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Esophageal Motility Disorders PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Esophageal Motility Disorders”.

This medical PowerPoint presentation talks about esophageal motility disorders, a group of conditions that affect the normal movement of food and liquid through the esophagus, which is the muscular tube that connects the throat to the stomach. These disorders can cause symptoms such as difficulty swallowing, chest pain, and regurgitation.

There are several types of esophageal motility disorders, including Achalasia, Diffuse esophageal spasm, Hypertensive lower esophageal sphincter, Nutcracker esophagus, and Esophageal dysmotility.

Tags : Esophageal Motility Disorders, esophagus, Achalasia, Diffuse esophageal spasm, Hypertensive lower esophageal sphincter, Nutcracker esophagus, Esophageal dysmotility

Published on : May 02, 2023 | Views : 1928 | Downloads : 8

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Slide 1-

Esophageal Motility Disorders
Slide 2-

Esophageal Disorders Motility Anatomic & Structural Reflux Infectious Neoplastic Miscellaneous
Slide 3-

Esophageal Anatomy Upper EsophagealSphincter (UES) Lower EsophagealSphincter (LES) Esophageal Body(cervical & thoracic) 18 to 24 cm
Slide 4-

Normal Phases of Swallowing Voluntary oropharyngeal phase – bolus is voluntarily moved into the pharynx Involuntary UES relaxation peristalsis (aboral movement) LES relaxation Between swallows UES prevents air entering the esophagus during inspiration and prevents esophagopharyngeal reflux LES prevents gastroesophageal reflux peristaltic and non-peristaltic contractions in response to stimuli capacity for retrograde movement (belch, vomiting) and decompression
Slide 5-

Normal Swallowing Cortical Swallowing Areas Swallowing Center Motor Nuclei Oropharynx & Esophagus Frontal cortex Brainstem
Slide 6-

Motility Disorders upper esophageal UES disorders neuromuscular disorders esophageal body achalasia diffuse esophageal spasm nutcracker esophagus nonspecific esophageal dysmotility LES achalasia hypertensive LES primary disorders achalasia diffuse esophageal spasm nutcracker esophagus nonspecific esophageal dysmotility secondary disorders severe esophagitis scleroderma diabetes Parkinson’s stroke
Slide 7-

Motility Disorders diagnostic tools cineradiology or videofluoroscopy (MBS) barium esophagram esophageal manometry endoscopy
Slide 8-

Normal Manometry
Slide 9-

Upper Esophageal Motility Disorders cause oropharyngeal dysphagia (transfer dysphagia) patients complain of difficulty swallowing tracheal aspiration may cause symptoms pharyngoesophageal neuromuscular disorders stroke Parkinson’s poliomyelitis ALS multiple sclerosis diabetes myasthenia gravis dermatomyositis and polymyositis upper esophageal sphincter (cricopharyngeal) dysfunction
Slide 10-

UES Disorders cricopharyngeal hypertension elevated UES resting tone poorly understood (reflex due to acid reflux or distension) cricopharyngeal achalasia incomplete UES relaxation during swallow may be related to Zenker’s diverticula in some patients clinical manifestations localizes as upper (cervical) dysphagia within seconds of swallowing coughing, choking, immediate regurgitation, ornasal regurgitation diagnosis: swallow evaluation & modified barium swallow
Slide 11-

Motility Disorders of the Body & LES symptoms: usually dysphagia (intermittent and occurring with liquids & solids) diagnostic tests barium esophagram endoscopy esophageal manometry disorders achalasia diffuse esophageal spasm (DES) nutcracker esophagus hypertensive LES nonspecific esophageal dysmotility hypomotility hypermotlity
Slide 12-

Achalasia first clinically recognized esophageal motility disorder described in 1672, treated with whale bone bougie term coined in 1929 dual disorder LES fails to appropriately relax resistance to flow into stomach not spasm of LES but an increased basal LES pressure often seen (55-90%) loss of peristalsis in distal 2/3 esophagus
Slide 13-

Achalasia epidemiology 1-2 per 200,000 population usually presents between ages 25 to 60 male=female Caucasians > others average symptom duration at diagnosis: 2-5 years pathology loss of ganglionic cells in the myenteric plexus (distal to proximal) vagal fiber degeneration underlying cause: unknown autoimmune? (antibodies to myenteric neurons in 50% of patients)
Slide 14-

Achalasia clinical presentation solid dysphagia 90-100% (75% also with dysphagia to liquids) post-prandial regurgitation 60-90% chest pain 33-50% pyrosis 25-45% weight loss nocturnal cough and recurrent aspiration diagnosis plain film (air-fluid level, wide mediastinum, absent gastric bubble, pulmonary infiltrates) barium esophagram (dilated esophagus with taper at LES) good screening test (95% accurate) endoscopy (rule out GE junction tumors, esp. age>60) esophageal manometry (absent peristalsis,  LES relaxation, & resting LES >45 mmHg)
Slide 15-

Achalasia treatment - reduce LES pressure and increase emptying nitrates and calcium channel blockers 50-70% initial response; <50% at 1 year limitations: tachyphylaxis and side-effects botulinum toxin (prevents ACH release at NM junction) 90% initial response; 60% at 1 year pneumatic dilation (disrupt circular muscle) 60-95% initial success; 60% at 5 years recent series suggest 20-40% will require re-dilation risk of perforation 1-13% (usually 3-5%); death 0.2-0.4% surgical myotomy (open or minimally-invasive) >90% initial response; 85% at 10 years; 70% at 20 years (85% at 5 years with min. inv. techniques) <1% mortality; <10% major morbidity 10-25% acutely develop reflux, up to 52% develop late reflux
Slide 16-

Spastic Motility Disorders of the Esophagus “lumper” approach normal achalasia spastic motility disorder “splitter” approach (radiology and manometry) diffuse esophageal spasm nutcracker esophagus hypertensive LES nonspecific esophageal dysmotility “splitting” has not resulted in a clinical benefit
Slide 17-

Diffuse Esophageal Spasm frequent non-peristaltic contractions simultaneous onset (or too rapid propagation) of contractions in two or more recording leads occur with >30% of wet swallows (up to 10% may be seen in “normals”)
Slide 18-

Nutcracker Esophagus high pressure peristaltic contractions avg pressure in 10 wet swallows is >180 mm Hg 33% have long duration contractions (>6 sec) may inter-convert with DES
Slide 19-

Hypertensive LES Nonspecific Esophageal Dysmotility high LES pressure >45 mm Hg normal peristalsis often overlaps with other motility disorders abnormal motility pattern fits in no other category non-peristalsis in 20-30% of wet swallows low pressure waves (<30 mm Hg) prolonged contractions
Slide 20-

Spastic Motility Disorders of the Esophagus epidemiology any age (mean age 40) female > male symptoms dysphagia to solids and liquids intermittent and non-progressive present in 30-60%, more prevalent in DES (in most studies) chest pain constant % across the different disorders (80-90%) swallowing is not necessarily impaired can mimic cardiac chest pain pyrosis (20%) and IBS symptoms (>50%) symptoms and manometry correlate poorly
Slide 21-

Spastic Motility Disorders of the Esophagus diagnosis manometry barium esophagram endoscopy pH monitoring treatment reassurance nitrates, anticholinergics, hydralazine - all unproven calcium channel blockers - too few data with negative controlled studies in chest pain psychotropic drugs – trazodone, imipramine and setraline effective in controlled studies dilation - anecdotal reports, probable placebo effect
Slide 22-

Manometry in Esophageal Symptoms Non-Cardiac Chest Pain Dysphagia JE Richter, Ann Int Med, 1987
Slide 23-

Hypomotilty Disorders primary (idiopathic) aging produces gradual decrease in contraction strength reflux patients have varying degrees of hypomotility more common in patients with atypical reflux symptoms usually persists after reflux therapy defined as low contraction wave pressures (<30 mm Hg) incomplete peristalsis in 30% or > of wet swallows
Slide 24-

Hypomotilty Disorders secondary scleroderma in >75% of patients progressive, resulting in aperistalsis in smooth-muscle region incompetent LES with reflux other “connective tissue diseases” CREST polymyositis & dermatomyositis diabetes 60% with neuropathy have abnormal motility on testing (most asx) other hypothyroidism, alcoholism, amyloidosis
Slide 25-

Nonischemic Chest Pain remains poorly understood (functional chest pain) enthusiastic investigation finds numerous associations in studies psychiatric disorders (depression, panic or anxiety disorder…) esophageal disorders (GERD, motility disorders…) musculoskeletal disorders cardiac disease (microvascular, MVP, tachyarrhythmias…) GERD is by far the most common, diagnosable, esophageal cause 50-60% of patients have heartburn or acid regurgitation symptoms 50% have abnormal esophageal pH studies (not always correlating to sxs) very low incidence of endoscopic findings “PPI Test” may be best and most cost-effective approach a small subset of patients with non-GERD NCCP display a variety of esophageal motility disorders symptoms and motility findings correlate poorly esophageal hypersensitivity/hyperalgesia may explain the symptoms