofágicas, así como su representación en algunas enfermedades frecuentes.

Abstract The study of esophageal diseases requires multiple diagnostic tests since no one test alone can provide full information on upper digestive tract anatomy and functionality. For general surgeons and gastrointestinal surgeons, the esophagogram is an essential tool that can suggest a diagnosis while simultaneously providing an idea of ​​the anatomy of the organ and outlining an easily evaluated map without the need of a radiologist. This information can be used to establish a surgical plan. The aim of this article is to show readers the usefulness of esophagograms at referral centers for study and treatment of esophageal diseases while providing representations of several frequent diseases.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram / Alterações radiológicas encontradas no megaesôfago chagásico em radiografias simples de tórax e esofagogramas

Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.

Reporte de un caso con diagnóstico de anillo vascular / Report of a Patient with Vascular Ring

Se presentó un paciente masculino de cuatro meses portador de un anillo vascular, operado de mielomeningocele con antecedentes de infecciones respiratorias frecuentes, broncoespasmo, estridor laríngeo y reflujo gastroesofágico. Es común que estas malformaciones vasculares se asocien con otros defectos cardíacos congénitos, fundamentalmente defectos septales y troncoconales. Representan alrededor del 1 por ciento de todas las anomalías cardiovasculares congénitas. Se ha comunicado una mayor frecuencia de anillos vasculares en el sexo masculino. Varios tipos de anillos vasculares están asociados con un arco aórtico a la derecha Los síntomas en la edad pediátrica son principalmente respiratorios y digestivos, por compresión traqueal y esofágica que producen trastornos en la deglución que se manifiestan por vómitos o intolerancia a la alimentación y que agravan los síntomas respiratorios como resultado de broncoaspiración(AU)...

A male patient case of 4 month of age with vascular ring thet underwent surgery of myelomeningocele and a history of frequent respiratory infections, bronchospasm, laryngeal stridor, and gastroesophageal reflux was presented in this paper. These vascular malformations are commonly associated with other congenital heart defects like septal and truncoconal defects. Vascular rings represent about ,1, percent of all congenital heart anomalies and have been frequently reported in males. Several types of vascular rings are associated with right aortic arch. Symptoms in children are mainly respiratory and digestive because of tracheal and esophageal compression resulting in swallowing disorders presented by vomiting or food intolerance. These disorders worsen respiratory symptoms as a result of pulmonary aspiration(AU)...

Megaesôfago idiopático não avançado: relato de caso / Not advanced esophageal idiopathic achalasia: case report

Objetivo: relatar um caso de megaesôfago idiopático grau II, tratado pela técnicavideolaparoscópica, em um paciente de 32 anos, sexo masculino. Relato de caso: foram realizadosmanometria, endoscopia digestiva alta com biópsia e análise histopatológica e esofagograma, comométodos diagnósticos auxiliares. Em janeiro de 2007, o paciente foi submetido a tratamento cirúrgicopela técnica de Heller-Pinotti por videolaparoscopia, evoluindo com melhora clínica posterior,devido ao procedimento, com episódios reduzidos de disfagia e sem demais intercorrências.Considerações Finais: casos não avançados de megaesôfago devem ser tratados preferencialmentepela técnica de Heller-Pinotti por via laparoscópica, mostrando excelentes resultados. Os casos deetiologia idiopática não necessitam de qualquer outro tratamento adicional.

Objective: report a case of esophageal achalasia idiopathic stage II of a male 32 years oldpatient, treated by videolaparoscopic technique. Report case: manometry,esophagogastroduodenoscopy and esophagogram were performed as auxiliary diagnosticmethods. On January 2007, the patient went to surgical treatment through the technique ofHeller-Pinotti by videolaparoscopy. After that, the patient had a clinical improvement withreduced episodes of dysphagia and without other complications. Final considerations: casesnot advanced of esophageal achalasia should be treated preferentially by the technique of Heller-Pinotti by laparoscopy, which has shown excellent result. The idiopathic cases do notneed additional treatment.

Síndrome de Boerhaave / Boerhaave syndrome

Se trata de un paciente de 38 años con hábitos de alcoholismo y tabaquismo frecuentes. Dieciséis horas antes de su ingreso al servicio de Emergencia tras ingerir copiosamente alcohol y alimentos presenta vómito de gran esfuerzo con contenido alimentario, con estrías de sangre roja rutilante acompañado de dolor retroesternal y epigástrico de gran intensidad. Al examen físico el cuello está aumentado de tamaño palpándose efisema subcutáneo cervical y preesternal. A la auscultación pulmonar el murmullo vesicular está disminuido en la fase izquierda. los exámenes de laboratorio revelan leucocitos con desviación a la izquierda. Se solicita un esofagograma el cual permitió observar una colección sacular por extravasación de contraste sobre el esófago distal en vecindad a la unión gastroesofágica. el paciente fue intervenido quirúrgicamente y se efectúo una rafia primaria de la perforación reforzada con la colocación del parche preural y drenaje; posteriormente ingresa a UCI donde recibe antibiótico de amplio espectro, protectores gástricos y analgesia. su evolución tanto clínica como en controles de laboratorio fueron satisfactorios. Se realizó un esofagograma al octavo día posteriormente demostrando paso normal del contraste desde el esófago al estómago, por lo que se inició líquidos claros, Al décimo día postquirúrgico fue dado de alta.

This is a 38-year-old patient with frequent alcoholism and smoking habits. Sixteen hours before entering the Emergency Service after copiously consuming alcohol and food, she presented vomiting of great effort with food content, with glowing red blood streaks accompanied by retrosternal and epigastric pain of great intensity. On physical examination, the neck is enlarged, palpating the cervical and presternal subcutaneous episema. Upon pulmonary auscultation, the vesicular murmur is decreased in the left phase. Laboratory tests reveal leukocytes with a left shift. An esophagogram was requested, which allowed observing a saccular collection by contrast extravasation on the distal esophagus in the vicinity of the gastroesophageal junction. the patient underwent surgery and a primary raffia was made from the reinforced perforation with the placement of the preural patch and drainage; Later, he entered the ICU where he received a broad-spectrum antibiotic, gastric protectors, and analgesia. Its evolution, both clinical and in laboratory controls, was satisfactory. An esophagogram was performed on the eighth day later, demonstrating a normal passage of contrast from the esophagus to the stomach, so clear liquids were started. On the tenth day after surgery, he was discharged.

Anillo vascular por doble arco aórtico simétrico. Reporte de un caso / Double symmetrical aortic arch. Case report

Describimos un paciente de 6 meses de edad con doble arco aórtico simétrico y sintomatología obstructiva traqueal y esofágica, tratado quirúrgicamente. Se realizó una correlación entre las imágenes diagnósticas obtenidas con esofagograma, ecococardiografía y angiografía con un espécimen anatómico, dando énfasis a la utilidad del ecocardiograma como estudio inicial.

We report a six-month-old patient with a double symmetrical aortic arch with tracheal and esophageal obstructive symptoms, who was treated surgically. The diagnostic images consisting of esophagogram, echocardiography and angiography were correlated with an anatomical specimen; the usefulness of the echocardiogram as an initial test is emphasized. (Arch Cardiol Mex 2005; 75: 178-181).