Esophageal

Motility

DisordersRichard HuangSGU MS4

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IntroductionAchalasiaDESSclerodermaGERD

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Normal function of the esophagusTransport food from mouth to stomach: peristalsis and gravityPrevent retrograde flow of stomach contents: constriction of LESDiagnosticsClinical: signs and symptomsRadiologic: fluoroscopy, esophagramEvaluate both structural and motor abnormalitiesEndoscopic: direct visualizationManometry: motility patterns

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Features:Loss of peristalsisLES does not relax in response to swallowingPathophysiologyLoss of intramural neurons that regulate smooth muscle activityDegeneration of nerve cell bodiesSigns and SymptomsDysphagia, chest pain, and regurgitationDysphagia with both liquids and solidsSymptoms of reflux point away from achalasiaDiagnosisClinical: (see signs and symptoms)Radiologic: (see next)Manometry: (see next)

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Radiologic:Barium swallow shows esophageal dilatationTerminal esophagus shows persistent bird beak narrowing representing a constricted LES

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Radiologic:Normal peristalsis is lost in the lower esophagus

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Manometry:Elevated basal LES pressureSwallow induced relaxation of LES is reducedEsophageal body shows reduced contraction amplitude

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Features:Nonperistaltic contractionsLES relaxes normally in response to swallowingPathophysiologyDysfunction of inhibitory nerves that regulate peristaltic smooth muscle activityDegeneration of nerve processesSigns and SymptomsChest pain triggered by swallowingDysphagia with both liquids and solidsCould mimic MI painDiagnosisClinical: (see signs and symptoms)Radiologic: (see next)Manometry: (see next)

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Radiologic:corkscrew appearance is classic

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Radiologic:Barium swallow shows uncoordinated contractions

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Manometry:Esophageal body shows uncoordinated contractionsContraction amplitude is increased

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Features:Weakness of lower esophagus contractionsIncompetence of LESPathophysiologyAutoimmune damage to esophageal smooth muscleFibrosis replaces damaged smooth muscle, which may form strictureSigns and SymptomsDysphagia to solids, and rarely liquidsGERD is a common complicationDiagnosisClinical: (see signs and symptoms)Radiologic: (see next)Manometry: (see next)

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Radiologic:Barium swallow shows esophageal dilatationEsophageal wall is thin and atrophicFibrotic stricture may be seen, and can also involve LES

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Manometry:Reduced basal LES pressureSwallow induced relaxation of LES is reducedEsophageal body shows reduced contraction amplitude

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Features:Most prevalent GI disorderBackflow of gastric acid into esophagusPathophysiologyIncompetent barrier at the GE junctionOccurs when the pressure gradient between LES (high) and the stomach (low) is reversedSigns and SymptomsRegurgitation, chest pain, dysphagia, coughBarretts esophagus is a common complication; risk factor for adenocarcinomaDiagnosisClinical: (see signs and symptoms)Radiologic: (see next)Manometry: (see next)

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Radiologic:Barium swallow shows reflux of contrast agent

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ThankYou

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