Oesophageal Motility Disorders Flashcards
What are OMDs?
A group of conditions characterised by abnormalities in oesophageal peristalsis.
Epidemiology
Less common than mechanical and inflammatory diseases of oesophagus
Typically manifest with dysphagia of solids and liquids together.
What are the two major causes of oesophageal dysmotility?
Achalasia
Diffuse oesophageal spasm
Explain the oesophageal anatomy
25cm divided into thirds:
Upper third = skeletal muscle
Middle third = transition zone of both skeletal and smooth muscle
Lower third = composed of just smooth muscle
What is the upper oesophageal sphincter comprised of?
Skeletal msucle to prevent air from entering the GI tract
What is the LOS comprised of?
Smooth muscle to prevent reflux from the stomach
Explain the peristaltic waves
Controlled by oesophageal myenteric neurones.
They propel ingested food downwards.
Primary wave = is under control of the swallowing centre
Secondary wave = activated in response to distention
Dx of OMD
GORD
Oesophageal malignancy
Angina pectories
What is achalasia?
A primary motility disorder of the oesophagus.
Failure of relaxation of the LOS and progressive failure of contraction of the oesophageal smooth muscle
Epidemiology of achalasia
Quite rare
1 per 100000
Mean age of diagnosis at 50 yo
Histological feature of achalasia
Progressive destruction of ganglion cells in the myenteric plexus
Explain pathophysiology
High resting tone and failure of relaxation of LOS -> food gets stuck and can’t reach the stomach.
It also causes further dysfunction of the more proximal oesophagus.
Clinical features of achalasia
Progressive dysphagia when ingesting both solids and liquids
Vomiting and chest discomfort
Regurgitation of food
Coughing (especially at night)
Chest pain
Weight loss
Examination findings
Usually null
Might see visible weight loss in longstanding or severe cases
Ix
Oesophageal cancer always need to be excluded -> Urgent endoscopy
Gold standard for diagnosis = Oesophageal manometry