ESOPHAGEAL MOTILITY DISORDERS
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Transcript of ESOPHAGEAL MOTILITY DISORDERS
ESOPHAGEAL MOTILITY DISORDERS
DR V JONKER
DEPT CARDIOTHORACIC SURGERY
TYPES
Achalasia Diffuse esophageal spasm Hypercontracting esophagus Hypocontracting esophagus Hypertensive LES Secondary motility disorders
(related to systemic disease)
ACHALASIA
Etiology Incidence 0.5/100 000 Age 20-50 Patophysiology
Auerbach plexus destruction Loss of postganglionic inhibitory neurons
DIAGNOSIS Clinical CXray esophagus and pulmonary Contrast esophagogram
Endoscopy
Manometry Incomplete relaxation of LES Aperistalsis of the body
Treatment Reduce pressure gradient
Medical Botulinum toxin Pneumatic Dilatation Esophagomyotomy
Laparoscopy with partial (Dor) wrap Thoracotomy vs laparotomy
Esophagectomy
DIFFUSE ESOPHAGEAL SPASM 5% of motility disorders 50 year female Pathology Pathophysiology
Diagnosis Clinical Radiographic
Manometry
Treatment Exclude IHD Medical Dilatation Botulinum toxin Extended esophagomyotomy
HYPERCONTRACTING ESOPHAGUS(NUTCRACKER ESOPHAGUS) High amplitude esophageal contractions Pathophysiology 50 year female Diagnosis
Clinical Radiological – (N) Manometry –peristaltic > 180mmHg
Treatment Similar to DES
OTHER
HIPERTENSIVE LES Resting pressure > 45mmHg mid-resp
HYPOCONTRACTING ESOPHAGUS Low amplitude peristalsis Scleroderma Treatment – control reflux
SECONDARY MOTILITY DISORDERS Another systemic disease Treat underlying cause and GERD Chaga’s disease Pseudoachalasia- GEJ ca