Oesophageal Motility Disorders

Question 1

Ix for Achalasia (inc. findings)

Answer 1

• Video barium swallow (bird’s beak or rats tail)
• Oesophageal manometry (hypertonic lower oesophageal high pressure zone with failure of relaxation)
• Oesophagoscopy (to exclude benign and malignant strictures)

Question 2

Ix for Diffuse oesophageal spasm (inc. findings)

Answer 2

• Video barium swallow (corkscrew apperance)
• Oesophageal manometry (Diffuse hypertonicity and failure of relaxation)
• Oesophagoscopy (exclude malignancy)

Question 3

Management of Achalasia

Answer 3

1. Endoscopically guided controlled balloon dilatation
2. Botolinum toxin injections
3. Surgical myotomy (Hellers cardiomyotomy)

Question 4

Management of Diffuse oesophageal spasm

Answer 4

1. Oral calcium channel blockers or relaxants e.g benzos
2. Long acting nitric oxide donors
3. Long surgical open myotomy (rare)