Oesophageal Motility Disorders Flashcards
What are motility disorders
Group of conditions that are characterised by abnormalities in oesophageal peristalsis
What are the two major causes of oesophageal dysmotility
Oesophageal achalasia
Diffuse oesophageal spasm
What is the upper third of the oesophagus made up of
Skeletal muscle
What is the middle third of the oesophagus made up of
This is called the transition zone, made up of skeletal and smooth muscle cells
What is the lower third of the oesophagus made up of
Smooth muscle
What is the UOS composed of and what is its function
Skeletal muscle
Prevents air entry into the GI tract
What is the LOS composed of and what is its action
Smooth muscle
Prevents acid reflux from stomach into the oesophagus
What is achalasia
Primary motility disorder of the oesophagus characterised by failure of relaxation of the LOS and progressive failure of contraction of the oesophageal smooth muscle
What is the pathophysiology of achalasia
Poorly understood but thought to be due to progressive destruction of ganglion cells in the myenteric plexus leading to failure of relaxation of the LOS
What is the clinical features of someone with achalasia
- Progressive dysphagia with solids and liquids
- Chest discomfort
- Vomiting
- Food regurgitation
- Weight loss
What are the differential diagnosis of Achalasia
Same as those for dysphagia
How would you investigate achalasia
Achalasia presents with dysphagia therefore first a OGD must be performed to exclude cancer. Once excluded the gold standard is oesophageal manometry.
What is oesophageal manometry
A pressure sensitive probe is inserted into the oesophagus which measures the pressure of the sphincter
What are the three key features seen for achalasia on manometry
- absence of oesophageal peristalsis
- failure of the LOS to relax
- high resting LOS tone
What is the conservative treatment for Achalasia
- Sleeping with many pillows to minimise regurgitation
- Eating slowly
- Drinking plenty of fluids with meals
- CCBs/nitrates can give partial relief
- Botox injections
What are the surgical management options for achalasia
Endoscopic balloon dilation - insertion of balloon into the LOS which is inflated and dilates the LOS
Laparoscopic heller myotomy - division of muscle fibres in the LOS
There is a increase in which type of cancer for patients with long standing Achalasia
Oesophageal cancer
What is diffuse oesophageal spasm
A disease characterised bu multi-focal high amplitude contractions of the oesophagus thought to be due to the dysfunction of the inhibitory nerves of the oesophagus.
DOS can progress to achalasia
What are the clinical features of diffuse Oesophageal spasm
- > severe dysphagia to solids and liquids
- > central chest pain exacerbated by food
- > chest pain relived by nitrates making it hard to distinguish between angina
What would you see in a patient with DOS on barium swallow test
Cork screw appearance
What is the gold standard investigation for diffuse oesophageal spasm
Oesophageal manometry which shows repetitive, simultaneous, and ineffective contractions of the oesophagus.
What is the first line management of diffuse oesophageal spasm.
Nitrates
CCBS
What is the treatment for patients with DOS and hypertension of the LOS
Pneumatic dilation
