Effect of laparoscopic esophagomyotomy on chest pain associated with achalasia and prediction of therapeutic outcomes.
ABSTRACT The effect of myotomy for achalasia on chest pain has not been clarified. The current study aimed to investigate the therapeutic effect of laparoscopic myotomy on chest pain associated with achalasia and to identify prognostic factors for outcomes.
Between March 2005 and September 2008, 95 patients were available for detailed interviews and for assessment of clearance by timed barium esophagogram (TBE) before and after surgery. Of the 95 patients, 47 (24 men; mean age, 42.9 ± 13.5 years) who experienced chest pain before surgery were studied. The subjects were asked in detail about dysphagia and chest pain before surgery and 6 months after surgery. The frequency and severity of the symptoms were graded on a scale of 0 to 4. In addition, the values obtained by multiplying the grade for frequency by the grades for severity of the two symptoms were defined as the dysphagia score and the chest pain score, respectively. The patients with chest pain scores of 0 after surgery were defined as group A and those with scores smaller than their preoperative scores as group B. The remaining patients with other scores were defined as group C. The background factors and clinical conditions of the three groups were compared.
The mean chest pain score decreased from 5.0 ± 3.2 to 1.0 ± 1.6 (p < 0.001). The score after surgery was 0 for 27 patients and showed a decrease for 15 patients. Although the three groups did not differ in their characteristics, differences were noted in postoperative TBE factors (i.e., groups A and B had significantly shorter barium columns than group C at 1 and 5 min after surgery (p = 0.001).
Laparoscopic myotomy had a therapeutic effect on chest pain associated with achalasia, and improvement in postoperative esophageal clearance may influence the therapeutic effect.
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ABSTRACT: Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.Nature Reviews Gastroenterology & Hepatology 06/2011; 8(6):311-9. · 10.43 Impact Factor
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ABSTRACT: Prior to the 2009 season, sweet cherry fruits, Prunus avium (L.) L., from North America were required to be fumigated with methyl bromide before being exported to Japan to eliminate possible infestation by codling moth, Cydia pomonella (L.) (Lepidoptera: Tortricidae). However, based on recent biological research on host status, a new procedure (the “systems approach”) was implemented relying on the cumulative effects of pre- and post-harvest practices to produce pest-free sweet cherry fruits for export. This is an organized process that involves the integration of procedures used in the production, harvest, packaging, and distribution of a commodity which cumulatively meet the requirements for quarantine security. The objective of our study was to provide additional information to support the systems approach for codling moth in sweet cherries fruits. For four seasons, branches with sweet cherry fruits were caged on trees and infested by released ovipositing codling moths into the cages. Fruits were sampled weekly for codling moth individuals at each life stage. Eggs were laid mostly on leaves with the seasonal average numbers per cage ranging from 142 to 617. Populations declined rapidly after egg eclosion, withCrop Protection - CROP PROT. 01/2011; 30(9):1223-1226.