Esophageal Motility Disorders Flashcards
What is the Chicago Classification?
differentiation of esophageal motility disorders based on high-resolution manometry findings
no current clinical application
What is high resolution manometry?
primary difference between HRM and conventional manometry is that in HRM, the pressure sensors are no more than 1 cm apart rather than every 3 to 5 cm
Manometry findings for Diffuse Esophageal Spasm
strong disorganized non-peristaltic contractions (occur >10% wet swallows)
normal LES
intermittent normal peristalsis
Treatment: Diffuse Esophageal Spasm
calcium channel blocker, trazodone
EGD/Dilation (50 or 60Fr)/Botulinum
Heller myotomy if those fail (myotomy of upper and lower esophagus; right thoracotomy) Dor fundoplication
What side thoracotomy is best for exposure of upper 2/3 of esophagus?
right thoracotomy
avoid aortic arch
What side thoracotomy is best for exposure of lower 1/3 of esophagus?
left thoracotomy
you get exposure from aortic arch to the hiatus
Manometry findings for Hypertensive Lower Esophageal Sphincter (Esophagogastric Junction Outflow Obstruction)
normal peristalsis, hypertensive LES
Treatment: Hypertensive Lower esophageal sphincter
Botox - temporary
Dilation - some long term benefit
Surgery - for failure of other interventional methods - laparoscopic heller myotomy with dor vs toupet is ideal
Manometry findings for achalasia
no peristalsis and unrelaxed/hypertensive LES
- Hypertensive LES
- Failure of LES to relax
- Increased esophageal pressures
- no progressive peristalsis
- Low amplitude waveforms (reflects poor muscle tone)
Treatment: achalasia
nonsurgical: medications/endoscopic intervention = short term solution
surgical:
- heller myotomy = durable effective results; need dor or toupet as well
- esophagectomy considered if:
megaesophagus is present
sigmoid esophagus is present
failure of 1+ myotomy
strictures from reflux not amenable to dilation
What is ineffective esohageal motility
Contraction abnor
