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.

Up to date. Gastroesophageal reflux disease (GERD) influence of obesity.

In this paper the author reviews the epidemiology of gastroesophageal reflux disease, as well as the etiology, methods of study, esophageal pathology association, and medical and surgical treatment of obesity as related to GERD.

[History of medicine: the esophagology in Argentina]. / Historia de la medicina: la esofagología en la República Argentina.

The author reviews the history of the people, their contributions, and the facts related to the development of esophageal pathology knowledge in Argentina.

[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.

[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.

[Esophageal intramural pseudodiverticulosis]. / Seudodiverticulosis intramural del esófago.

We discuss the features of a case of the unusual entity known as esophageal intramural pseudodiverticulosis. We believe that esophagography is the most appropriate diagnostic method for this disease, whereas endoscopy, electromanometry, computerized tomography and ultrasonography play a secondary role. The findings of esophageal ultrasonography described in our patient are, we believe, the first described in the literature.

[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.

[Esophageal achalasia: review of the results after 15 years' experience]. / Acalasia del esófago: revisión de resultados a los quince años de experiencia.

The purpose of this paper is to evaluate the experience acquired along a 15 years period (1971-1985) in the treatment of achalasia of the esophagus. One hundred and fifty six patients were evaluated. The average age was 50.8 years, and the M/F ratio 0.9/1. Dysphagia was present in 100%, regurgitation in 78.2%, weight loss in 61.5%, and chest pain in 50% of the cases, being the main symptoms. Serology for Chagas disease was positive in 21.2% of the patients. When classified by radiologic criteria the groups were: grate I 18.5%, grate II 53.8%, grate III 14.7% and grate IV 12.8%. The high pressure zone was X 23 mmHg (N 14.8 mmHg) pre dilatation. The incidence of vigorous achalasia was 5.7% and the urecholine test was positive in 61.1%. Only 95 patients were submitted to pneumatic dilatation, and this is the group that we shall analyze in detail. We performed 110 dilatations, since 80 patients were dilated once and 15 received 2 dilatations. The high pressure zone post dilatations was X 12.5 mmHg. We obtained good results in 82.1%, regular in 3.1% and bad results in 14.7% of the patients. The morbidity was 4.5% (3 perforations and 2 gastroesophageal reflux), and the mortality 0.9%. There was relapse in 26.3% of the cases. In 53.3% of the patients submitted to a second dilatation we obtained good results. The average hospital stay was 2.5 days, and the follow up X 32.4 months. Thirty nine patients were sent to surgery with good results in 82%, regular in 2.5%, and bad in 15.6%. The morbidity was 15.3% and the mortality 5.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of benign esophageal stenosis by prolonged dilatation: re-evaluation after 15 years]. / Tratamiento de la estenosis benigna del esófago por medio de la dilatación prolongada: re-evaluación a los quince años.

The purpose of this paper is to re-appraise the results of a method for slow continuous dilatation of benign esophageal stenosis comparing previous experience of a decade with that accumulated during the following five-year period. A total of 78 patients were dilated, the average age was 58.1 years, and the M/F dilated, the average age was 58.1 years, and the M/F ratio 3.3/1. Reflux esophagitis was the most frequent etiology when comparing both groups (77.5% and 79.4% respectively). Esophageal hiatus hernia was the most common associated pathology in both groups (83.3% and 87.7% respectively). Gastric analysis showed average values within the limits of normal, 40% of de cases showed a hypersecretion pattern. The mean lower esophageal sphincter pressure was low, and a group of patients showed aperistalsis in more than 50% of the swallows, fact that was thought to be due to esophageal inability to clear the refluxed material. Another important fact was an increase in the frequency of Barrett's epithelium (6.5% to 9.3%). Undoubtedly the most important features were the increase in the number of good results of dilatation (87.7% to 92.3%), the decrease of morbidity (6.1% to 0.7%) and mortality (2% to 0.2%). The follow-up increased from X 27.3 to X 33.8 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of benign esophageal stenosis: re-evaluation after 20 years]. / Tratamiento de la estenosis benigna del esófago: re-evaluación a los 20 años.

In 1972 we described a method for dilatation of esophageal stenosis. The purpose of this paper is to report the results obtained between 1970 and 1989, the patients were studied by X-Rays, "calibration" of the stenosis, endoscopy, biopsy, cytology, gastric analysis and esophageal motility. One hundred and seven patients were treated (mean 60.5 years, M/F 3.9/1). The most frequent etiology was reflux esophagitis (80.3%). Hiatus hernia was present in 84.9%. The stenosis was in the lower third of the esophagus in 92.5%. The BAO was mean: 3.6 mEq/h, and the MAO mean 16.4 mEq/h with a hypersecretion pattern in 33.1% of the cases. Cytology was negative for malignancy in 100%. Biopsy showed esophagitis in 86.9%, Barrett's epithelium in 12.1%, normal tissue in 6.5% and insufficient material in 1.8%. Endoscopy showed 98.1% of grade IV esophagitis. Esophageal motility showed a HPZ of mean 6.5 mmHg. and varying degrees of aperistalsis in 24.3% of the patients. The total number of dilatations was 555 (mean 5.1/pt). The "calibration" of the stenosis previous to the dilatation was mean 8.6 mm, and post dilatation mean 15.6 mm. The result of the procedure was good in 92.5%, regular in 2.8% and bad in 4.6%. The morbidity was 0.9% and the mortality 0.1%. There was relapse of the stenosis in 42% of the cases, the follow-up was mean 3.2 years. Twenty nine patients were submitted to surgery due to failure of the procedure with 68.1% of good results, morbidity of 9% and mortality of 9%. We conclude that this dilatation procedure offers excellent results with a very low morbi-mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Esophageal lesion caused by drugs]. / Lesión esofágica por drogas.

Two cases of esophageal injury secondary to drugs are hereby presented, reviewing the different types of drugs, predisposing factors, physiopathology and complications.

[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.

[Esophageal motility dysfunction and radioisotopes. Its modification with a calcium channel blocker]. / Disfunción motora esogágica y radioisótopos. Su modificación con un bloqueante cálcico.

We described the esophageal radionuclide transit (ERT) of a liquid bolus through 5 areas in pharynx, esophagus (3 levels) and gastric fundus before and after the administration of 30 mg of sublingual nifedipine, in 8 normal individuals and 13 patients with different esophageal motor disturbances. The controls and patients were previously studied by esophageal manometry (EM). The results in control individuals were as follows: 1) the total transit time (TTT) was 11.85 +/- 1.13 sec, 2) the time of beginning of gastric filling (GF) was 3.99 +/- 0.65 sec, 3) the residual activity (RA) was 9.53 +/- 4.64%, 4) nifedipine showed a statistically significant increase of the RA. The ERT detected 100% of the achalasic patients with a TTT that was not greater than 40 seconds and a delayed GF. In the classic achalasia patients nifedipine did not produce significant modifications in the ERT. The only case of vigorous achalasia studied showed an adynamic pattern with activity in peaks which improved after the administration of nifedipine. One of the nutcracker esophagus showed a pattern of sequential peaks with a similar response to nifedipine. The sensitivity of the method was 100%, nifedipine seems to be useful in the sense that improves the esophageal transit. Since the ERT as a non-invasive method and has a 100% sensitivity, we propose it as a step previous to EM in the study of esophageal motor disorders.

Esophageal perforation after pneumatic dilatation for achalasia: why?

UNLABELLED: A retrospective study was performed to asses risk factors in patients with esophageal achalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4%). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. CONCLUSIONS: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4% risk of perforation and 0.6% mortality rate. 2) The risk of developing an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested.

[Autoimmunity factor in chronic gastritis: incidence of antiparietal cell antibodies and their relation to antral histology and basal blood gastrins]. / El factor autoinmunitario en las gastritis crónicas: incidencia de anticuerpos anticélulas parietales y su relación con la histología antral y la gastrinemia basal.

In 118 patients with histological proven chronic gastritis, was performed a study of seric antibodies against parietal cells (ACCP), following the indirect inmuno-fluorescence method. The results were positives in 36 cases (30%). Four positives cases were found in 40 normal controls (10%), two of them were compensated diabetics, one have the thyrohyoid Hashimoto's disease, and the remainder, brother of a patient with chronic gastritis, was a positive ACCP. A major positiveness (44.4%) was obtained in 9 cases of gastric atrophy than in 65 cases with atrophic gastritis (32%) and in 44 cases of superficial gastritis (25%); although due to the few cases of gastric atrophy regarding other histological types, conclusions cannot be obtained about the incidence of ACCP and histological variety of chronic gastritis. If we do group the patients according to their acid secretory debit, 53 achlorhydric patients had a positiveness of ACCP of 45%, while over 63 with decreased secretory capability, only 18.4%, was positive. The distribution by age groups, shows a major incidence of ACCP about the 4th and 5th decade of life. Thirty seven patients with chronic atrophic gastritis and achlorhydria, and seven with chronic superficial gastritis and hypochlorhydria, besides the antibodies study were on a basal dosage of gastrinemia and antral endoscopic biopsy, finding out that, achlorhydric patients (15 on 19) with normal or slightly altered antrus, have gastrinemia (222 +/- 123 Pgo/oo) and the majority of patients with normal gastrinemia (32 +/- 16 pgo/oo) have more important antral lesions. The ratio between antral histology and ACCP in auto--immune gastritis (Type A), conciliates only partially with the observation by Strickland et al., as only 52.4% of achlorhydric patients and ACCP have a normal antrus or al least with mild lesions. Our results suggest the possibility of that on auto--immune gastritis could act other pathogenic factors of antral lesion.

[Achalasia of the esophagus]. / Acalasia del esófago.

Thirty-two cases of achalasia of the esophagus are studied in retrospect. The evolution was carried on from different standpoints: clinical, radiological, endoscopic, and motility studies. Patients were treated by dilatation (either pneumatic or mercury bougies) or surgery. The result of treatment was evaluated from the clinical standpoint correlating it with the remaining studies in order to establish wether or not they were related.

[Benign stenosis of the esophagus]. / Estenosis benigna de esófago.

In the present study 39 patients with benign esphageal stenosis were studied (average age 59,9 years). The most common etiology was refux esofagitis, and the most common associated pathology was esophageal hiatus hernia. Thirty one patients received medical treatment (diet. antireflux drugs and dilatations.) Twenty four were dilated with the slow continuous method, six with metalic bougies. One patient was not dilated. Seven patients were not treated since the stenosis was due to extrinsec compression. One patient was surgically treated from the onset. Seventy percent of the patients had goods results with esophageal dilatation. We propose that patients with benign esophageal stenosis should be treated by the slow continuous dilatation method.

[Action of metoclopramide bromide and metoclopramide chloride on the lower esophagogastric junction and the peristalsis of the lower 3d of the esophagus]. / Acción del bromuro de metoclopramida y del chlorhidrato de metoclopramida sobre el esfínter esofágico inferior y la peristalsis del tercio inferior del esófago.

In 10 patients with esophageal hiatus hernia the effect of metoclopramide bromide and metoclopramide chloride compared with placebo, was studied by the double blind method. Both drugs produced an increase of the lower esophageal sphincter pressure and of the peristalsis of the lower third of the esophagus, only being statistically significative the action of metoclopramide chloride on the perstalsis. No significative side-effects were noted.

[Megaesophagus secondary to carcinoma of the cardia: apropos of 4 cases]. / Megaesófago secundario a carcinoma de cardias: a propósito de 4 casos.

Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbach's plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.