Achalasia cardia,the most prevalent primary esophageal motility disorder,is predominantly characterized by symptoms of dysphagia and regurgitation.The principal therapeutic approaches for achalasia encompass pneumatic...Achalasia cardia,the most prevalent primary esophageal motility disorder,is predominantly characterized by symptoms of dysphagia and regurgitation.The principal therapeutic approaches for achalasia encompass pneumatic dilatation(PD),Heller's myotomy,and the more recent per-oral endoscopic myotomy(POEM).POEM has been substantiated as a safe and efficacious modality for the management of achalasia.Although POEM demonstrates superior efficacy compared to PD and an efficacy parallel to Heller's myotomy,the incidence of gastroesophageal reflux disease(GERD)following POEM is notably higher than with the aforementioned techniques.While symptomatic reflux post-POEM is relatively infrequent,the significant occurrence of erosive esophagitis and heightened esophageal acid exposure necessitates vigilant monitoring to preclude long-term GERD-related complications.Contemporary advancements in the field have enhanced our comprehension of the risk factors,diagnostic methodologies,preventative strategies,and therapeutic management of GERD subsequent to POEM.This review focuses on the limitations inherent in the 24-h pH study for evaluating post-POEM reflux,potential modifications in the POEM technique to mitigate GERD risk,and the strategies for managing reflux following POEM.展开更多
Achalasia cardia,type of esophageal dynamic disorder,is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sph...Achalasia cardia,type of esophageal dynamic disorder,is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter.Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia,and is more likely to occur in the elderly.Histological changes in the esophageal mucosa are considered pathogenic;however,studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia,resulting in dysphagia,reflux,aspiration,retrosternal pain,and weight loss.Currently,the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter,helping to empty the esophagus and relieve symptoms.Treatment measures include botulinum toxin injection,inflatable dilation,stent insertion,and surgical myotomy(open or laparoscopic).Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness,particularly in older patients.Herein,we review clinical epidemiological and experimental data to determine the prevalence,pathogenesis,clinical presentation,diagnostic criteria,and treatment options for achalasia to support its clinical management.展开更多
Achalasia cardia is an idiopathic disease that occurs as a result of inflammation and degeneration of myenteric plexi leading to the loss of postganglionic inhibitory neurons required for relaxation of the lower esoph...Achalasia cardia is an idiopathic disease that occurs as a result of inflammation and degeneration of myenteric plexi leading to the loss of postganglionic inhibitory neurons required for relaxation of the lower esophageal sphincter and peristalsis of the esophagus.The main symptoms of achalasia are dysphagia,regurgitation,chest pain and weight loss.At present,there are three main hypotheses regarding etiology of achalasia cardia which are under consideration,these are genetic,infectious and autoimmune.Genetic theory is one of the most widely discussed.Case report given below represents an inheritable case of achalasia cardia which was not diagnosed for a long time in an 81-year-old woman and her 58-year-old daughter.展开更多
This editorial is an analysis the review article by Nabi et al recently published in this journal.Achalasia Cardia is a disease whose pathophysiology is still unclear.It is known that there is inflammation of unknown ...This editorial is an analysis the review article by Nabi et al recently published in this journal.Achalasia Cardia is a disease whose pathophysiology is still unclear.It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria.The end result is lower oesophageal sphincter spasm,loss of receptive relaxation,decreased oesophageal peristalsis,all leading on to varying degrees of dysphagia.The treatment of this condition is palliative in nature,performed by myotomy of the lower oesophagus either surgically or endoscopically.Gastroesophageal reflux disease(GERD)has been associated with the myotomy performed,particularly with the Peroral Endoscopic Myotomy(POEM)procedure.Nabi et al have provided an excellent overview of the latest developments in predicting,preventing,evaluating,and managing GERD subsequent to POEM.Based on this theme,this review article explores the concept of using histology of the oesophageal muscle layer,to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure.In the future,will a histology based algorithm available preoperatively,help modify the POEM procedure,thereby decreasing the incidence of GERD associated with POEM?展开更多
Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;rad...Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.展开更多
目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;...目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;25mm 直径支架8只),治疗前所有患者均有不同程度的吞咽困难,并给予食管下段括约肌(LES)静息压力测定。结果 20例患者支架置入和支架取出成功率均为100%,操作死亡率为0%,支架置入后吞咽困难明显好转,吞咽困难评分0级;贲门管腔直径20 mm 和25mm,平均(22±3)mm,暂时性支架扩张术后,贲门狭窄直径明显高于治疗前、吞咽困难评分明显低于治疗前、LES 静息压明显降低(P<0.001);支架置入前,食管管腔直径1～9(平均5±4) mm;支架取出1wk 内管腔直径为10～18(平均14±3)mm.吞咽困难评分术前为2～3(平均2.4±0.3)级;支架取出后吞咽困难评分为0～1(平均O.5±0.3)级支架置入前 LES 静息压力为40～66(平均53±10)mmHg(1mmHg=0.133kPa);支架取出后 LES 静息压力为0～20(平均10±8)mmHg.支架置入后并发症有胸部胀痛12例,反流8例,支架取出后少量出血3例,反流2例,所有并发症均给予有效处理,所有患者术后随访6～26(平均16.5±9.3)mo.随访期内使用直径20mm 支架的患者有3例(15%)在治疗后6mo 内复发吞咽困难,17例(85%)在随访期内吞咽能力明显好转。结论暂时性金属内支架扩张术是贲门失弛缓介入治疗中最有效的方法之一,且中远期疗效较好.展开更多
目的：探讨腹腔镜Heller肌切开联合胃底折叠术（1aparoscopic Heller myotomy with a Toupet fundoplication，LHT）治疗贲门失弛缓症的临床价值：方法：回顾分析2000年4月至2008年4月我院为48例责门失弛缓症患者行LHT的临床资料。结果...目的：探讨腹腔镜Heller肌切开联合胃底折叠术（1aparoscopic Heller myotomy with a Toupet fundoplication，LHT）治疗贲门失弛缓症的临床价值：方法：回顾分析2000年4月至2008年4月我院为48例责门失弛缓症患者行LHT的临床资料。结果：手术均获成功，无中转开腹。手术时间65～150min，平均86min，术中出血5—50ml。术后平均住院5．2d。随访1～24个月，术前吞咽困难症状均缓解。结论：LHT具有定位准确、安全、可靠、创伤小、痛苦轻、疗效好等优点，同时可提高手术质量，减少并发症？LHT治疗责门失弛缓症值得临床推广。展开更多
文摘Achalasia cardia,the most prevalent primary esophageal motility disorder,is predominantly characterized by symptoms of dysphagia and regurgitation.The principal therapeutic approaches for achalasia encompass pneumatic dilatation(PD),Heller's myotomy,and the more recent per-oral endoscopic myotomy(POEM).POEM has been substantiated as a safe and efficacious modality for the management of achalasia.Although POEM demonstrates superior efficacy compared to PD and an efficacy parallel to Heller's myotomy,the incidence of gastroesophageal reflux disease(GERD)following POEM is notably higher than with the aforementioned techniques.While symptomatic reflux post-POEM is relatively infrequent,the significant occurrence of erosive esophagitis and heightened esophageal acid exposure necessitates vigilant monitoring to preclude long-term GERD-related complications.Contemporary advancements in the field have enhanced our comprehension of the risk factors,diagnostic methodologies,preventative strategies,and therapeutic management of GERD subsequent to POEM.This review focuses on the limitations inherent in the 24-h pH study for evaluating post-POEM reflux,potential modifications in the POEM technique to mitigate GERD risk,and the strategies for managing reflux following POEM.
文摘Achalasia cardia,type of esophageal dynamic disorder,is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter.Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia,and is more likely to occur in the elderly.Histological changes in the esophageal mucosa are considered pathogenic;however,studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia,resulting in dysphagia,reflux,aspiration,retrosternal pain,and weight loss.Currently,the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter,helping to empty the esophagus and relieve symptoms.Treatment measures include botulinum toxin injection,inflatable dilation,stent insertion,and surgical myotomy(open or laparoscopic).Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness,particularly in older patients.Herein,we review clinical epidemiological and experimental data to determine the prevalence,pathogenesis,clinical presentation,diagnostic criteria,and treatment options for achalasia to support its clinical management.
文摘Achalasia cardia is an idiopathic disease that occurs as a result of inflammation and degeneration of myenteric plexi leading to the loss of postganglionic inhibitory neurons required for relaxation of the lower esophageal sphincter and peristalsis of the esophagus.The main symptoms of achalasia are dysphagia,regurgitation,chest pain and weight loss.At present,there are three main hypotheses regarding etiology of achalasia cardia which are under consideration,these are genetic,infectious and autoimmune.Genetic theory is one of the most widely discussed.Case report given below represents an inheritable case of achalasia cardia which was not diagnosed for a long time in an 81-year-old woman and her 58-year-old daughter.
文摘This editorial is an analysis the review article by Nabi et al recently published in this journal.Achalasia Cardia is a disease whose pathophysiology is still unclear.It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria.The end result is lower oesophageal sphincter spasm,loss of receptive relaxation,decreased oesophageal peristalsis,all leading on to varying degrees of dysphagia.The treatment of this condition is palliative in nature,performed by myotomy of the lower oesophagus either surgically or endoscopically.Gastroesophageal reflux disease(GERD)has been associated with the myotomy performed,particularly with the Peroral Endoscopic Myotomy(POEM)procedure.Nabi et al have provided an excellent overview of the latest developments in predicting,preventing,evaluating,and managing GERD subsequent to POEM.Based on this theme,this review article explores the concept of using histology of the oesophageal muscle layer,to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure.In the future,will a histology based algorithm available preoperatively,help modify the POEM procedure,thereby decreasing the incidence of GERD associated with POEM?
文摘Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.
文摘目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;25mm 直径支架8只),治疗前所有患者均有不同程度的吞咽困难,并给予食管下段括约肌(LES)静息压力测定。结果 20例患者支架置入和支架取出成功率均为100%,操作死亡率为0%,支架置入后吞咽困难明显好转,吞咽困难评分0级;贲门管腔直径20 mm 和25mm,平均(22±3)mm,暂时性支架扩张术后,贲门狭窄直径明显高于治疗前、吞咽困难评分明显低于治疗前、LES 静息压明显降低(P<0.001);支架置入前,食管管腔直径1～9(平均5±4) mm;支架取出1wk 内管腔直径为10～18(平均14±3)mm.吞咽困难评分术前为2～3(平均2.4±0.3)级;支架取出后吞咽困难评分为0～1(平均O.5±0.3)级支架置入前 LES 静息压力为40～66(平均53±10)mmHg(1mmHg=0.133kPa);支架取出后 LES 静息压力为0～20(平均10±8)mmHg.支架置入后并发症有胸部胀痛12例,反流8例,支架取出后少量出血3例,反流2例,所有并发症均给予有效处理,所有患者术后随访6～26(平均16.5±9.3)mo.随访期内使用直径20mm 支架的患者有3例(15%)在治疗后6mo 内复发吞咽困难,17例(85%)在随访期内吞咽能力明显好转。结论暂时性金属内支架扩张术是贲门失弛缓介入治疗中最有效的方法之一,且中远期疗效较好.
文摘目的：探讨腹腔镜Heller肌切开联合胃底折叠术（1aparoscopic Heller myotomy with a Toupet fundoplication，LHT）治疗贲门失弛缓症的临床价值：方法：回顾分析2000年4月至2008年4月我院为48例责门失弛缓症患者行LHT的临床资料。结果：手术均获成功，无中转开腹。手术时间65～150min，平均86min，术中出血5—50ml。术后平均住院5．2d。随访1～24个月，术前吞咽困难症状均缓解。结论：LHT具有定位准确、安全、可靠、创伤小、痛苦轻、疗效好等优点，同时可提高手术质量，减少并发症？LHT治疗责门失弛缓症值得临床推广。
