1/6. Esophageal motor disorders: achalasia and esophageal spasm.PURPOSE: To define the esophageal motor disorders of achalasia and esophageal spasms and describe their presentation in the clinical setting. DATA SOURCES: Selected research-based articles, textbooks, and expert opinion. A case study is presented. CONCLUSIONS: The presentation of esophageal motor disorders may not be clear, particularly when the presenting symptom is chest pain. Determining whether the pain is cardiac or digestive in origin is crucial. IMPLICATIONS FOR PRACTICE: Progressive dysphagia for both solids and liquids is the major symptom of achalasia; other symptoms include regurgitation, chest pain, and nocturnal cough. Diffuse esophageal spasm typically causes substernal chest pain with nonprogressive dysphagia and odynophagia for both liquids and solids. Dysphagia related to esophageal motility is characterized by a sensation of swallowed food "sticking" in the throat or chest; there is no problem initiating the act of swallowing.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
2/6. Long myotomy of the esophagus and gastric cardia with a complete fundic patch procedure for diffuse esophageal spasm.Under the hypothesis that the surgical management of diffuse esophageal spasm requires the elimination or reduction of episodes of dysphagia and chest pain and prevention of postoperative gastroesophageal reflux, long esophageal myotomy and fundoplication had been performed. However, there have been some cases with unsatisfactory results. We describe herein a new surgical procedure of long myotomy of the esophagus and gastric cardia with a complete fundic patch operation for the patient with diffuse esophageal spasm. The advantages of this procedure are to preserve the separation of each myotomized edge and to reinforce the wall of the surface of the myotomized mucosa in order to avoid the postoperative problems. Postoperative course of the patient with this procedure was satisfactory.- - - - - - - - - - ranking = 0.33111019605268keywords = chest pain, chest (Clic here for more details about this article) |
3/6. Coexistent coronary artery disease and oesophageal spasm: the importance of establishing the source of chest pain.A 55 year old woman presenting with chest pain was found to have significant triple vessel coronary artery disease. Non-invasive investigations showed that she had a good exercise tolerance without inducible ischaemia. The history was more suggestive of an oesophageal source of pain, an impression supported by manometry. This case illustrates some of the problems encountered during the investigation of chest pain and the need to interpret angiographic findings in the context of the patient's functional state.- - - - - - - - - - ranking = 1.9866611763161keywords = chest pain, chest (Clic here for more details about this article) |
4/6. Laparoscopic Heller cardiomyotomy and thoracoscopic esophageal long myotomy for the treatment of primary esophageal motor disorders.The technique of laparoscopic and thoracoscopic esophageal myotomy is described. The laparoscopic Heller procedure was performed in a patient with manometrically diagnosed achalasia and the thoracoscopic long esophageal myotomy in another with diffuse esophageal spasm. Both operations were performed in the same fashion as during open surgery, using standard laparoscopic surgical instruments. Antireflux procedures using the Dor and modified Belsey fundoplications protected patients from iatrogenic reflux. Complete relief of dysphagia in the first case and chest pain in the second has been confirmed after 2- and 4-month follow-up, respectively. Laparoscopic Heller myotomy and thoracoscopic long esophageal myotomy are technically feasible and reduce surgical trauma, hospitalization, and postoperative recovery. They offer a viable alternative for the definitive management of primary esophageal motor disorders comparable with that of open surgery.- - - - - - - - - - ranking = 0.0066694118419682keywords = chest (Clic here for more details about this article) |
5/6. Long esophageal myotomy with a fundic patch procedure for treating diffuse esophageal spasm: report of a case.A diagnosis of diffuse esophageal spasm (DES) based on radiological and manometric studies was made in a 70-year-old man who presented with severe dysphagia, vomiting, and spontaneous chest pain. The manometric studies revealed a simultaneous onset of high amplitude contractions and a hypertensive lower esophageal sphincter (LES) that was well relaxed in response to deglutition, in contrast to the incomplete relaxation seen in achalasia. Because his dysphagia was so severe and did not respond to pneumatic dilatation, the patient was treated by a long esophageal myotomy with a full thickness incision through the LES and mucosa, adding a Thal-Hatafuku procedure. The patient made a good postoperative recovery and has since been eating normally without any further dysphagia or chest pain. Good manometric and radiological results have been obtained in this patient during 5 years of follow-up.- - - - - - - - - - ranking = 0.66222039210535keywords = chest pain, chest (Clic here for more details about this article) |
6/6. Olfactory stimuli provoke diffuse esophageal spasm: reversal by ipratropium bromide.Diffuse esophageal spasm (DES) is a motor disorder of the esophageal smooth muscle characterized by multiple spontaneous contractions and by swallow-induced contractions that are of simultaneous onset, large amplitude, long duration, and repetitive occurrence. Although the pathogenesis of DES is unknown, provocative studies with cholinergic stimulation, esophageal balloon distention, or acid instillation have suggested involvement of both sensory and motor mechanisms. This report describes a patient with DES who would predictably become symptomatic with dysphagia and chest pain upon inhalation of perfume or other strong odors. Using esophageal scintigraphy to quantitate and analyze esophageal transit in this patient, we report for the first time that olfactory stimulation triggers episodes of DES and that such phenomena are mediated through the vagus nerve, because they can be ameliorated by the administration of ipratropium bromide. These observations suggest a new (sensory) pathway for the induction of DES and raise the intriguing possibility that inhaled anticholinergics may have a therapeutic role in the management of spastic esophageal motility disorders.- - - - - - - - - - ranking = 0.33111019605268keywords = chest pain, chest (Clic here for more details about this article) |