Desordenes motores del esofago

Question 1

Pueden ser:

Answer 1

Systemic sclerosis and CREST syndrome

Achalasia

Question 2

Epidemiologia:

Answer 2

(1) Bimodal age distribution
(a) Occurs in those 20 to 40 years old
(b) Occurs after 60 years of age
(2) Men and women affected equally
(3) Most common neuromuscular disorder of esophagus
(4) Risk for esophageal cancer

Question 3

Patogenia:

Answer 3

(1) Normal relaxation of the smooth muscle in the LES is due to nitric oxide (NO) and
vasoactive intestinal peptide (VIP).
(2) In achalasia, there is incomplete relaxation of the LES.
(a) Loss of myenteric nerve fibers and inhibitory neurons in the myenteric plexus
producing nitric oxide synthase
• Probably autoimmune destruction
(b) Decrease in both NO and VIP
(3) Dilation of esophagus occurs proximal to LES, but peristalsis is absent.
(4) Acquired cause is Chagas disease.
• Destruction of ganglion cells by amastigotes (lack flagella)

Question 4

Hallazgos Clínicos:

Answer 4

(1) Nocturnal regurgitation of undigested food
(2) Dysphagia for solids and liquids
(3) Chest pain and heartburn
(4) Frequent hiccups
(5) Nocturnal cough from aspiration
(6) Difficulty belching

Question 5

Diagnostico:

Answer 5

(1) Abnormal findings with barium swallow
• Dilated, aperistaltic esophagus with a beak-like tapering at distal end
(2) Abnormal findings with esophageal manometry
• Detects aperistalsis and failure of LES relaxation

Question 6

Tratamiento:

Answer 6

(1) Nonpharmacologic
(a) Pneumatic dilation
(b) Esophagomyotomy
(2) Pharmacologic (short-term)
(a) Long-acting nitrates
(b) Calcium channel blockers
(c) Botulinum toxin injection