Pulmonary complications of benign esophageal disease

McArthur, Michael S.

doi:10.1016/0002-9610(86)90091-7

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…The mechanisms of lung involvement in patients with achalasia may include: extrinsic compression of the tracheo-bronchial tree by the dilated oesophagus and recurrent microaspiration. [25][26][27][28] In fact regurgitation, which predisposes to microaspiration, was significantly more common in this study in patients with dilated oesophagus. In addition, hyper-reactivity of airways to the microaspirated food particles may also be responsible for respiratory abnormalities in them.…”

Section: Discussionmentioning

confidence: 42%

“…The mechanisms of lung involvement in patients with achalasia may include: extrinsic compression of the tracheo‐bronchial tree by the dilated oesophagus and recurrent microaspiration 25–28 . In fact regurgitation, which predisposes to microaspiration, was significantly more common in this study in patients with dilated oesophagus.…”

Section: Discussionmentioning

confidence: 52%

“…Although, such a compression of tracheo‐bronchial tree resulting in segmental atelectasis may remain asymptomatic, a marked and symptomatic compression of airways however has been reported 16,18 . The dilated oesophagus has been known to cause compression over the recurrent laryngeal nerve, superior venacava, and conducting airways such as trachea and major bronchi 25,26 . Tracheal obstruction with respiratory distress in a patient with achalasia was first reported in 1950 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Microaspiration from the dilated oesophagus in general leads to aspiration bronchiolitis, broncho‐pneumonia, obliterative bronchiolitis and mediastinitis 25,26,28 …”

Section: Discussionmentioning

confidence: 99%

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Structural and functional abnormalities in lungs in patients with achalasia

Makharia

Seith

Sharma

et al. 2009

Neurogastroenterology Motil

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Dilatation and oesophageal body aperistalsis in achalasia can lead to stasis which in turn can induce repeated microaspiration. It is therefore conceivable that patients with achalasia may also have abnormalities in lungs secondary to repeated episodes of microaspiration. There is a lack of systematic study on involvement of lungs in patients with achalasia. Thirty patients with achalasia underwent pulmonary function tests (spirometry, and carbon mono-oxide diffusion capacity) and high resolution computerized tomography (HRCT) of the chest. The mean age of patients and mean duration of disease were 33.5 +/- 10.9 years and 28.1 +/- 27.3 months respectively. Regurgitation was present in 22 (73.3%) of them. Respiratory symptoms in them were dry cough in 17 (56.6%), and chest pain in 18 (60%). The oesophagus was dilated in 26 (86.6%) and 13 (43.3%) had residue in oesophagus. Sixteen (53.3%) patients had either anatomical changes as seen on HRCT or functional changes as observed on pulmonary function tests. Of those with functional abnormalities, five (16.6%) and one (3.3%) had restrictive and obstructive airways disease respectively. While evidence of tracheo-bronchial compression by dilated oesophagus was present in eight (26.6%), 10 (33.3%) patients had parenchymal lung disease [nodular opacities in five (16.6%), ground glass appearance six (20%), patchy pulmonary fibrosis five (16.6%), air trapping two (6.6%), consolidation and bronchiectasis one (3.3%) each]. There was a significant association between presence of regurgitation and dilatation of oesophagus (P = 0.032). More than half (53.3%) of patients with achalasia have structural and/or functional abnormalities in lungs.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

“…Microaspiration from the dilated oesophagus in general leads to aspiration bronchiolitis, broncho‐pneumonia, obliterative bronchiolitis and mediastinitis 25,26,28 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Structural and functional abnormalities in lungs in patients with achalasia

Makharia

Seith

Sharma

et al. 2009

Neurogastroenterology Motil

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“…Although the pathophysiology is now known, it has been postulated that impaired esophageal emptying from achalasia may result not only in dysphagia but also that the retained food and secretions pooled in the esophagus may give rise to episodes of microand macro-aspiration, leading to symptoms or airway and pulmonary disease. 9,10 Treatment of achalasia, whether surgical or non-surgical, is palliative and focuses on ablation of the LES to relieve distal esophageal obstruction and improve esophageal emptying. Surgical myotomy has so far demonstrated the best long-term outcome with regard to improvement in upper digestive symptoms and relief of dysphagia.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Respiratory Symptoms Following Heller Myotomy for Achalasia

Khandelwal

Petersen

Tatum

et al. 2011

Journal of Gastrointestinal Surgery

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The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease (GERD): A Clinical Investigation of 225 Patients Using Ambulatory 24‐Hour pH Monitoring and an Experimental Investigation of the Role of Acid and Pepsin in the Development of Laryngeal Injury

1991

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Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order to test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double‐probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty‐five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24‐hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double‐probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty‐eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentag with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow‐up was available on 68% of the patients and the mean follow‐up period was 11.6 ± 12.7 months. After 6 months of treatment, symptoms had resolved in 85% and medical therapy had failed in 15%. Subsequently, an additional 20% experienced medical treatment failure. Fifteen percent of patients underwent Nissen fundoplication, and all subsequently had resolution of symptoms. To further investigate the role of gastroesophageal reflux in the development of laryngeal damage, experiments mimicking the effects of intermittent reflux (of acid and pepsin...

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Pulmonary complications of benign esophageal disease

Cited by 12 publications

References 7 publications

Structural and functional abnormalities in lungs in patients with achalasia

Structural and functional abnormalities in lungs in patients with achalasia

Improvement of Respiratory Symptoms Following Heller Myotomy for Achalasia

The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease (GERD): A Clinical Investigation of 225 Patients Using Ambulatory 24‐Hour pH Monitoring and an Experimental Investigation of the Role of Acid and Pepsin in the Development of Laryngeal Injury

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