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Published byBruno Wilkinson Modified over 9 years ago
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ESOPHAGEAL MOTILITY DISORDERS DR V JONKER DEPT CARDIOTHORACIC SURGERY
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TYPES Achalasia Diffuse esophageal spasm Hypercontracting esophagus Hypocontracting esophagus Hypertensive LES Secondary motility disorders (related to systemic disease)
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ACHALASIA Etiology Incidence 0.5/100 000 Age 20-50 Patophysiology Auerbach plexus destruction Loss of postganglionic inhibitory neurons
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DIAGNOSIS Clinical CXray esophagus and pulmonary Contrast esophagogram
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Endoscopy
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Manometry Incomplete relaxation of LES Aperistalsis of the body
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Treatment Reduce pressure gradient Medical Botulinum toxin Pneumatic Dilatation Esophagomyotomy Laparoscopy with partial (Dor) wrap Thoracotomy vs laparotomy Esophagectomy
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DIFFUSE ESOPHAGEAL SPASM 5% of motility disorders 50 year female Pathology Pathophysiology
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Diagnosis Clinical Radiographic
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Manometry
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Treatment Exclude IHD Medical Dilatation Botulinum toxin Extended esophagomyotomy
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HYPERCONTRACTING ESOPHAGUS (NUTCRACKER ESOPHAGUS) High amplitude esophageal contractions Pathophysiology 50 year female Diagnosis Clinical Radiological – (N) Manometry –peristaltic > 180mmHg
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Treatment Similar to DES
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OTHER HIPERTENSIVE LES Resting pressure > 45mmHg mid-resp HYPOCONTRACTING ESOPHAGUS Low amplitude peristalsis Scleroderma Treatment – control reflux
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SECONDARY MOTILITY DISORDERS Another systemic disease Treat underlying cause and GERD Chaga’s disease Pseudoachalasia- GEJ ca
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