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ESOPHAGEAL MOTILITY DISORDERS

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

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ESOPHAGEAL MOTILITY DISORDERS

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  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

  11. Treatment • Exclude IHD • Medical • Dilatation • Botulinum toxin • Extended esophagomyotomy

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

  13. Treatment • Similar to DES

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

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

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