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.

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.

Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape?

1997 ◽  
Vol 272 (6) ◽  
pp. G1509-G1517 ◽  
Author(s):  
J. Liu ◽  
V. K. Parashar ◽  
R. K. Mittal
Keyword(s):  
Lower Esophageal Sphincter ◽  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Muscle Thickness ◽  
Close Correlation ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Contraction Phase ◽  
Esophageal Sphincter ◽  
Pull Through

Lower esophageal sphincter (LES) pressure shows axial and circumferential asymmetry, the reasons for which are not clear. Our aim was to determine whether the muscle thickness and shape of the LES were the reasons for the axial and circumferential asymmetry in the LES pressure. High-frequency, catheter-based intraluminal ultrasonography was performed to obtain images of the human LES and esophagus. Station pull-through manometry was performed to record the axial and circumferential asymmetry of LES pressure. Circular and longitudinal muscle were thicker in the LES compared with in the esophagus. There was a close correlation between the axial asymmetry in LES pressure and circular muscle thickness. The thickness of LES muscle increased and decreased with an increase and decrease in the LES pressure, respectively. The circumferential asymmetry in resting LES pressure was related to the noncircular shape of the LES. A swallow-induced LES relaxation was followed by its contraction. During the contraction phase, the LES and esophagus showed relative symmetry in pressure and shape. We conclude that the axial asymmetry of LES pressure is explained by its muscle thickness. On the other hand, circumferential asymmetry is related to the noncircular shape of the LES.

Mechanism of cholecystokinin inhibition of lower esophageal sphincter pressure

1975 ◽  
Vol 228 (5) ◽  
pp. 1469-1473 ◽  
Author(s):  
RS Fisher ◽  
AJ DiMarino ◽  
S Cohen
Keyword(s):  
Lower Esophageal Sphincter ◽  
Circular Muscle ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Response Curves ◽  
Site Of Action ◽  
Threshold Doses ◽  
Esophageal Sphincter

The purpose of this study were 1) to quantify the lower esophageal sphincter (LES) response to intravenous cholecystokinin (CCK) in both man and the opossum in vivo, 2) to characterize the interaction of CCK and gastrin on circular muscle of the LES, and 3) to determine the site of action of CCK on LES muscle. In both man and the opossum LES pressure was decreased significantly by either constant intravenous infusion or bolus injection of CCK. In vitro dose-response curves to gastrin I, CCK, and the octapeptide of CCK (OP) demonstrated that both CCK and OP were partial agonists on the LES muscle. Both CCK and OP contract LES muscle at lower threshold doses, but give smaller maximum responses than gastrin I. The maximum response of LES muscle to CCK was antagonized only by atropine and tetrodotoxin, but not by other antagonists, suggesting that CCK contracts LES muscle by acetylcholine release. In vitro studies on LES muscle showed that CCK selectively antagonized the effect of gastrin I, but not other agonists. These studied suggest that CCK reduces LES pressure in vivo by inhibition of the endogenous gastrin effect.

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.  

scholarly journals Effect of intraduodenal peptone on the lower esophageal sphincter pressure in the dog

1978 ◽  
Vol 75 (2) ◽  
pp. 283-285 ◽  
Author(s):  
H.R. Koelz ◽  
G. Lepsien ◽  
A.P. Hollinger ◽  
H. Säuberli ◽  
F. Largiadér ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Esophageal Sphincter
Sign in / Sign up

Export Citation Format

Share Document