Oesophageal motility disorders Flashcards
What is achalasia?
Lower oesophageal sphincter fails to relax due to degeneration of the myenteric plexus
What are the two main divisions of the enteric nervous system?
Myenteric (Auerbach’s plexus)- controls muscles
Submucosal (Meissner’s plexus)- controls secretions
Clinical presentation of achalasia?
Dysphagia
Regurgitation
Sub-sternal cramps
Weight loss
What diagnostic tests are performed in achalasia?
3 tests are standard oesophagus investigations
Barium swallow
Oesophageal manometry
Oesophagogastroduodenoscopy
CXR
What will a barium swallow show in achalasia?
BEAK deformity – dilated oesophagus with gradually tapering lower end
What is oesophageal manometry?
pressure sensitive tube – measures contraction/relaxation of lower oesophageal sphincter
What test is used to exclude cancer?
Oesophagogastroduodenoscopy
What will CXR show?
Dilated oesophagus
Treatment for achalasia?
Endoscopic balloon dilation or surgical division of the LOS
PPI
Botox endoscopic injection into LOS, relaxes muscle
Calcium channel blockers and nitrates also relax the sphincter.
How does Botulinum toxin relax muscles?
Inhibits release of ACh
What are complications of achalasia?
increases the risk of squamous cell carcinoma.
What is systemic sclerosis?
A multisystem autoimmune disease where there is increased fibroblast activity
This results in abnormal growth of connective tissue causing vascular damage and fibrosis
There is oesophageal involvement in most patients with systemic sclerosis. What occurs?
Smooth muscle in oesophagus is replaced by fibrous tissue
LOS pressure is reduced allowing GORD
Symptoms are the result of reflux (oesophagitis and strictures) and oesophageal hypomotility
Treatment same as reflux
What is odynophagia?
Pain on swallowing
