Oesophageal motility disorders Flashcards
What are oesophageal motility disorders?
A group of conditions characterised by abnormalities in oesophageal peristalsis
What is the upper third of oesophagus made of?
skeletal muscle
What is the middle third of the oesophagus made of?
transition zone of skeletal and smooth muscle
What is the lower third of the oesophagus made of?
smooth muscle
What is the upper oesophageal sphincter made out of and what does it do?
Skeletal muscle, prevents air from entering the GI tract
What is the lower oesophageal sphincter made out of and what does it do?
smooth muscle and prevents reflux from the stomach
What neurones are peristaltic waves controlled by?
Oesophageal myenteric neurones
What are the two waves of peristalsis controlled by?
Primary wave- swallowing centre and secondary wave- response to distention
What is Achalasia?
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
What are the histological features of achalasia?
progressive destruction of the ganglion cells in the myenteric plexus
What is the problem that occurs with Achalasia?
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
What are the clinical features of achalasia?
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
What are the differential diagnosis of achalasia?
Oesophageal motility disorders, GORD, Malignancy and angina pectoris
What investigations need to be done for achalasia?
Urgent endoscopy to check for cancer, but in achalasia may have a tight oesophageal observed, GOLD standard is oesophageal manometry
What is oesophageal manometry?
pressure sensitive probe is inserted into the oesophagus and measures the pressure of the sphincter and the surrounding muscle
What are the key features of achalasia on manometry?
Absence of oesophageal peristalsis, failure of relaxation of the LOS, high resting lower oesophageal sphincter tone
What is the conservative management for achalasia?
Sleep with many pillows, eat slowly and lots of fluids, calcium channel blockers, botox injections
What is the surgical management for achalasia?
Endoscopic balloon dilation, laparoscopic Heller myotomy
If patients have long standing achalasia what are they 8-16x more likely at risk of?
Oesophageal cancer
What is diffuse oesophageal spasm?
Multi-focal high amplitude contractions of the oesophagus
What causes diffuse oesophageal spasm?
dysfunction of oesophageal inhibitory nerves
What can diffuse oesophageal spasm progress to?
achalasia
What are the clinical features of diffuse oesophageal spasm?
Severe dysphagia to solids and liquids, central chest pain responds to nitrates so difficult to distinguish from angina pectoris
What are the investigations of diffuse oesophageal spasm?
manometry shows repetitive, simultaneous, and ineffective contractions of the oesophagus
What is the management of diffuse oesophageal spasm?
Nitrates and CCBas these limit contractions and provide symptom improvements, pneumatic dilatation and myotomy
What autoimmune and connective tissue disorders are associated with oesophageal dysmotility?
Systemic sclerosis, polymyositis, dermatomyositis
