Laparoscopic Heller myotomy provides significant improvement in dysphagia and regurgitation symptoms in achalasia patients regardless of the type of partial fundoplication. Although a higher percentage of patients in the Dor group had abnormal 24-h pH test results compared to those of patients who underwent Toupet, the differences were not statistically significant.

With treatment Achalasia patients exhibit some restoration in peristalsis as well as improved bolus clearance. After Heller Myotomy, the return of peristalsis correlates with esophageal clearance, which may partly explain its superior relief of dysphagia.

SUMMARY Laparoscopic Nissen fundoplication (LNF) is an effective treatment for gastroesophageal reflux disease; however, some patients develop dysphagia postoperatively. Manometry is used to evaluate disorders of peristalsis, but has not been proven useful to identify which patients may be at risk for postoperative dysphagia. Multichannel intraluminal impedance (MII) evaluates the effective clearance of a swallowed bolus through the esophagus. We hypothesized that MII combined with manometry may detect those patients most at risk of developing dysphagia after LNF. Between March 2003 and January 2007, 74 patients who agreed to participate in this study were prospectively enrolled. All patients completed a preoperative symptom questionnaire, MII/manometry, and 24‐h pH monitoring. All patients underwent LNF. Symptom questionnaires were administered postoperatively at a median of 18 months (range: 6–46 months), and we defined dysphagia (both preoperatively and postoperatively) as occurring more than once a month with a severity ≥4 (0–10 Symptom Severity Index). Thirty‐two patients (43%) reported preoperative dysphagia, but there was no significant difference in pH monitoring, lower esophageal sphincter pressure/relaxation, peristalsis, liquid or viscous bolus transit (MII), or bolus transit time (MII) between patients with and without preoperative dysphagia. In those patients reporting preoperative dysphagia, the severity of dysphagia improved significantly from 6.8 ± 2 to 2.6 ± 3.4 (P < 0.001) after LNF. Thirteen (17%) patients reported dysphagia postoperatively, 10 of whom (75%) reported some degree of preoperative dysphagia. The presence of postoperative dysphagia was significantly more common in patients with preoperative dysphagia (P= 0.01). Patients with postoperative dysphagia had similar lower esophageal sphincter pressure and relaxation, peristalsis, and esophageal clearance to those without dysphagia. Neither MII nor manometry predicts dysphagia in patients with gastroesophageal reflux disease or its occurrence after LNF. The presence of dysphagia preoperatively is the only predictor of dysphagia after LNF.

BackgroundBehçet’s disease (BD) is an inflammatory disease characterised by recurrent oral aphthous ulcers and numerous potential systemic manifestations.PurposeTo describe the experience of our centre with the use of adalimumab, etanercept and infliximab for the treatment of severe clinical manifestations in patients with BD in whom immunosuppressive treatment had failed.Material and methodsRetrospective review of medical records of 36 months (January 2010–December 2013) from patients with BD treated with adalimumab, etanercept or infliximab as compassionate use. Demographic and clinical data included age, sex, previous treatment, indication, side effects, concomitant drugs and clinical outcome.Results12 patients were included (5/7 women/men) 3/12 treated with infliximab, 2/12 etanercept, and 7/12 adalimumab; with a mean age of 36 years (range 21–55). We decided to start treatment due to the lack of response in the control of symptoms (3/12 patients had cutaneous lesions), and ocular involvement (9/12 patients with uveitis of repetition and visual deterioration). The patients had received conventional treatment: 4/12 had received two drugs, 4/12 three drugs, 2/12 four drugs, 1/12 five drugs and one had received six drugs previously. The most prescribed drugs were corticosteroids, azathioprine and cyclosporine. 1/12 patient had received previous treatment with infliximab before adalimumab with relapse of symptoms. We did not detect any adverse effects in patients treated. In all patients, clinical improvement was evident from the first administration. 8/12 patients showed reduction of symptoms, while 4/12 patients became asymptomatic. They continue in treatment.ConclusionAnti-TNF agents are a good option for patients with severe BD who are resistant to steroid and immunosuppressive treatment, with a good safety profile. The benefit of this treatment supports the hypothesis that TNF-a is an important factor in the pathogenesis of BD. Moreover, no adverse effects were detected in the treated patients, in agreement with the few cases described in the literature reviewed.References and/or AcknowledgementsNo conflict of interest.