1. ESOPHAGEAL MOTILITY DISORDERS DR V JONKER DEPT CARDIOTHORACIC SURGERY

2. TYPES Achalasia Diffuse esophageal spasm Hypercontracting esophagus Hypocontracting esophagus Hypertensive LES Secondary motility disorders (related to systemic disease)

3. ACHALASIA Etiology Incidence 0.5/100 000 Age 20-50 Patophysiology  Auerbach plexus destruction Loss of postganglionic inhibitory neurons

4. DIAGNOSIS  Clinical  CXray esophagus and pulmonary  Contrast esophagogram

5. Endoscopy

6. Manometry  Incomplete relaxation of LES  Aperistalsis of the body

7. Treatment  Reduce pressure gradient Medical Botulinum toxin Pneumatic Dilatation Esophagomyotomy  Laparoscopy with partial (Dor) wrap  Thoracotomy vs laparotomy  Esophagectomy

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

9. Diagnosis  Clinical  Radiographic

10.  Manometry

12. Treatment  Exclude IHD  Medical  Dilatation  Botulinum toxin  Extended esophagomyotomy

13. HYPERCONTRACTING ESOPHAGUS (NUTCRACKER ESOPHAGUS) High amplitude esophageal contractions Pathophysiology 50 year female Diagnosis  Clinical  Radiological – (N)  Manometry –peristaltic > 180mmHg

14. Treatment  Similar to DES

15. OTHER  HIPERTENSIVE LES  Resting pressure > 45mmHg mid-resp  HYPOCONTRACTING ESOPHAGUS  Low amplitude peristalsis  Scleroderma  Treatment – control reflux

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