ESOPHAGEAL MOTILITY DISORDERS

DR V JONKER

DEPT CARDIOTHORACIC SURGERY

TYPES

Achalasia Diffuse esophageal spasm Hypercontracting esophagus Hypocontracting esophagus Hypertensive LES Secondary motility disorders

(related to systemic disease)

ACHALASIA

Etiology Incidence 0.5/100 000 Age 20-50 Patophysiology

Auerbach plexus destruction Loss of postganglionic inhibitory neurons

DIAGNOSIS Clinical CXray esophagus and pulmonary Contrast esophagogram

Endoscopy

Manometry Incomplete relaxation of LES Aperistalsis of the body

Treatment Reduce pressure gradient

Medical Botulinum toxin Pneumatic Dilatation Esophagomyotomy

Laparoscopy with partial (Dor) wrap Thoracotomy vs laparotomy

Esophagectomy

DIFFUSE ESOPHAGEAL SPASM 5% of motility disorders 50 year female Pathology Pathophysiology

Diagnosis Clinical Radiographic

Manometry

Treatment Exclude IHD Medical Dilatation Botulinum toxin Extended esophagomyotomy

HYPERCONTRACTING ESOPHAGUS(NUTCRACKER ESOPHAGUS) High amplitude esophageal contractions Pathophysiology 50 year female Diagnosis

Clinical Radiological – (N) Manometry –peristaltic > 180mmHg

Treatment Similar to DES

OTHER

HIPERTENSIVE LES Resting pressure > 45mmHg mid-resp

HYPOCONTRACTING ESOPHAGUS Low amplitude peristalsis Scleroderma Treatment – control reflux

SECONDARY MOTILITY DISORDERS Another systemic disease Treat underlying cause and GERD Chaga’s disease Pseudoachalasia- GEJ ca