MOTILITY DISEASES

• Motility Diseases

  • Achalasia
  • Diffuse Oesophageal Spasm
  • GERD
• Achalasia

  A motility disorder characterized by the loss of ganglion cells within the oesophageal myenteric plexus
• Risk factors for Achalasia

  • Reflux disease
  • Barrett’s metaplasia
  • Smoking
  • Alcohol consumption
  • Caustic injury
  • HPV infection
• Types of Achalasia

  • Type I (classic achalasia)
  • Type II (achalasia with pan-oesophageal pressurization)
  • Type III (spastic achalasia with premature or spastic contractions)
• Pathogenesis of Achalasia

  Absence of inhibitory (nitric oxide) ganglionic neurons, leading to impaired lower oesophageal sphincter (LES) relaxation and absent peristalsis
• Pathophysiological manifestations of Achalasia

  Progressive dilatation and sigmoid deformity, along with hypertrophy of the LES
• Clinical signs of Achalasia

  • Dysphagia
  • Regurgitation
  • Chest pain
  • Weight loss
  • Bronchitis
  • Pneumonia
  • Lung abscess
• Complications of Achalasia may include stasis esophagitis and oesophageal squamous cell cancer
• Diagnosis of Achalasia

  1. Barium swallow x-ray

  2. Oesophageal manometry
• Differential diagnoses for Achalasia

  • DES
  • Chagas’ disease
  • Pseudoachalasia
• Management of Achalasia

  1. Promoting oesophageal emptying through pneumatic balloon dilation

  2. Surgical myotomy

  3. Muscle relaxants like nitroglycerin and nifedipine
• Treatment options for Achalasia include pneumatic dilation and Heller myotomy
• Diffuse Oesophageal Spasm

  A motility disorder characterized by the impairment of inhibitory myenteric plexus neurons
• Clinical signs of Diffuse Oesophageal Spasm

  • Abnormal oesophageal contractions
  • Spontaneous and repetitive contractions
  • Normal lower oesophageal sphincter
• Diffuse Oesophageal Spasm may result in a "corkscrew oesophagus" appearance due to tertiary contractions
• Common symptoms of Diffuse Oesophageal Spasm

  • Dysphagia
  • Chest pain
  • Regurgitation
  • Heartburn
• Diagnosis of Diffuse Oesophageal Spasm

  1. Radiography

  2. Manometry

  3. Endoscopy
• Differential diagnoses for Diffuse Oesophageal Spasm

  • Angina pectoris
  • Peptic or infectious oesophagitis
• Treatment options for Diffuse Oesophageal Spasm may include long myotomy or oesophagectomy
• GERD

  Gastroesophageal reflux disease characterized by transient lower oesophageal sphincter (LES) relaxations, LES hypotension, hiatal hernia, and impaired oesophageal clearance mechanisms
• Risk factors for GERD

  • Obesity
  • Smoking
  • Alcohol consumption
  • Pregnancy
  • Certain medications like calcium channel blockers and nitrates
• Types of GERD

  • Erosive esophagitis
  • Non-erosive reflux disease (NERD)
  • Barrett's oesophagus
  • Reflux-induced respiratory or laryngeal symptoms (extraoesophageal reflux)
• Pathophysiological mechanisms of GERD

  Injurious effects of gastric contents on the oesophageal mucosa, leading to chronic inflammation, erosions, and ulcerations
• Clinical manifestations of GERD

  • Erosions
  • Ulcerations
  • Strictures
  • Symptoms like dysphagia, heartburn, regurgitation, chronic cough
• Complications of GERD can range from bleeding and stricture formation to Barrett's oesophagus and adenocarcinoma
• Diagnosis of GERD

  1. Endoscopy

  2. Biopsy

  3. Manometry

  4. Barium swallow
• Differential diagnoses for GERD

  • Peptic ulcer
  • Eosinophilic oesophagitis
  • Cardiac conditions like angina or myocardial infarction
• Management of GERD

  1. Lifestyle changes

  2. Medications such as proton pump inhibitors (PPIs) and H2 antagonists

  3. Surgical options like laparoscopic Nissen fundoplication