ESOPHAGEAL MOTILITY DISORDERS

Question 1

Esophageal motility disorders include

Answer 1

Achalasia
Diffuse esophageal spasms
Scleroderma

Question 2

What is achalasia

Answer 2

Neurologic disorder involving failure of the lower esophageal sphincter to relax during swallowing due to destruction of the myenteric plexus

Question 3

Characteristics of achalasia

Answer 3

High LES pressure
Absent peristalsis
Failure of LES to relax
Bird’s beak appearance on barium Swallow

Question 4

Signs & symptoms of achalasia

Answer 4

Dysphagia to both liquid & solid (most common)
Regurgitation
Chest pain
Heartburn
Weight loss
Bad breath due to food accumulation

Question 5

Classifications of achalasia

Answer 5

GRADE 1 LES diameter<4cm
GRADE 2 LES 4-6cm
GRADE 3 LES>6cm

Question 6

Diagnosis

Answer 6

1) History/ chief complain
- Dysphagia, regurgitation
2) Barium Swallow
- Bird’s beak
3) Endoscopy
- Dilated esophagus with retained saliva & food
4) Manometry
- absent peristalsis, decreased LES relaxation

Question 7

Treatment of achalasia

Answer 7

Nitrates
Calcium channel blockers
Botulinum toxin injection
Pneumatic dilation
Surgical HELLER myotomy

Question 8

Causes of Achalasia

Answer 8

Idiopathic loss of ganglion cells in Auerbach’s plexus
Chronic Chagas disease

Question 9

What is chagas disease

Answer 9

Caused by TRYPANOSOMA CRUZI protozoa