Oesophageal motility disorders

Question 1

What are oesophageal motility disorders?

Answer 1

A group of conditions characterised by abnormalities in oesophageal peristalsis

Question 2

What is the upper third of oesophagus made of?

Answer 2

skeletal muscle

Question 3

What is the middle third of the oesophagus made of?

Answer 3

transition zone of skeletal and smooth muscle

Question 4

What is the lower third of the oesophagus made of?

Answer 4

smooth muscle

Question 5

What is the upper oesophageal sphincter made out of and what does it do?

Answer 5

Skeletal muscle, prevents air from entering the GI tract

Question 6

What is the lower oesophageal sphincter made out of and what does it do?

Answer 6

smooth muscle and prevents reflux from the stomach

Question 7

What neurones are peristaltic waves controlled by?

Answer 7

Oesophageal myenteric neurones

Question 8

What are the two waves of peristalsis controlled by?

Answer 8

Primary wave- swallowing centre and secondary wave- response to distention

Question 9

What is Achalasia?

Answer 9

primary motility disorder of the oesophagus which is characterised by a failure of relaxation of the lower oesophageal sphincter and progressive failure of contraction of oesophageal smooth muscle

Question 10

What are the histological features of achalasia?

Answer 10

progressive destruction of the ganglion cells in the myenteric plexus

Question 11

What is the problem that occurs with Achalasia?

Answer 11

high resting tone and failure of relaxation of the LOS means that a food bolus can get stuck and fail to pass to the stomach which will also cause more dysfunction of the proximal oesophagus due to continually squeezing against a fixed outflow

Question 12

What are the clinical features of achalasia?

Answer 12

progressive dysphagia with solids and liquids, then vomiting and chest discomfort regurgitation of food, coughing due to overspill and aspiration at night usually, chest pain, weight loss

Question 13

What are the differential diagnosis of achalasia?

Answer 13

Oesophageal motility disorders, GORD, Malignancy and angina pectoris

Question 14

What investigations need to be done for achalasia?

Answer 14

Urgent endoscopy to check for cancer, but in achalasia may have a tight oesophageal observed, GOLD standard is oesophageal manometry

Question 15

What is oesophageal manometry?

Answer 15

pressure sensitive probe is inserted into the oesophagus and measures the pressure of the sphincter and the surrounding muscle

Question 16

What are the key features of achalasia on manometry?

Answer 16

Absence of oesophageal peristalsis, failure of relaxation of the LOS, high resting lower oesophageal sphincter tone

Question 17

What is the conservative management for achalasia?

Answer 17

Sleep with many pillows, eat slowly and lots of fluids, calcium channel blockers, botox injections

Question 18

What is the surgical management for achalasia?

Answer 18

Endoscopic balloon dilation, laparoscopic Heller myotomy

Question 19

If patients have long standing achalasia what are they 8-16x more likely at risk of?

Answer 19

Oesophageal cancer

Question 20

What is diffuse oesophageal spasm?

Answer 20

Multi-focal high amplitude contractions of the oesophagus

Question 21

What causes diffuse oesophageal spasm?

Answer 21

dysfunction of oesophageal inhibitory nerves

Question 22

What can diffuse oesophageal spasm progress to?

Answer 22

achalasia

Question 23

What are the clinical features of diffuse oesophageal spasm?

Answer 23

Severe dysphagia to solids and liquids, central chest pain responds to nitrates so difficult to distinguish from angina pectoris

Question 24

What are the investigations of diffuse oesophageal spasm?

Answer 24

manometry shows repetitive, simultaneous, and ineffective contractions of the oesophagus

Question 25

What is the management of diffuse oesophageal spasm?

Answer 25

Nitrates and CCBas these limit contractions and provide symptom improvements, pneumatic dilatation and myotomy

Question 26

What autoimmune and connective tissue disorders are associated with oesophageal dysmotility?

Answer 26

Systemic sclerosis, polymyositis, dermatomyositis