PNEUMATIC DILATION FOR ACHALASIA CARDIA: REDUCTION IN LOWER ESOPHAGEAL SPHINCTER PRESSURE IN ASSESSING RESPONSE AND FACTORS ASSOCIATED WITH RECURRENCE DURING LONG-TERM FOLLOW UP

2011 ◽  
Vol 24 (1) ◽  
pp. 7-15 ◽  
Author(s):  
UDAY C GHOSHAL ◽  
MURALI RANGAN ◽  
ASHA MISRA
Keyword(s):  
Lower Esophageal Sphincter ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
Achalasia Cardia ◽  
Factors Associated ◽  
Long Term Follow Up ◽  
Esophageal Sphincter

Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia

2021 ◽  
Vol 10 (1) ◽  
pp. 8-13
Author(s):  
Shankar Baral ◽  
Bidhan NIdhi Paudel ◽  
Ajit Khanal ◽  
Jiwan Thapa ◽  
Bhuwneshwer Yadhav ◽  
...  
Keyword(s):  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Poor Response ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilatation ◽  
Response To Treatment ◽  
Sphincter Pressure ◽  
Achalasia Cardia ◽  
Type Iii ◽  
Esophageal Sphincter

Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p<0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation.  

Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 798-805
Author(s):  
William E. Berquist ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
Eric W. Fonkalsrud ◽  
Arthur R. Euler
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
School Aged Children ◽  
Retrosternal Pain ◽  
Esophageal Sphincter

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.

scholarly journals Achalasia: Treatment Options Revisited

2000 ◽  
Vol 14 (5) ◽  
pp. 406-409 ◽  
Author(s):  
Willemijntje A Hoogerwerf ◽  
Pankaj J Pasricha
Keyword(s):  
Treatment Options ◽  
Pneumatic Dilation ◽  
Short Term ◽  
Laparoscopic Myotomy ◽  
Mechanical Disruption ◽  
Attractive Option ◽  
Long Term Follow Up ◽  
Esophageal Sphincter

The aim of all current forms of treatment of achalasia is to enable the patient to eat without disabling symptoms such as dysphagia, regurgitation, coughing or choking. Historically, this has been accomplished by mechanical disruption of the lower esophageal sphincter fibres, either by means of pneumatic dilation (PD) or by open surgical myotomy. The addition of laparoscopic myotomy and botulinum toxin (BTX) injection to the therapeutic armamentarium has triggered a recent series of reviews to determine the optimal therapeutic approach. Both PD and BTX have excellent short term (less than three months) efficacy in the majority of patients. New data have been published that suggest that PD and BTX (with repeat injections) can potentially obtain long term efficacy. PD is still considered the first-line treatment by most physicians; its main disadvantage is risk of perforation. BTX injection is evolving as an excellent, safe option for patients who are considered high risk for more invasive procedures. Laparoscopic myotomy with combined antireflux surgery is an increasingly attractive option in younger patients with achalasia, but long term follow-up studies are required to establish its efficacy and the potential for reflux-related sequelae.

scholarly journals Pnematic Dilation in Achalasia

2001 ◽  
Vol 15 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Maximilian Bittinger ◽  
Martin Wienbeck
Keyword(s):  
Lower Esophageal Sphincter ◽  
Young Patients ◽  
Circular Muscle ◽  
Lower Esophageal Sphincter Pressure ◽  
Long Term Results ◽  
Pneumatic Dilation ◽  
Muscle Fibres ◽  
Sphincter Pressure ◽  
First Line Therapy ◽  
Esophageal Sphincter

Pneumatic dilation is the most common first-line therapy for the treatment of achalasia. The aim of dilation is a controlled disruption of circular muscle fibres of the lower esophageal sphincter to reduce the functional obstruction. Several types of dilators and different dilation techniques are used, but the achieved results are similar. The mean success rate is about 80% in the short term, but some patients need redilation in the further course (particularly young patients). Best long term results are obtained if the lower esophageal sphincter pressure can be reduced below 10 mmHg. Major complications are rare after pneumatic dilation; the most serious complication is esophageal perforation, which occurs at a mean rate of about 2.5%. Considering the pros and cons of other effective forms of treatment of achalasia (esophagomyotomy and intrasphincteric injection of botulinum toxin), pneumatic dilation is still the treatment of choice in the majority of patients with achalasia.

scholarly journals Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

GastroHep ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 107-115
Author(s):  
Inka Koskinen ◽  
Kaisa Hervonen ◽  
Eero Pukkala ◽  
Timo Reunala ◽  
Katri Kaukinen ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Cancer Incidence ◽  
Factors Associated ◽  
Long Term Follow Up
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