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/ Age 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