OESOPHAGEAL

MOTILITY

DISORDERS

Pain with or with out swallowing.usually

intermittent

Associated with GORD or a part of diffuse GI

motility disorders

Barium impregnated food bolus seen to stick to oesophagus

DISORDERS OF PHARYNGO-OESOPHAGEAL JN

Neurological-stroke ,motor neurone ds

,multiple sclerosis,parkinsons ds.

Myogenic-myasthenia gravis,mus dystrophy

Pharyngo-oesophageal(zenkers) diverticulum

DISORDERS OF BODY OF OESOPHAGUS

DIFFUSE OESOPHAGEAL

SPASM

NUT CRACKER OESOPHAGUS

AUTOIMMUNE DISORDERS-ESPECIALLY

SYSTEMIC SCLEROSIS(CREST-

calcinosis,raynaud’s synd,esoph motility

disorders,sclerodactyly,telangiectasia) REFLEX ASSOCIATED

IDIOPATHIC

ALLERGIC

EOSINOPHILIC OESOPHAGITIS

NON SPECIFIC OESOPHAGEAL DYSMOTILITY

ACHALASIA

INCOMPETENT LOWER OESOPHAGEAL

SPHINCTER(GORD)

LOSS OF GANGLION CELLS IN MYENTERIC

PLEXUS IN LOWER OESOPHAGUS

DILATATION , TORTUOSITY $ HYPERTROPHY

OF PROXIMAL OESOPHAGEAL SEGMENT

HISTOLOGY -REDUCTION IN NO: OF GANGLION

CELLS WITH VARIABLE DEGREE OF C/C INFLMTN

VIGOROUS ACHALASIA-NORMAL NO: OF

GANGLION CELLS WITH INFLMTN AND NEURAL

FIBROSIS

AETIOLOGY:IDIOPATHIC, ASSOC WITH CHAGAS

DS,STRESS $ EMOTIONAL FACTORS, VIT DEF

WOMEN AROUND 30-40 YRS COMMONLY

AFFECTED M:F=2:3

DYSPHAGIA MAINLY FOR LIQUIDS

RECCURENT RESP TRACT INFN

COMPLICATIONS-INCREASED INCIDENCE OF

CARCINOMA

Achalasia like usually produced by

adenocarcinoma of cardia and also by benign

tumors at this level

Inability of sphincter to relax is due to

absent body peristalsis

Also seen in carcinoma of bronchus $

pancreas

1. BARIUM SWALLOW-uniform dilated oesph above

with tapering segmet below(BIRDS BEAK)

2. Oesophagoscopy-tight cardia and food residue

in oesophagus

3. PLAIN X-RAY ABD ERECT-ABSENTGASTRIC GAS

BUBBLE

4. Lower oesophageal sphincter pressure may be

increased

5. Oesophageal manometry:show simultaneous contrn

of oesoph body $ incomplete relxn of los

Forceful dilatation of

cardia:stretching of cardia with

balloon to disrupt muscle and render it

less competent.balloons of 30-40 mm

diameter inserted over guideline.

Hellers myotomy:it involves cutting

muscle of lower oesophagus and

cardia.used after failed dilatation.90%

success

Botulinum toxin:interfere with cholinergic

excitatory neural activity at LOS.effect is

permanent so repeated for months.used in

elderly.

DRUGS:relieve symptoms.CALCIUM CHANNEL

BLOCKERS:Nifedipine S/L