RESUMO
BACKGROUND: Secondary achalasia or pseudoachalasia is a clinical presentation undistinguishable from achalasia in terms of symptoms, manometric, and radiographic findings, but associated with different and identifiable underlying causes. METHODS: A literature review was conducted on the PubMed database restricting results to the English language. Key terms used were "achalasia-like" with 63 results, "secondary achalasia" with 69 results, and "pseudoachalasia" with 141 results. References of the retrieved papers were also manually reviewed. RESULTS: Etiology, diagnosis, and treatment were reviewed. CONCLUSIONS: Pseudoachalasia is a rare disease. Most available evidence regarding this condition is based on case reports or small retrospective series. There are different causes but all culminating in outflow obstruction. Clinical presentation and image and functional tests overlap with primary achalasia or are inaccurate, thus the identification of secondary achalasia can be delayed. Inadequate diagnosis leads to futile therapies and could worsen prognosis, especially in neoplastic disease. Routine screening is not justifiable; good clinical judgment still remains the best tool. Therapy should be aimed at etiology. Even though Heller's myotomy brings the best results in non-malignant cases, good clinical judgment still remains the best tool as well.
Assuntos
Acalasia Esofágica , Neoplasias , Humanos , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/etiologia , Acalasia Esofágica/terapia , Manometria/efeitos adversos , Manometria/métodosAssuntos
Terapia por Acupuntura , Acalasia Esofágica , Transtornos da Motilidade Esofágica , Humanos , Acalasia Esofágica/terapia , Manometria , Terapia por Acupuntura/efeitos adversos , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/terapiaRESUMO
Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.
Assuntos
Doença de Chagas , Transtornos de Deglutição , Acalasia Esofágica , Doença de Chagas/complicações , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Acalasia Esofágica/complicações , Acalasia Esofágica/terapia , Esfíncter Esofágico Inferior , Humanos , Resultado do TratamentoRESUMO
Achalasia in pregnancy is an infrequent, poorly understood condition and its treatment is not clearly defined. The repercussions on the patients nutritional status are serious and in a pregnant woman have serious implications for the course of gestation, with high risk of intrauterine growth restriction, preterm delivery and even fetal loss; there are symptoms that can be confused with hyperemesis gravidarum delaying the diagnosis. The therapeutic options are medical treatment, endoscopic and surgical interventions; to decide what is the best treatment, we should be taken into account the severity, gestational age and patient conditions. Within the spectrum mentioned in the management include calcium antagonists and nitrates, however these have restrictions in pregnancy, another options are botulinum toxin, endoscopic pneumatic dilation, laparoscopic Heller myotomy and recently POEM. In pregnancy there is a few evidence in the literature and in this moment there are about 40 reported cases, some with complications such as fetal loss and maternal death. We present our experience at the San Ignacio University Hospital in Bogotá, Colombia, with a 26-year-old woman with a novo diagnosis of achalasia type II during the first trimester of pregnancy, with a clinical history of severe dysphagia associated with malnutrition. She was management with enteral nutrition support with nasogastric tube to achieve repletion of the body mass index (BMI) and after that, she had a endoscopic management with Rigiflex balloon dilation. It allowed to successfully carry out pregnancy without adverse effects on the mother or the fetus, with adequate evolution and oral tolerance without dysphagia. We consider that nutritional support is important prior to taking a desicion with this type of patient, in addition that endoscopic management with balloon dilation can be safe and effective for the management of achalasia in pregnancy.
Assuntos
Dilatação/métodos , Acalasia Esofágica/terapia , Esofagoscopia/métodos , Complicações na Gravidez/terapia , Adulto , Índice de Massa Corporal , Terapia Combinada , Transtornos de Deglutição/etiologia , Nutrição Enteral , Acalasia Esofágica/diagnóstico por imagem , Feminino , Humanos , Intubação Gastrointestinal , Desnutrição/complicações , Manometria , GravidezRESUMO
La acalasia en el embarazo es una condición infrecuente, pobremente conocida y su manejo no esta claramente definido. Las repercusiones sobre el estado nutricional de los pacientes con esta entidad son graves y en una gestante tienen implicaciones serias para el curso de la gestación, con riesgo elevado de restricción del crecimiento intrauterino, parto pretérmino e incluso pérdida fetal; existen síntomas que pueden confundirse con hiperémesis gravídica retrasando el diagnóstico. Dentro de las opciones terapéuticas está el manejo médico, endoscópico e intervenciones quirúrgicas; para decidir cual es tratamiento adecuado se debe tener en cuenta la severidad, edad gestacional y condicien clasificaci de teratogenicidad conocido siendo su uso bienestar del binomioones del paciente, dentro del espectro mencionado en el manejo se incluyen los calcioantagonistas y nitratos, estos con restricciones en el embarazo, además toxina botulínica, dilatación neumática endoscópica, miotomía laparoscópica de Heller y recientemente el POEM; estas últimas con riesgo elevado de complicaciones. En el embarazo existe poca evidencia en la literatura y alrededor de 40 casos reportados, algunos con complicaciones como perdida fetal y muerte materna. Presentamos nuestra experiencia en el Hospital Universitario San Ignacio, Bogotá, Colombia de una mujer de 26 años de edad con diagnóstico de acalasia tipo 2 de novo durante el primer trimestre de gestación, cuadro clínico de disfagia severa asociado a desnutrición, a quien el manejo oportuno con soporte nutricional enteral con sonda nasogástrica para lograr repleción del índice de masa corporal (IMC) y luego de esto manejo endoscópico con dilatación con balón. Permitió llevar con éxito a término la gestación sin efectos adversos sobre la madre o el feto, con evolución adecuada y tolerancia a vía oral sin disfagia. Consideramos que es importante el soporte nutricional previo a la toma de conducta con este tipo paciente, además que el manejo endoscópico con dilatación puede ser seguro y efectivo a mediano plazo para el manejo de acalasia en embarazo.
Achalasia in pregnancy is an infrequent, poorly understood condition and its treatment is not clearly defined. The repercussions on the patients nutritional status are serious and in a pregnant woman have serious implications for the course of gestation, with high risk of intrauterine growth restriction, preterm delivery and even fetal loss; there are symptoms that can be confused with hyperemesis gravidarum delaying the diagnosis. The therapeutic options are medical treatment, endoscopic and surgical interventions; to decide what is the best treatment, we should be taken into account the severity, gestational age and patient conditions. Within the spectrum mentioned in the management include calcium antagonists and nitrates, however these have restrictions in pregnancy, another options are botulinum toxin, endoscopic pneumatic dilation, laparoscopic Heller myotomy and recently POEM. In pregnancy there is a few evidence in the literature and in this moment there are about 40 reported cases, some with complications such as fetal loss and maternal death. We present our experience at the San Ignacio University Hospital in Bogotá, Colombia, with a 26-year-old woman with a novo diagnosis of achalasia type II during the first trimester of pregnancy, with a clinical history of severe dysphagia associated with malnutrition. She was management with enteral nutrition support with nasogastric tube to achieve repletion of the body mass index (BMI) and after that, she had a endoscopic management with Rigiflex balloon dilation. It allowed to successfully carry out pregnancy without adverse effects on the mother or the fetus, with adequate evolution and oral tolerance without dysphagia. We consider that nutritional support is important prior to taking a desicion with this type of patient, in addition that endoscopic management with balloon dilation can be safe and effective for the management of achalasia in pregnancy.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/terapia , Acalasia Esofágica/terapia , Esofagoscopia/métodos , Dilatação/métodos , Transtornos de Deglutição/etiologia , Acalasia Esofágica/diagnóstico por imagem , Índice de Massa Corporal , Nutrição Enteral , Terapia Combinada , Desnutrição/complicações , Intubação Gastrointestinal , ManometriaAssuntos
Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/terapia , Esfíncter Esofágico Inferior/fisiopatologia , Fundoplicatura , Miotomia de Heller , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Inibidores da Liberação da Acetilcolina/uso terapêutico , Sulfato de Bário , Toxinas Botulínicas Tipo A/uso terapêutico , Meios de Contraste , Acalasia Esofágica/diagnóstico por imagem , Esfíncter Esofágico Inferior/diagnóstico por imagem , Esfíncter Esofágico Inferior/patologia , Esofagoscopia , Humanos , Manometria , Guias de Prática Clínica como Assunto , Radiografia , Resultado do TratamentoRESUMO
The treatment for achalasia changed dramatically after the introduction of minimally invasive surgery. Since 1991, laparoscopic Heller myotomy (LHM) has replaced pneumatic dilatation (PD) as the primary form of treatment in many centers. Over time, PD became safer, and eventually endoscopic experts were able to perform an endoscopic myotomy via a per oral endoscopic myotomy (POEM). This article reviews the advantages and disadvantages of each technique. Ultimately, the best outcomes are obtained by a multidisciplinary team that can tailor a specific treatment to each individual patient.
Assuntos
Acalasia Esofágica/cirurgia , Fundoplicatura/métodos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Dilatação/métodos , Acalasia Esofágica/terapia , Humanos , Equipe de Assistência ao Paciente , Resultado do TratamentoRESUMO
Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter (LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology. The most recent findings indicate an autoimmune component, as suggested by the presence of circulating anti-myenteric plexus autoantibodies, and a genetic predisposition, as suggested by observed correlations with other well-defined genetic syndromes such as Allgrove syndrome and multiple endocrine neoplasia type 2 B syndrome. Viral agents (herpes, varicella zoster) have also been proposed as causative and promoting factors. Unfortunately, the therapeutic approaches available today do not resolve the causes of the disease, and only target the consequential changes to the involved tissues, such as destruction of the LES, rather than restoring or modifying the underlying pathology. New therapies should aim to stop the disease at early stages, thereby preventing the consequential changes from developing and inhibiting permanent damage. This review focuses on the known characteristics of idiopathic achalasia that will help promote understanding its pathogenesis and improve therapeutic management to positively impact the patient's quality of life.
Assuntos
Acalasia Esofágica/terapia , Transtornos da Motilidade Esofágica/fisiopatologia , Esfíncter Esofágico Inferior/fisiopatologia , Insuficiência Adrenal , Autoanticorpos/sangue , Doenças Autoimunes/metabolismo , Transtornos de Deglutição/fisiopatologia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/fisiopatologia , Azia/fisiopatologia , Humanos , Inflamação , Manometria , Plexo Mientérico/fisiopatologia , Peristaltismo/fisiologia , Qualidade de VidaRESUMO
Introducción: la acalasia es un trastorno degenerativo de la motilidad esofágica cuyo resultado es la ausencia o pobre relajación del esfínter esofágico inferior a la deglución asociado a trastorno motor del cuerpo esofágico. Afecta a ambos sexos con una incidencia de 1/100 000 y una prevalencia de 10/100 000. En su fisiopatología se han involucrado factores inmunológicos, genéticos, infecciosos y neurodegenerativos, que conllevan a pérdida selectiva de las neuronas inhibitorias del plexo mientérico e infiltrado inflamatorio en el esfínter esofágico inferior. Objetivo: revisar las modalidades terapéuticas en el tratamiento de la acalasia con un análisis a corto y largo plazo de las opciones de tratamiento. Métodos: con la introducción para su diagnóstico de la manometría de alta resolución se ha creado un novedoso sistema de clasificación que puede evaluar el pronóstico para el paciente y predecir la respuesta al tratamiento. La terapéutica descansa sobre la base de: tratamiento médico, procederes endoscópicos y tratamiento quirúrgico, siendo éste el estándar terapéutico, aunque continúa el debate sobre qué método es mejor, si la dilatación neumática, o la miotomía de Heller. Resultados: la miotomía laparoscópica de Heller (MLH) ha emergido en los últimos años como el tratamiento de elección, particularmente en pacientes jóvenes (≤ 45 años). Desde noviembre del 2012 hasta septiembre del 2015 se han realizado 27 dilataciones endoscópicas,15 mujeres (55,6 por ciento) y 12 hombres (44,4 por ciento), sin reportar complicaciones. Desde enero 2010 hasta diciembre 2014 se realizaron 188 miotomías de Heller por abordaje laparoscópico, el promedio de estadía hospitalaria fue de un día, no hubo conversión ni reintervención y la mortalidad fue nula(AU)
Introduction: Achalasia is a neurodegenerative motility disorder of the esophagus resulting in failure of the lower esophageal sphincter to relax properly in response to swallowing and associated to motor disorder of the esophageal body. It affects both sex with an incidence rate of 1/100 000 and a prevalence of 10/100 000. Its pathophysiology includes immune, genetics, infectious and neurodegenerative factors that result in a selective loss of inhibitory neurons of the myenteric plexus and inflammatory infiltrate in the lower esophageal sphincter. Objective: Objectives: To review the therapeutic modalities in the treatment of achalasia with short- and long-term analysis of treatment options. Methods: Through the introduction of high resolution manometry, a novel classification system for achalasia has been created to evaluate the prognosis of a patient and to predict response to treatment. Therapeutics is based on medical treatment, endoscopic procedures and surgery, being the latter the gold standard; however there is currently much debate over whether pneumatic dilation is better than Heller myotomy procedure in the treatment of achalasia. Results: Laparoscopic Heller myotomy has emerged in the last few years as the treatment of choice, particularly for young patients 45 years of age or younger. From November 2012 to September 2015, 27 endoscopic dilations have been perfomed in 15 women (55.6 percent) and 12 men (44.4 percent) with no reported complications. From January 2010 to December 2014, one hundred and eighty eight laparoscopic Heller myotomies were performed; the hospital stay was one day, neither conversion nor reoperation was necessary and the mortality rate was zero(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Acalasia Esofágica/terapia , Fatores Imunológicos/efeitos adversos , Laparoscopia/métodos , Manometria/estatística & dados numéricosRESUMO
Esta guía aborda aspectos relacionados con el diagnóstico y el tratamiento de la acalasia en adultos
Assuntos
Adulto , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/terapia , Acalasia Esofágica/cirurgia , Acalasia Esofágica/tratamento farmacológicoRESUMO
The esophageal achalasia is an infrequent disease with significant morbidity. Multiple therapeutic alternatives are available with varying results. In 2008, POEM (Peroral Endoscopic Myotomy) endoscopic surgery was initiated in Japan (Inoue, Yokohama). Since then, it has been performed with excellent results. Objective: To describe this technique and the performance of POEM surgery based on a clinical case. Methods: The first POEM surgery was performed in Chile, according to the standards described in Inoues technique. It was performed by a single operator with previous training. Original devices were used. Prior informed consent was obtained, at Hospital Padre Hurtado in Santiago in January 2014. Results: A 34-year-old female patient, due to significant dysphagia and weight loss, was fully studied and diagnosed of esophageal achalasia type II. POEM surgery was carried out using the technique described by Inoue. The operating time was 150 minutes. No bleeding or intraoperative complications were detected. Upper endoscopic control at 24 h was normal, initiating progressive oral feeding. Discharged at the 4th postoperative day, without problems after a month. Conclusions: POEM surgery is a safe, effective and replicable treatment for esophageal achalasia in a public hospital in Chile.
La acalasia esofágica es una enfermedad infrecuente con morbilidad significativa. Existen múltiples alternativas terapéuticas con diferentes resultados. El año 2008 se inicia en Japón (Inoue, Yokohama) la cirugía endoscópica de POEM (Peroral Endoscopic Myotomy) con excelentes resultados. Objetivo: Describir la técnica y realización de la cirugía de POEM en base a un caso clínico. Métodos: Se planifico la realización de la primera cirugía de POEM en Chile, siguiendo los estándares descritos en su técnica. Fue realizada por un solo operador con entrenamiento previo, utilizando accesorios originales, previo consentimiento informado, en el Hospital Padre Hurtado de Santiago, en enero de 2014. Resultados: Se realizó en un paciente femenino de 34 años, previo estudio completo por disfagia y baja de peso significativa, diagnosticándose una acalasia esofágica tipo II. Se realizó una cirugía de POEM, siguiendo la técnica descrita por el Dr. Inoue. El tiempo quirúrgico fue de 150 min. No se presentó sangrado o complicaciones intraoperatorias. Endoscopia digestiva alta control a las 24 h fue normal, iniciando régimen progresivo. Alta al 4° día post operatorio, con favorable evolución al mes post operatorio. Conclusiones: La cirugía de POEM es segura, efectiva y reproducible para el tratamiento de la acalasia esofágica en un Hospital Público en Chile.
Assuntos
Humanos , Feminino , Adulto , Acalasia Esofágica/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Endoscopia do Sistema Digestório/métodos , Acalasia Esofágica/terapia , Resultado do TratamentoRESUMO
Esophageal idiopathic achalasia is a complex disease associated with loss of neuronal Auerbach Plexus in the esophagus, and possibly caused by specific anti-neural antibodies, characterized by incomplete relaxation of the lower esophageal sphincter (LES), together with progressive loss of esophageal body motility. Its cardinal symptom is dysphagia which is accompanied by intermittent chest pain and pseudoregurgitation. A barium swallow shows a classic regular obstruction at the esophago-gastric junction and typical manometry features, being incomplete relaxation of LES the essential element. The goal of management is palliation of dysphagia and is based on endoscopic or surgical LES myotomy with the purpose of reducing the obstructive effect of incomplete-relaxing LES. Endoscopic dilation and endoscopic and surgical myotomy procedures are evolving to provide greater efficacy and safety in the management of achalasia, resulting in the lower rate of side effects such as gastro-esophageal reflux. Among these therapies, surgical myotomy is the only one that shows acceptable long-term results, however, late complications such as severe gastro-esophageal reflux, Barretts esophagus and esophageal carcinoma should alert about side effects of an effective myotomy.
La acalasia esofágica idiopática es una enfermedad compleja asociada a la pérdida del plexo neuronal de Auerbach en el esófago, posiblemente causada por anticuerpos anti-neurales específicos. Se caracteriza por la relajación incompleta e hipertonía del esfínter esofágico inferior (EEI), junto con pérdida progresiva de la motilidad del cuerpo esofágico. Su síntoma cardinal es la disfagia que se acompaña de dolor torácico intermitente y pseudo-regurgitación. Su diagnóstico de certeza lo aporta un clásico esófago-grama y hallazgos manométricos típicos, siendo la relajación incompleta del EEI un elemento imprescindible. Su manejo busca paliar la disfagia y se basa en procedimientos endoscópicos o quirúrgicos para reducir el efecto obstructivo que causa la anomalía del EEI. Las terapias de dilatación endoscópica, miotomía endoscópica y quirúrgica están en permanente evolución para brindar la mayor eficacia y seguridad en el manejo de la acalasia, causando la menor tasa de efectos colaterales como el RGE. De estas terapias, la miotomía quirúrgica es la única que muestra buenos resultados sostenidos en el largo plazo, pero surge la inquietud de la aparición de complicaciones tardías como reflujo gastroesofágico grave, esófago de Barrett y carcinoma esofágico.
Assuntos
Humanos , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/terapiaRESUMO
The following on achalasia and disorders of the esophageal body includes commentaries on controversies regarding whether patients with complete lower esophageal sphincter (LES) relaxation can be considered to exhibit early achalasia; the roles of different mucle components of the LES in achalasia; sensory neural pathways impaired in achalasia; indications for peroral endoscopic myotomy and advantages of the technique over laparoscopic and thorascopic myotomy; factors contributing to the success of surgical therapy for achalasia; modifications to the classification of esophageal body primary motility disorders in the advent of high-resolution manometry (HRM); analysis of the LES in differentiating between achalasia and diffuse esophageal spasm (DES); and appropriate treatment for DES, nutcracker esophagus (NE), and hypertensive LES (HTLES).
Assuntos
Acalasia Esofágica/terapia , Transtornos da Motilidade Esofágica/terapia , Esôfago/fisiopatologia , Endoscopia , Acalasia Esofágica/etiologia , Acalasia Esofágica/fisiopatologia , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Humanos , Laparoscopia , ManometriaRESUMO
Achalasia is a rare disease in children. It is an idiopathic disease characterized by loss of normal peristalsis in the distal esophagus and the inability of the lower esophageal sphincter (LES) to relax properly. It presents with dysphagia and weight loss. The imaging study, particularly the study of the esophagus, stomach, duodenum with barium contrast medium, is the diagnostic test of choice, which in 95% of cases enables a diagnosis. There are various therapeutic options including pneumatic dilation (PD), botulinum toxin injection (BT) and surgery, with the latter giving the best long-term results, the access path is mainly laparoscopic. We report the case of a pediatric patient, evaluated in our department, diagnosed with achalasia.
La acalasia es una enfermedad infrecuente en población pediátrica. Es una enfermedad de causa desconocida que se caracteriza por la pérdida de la peristalsis normal del esófago distal y de la incapacidad del esfínter esofágico inferior de relajarse adecuadamente. El estudio con imágenes, particularmente el estudio del esófago, estómago, duodeno con medio de contraste baritado, es el test de elección, el cual en un 95% de los casos nos otorga un diagnóstico de certeza. Existen diversas opciones terapéuticas, entre ellas la dilatación neumática, la toxina botulínica y la cirugía, siendo esta última la con mejores resultados a largo plazo, la vía de acceso es principalmente laparoscópica. Presentamos el caso de un paciente pediátrico, evaluado en nuestro departamento, diagnosticado de acalasia.
Assuntos
Humanos , Feminino , Criança , Acalasia Esofágica/diagnóstico por imagem , Acalasia Esofágica/terapia , Esôfago/diagnóstico por imagemRESUMO
Objetivos: Caracterizar la población de pacientes vistos con esta entidad en el Hospital "Dr. Rafael Angel Calderón Guardia" durante los últimos 6 años y determinar su presentación clínica, método(s) de diagnóstico utilizado (s), tratamiento brindado y evolución durante el primer año postratamiento. Materiales y métodos: Se analizaron los expedientes clínicos de hospitalización de los pacientes con acalasia atendidos desde enero de 2001 hasta enero de 2007; luego se revisaron las notas de evolución de la consulta externa de Gastroenterología durante el año posterior a la terapia brindada. Resultados: Durante el periodo se analizaron 30 pacientes en total. Hubo una discreta predominancia del género masculino y la edad promedio en el momento del diagnóstico fue de 50,37 años. El 100% de los pacientes presentó disfagia de larga data y los síntomas asociados más frecuentes fueron la pérdida de peso y el dolor torácico. Los métodos diagnósticos más utilizados fueron la manometría esofágica, la endoscopía y el esofagograma. El tratamiento que más se empleó fue la dilatación neumática seguida de la cirugía. El 50% de los pacientes reinició o persistió con disfagia durante el año siguiente a su tratamiento. La incidencia de complicaciones fue baja y no hubo perforación esofágica. Conclusiones: Las características generales y la presentación clínica de los pacientes coincidieron con lo descrito en la bibliografía. El tratamiento que más se brindó fue la dilatación neumática. La mitad de los pacientes presentaron o continuaron con síntomas postratamiento.
Objectives: To determine the general characteristics of patients with diagnosis of achalasia seen during the last 6 years at the Dr. Rafael Angel Calderon Guardia Hospital, their clinical presentation, diagnostic methods utilized, treatments given and the presence of disphagia within the following year after therapy. Methods: We analized the clinical records of patients with achalasia seen from january 2001 to january 2007. We also reviewed out patient clinic notes, looking for the persistence or recurrence of disphagia during the first year after therapy. Results: 30 patients were found and included in the study. There was a slight male gender predominance, and an average age of 50,37 years. All the patients had long standing dysphagia, the other most frequent symptoms were weight loss (43,33%) and chest pain (13,33%). The more commonly used diagnostic methods were esophageal manometry, endoscopy and barium esophagogram. Pneumatic dilation was the most frequently utilized treatment (46,67%) followed by surgery (26,67%). Half the patients recurred or continue having dysphagia during the year following treatment. The rate of complications was low and there were no esophageal perforations or mediastinitis. Conclusions: The general characteristics and clinical presentation of the patients agreed with those mentioned in the literature. Esophagic manometry was the most used diagnostic test and esophageal dilation was the preferred treatment. The rate of dysphagia within a year posttreatment was high.
Assuntos
Humanos , Costa Rica , Transtornos de Deglutição/tratamento farmacológico , Acalasia Esofágica/tratamento farmacológico , Acalasia Esofágica/cirurgia , Acalasia Esofágica/terapia , Transtornos da Motilidade EsofágicaRESUMO
Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
Assuntos
Doença de Chagas/cirurgia , Acalasia Esofágica/cirurgia , Esôfago/patologia , Brasil , Cateterismo/métodos , Doença de Chagas/mortalidade , Doença de Chagas/terapia , Acalasia Esofágica/mortalidade , Acalasia Esofágica/terapia , Esofagectomia/métodos , Esofagoplastia/métodos , Esofagoscopia/métodos , Esôfago/cirurgia , Feminino , Humanos , Injeções Intralesionais , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fármacos Neuromusculares/uso terapêutico , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: The radiological features of achalasia of the esophagus are well known and have been described. However, very little is known concerning the natural history of this disease. We aimed to determine the evolutive radiological changes of the esophagus in a group of patients with achalasia who had not previously undergone any treatment. METHODS: We undertook a prospective study of 14 patients with achalasia from a group of 205 patients. They included 9 women and 5 men who did not receive any treatment at the initial diagnosis. Two radiological parameters were evaluated: (a) the maximal internal diameter of the middle third of the thoracic esophagus in millimeters and (b) the internal diameter of the esophagogastric junction in millimeters. RESULTS: At a mean follow-up of 5-years without any treatment, there was a significant increase in the diameter of the thoracic esophagus, with a rate of "dilatation" of 6.1 mm/year. In addition, there was a significant decrease of the internal diameter of the esophagogastric junction, with a rate of "stenosis" of 1 mm/year. The lower esophageal sphincter was hypertensive in all with an incomplete relaxation. CONCLUSION: These results suggest that there is a progressive deterioration in the radiological parameters of the esophagus in patients with achalasia not treated over a 5-year period of observation.
Assuntos
Acalasia Esofágica/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Adulto , Idoso , Progressão da Doença , Acalasia Esofágica/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RadiografiaRESUMO
Presentar la experiencia obtenida por los autores practicando la esofagocardiomiotomía de Heller con fundoplicatura anterior de Dor por laparoscopia en el tratamiento de los pacientes con diagnóstico de acalasia, en el Centro Policlínico Valencia. Es un estudio retrospectivo realizado en el Centro Policlínico La Villa, Valencia, hospital privado donde se revisaron las historias clínicas de 12 pacientes que acudieron a la consulta quirúrgica con diagnóstico de acalasia entre noviembre del año 1996 y diciembre del 2005, a quienes se les practicó esofagocardiomiotomía de Heller con fundoplicatura anterior de Dor por laparoscopia. Los pacientes a quienes se les practicó la esofagocardiomiotomía de Heller con fundoplicatura anterior de Dor por laparoscopia presentaban disfagia como síntoma principal, dilataciones previas en el 100 por ciento de los casos, manometría que reportaba aperistalsis en el 100 por ciento y un promedio de presión en el Esfínter Esofágico Interior de 48.8 mmHg. El tiempo quirúrgico osciló entre 65 y 150 minutos, tolerancia a la vía oral en las primeras 24 horas, estancia hospitalaria promedio de 31.6 horas y sólo un paciente presentó una micro-perforación esofágica que evolucionó satisfactoriamente con tratamiento conservador. Hubo contacto telefónico con siete pacientes y no refirieron síntomas. Las complicaciones intra y post-operatorias de muestran lo seguro del procedimiento, aunado a los resultados satisfactorios hacen de la esofagocardiomiotomía de Heller con fundoplicatura de Dor por laparoscopia el procedimiento de elección en la Acalasia.
Assuntos
Acalasia Esofágica/cirurgia , Acalasia Esofágica/patologia , Acalasia Esofágica/terapia , Laparoscopia/métodos , Prontuários Médicos , Transtornos de Deglutição/diagnósticoRESUMO
Racional: Existem alguns relatos de casos de refluxo gastroesofágico, não relacionados com estase e fermentação alimentar, em pacientes com acalásia virgem de tratamento. essa associação segue diferentes padrões evolutivos, podendo o refluxo proceder, coincidir com ou suceder a diagnóstico de acalásia. Objetivo: Relatar caso de paciente sem história típica de pirose, que apresentou hemorragia digestiva alta, com endoscopia digestiva alta evidenciando esofagite intensa, sem sinais de estase. evoluiu com disfagia e esofagomanometria diagnóstica de acalásia (cardiomiotomia laparoscópica com procedimento anti-refluxo. Conclusão: A demonstração de esofagite intensa sem estase sugere que o refluxo precedeu o diagnóstico de acalásia e foi resolvido após o aparecimento desta. A paciente recebeu tratamento habitualmente indicado para acalásia