Oesophageal motility disorders Flashcards
What is achalasia?
oesophageal aperistalsis and failure of the LOS impair oesophageal emptying
pathology achalasia
decrease in ganglionic cells in nerve plexus of the oesophageal wall and degeneration in the vagus nerve
clinical features of achalasia
long Hx of dysphagia for both liquids and solids, may be associated with regurgitation
retrosternal chest pain
investigations for achalasia
barium swallow: dilated oesophagus with gradually tapering lower end. absence of peristalsis
oesophageal manometry: aperistalsis + failure of LOS on swallowing
OGD: to exclude cancer
CXR: dilated oesophagus? fluid level behind heart?
management for achalasia
no cure
endoscopic balloon dilatation
surgical division of the LOS
medical to relax LOS e.g. oral nitrates
how does systemic sclerosis/sclerodema –> gastro-oesophageal reflux?
systemic sclerosis was formerly CREST syndrome
smooth muscle layer is replaced by fibrous tissue and LOS pressure is reduced
symptoms of scleroderma?
result of reflux (leading to oesophagitis and strictures)
oesophageal hypomobility
treatment for scleroderma?
same as for reflux and stricture formation
