scholarly journals Pseudocyst presenting as pseudoachalasia

2019 ◽  
Vol 6 (12) ◽  
pp. 4583
Author(s):  
Nishanth S. ◽  
Sudhir Kumar Jain ◽  
Chandra Bhushan Singh
Keyword(s):  
Lower Esophageal Sphincter ◽  
Rare Case ◽  
Ganglion Cells ◽  
Motility Disorder ◽  
Benign Tumors ◽  
Achalasia Cardia ◽  
Esophageal Sphincter ◽  
Similar Disorder

Achalasia cardia is a primary motility disorder of esophagus which is due to loss of ganglion cells in myentric plexus, etiology of which is unknown. The condition causes dysphagia due to failure of relaxation of lower esophageal sphincter. Pseudoachalasia is a similar disorder which occurs usually due to adenocarcinoma of the cardia and also due benign tumors at this level. We present a rare case of pseudocyst of pancreas extending into mediastinum which mimics as pseudoachalasia.

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 A Rare Paraneoplastic Syndrome of Lung Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
R. Azzeddine ◽  
L. Herrak ◽  
A. Rhanim ◽  
A. Jniene ◽  
M. Elftouh ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lower Esophageal Sphincter ◽  
Paraneoplastic Syndrome ◽  
Rare Case ◽  
Loss Of Function ◽  
Esophageal Sphincter

Achalasia is a neurodegenerative motor disease of the esophagus resulting mainly from a loss of function of the lower esophageal sphincter, the pathophysiology of which is still poorly understood. Its incidence is rare—it is 1.6 per 100,000—and its occurrence in the context of paraneoplastic syndrome has been rarely described in the literature. We report a rare case of paraneoplastic achalasia associated with lung cancer.

O10 GIANT ESOPHAGEAL POLYP PROTRUDING THROUGH THE MOUTH: A RARE CASE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
I Tsomidis ◽  
G Kalopitas ◽  
K Dinaki ◽  
G Germanidis ◽  
J Constantinidis
Keyword(s):  
Respiratory Distress ◽  
Endoscopic Resection ◽  
Current Literature ◽  
Surgical Approach ◽  
Open Surgery ◽  
Rare Case ◽  
Upper Esophageal Sphincter ◽  
Benign Tumors ◽  
Rare Entity ◽  
Esophageal Sphincter

Abstract Aim Giant esophageal polyps are a relative rare and benign entity, which can lead to major complications. Our knowledge about their pathology and management originates from scattered case reports. Our aim is to report the clinical presentation and management of this rare case in order to enrich the current literature. Background & Methods Large pedunculated esophageal polyps are a rare entity encountered in clinical practice. The majority of these polyps are located near the upper esophageal sphincter or upper esophagus. They are slowly growing and asymptomatic. Most common clinical symptoms, associated with polyp size, include dysphagia, chest pain, regurgitation and, rarely, acute respiratory distress. Histology reveals benign submucosal tumors with fibrous and vascular components, covered by normal squamous cells, in most cases. Malignant transformation of these polyps has been infrequently described. Surgical approach, either with endoscopic resection or with open surgery, is the treatment of choice and recurrence is extremely uncommon. A review of current literature was conducted, followed by presentation of our rare case. Results A 50 year-old woman with clear medical history presented with a 3-month history of dysphagia and endoscopy revealed a large esophageal polyp extending from the upper esophageal sphincter to the lower esophageal sphincter. The initial attempt of endoscopic resection of the polyp led to regurgitation and intraoral prolapse of the polyp, causing respiratory distress. The patient was transferred to the ENT operation room and an orotracheal intubation was performed. The tumor was successfully removed transorally after ligation of its stem. Histopathology showed an inflammatory fibroid polyp (IFP) and postsurgical follow-up revealed no recurrence of the mass. Conclusion Giant IFPs are an extremely rare entity among upper esophageal polyps and the pathogenesis of these tumors remains poorly understood. Life threatening regurgitation of the polyp causing respiratory distress is an uncommon complication demanding urgent surgical approach. Once diagnosed, these benign tumors can be removed either with open surgery or endoscopic resection depending on the location and the size of the tumor. The impressive size of these polyps renders them a challenge for surgeons and endoscopists, whose cooperation is often in need.

scholarly journals Achalasia in the elderly patient: a comparative study

2011 ◽  
Vol 48 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Rosana B. Schechter ◽  
Eponina M. O. Lemme ◽  
Paula Novais ◽  
Beatriz Biccas
Keyword(s):  
Elderly Patients ◽  
Lower Esophageal Sphincter ◽  
Chagas Disease ◽  
Myenteric Plexus ◽  
Ganglion Cells ◽  
Young Patients ◽  
The Elderly ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Esophageal Sphincter

CONTEXT: Achalasia is a primary esophageal motor disorder secondary to the degeneration of ganglion cells of the inhibitory intramural myenteric plexus. It affects both sexes similarly and has two peaks of incidence, one in the 3rd to 4th decades of life and the other after 60 years of age. The effect of age on esophageal motility of patients with achalasia is not well known. Studies have shown that healthy older people, when compared to the young, have: a) a lower number of ganglion cells in the intramural myenteric plexus; b) a reduced normal relaxation of the lower esophageal sphincter; and c) a reduced esophageal peristalsis. Thus, as both age and achalasia can produce comparable degenerative changes in the intramural myenteric plexus, it is possible that advanced age could be an important factor in enhancing the clinical and manometric abnormalities commonly found in patients with achalasia. OBJECTIVES: To compare the clinical, radiological and manometric findings in young as compared to elderly (>60 years old) achalasia patients. METHODS: A retrospective study of a group of patients with untreated achalasia separated into young and elderly patients. Demographic, clinical, serology for Chagas' disease, radiological and manometric data were compared between these groups. The level of significance was P<0.05. RESULTS: The study included 105 patients, 52 young (25 M/27 F, mean age 40 years old) and 53 elderly (21 M/32 F, mean age 70 years old). The elderly group had a higher prevalence of Chagas' disease (P = 0.004) and a lower pressure of the lower esophageal sphincter [26.4 mm Hg vs 31.9 mm Hg] P = 0.001, a difference that persisted when analyzed only elderly and young patients with idiopathic achalasia. Younger patients had a higher prevalence of heartburn (P = 0.001) and chest pain (P = 0.012) than the elderly. CONCLUSION: Elderly patients with achalasia had a lower esophageal sphincter pressure than the young, even when we excluded patients with Chagas' disease but, as a group, they were less symptomatic.

scholarly journals Successful Management of Esophageal Perforation with Self-Expandable Metal Stent following Pneumatic Dilation for Achalasia Cardia

2019 ◽  
Vol 10 (03) ◽  
pp. 183-185
Author(s):  
Abhai Verma ◽  
Samir Mohindra ◽  
Vivek Anand Saraswat ◽  
Uday Chand Ghoshal
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Perforation ◽  
Esophageal Stent ◽  
Pneumatic Dilation ◽  
Metal Stent ◽  
Successful Management ◽  
Common Cause ◽  
Achalasia Cardia ◽  
Esophageal Sphincter ◽  
Self Expandable Metal Stent

AbstractAchalasia cardia is the most common cause of motor dysphagia. Pneumatic dilation (PD) of lower esophageal sphincter remains the cornerstone of treatment. However, it is associated with esophageal perforation in some cases. We present a case of esophageal perforation following PD of achalasia cardia which was successfully managed with esophageal stent.

scholarly journals Peroral Endoscopic Myotomy in a Patient with Achalasia Cardia with Prior Heller’s Myotomy

2020 ◽  
Vol 14 (1) ◽  
pp. 48-55
Author(s):  
Muhammad Miftahussurur ◽  
Manu Tandan ◽  
Dadang Makmun ◽  
Zaheer Nabi
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Gastroesophageal Junction ◽  
Barium Swallow ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Eckardt Score ◽  
Heller's Myotomy ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia cardia is an esophageal myenteric plexus disorder characterized by absence of or incomplete lower esophageal sphincter relaxation and esophageal aperistalsis; Heller’s myotomy is the main treatment of choice due to a lower failure rate. Recently, peroral endoscopic myotomy (POEM) has been reported as an alternative treatment for achalasia due to persistent symptoms after Heller’s myotomy. An Indian male, aged 18 years, was admitted to the hospital due to dysphagia which had started more than 3 years ago. He also complained of occasional regurgitation and retrosternal pain with Eckardt score 6. Heller’s myotomy was performed 2 years ago. Barium swallow showed achalasia cardia and upper gastrointestinal endoscopy found liquid residue and resistance at the gastroesophageal junction. Esophageal manometry is concluded as achalasia cardia type II with a median integrated relaxation pressure (IRP) of 25.6 mm Hg. He underwent POEM; with the help of a submucosal tunnel, an extension of up to 1 cm beyond the gastroesophageal junction could be achieved with a posterior orientation of myotomy. There were no adverse events after the POEM procedure. He was treated with a soft diet for 10 days and other supportive treatments. Following POEM, barium swallow showed a significant improvement and esophageal manometry exhibited that the basal lower esophageal sphincter pressure was normal with complete relaxation on swallowing and normal median IRP. The post-procedure Eckardt score was 0. We reported an achalasia patient who received POEM after unsuccessful Heller’s myotomy and showed clinical improvement.

scholarly journals Autoantigen characterization in the lower esophageal sphincter muscle of patients with achalasia.

2021 ◽  
Author(s):  
Angel Priego-Ranero ◽  
Ghislain Opdenakker ◽  
Norma Uribe-Uribe ◽  
Diana Aguilar-Leon ◽  
Carlos A Nunez-Alvarez ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Ganglion Cells ◽  
Ectopic Expression ◽  
Cross Sectional Study ◽  
Sphincter Muscle ◽  
Cross Sectional ◽  
Antineuronal Antibodies ◽  
Esophageal Sphincter ◽  
Inflammatory Infiltrates ◽  
Cells Of Cajal

OBJECTIVE: To characterize in sera anti-myenteric autoantibody profiles and in tissues MMP-9 proteoforms towards the identification of possible autoantigenic proteins in the muscle of the lower esophageal sphincter (LES) of achalasia patients. METHODS: Biopsies of the LES muscle from 36 achalasia patients, 6 esophagogastric junction outflow obstruction (EGJOO) patients, and 16 transplant donors (TD) were compared in a blind cross-sectional study. Histological characteristics such as inflammation, fibrosis, presence of ganglion cells, cells of Cajal, GAD65, PNMA2, S100, P substance, and MMP-9 proteforms in tissue were assessed by H&E and Picro-Sirius Red stainings, and immunohistochemistry analysis. Antineuronal antibodies (amphiphysin, CV2, and PNMA2 (Ma2/Ta)), onconeural antigens (Ri, Yo, and Hu), recoverin, SOX-1, titin, zic4, GAD65, and Tr (DNER) were evaluated by immunoblot/line assay. RESULTS: Tissue of achalasia patients had heterogeneous inflammatory infiltrates with fibrosis and contrasting higher levels of activated MMP-9 compared with EGJOO and TD. Moreover, lower ganglion cell percentages and cell of Cajal percentages were determined in esophageal tissues of achalasia patients vs. TD. In addition, tissue of achalasia patients had higher GAD65 and PNMA2 protein expression vs. EGJOO. Unexpectedly, these proteins were absent in TD tissue. S100 and P substance had similar expression levels in tissues of achalasia patients vs.TD and EGJOO. Most of the achalasia sera had anti-GAD65 (83%) and anti-PNMA2 (90%) autoantibodies vs. EGJOO (17% and 33%, respectively) and healthy volunteers (10% and 0%, respectively). CONCLUSION: Tissue-specific ectopic expression of GAD65 and PNMA/Ta2 and active MMP-9, associated with the presence of specific autoantibodies directed against these proteins, might participate in the pathophysiology of achalasia triggering and/or perpetuating autoimmune disease.

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