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Related Concept Videos

Direct-Acting Cholinergic Agonists: Pharmacological Actions00:59

Direct-Acting Cholinergic Agonists: Pharmacological Actions

Direct-acting cholinergic agonists exert their pharmacological actions by mimicking the effects of acetylcholine on postsynaptic muscarinic receptors to generate parasympathetic responses. These agents elicit a range of physiological responses, including cardiovascular effects. For example, activation of muscarinic receptors induces bradycardia, decreased cardiac output, reduced peripheral resistance, and consequent hypotension. In the eye, stimulation of M3 receptors leads to smooth muscle...
Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

Direct-Acting Cholinergic Agonists: Therapeutic Uses

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 syndrome.
Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

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...
Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
Esophageal Achalasia01:27

Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
Pyloric Obstruction01:11

Pyloric Obstruction

Pyloric obstruction, also referred to as gastric outlet obstruction, is a condition characterized by narrowing or blockage at the pylorus—the muscular valve regulating the flow of stomach contents into the duodenum. When this passage becomes impaired, the stomach cannot effectively empty its contents into the small intestine. This disruption leads to a range of gastrointestinal symptoms, including early satiety, bloating, epigastric pain, postprandial nausea, persistent vomiting, and...

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Related Experiment Video

Updated: Jun 19, 2026

Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
06:42

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Published on: March 3, 2023

Pneumatic dilatation in achalasia.

I W Fellows, A L Ogilvie, M Atkinson

    Gut
    |November 1, 1983
    PubMed
    Summary

    Pneumatic dilatation offers a safe and effective treatment for achalasia, significantly improving swallowing. This minimally invasive procedure is particularly beneficial for older patients, making it a recommended initial therapy.

    Area of Science:

    • Gastroenterology
    • Surgical Innovation
    • Esophageal Motility Disorders

    Background:

    • Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis.
    • Current treatment options for achalasia include pneumatic dilatation, balloon dilatation, and surgical cardiomyotomy.
    • The efficacy and safety of pneumatic dilatation require ongoing assessment.

    Purpose of the Study:

    • To evaluate the clinical value and long-term outcomes of pneumatic dilatation of the cardia in patients diagnosed with achalasia.
    • To determine the safety profile, including complication rates and mortality, associated with pneumatic dilatation.
    • To identify patient factors, such as age, that may influence the need for repeat dilatations or alternative treatments.

    Main Methods:

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    • A retrospective analysis of 107 pneumatic dilatations performed on 63 achalasia patients over six years.
    • Assessment of immediate post-dilatation swallowing improvement and monitoring for serious complications.
    • Long-term follow-up (9-73 months) of the initial 50 patients to record subsequent dilatations and need for cardiomyotomy.

    Main Results:

    • Immediate improvement in swallowing was observed in all but two patients (96.8%).
    • Serious complications occurred in only 1.6% of patients, with no procedure-related deaths.
    • 58% of patients did not require further dilatation, while 38% needed 1-3 additional dilatations. Younger patients (<45 years) showed a significantly higher need for repeat dilatations (p<0.001).
    • Cardiomyotomy was necessary in 10% of patients, all of whom were under 45 years old at initial treatment.

    Conclusions:

    • Pneumatic dilatation is a safe and effective first-line treatment for achalasia, with a low complication rate.
    • The procedure demonstrates sustained benefits, particularly in older patients (≥45 years).
    • Surgical cardiomyotomy should be reserved for patients who do not respond adequately to multiple pneumatic dilatations.