Dysphagia due to scleroderma Flashcards
What is achalasia?
Oesophageal motor disorder with loss of oesophageal peristalsis and failure of lower oesophageal sphincter to relax in response to swallowing.
Smooth muscle of the distal oesophageal wall and lower oesophageal sphincter supplied by vagal pre-ganglionic fibres arising in dorsal motor nucleus.
They synapse in Auerbach nerve plexus, with excitatory neurons and inhibitory neurons containing NO and vasoactive intestinal peptide.
Loss of ganglionic cells in Auerbach plexus occurs with inflammatory response with lymphocytes and mast cells.
Cholinergic neurons remain intact, resulting in high basal lower oesophageal sphincter pressure.
What is diffused oesophageal spasm?
Uncoordinated contractions of the oesophagus, causing difficulty swallowing or regurgitation “corkscrew” appearance or “functional diverticula”.
Simultaneous and prolonged repetitive contractions of lower oesophagus.
Normal peristalsis in the upper part of the oesophagus. Lower 2/3 of oesophagus shows increased tone with pseudo-diverticulum formation.
What is scleroderma?
Smooth musculature of lower oesophagus replaced by fibrous tissue and oesophageal mucosa is inflamed (middle and lower 1/3 of oesophagus).
Ulceration can be present and leukoplakia develops. Striated muscle of upper 1/3 of oesophagus looks normal.
What is Schatzki’s ring?
A narrowing, “ring” at the lower oesophagus causing dysphagia. Aetiology is unclear is thought to be caused most commonly by GORD.
