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