PubMed · 13027582
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
M BERTOLOTTI. 1952. [Megaesophagus].. https://pubmed.ncbi.nlm.nih.gov/13027582/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Achalasia is a rare neurologic deficit of the esophagus, producing a syndrome of impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body for which the cause is unknown. The resultant chronic esophageal stasis produces discomforting symptoms that can be managed with medication, chemical paralysis of the lower esophageal sphincter, mechanical dilation, or surgical esophagomyotomy. Chemical paralysis by injection of the esophagus with botulinum toxin and dilation with an inflatable balloon offers good short-term relief of symptoms; however, the best long-term results are produced by surgery, and advancing minimally invasive techniques continually reduce the morbidity of these operations. The type of surgical procedure, the necessity for fundoplication, and the order of treatment continue to be unresolved issues, but prospective evaluation with objective followup should allow us to provide the optimal treatment regimen to our patients.
BACKGROUND: Achalasia is a disease that impairs oesophageal motility. Though nitrates have been used to treat achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial. OBJECTIVES: To quantify short-term and long-term effects of nitrate therapy in patients with achalasia. SEARCH STRATEGY: Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4-2001), MEDLINE (1966-2001), EMBASE (1980-2001), LILACS - Latin American and Caribbean health science literature (1982-2001) and CBM-Chinese Biomedical database(1980-2000). Additionally, all references in the identified trials were checked for further relevant trials. SELECTION CRITERIA: All randomised controlled trials involving achalasic patients given any type of nitrates were included. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent observers based on the intention to treat principle. MAIN RESULTS: Two randomised cross-over studies were found, but no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes. REVIEWER'S CONCLUSIONS: We can conclude no implications for practice at this stage. Appropriately designed parallel group randomised controlled trials with long term follow-up are needed to determine the effects of nitrates.
Laparoscopic Heller myotomy has emerged as an excellent primary treatment for patients with dysphagia secondary to achalasia. A laparoscopic rather than thoracoscopic approach has stood the test of time. An antireflux procedure combined with the myotomy is crucial to the maintenance of the antireflux barrier. Thoracoscopic long myotomy offers effective relief for spastic disorders of the esophagus. Endoscopic stapled diverticulotomy is a safe and effective procedure for Zenker's diverticulum and has potential advantages over the open approach.