Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Primary Motility Disorders of the Esophagus
Chapter: Achalasia (hypomotility) is the best known entity

89. Have any specific changes in the ultrastructure of the smooth esophageal muscle been demonstrated in patients suffering from achalasia ?
J.N. Blackwell (Newtownabbey)

90. Should achalasia be considered as a strictly primary myopathy ?
D.O. Castell (Philadelphia)

91. Could a central origin be responsible for achalasia ?
Ph. Ducrotté (Rouen)

92. Do the nerve alterations point to a neurogenic pathogenesis ?
H.D. Appelman (Ann Arbor)

93. What are the morphologic expressions of achalasia in the esophagus and what are its morphologic complications ?
H.D. Appelman (Ann Arbor)

94. Is the role of defective extrinsic and intrinsic innervation established ?
H.D. Appelman (Ann Arbor)

95. How is one to interpret the presence of Lewy bodies in the wall of the megaesophagus ?
S.J. Qualman (Columbus)

96. The cholinergic fibres of the vagus are poorly preserved, but not the non cholinergic fibres.
J. Dent (Adelaide)

97. Is the role of the vagal fibers unequivocal ?
P. Meunier (Lyons)

98. Could the role of vagal fibers account for the effect of acupuncture in certain achalasias ?
C. Tremolada (Venice), A. Nosadini, M. Ferrini (Padova)

99. What is the role of atropine ?
D. Couturier (Paris)

100. What is the role of the reduced number of vasoactive intestinal polypeptide fibers in the achalasic esophagus ?
G. Hambraeus, S. Aggestrup, G. Fernström, F. Sundler, R. Uddman (Lund, Copenhagen, Malmö)

101. What is the role of vasoactive intestinal polypeptides (VIP) and transcutaneous nerve stimulation in esophageal motility disorders ?
B Kaada (Stavanger), K Nygaard (Oslo)

102. May the abolition of LES electrical oscillations induced by sphincter relaxation contribute to the understanding of achalasia in man ?
J. Dent (Adelaide)

103. Can isolated pain be one of the initial features of achalasia ?
D. Couturier (Paris)

104. Do there really exist features specific to dysphagia ?
S.B. Benjamin (Washington)

105. What is the incidence of pulmonary complications in patients with achalasia ?
A.C. Duranceau, C. Deschamps, E. Lafontaine (Montreal)

106. Endoscopy still has an important part to play in this disorder, to exclude cancer of the cardia with deceptive symptomatology
C. Theodore (Paris)

107. Is there any correlation between the rest-pressure of the LES and the stage of esophageal emptying as shown by scintigraphy ?
RW. McCallum (Charlottesville)

108. There is no longer any controversy about the manometric aspects of achalasia.
D.O. Castell (Philadelphia)

109. But incomplete relaxation of the LES may be observed in healthy people
K. Bielefeldt, G. Strohmeyer (Dusseldorf)

110. Can propagation be maintained in some parts of the esophagus ?
D. Couturier (Paris)

111. Is the proximal segment of the esophagus often involved in this disorder ?
R.R. Klingman, H.J. Stein, T.R. De Meester (Omaha)

112. Are pharyngeal abnormalities often found in achalasia ?
M. W. Dormer, B.J. Jones, W.J. Ravich (Baltimore)

113. Which are the three main disorders of motor function ?
J-Y. Touchais, P. Ducrotte, Ph. Denis (Rouen)

114. Are diagnostic tests necessary ?
J.R. Siewert, H. Feussner, R. Bumm (Munich)

115. Is decreased amplitude of the synchronous waves after swallowing an index of more serious involvement of the intramural plexuses ?
J.R. Crist (Boston)

116. What is the true role of sphincter relaxation in cardiospasm ?
E. H. Metman, F. Lombard (Tours)

117. Can cases where relaxation is preserved be considered as initial stages ?
J.E. Richter (Birmingham)

118. What is the duration of relaxation in these cases ?
J.E. Richter (Birmingham)

119. How is one to interpret aperistalsis with « normal » relaxation of the LES ?
D.O. Castell (Philadelphia)

120. Does manometry allow detection of achalasia of neoplastic origin ?
J.R. Siewert, H. Feussner, R. Bumm (Munich)

121. Does the calibre of the catheters employed for manometry influence the values obtained for sphincteric pressures ?
J. Dent (Adelaide)

122. What is vigorous achalasia ?
F. H. Ellis Jr (Boston)

123. Are its histologic criteria known ?
K. Geboes, J. Mebis, N. Ectors (Leuven), /. El-Dosoky (Mansoura)

124. Should it be regarded as a separate entity ?
R. Pare, F. Hakami (Paris)

125. Is the megaesophagus of Chagas' disease physiologically comparable to that of idiopathic achalasia of the esophagus ?
R.J. Earlam (London)

126. In Chagas' disease, the lower esophageal sphincter pressure (LESP) is still a matter of controversy
R.O. Dantas (Ribeirao Preto)

127. Is the myenteric esophageal plexus degeneration identical in Chagas' disease and idiopathic achalasia ?
R. O. Dantas (Ribeirao Preto)

128. How useful are radionuclide transit studies in the early diagnosis of aperistalsis in Chagas' disease ?
I. Cecconello, B. Zilberstein ,C.E. Domene,R.A. Aissar Sallum, A. Nasi, H. W. Pinotti (Sao Paulo)

129. Calcium inhibitors : how do they act ?
J. Fournet (Grenoble)

130. Nifedipine lowers LES pressure in the same way as in normal subjects
R. W. McCallum (Charlottesville)

131. Nitroderivates
E. Tiomny, P. Rozen (Tel Aviv)

132. What are the comparative effects of isosorbide dinitrate and nifedipine in treatment of achalasia ?
J-C. Grimaud, L. Thervet (Marseilles)

133. Does nifedipine have the same effect in Chagas' disease as in idiopathic achalasia ?
R. O. Dantas (Ribeirao Preto)

134. What is the effect of medical treatment on the different stages of the disease ?
J. Fournet (Grenoble)

135. Is it possible to stop the treatment ?
J. Fournet (Grenoble)

136. Is radiography always necessary before dilatation ?
M. Levesque, S. Attia, F. Aubert (Paris)

137. Hydrostatic dilatation in achalasia What pressure should be applied ?
E.H. Metman (Tours)

138. The technique of pneumatic dilatation
J. Escourrou, M. Delvaux, L. Buscail (Toulouse)

139. Achalasia and epiphrenic diverticulum : is pneumatic dilatation contraindicated ?
E. H. Metman, Ph. Codjovi, E. Danquechin Dorval (Tours)

140. For how long should dilation be continued ?
H. W. Boyce (Tampa)

141. How often does conservative treatment of perforation after pneumatic dilatation of the cardia result in healing ?
G. Vantrappen (Leuven)

142. What are the results of dilatation ?
A Csendes, I Braghetto (Santiago)

143. Does peristalsis ever return after pneumatic dilatation for achalasia ?
G. Vantrappen (Leuven)

144. To what degree does the esophageal diameter decrease after dilatation for achalasia ?
G. Vantrappen (Leuven)

145. What is the incidence of gastroesophageal reflux after dilatation ?
A. Csendes, I. Braghetto (Santiago)

146. Do manometric criteria exist to assess the effect of treatment ?
J. Cecconello, V.N. Felix ,M.T. Meniconi, H. W. Pinotti,B. Zilberstein (Sao Paulo)

147. Does the post-dilatation radiographic appearance of the LES correlate with the clinical response ?
D.J. On (Winston-Salem)

148. What are the radiographic criteria of effective treatment ?
P. Legmann, M. Levesque, O. Arcangioli, Ph. Soyer (Colombes)

149. Should failure of balloon dilatation foretell a poor result from surgery ?
H.W. Pinotti, R.A. Aissar Sallum, B. Zilberstein, I. Cecconello, J.M. Da Rocha, V.N. Felix (Sao Paulo)

150. In what circumstances should surgical treatment be envisaged from the outset ?
C. G. Bremner (Johannesburg)

151. The Thal-Hatafuku operation
O. Malafaia (Curitiba)

152. The Heller's operation by the transabdominale route
B. Launois, F. Siriser, G. Lebeau (Rennes)

153. Heller's operation by the thoracic route: with suture of the myotomy to the margins of the diaphragm
G. Pappalardo, F. Pitasi, P.M. Frattaroli, D. Reggio, G. Castrini (Rome)

154. How far should the myotomy extend on the stomach ?
C. T Bombeck, L M. Nyhus, Ph E. Donahue (Chicago)

155. The experimental effect of myectomy of the ventral obliquae sling fibres on the lower esophageal sphincter pressure
J. Schneider, H. D. Becker (Tubingen), G. Lepsien (Göttingen)

156. What are the effects of esophagomyotomy on esophageal motility and on tertiary contractions ?
F.H. Ellis Jr (Boston)

157. Does esophagomyotomy abolish high pressure zone ?
F.H. Ellis Jr (Boston)

158. What are the reflux patterns in patients with achalasia prior to treatment ?
G. Beauchamp, L. Perrault, G. Jobin, C. Edmond (Montreal)

159. May the risk of reflux esophagitis offset the value of surgery as against pneumatic dilatation ?
A. Csendes, I. Braghetto (Santiago)

160. Does the persistence of an LES high-pressure zone prevent reflux after a Heller myotomy ?
W.J. Dodds (Milwaukee) J.E. Richter (Birmingham)

161. Is surgical access to the hiatus conceivable without derangement of the functional anatomy ? Does this justify a thoracic approach ?
Ph. Boutelier (Bondy-Paris)

162. What are the gastric factors involved ?
G.G. Jamieson (Adelaide)

163. Is addition of a gastric drainage procedure legitimate ?
G. G. Jamieson (Adelaide)

164. Transabdominal procedures
C. Ricci, A. Arullani, F. Francioni, T. de Giacomo (Rome)

165. What is the role of repair of the crura to restore sphincter function ?
R. W. McCallum (Charlottesville)

166. How useful is peroperative manometry ?
D.E. Low (Coventry), L.D. Hill(Seattle)

167. Transthoracic antireflux procedures associated to myotomy with preservation of diaphragmatic control
G. Pappalardo (Rome)

168. Does the length of fundoplication involve a risk of residual dysphagia ?
A. Duranceau, C. Deschamps, E. Lafontaine (Montreal)

169. Are there any risk of functional obstruction of the esophagus when an antireflux procedure has been combined with the myotomy ?
M.-B. Orringer (Ann Arbor)

170. What are the results of peroperative manometry in anti-reflux procedures after myotomy ?
A. Del Genio, V. Maffetone, G. Izzo, L. Fei, G. Amato, V. Napolitano (Naples)

171. What are the preventive effects of fundoplication on reflux esophagitis in the treatment of achalasia ?
F. Veiga-Fernandez, L. Mascarenhas, A.B. Branca P.M. Costa (Lisbon)

172. Is it legitimate to envisage a combined selective vagotomy ?
M. Galliera, F. Torretta, L. Gallone (Milan)

173. May dysphagia related to achalasia occur after selective vagotomy, due to neuromuscular dysfunction of the LES ?
M. Guelrud (Caracas)

174. Reasons for failure after Heller operation
N.K. Altorki, D.B. Skinner (New York)

175. Does initial dilatation affect the results of myotomy ?
C.T. Bombeck , L.M. Nyhus, Ph. E. Donahue (Chicago)

176. Does an initial myotomy contraindicate subsequent dilation ?
H. W. Boyce (Tampa)

177. What are the criteria for choosing between dilatation and surgery ?
J. Salducci, L. Thervet, J.C. Grimaud (Marseilles)

178. After a long history, is it still appropriate to use a myotomy ?
C.T. Bombeck, L.M. Nyhus, Ph. E. Donahue (Chicago)

179. The subjective response to either treatment is related to the percent change in LESP and not the basal LESP or the absolute change in the LESP
R. W. McCallum (Charlottesville)

180. What are the late criteria for long term evaluation of treatment ?
C. Tohme, A. Bernard, H. Viard (Dijon)

181. What are the results of esophago-cardiomyotomy for cardiospasm ?
M. Ribet (Lille)

182. What is the role of radioactive transit in assessing the effectiveness of treatment ?
B. Zilberstein, I. Cecconello, C.E. Domene, R.A. Aissar Sallum, A. Nasi, H. W. Pinotti (Sao Paulo)

183. Is the incidence of adenocarcinoma of the esophagus after achalasia known ?
G. Champault, B. Rozenblum, N. Risk (Paris)

184. Is the role of achalasia as a risk factor certain ?
H. W. Tilanus, M.A.C. Meyssen, EL. Ong (Rotterdam)

185. Does this risk call for special precautions during endoscopy of these patients ?
C. Iascone, M. Caporossi, R. Area (Rome)

Publication date: May 1991 OESO©2015