Presentation is loading. Please wait.

Presentation is loading. Please wait.

BY : Niloofar Azizi Esophageal Motility Disorders.

Similar presentations


Presentation on theme: "BY : Niloofar Azizi Esophageal Motility Disorders."— Presentation transcript:

1 BY : Niloofar Azizi Esophageal Motility Disorders

2 The esophagus is a muscular tube that commences at the base of the pharynx at C6 and terminates in the abdomen, where it joins the cardia of the stomach at T11. Esophageal Anatomy

3 cervical esophagus : begins as a midline structure that deviates slightly to the left of the trachea as it passes through the neck into the thoracic inlet. Thoracic Esophagus : At the level of the carina, it deviates to the right to accommodate the arch of the aorta. It then winds its way back under the left main-stem bronchus. Abdominal Esophagus : Immediately before entering the abdomen, the esophagus is pushed anteriorly by the descending thoracic aorta

4 Upper Esophageal Sphincter (UES) Esophageal Body (cervical & thoracic) Lower Esophageal Sphincter (LES) 18 to 24 cm

5 1.cricopharyngeus muscle (14 mm) 2.bronchoaortic constriction (15 – 17 mm) 3.diaphragmatic constriction (16 – 19 mm) Anatomic Narrowing

6 Voluntary oropharyngeal phase – bolus is voluntarily moved into the pharynx Involuntary UES relaxation peristalsis LES relaxation Between swallows UES prevents air entering the esophagus during inspiration and prevents esophagopharyngeal reflux LES prevents gastroesophageal reflux Normal Phases of Swallowing

7 upper esophageal – UES disorders – neuromuscular disorders esophageal body – achalasia – diffuse esophageal spasm – nutcracker esophagus – nonspecific esophageal dysmotility LES – achalasia – hypertensive LES primary disorders – achalasia – diffuse esophageal spasm – nutcracker esophagus – nonspecific esophageal dysmotility secondary disorders – severe esophagitis – scleroderma – diabetes – Parkinson’s – stroke Motility Disorders

8 cause oropharyngeal dysphagia (transfer dysphagia) – patients complain of difficulty swallowing – tracheal aspiration may cause symptoms pharyngoesophageal neuromuscular disorders – stroke – Parkinson’s – poliomyelitis – ALS – multiple sclerosis – diabetes – myasthenia gravis – dermatomyositis and polymyositis upper esophageal sphincter (cricopharyngeal) dysfunction Upper Esophageal Motility Disorders

9 cricopharyngeal hypertension – elevated UES resting tone – poorly understood (reflex due to acid reflux or distension) cricopharyngeal achalasia – incomplete UES relaxation during swallow – may be related to Zenker’s diverticula in some patients UES Disorders

10 localizes as upper (cervical) dysphagia within seconds of swallowing coughing choking immediate regurgitation or nasal regurgitation clinical manifestations

11 swallow evaluation & modified barium swallow diagnosis

12 symptoms : usually dysphagia (intermittent and occurring with liquids & solids) diagnostic tests – barium esophagram – endoscopy – esophageal manometry disorders – achalasia – diffuse esophageal spasm (DES) – nutcracker esophagus – hypertensive LES – nonspecific esophageal dysmotility hypomotility hypermotlity Motility Disorders of the Body & LES

13 Your own footer Achalasia failure to relax which is said of any sphincter that remains in a constant state of tone with periods of relaxation

14 epidemiology per 100,000 population is seen in young women and middle-aged men and women alike. pathology is presumed to be idiopathic or infectious neurogenic degeneration, Severe emotional stress, trauma, drastic weight reduction, and Chagas' disease (parasitic infection with Trypanosoma cruzi) 1.destruction of the nerves to the LES 2.degeneration of the neuromuscular function of the body

15  dysphagia  regurgitation  weight loss  heartburn  postprandial choking  nocturnal coughing clinical presentation

16  esophagram  motility study 1.hypertensive LES (> 35 mm Hg) 2.fail to relax 3.a pressure above baseline 4.simultaneous mirrored contractions with no evidence of progressive peristalsis 5.low-amplitude waveforms diagnosis

17 surgical 1.Esophagomyotomy (Heller myotomy) 2.Esophagectomy 3.resection nonsurgical 1.medications : sublingual nitroglycerin, nitrates, or calcium channel blockers, Injections of botulinum toxin 2.endoscopic : Dilation with a Gruntzig-type (volume-limited, pressure- control) balloon treatment

18 Diffuse Esophageal Spasm Hypermotility disorder of the esophagus esophageal contractions are repetitive, simultaneous, and of high amplitude Hypermotility disorder of the esophagus esophageal contractions are repetitive, simultaneous, and of high amplitude

19 1 1 female > male epidemiology Muscular hypertrophy and degeneration of the branches of the vagus nerve in the esophagus pathology 2

20 chest pain Dysphagia Regurgitation Symptoms and Diagnosis  Esophagram  manometric studies : simultaneous, multipeaked contractions of high amplitude (>120 mm Hg) or long duration (>2.5 sec) erratic contractions occur after more than 10% of wet swallows

21 Nonsurgical Pharmacologic endoscopic intervention Surgical : long esophagomyotomy Treatment

22 Nutcracker Esophagus - a hypermotility disorder also known as supersqueeze esophagus - hypertensive peristalsis or high- amplitude peristaltic contractions - a hypermotility disorder also known as supersqueeze esophagus - hypertensive peristalsis or high- amplitude peristaltic contractions

23  chest pain  dysphagia  Odynophagia Symptoms and Diagnosis subjective complaint of chest pain with simultaneous objective evidence of peristaltic esophageal contractions on manometric tracings

24 Medical: Calcium channel blockers, nitrates, and antispasmodics Bougie dilation avoid caffeine, cold, and hot foods treatment

25 Hypertensive LES LES pressure is above normal, and relaxation will be incomplete but may not be consistently abnormal. The motility of the esophageal body may be hyperperistaltic or normal

26  chest pain  dysphagia Symptoms and Diagnosis Manometry: elevated LES pressure (>26 mm Hg) and normal relaxation of the LES Esophagram: narrowing at the GEJ with delayed flow

27 Endoscopic: hydrostatic balloon dilation surgical intervention: 1.laparoscopic modified Heller esophagomyotomy 2. partial antireflux procedure (e.g., a Dor or Toupet fundoplication) Botox injections Your Logo treatment

28 Nonspecific Esophageal Dysmotility abnormal motility pattern fits in no other category Several collagen vascular disorders are known to cause abnormalities of esophageal motility scleroderma, dermatomyositis, polymyositis, and lupus erythematosus abnormal motility pattern fits in no other category Several collagen vascular disorders are known to cause abnormalities of esophageal motility scleroderma, dermatomyositis, polymyositis, and lupus erythematosus

29  chest pain  Dysphagia  tend to experience more reflux symptoms and regurgitation Symptoms and Diagnosis barium esophagram manometric studies: incomplete relaxation (residual >5 mm Hg) Contractions of the esophageal body patterns: non-transmitted, triple-peaked, retrograde, low- amplitude ( 6 sec).

30 Summery

31 THANK YOU!


Download ppt "BY : Niloofar Azizi Esophageal Motility Disorders."

Similar presentations


Ads by Google