Achalasia and thyroid disease.

AIM: To investigate some possible etiologies of achalasia by screening patients with achalasia for some autoimmune diseases such as thyroid disease. METHODS: We examined 30 known cases of achalasia (20 females, 10 males). Their age ranged 15-70 years. All of them were referred to our institute for treatment. Their sera were evaluated to detect some possible associations with rheumatoid disease, thyroid disease, inflammatory process, anemia, etc. RESULTS: Seven out of 30 patients (23%) had thyroid disease including four patients with hypothyroidism (13.3%), two patients with hyperthyroidism (6.6%), and one had only thyroid nodule but was in euthyroid state (3.3%). Two of these hypothyroid patients had no related clinical symptoms (subclinical) and two had clinical manifestations of hypothyroidism. There were no correlations between the intensity of thyroid diseases and the severity of achalasia symptoms. CONCLUSION: The etiology of achalasia is unknown although autoimmunity has been implicated and is supported by several studies. Thyroid disease presents concomitantly with achalasia in about one fourth of our patients who may have a common etiology.

Pulmonary Function after Adenotonsillectomy.

INTRODUCTION: Adenotonsillar hypertrophy is a common disorder among children which, without proper treatment, may lead to considerable problems. Although the consequences of this disorder have been studied in other articles, we decided to evaluate the changes in pulmonary function tests in these children after adenotonsillectomy, and the correlation between clinical and spirometric parameters. MATERIALS AND METHODS: We conducted a before- and after- clinical trial. Forty children (17 females and 23 males) with a diagnosis of upper airway obstruction due to adenotonsillar hypertrophy were enrolled in this study. Mean age of the participants was 6.9±1.9 years. Eight spirometric parameters were selected for evaluation pre-operatively and 40 days postoperatively. Besides, symptom scores were defined for each patient to assess their disease severity, pre- and postoperatively. Data were analyzed statistically. RESULTS: Forced vital capacity (FVC) increased from 1.28±0.26% pre-operatively to 1.33±0.24%postoperatively (P=0.05). Peak expiratory flow increased from 2.74±0.65% pre-operatively to 2.84±0.51% postoperatively (P=0.02) and mid expiratory forced expiratory flow (FEF25-75) was 1.81±0.48% pre-operatively, increasing to 1.91±0.50% postoperatively (P=0.02). Maximal expiratory flow at 25% of FVC (MEF25) increased from 1.09±0.36% pre-operatively to 1.21±0.34% postoperatively (P=0.02). There was no correlation among the other spirometric parameters (FEV1, FEV1/FVC, MEF50 and MEF75) pre- and post-operatively (P>0.05). Despite some improvements in pulmonary function indices, there was no correlation between changes in spirometric parameters and severity of the snoring (P>0.05). CONCLUSION: Although our findings reveal that adenotonsillectomy had a positive effect on pulmonary function tests, we found no significant correlation between alterations in spirometric parameters and severity of snoring. However, performing a spirometric examination in children with adenotonsillar hypertrophy may be beneficial for assessing the pulmonary status of the affected patient.

Health related quality of life in irritable bowel syndrome patients, Kashan, Iran: A case control study.

BACKGROUND: Irritable bowel syndrome has significant impacts on the quality of life (QOL) but IBS subtypes may be different in QOL. This study aimed to assess QOL in IBS subtypes and also two prevalent questionnaires applied to evaluate the QOL in IBS. MATERIALS AND METHODS: In this case-control study conducted in Kashan in 2010-2013. One hundred and eighty- eight patients with IBS with 215 of non-IBS patients were included in the baseline. Subjects divided into three subtypes based on symptoms of diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) and IBS with mixed bowel habits (IBS-M) and in each subtype were 42, 62 and 84 patients, respectively. All IBS subjects completed questionnaires containing the disease-specific QOL for IBS (IBSQOL), World Health Organization QOL Assessment-BREF (WHOQOL-BREF) and IBS severity scores (IBSSS). The non-IBS subjects completed the WHOQOL-BREF only. RESULTS: Mean scores of IBSQOL in person with subtypes of IBS-D, IBS-C and IBS-M were 74.34 ± 19.01, 76.77 ± 22.91 and 73.15 ± 26.51, respectively which was not significantly different (P value = 0.507). As well as mean scores of WHOQOL-BREF in person with subtypes of IBS-D, IBS-C and IBS-M were 81.01 ± 16.23, 88.32 ± 15.66, and 82.65 ± 16.67, respectively, which were not significantly different (P value = 0.412) but mean scores of WHOQOL-BREF in non-IBS subjects was 89.53 ± 11.71 which was significantly different from IBS subjects (P value = 0.022). Strong positive relationship between two instruments was shown (r = 0.826 when P < 0.05). CONCLUSIONS: The WHOQOL-BREF instrument showed poorer QOL in IBS patients. The QOL was not different significantly among IBS-M, IBS-C, and IBS-D subtypes. We found that WHOQOL-BREF instrument strongly correlate with QOLIBS instrument.

Pneumatic balloon dilation therapy is as effective as esophagomyotomy for achalasia.

For many years different treatments have been used for achalasia. However, esophagomyotomy (ESM) and pneumatic balloon dilation (PBD) have been considered the treatments of choice. Despite new research, some controversies still exist. We compared patients who underwent open ESM (n=19) with those who underwent PBD (n=45). Data on age, gender, pre- and postprocedure symptoms, clinical manifestations at the time of research, clinical relief, type of surgery, and costs were collected via questionnaire. Open ESMs were performed by two expert surgeons, and PBDs were performed by one gastroenterologist. There was no significant difference in clinical symptoms and in patient satisfaction between the groups before and after the procedures except for chest pain. Clinical relief status (excellent, good, moderate, or poor) was comparable (26%, 42%, 15%, 15% for open ESM group and 40%, 20%, 24%, 15% for PBD group). Postprocedure complications were not significantly different between the two groups. Clinical rates of relapse for open ESM and PBD groups were 38.6% and 25%, respectively. There were no serious complications. There was no significant difference between the clinical outcomes of the two methods of achalasia treatment. Considering other important factors such as a shorter period of hospitalization, fewer sick days off, risk of general anesthesia, and cosmetic sequels, PBD is preferable for the majority of patients.