Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Esophageal Motor Disorders Essential Tremor 559

■Pneumatic dilation under fluoroscopic control improves dysphagia,

regurgitation and chest pain in the majority of cases but carries the

risk for perforation

■Laparoscopic myotomy with or without concomitant partial fundo-

plication is increasingly used because of its high efficacy and low

morbidity

follow-up

During Treatment

■Efficacy of therapy needs to be objectively assessed because of the

intermittent nature of the symptoms

Routine

■Endoscopic surveillance for cancer in patients with achalasia is not

cost-effective and thus not recommended

complications and prognosis

■Patients with achalasia are at an increased risk for developing squa-

mous esophageal cancer

■Generally good prognosis for patients with esophageal motor disor-

ders and most patients manage with medical therapy alone

■In patients with achalasia, botulinum toxin injection provides symp-

tom relief but needs to be repeated

■Both pneumatic dilation and surgery, if successful initially, have

long-lasting results

Essential Tremor.....................................

CHAD CHRISTINE, MD

history & physical

■Tremor of 1 or both hands, head and/or voice

■Family history common

■Tremor may become more prominent over decades

■May improve w/ alcohol or rest

■Worse w/ stress

■Fine, high-frequency postural or kinetic tremor

■May be head tremor (nodding or no-no)

tests

■Diagnosis made clinically