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Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

Direct-Acting Cholinergic Agonists: Therapeutic Uses

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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

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Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
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Direct-Acting Cholinergic Agonists: Pharmacokinetics01:31

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Direct-acting cholinergic agonists, such as synthetic choline esters and naturally occurring alkaloids, exert their effects by enhancing the actions of acetylcholine and stimulating the parasympathetic nervous system. Synthetic choline esters share structural similarities with acetylcholine. For example, they have a positively charged quaternary ammonium or onium group, contributing to their hydrophilic characteristics. As a result, they are poorly absorbed in the body through oral...
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Gastrointestinal Motility Disorders01:20

Gastrointestinal Motility Disorders

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Gastrointestinal or GI motility disorders are characterized by irregular gastrointestinal tract movements, disrupting food transit from the mouth to the anus. They are caused by damage or dysfunction in gut muscles or nerves. These disorders can cause symptoms such as severe constipation, diarrhea, abdominal pain, and swallowing difficulties. Disorders can affect any segment of the GI tract and range widely in severity, from common conditions like GERD to life-threatening conditions like...
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Direct-Acting Cholinergic Agonists: Chemistry and Structure-Activity Relationship01:22

Direct-Acting Cholinergic Agonists: Chemistry and Structure-Activity Relationship

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Cholinergic agonists or cholinomimetics mimic the action of acetylcholine to stimulate the parasympathetic nervous system. They are categorized into direct-acting and indirect-acting agents. The direct-acting cholinergic drugs induce the parasympathetic response by directly binding to the muscarinic or nicotine receptors. In comparison, the indirect-acting cholinergic drugs prevent acetylcholine hydrolysis, indirectly contributing to the extended parasympathetic response.
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Related Experiment Video

Updated: May 9, 2025

Robotic Myotomy and Partial Fundoplication for Achalasia
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Paediatric achalasia - what is different?

Ines Teixeira1, Catarina Lima2, Tiago Tuna3

  • 1Pediatric Surgery Department, Unidade Local de Saúde de Gaia/Espinho, Porto, Portugal.

ANZ Journal of Surgery
|May 6, 2025
PubMed
Summary

Laparoscopic Heller myotomy (LHM) effectively relieves achalasia symptoms in children. While not a cure, LHM offers significant relief, but long-term monitoring is crucial for managing this esophageal motility disorder.

Keywords:
achalasialaparoscopic myotomypaediatric

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Esophageal Motility Disorders

Background:

  • Achalasia is a rare esophageal motility disorder impacting children, presenting challenges in symptom management.
  • Current treatments for achalasia lack a definitive cure, necessitating effective interventions for symptom control.

Purpose of the Study:

  • To evaluate the safety and efficacy of Laparoscopic Heller myotomy (LHM) in pediatric patients with achalasia.
  • To assess long-term outcomes and complications following LHM in a pediatric cohort.

Main Methods:

  • Retrospective longitudinal cohort study of pediatric achalasia patients (2005-2022).
  • All patients underwent Laparoscopic Heller myotomy (LHM) with Dor fundoplicature.
  • Data collected on patient demographics, presentation, diagnostic methods, and postoperative outcomes.

Main Results:

  • Sixteen pediatric patients (81.2% male, mean age 11.6 years) with achalasia were included.
  • Solid dysphagia was the most common symptom (93.8%).
  • LHM provided immediate symptom relief; 12.5% required endoscopic dilatation for relapse, and 18.8% developed GERD. No re-operations were needed.

Conclusions:

  • Laparoscopic Heller myotomy (LHM) is a safe and effective treatment for symptomatic relief in pediatric achalasia.
  • Achalasia remains without a proven cure, highlighting the need for ongoing patient surveillance.
  • Close follow-up is essential for long-term disease management and control in pediatric achalasia patients.