Esophageal Motility Disorder, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Esophageal Motility Disorder, Diagnosis and Treatment and Related DiseasesRecently I have a patient who feels discomfort in the throat and has difficulty in swallowing his food. She feels as though the food is not going down to her stomach and she has to swallow air to help the food go down. Once in a while she feels the food has come back up into her mouth together with some acid.
An esophageal and gastric endoscopy did not reveal any obstruction in her esophagus but there was a small ulcer in the stomach lining. She has gastro-esophageal reflux from a gastric ulcer caused by nervous tension and irregular meals together with lower esophageal sphincter spasm. An esophageal motility disorder (EMD) is a medical disorder that causes difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods.
EMD can be divided into:A. Esophageal spasm sub-divided into:1. Diffuse esophageal spasm (DES) where is non-coordinated esophageal contractions2. Nutcracker esophagus (NE) where the contractions are coordinated but with an excess amplitudeB. Achalasia: When peristalsis is damagedSymptoms1. Dysphagia2. Gas and bloating can occur3. Loss of appetite and weight. Other symptoms might be a feeling of chest heaviness, regurgitation and heartburn linked with acid reflux (GERD).
Diagnosis1. Manometry, 2. Barium swallow, 3. Multi-channel intra-luminal impedance monitoring, 4. Endoscopy, and5.24-hour pH monitoringTreatmentThere are several choices for achalasia, such as medical therapy, endoscopic therapy, and surgery. Medical choices for achalasia are medicines that help relax smooth muscle in the body such as calcium channel blockers or nitroglycerin, drugs that are often taken for cardiovascular disease.
Surgical treatment:Endoscopic injection of botoxThe least invasive but also least durable option is endoscopic injection of botox into the lower esophageal sphincter. This loosens the muscle and gives some improvement in the feeling of dysphagia or difficulty swallowingBalloon dilatation of LESAnother endoscopic choice is dilatation, which is performed with a particularly designed balloon that is inflated to dilate the lower esophageal sphincterThis has been a good choice for patients who have too high risk of definitive surgery.
One issue is that the effect is not as durable as surgery, and repeat procedures are normally required. Heller myotomyThe surgical choice for achalasia is an intervention known as a Heller myotomyHeller myotomy is normally performed laparoscopically or through a few tiny incisions in the abdominal wall. This operation requires precise cutting of the thick, non-compliant lower esophageal sphincter to permit it to permanently open upIt is considered the gold standard for treatmentNovel endoscopic therapyOne such method is called POEM or per-oral endoscopic myotomy.
This requires the incision of the lower esophageal sphincter from the inside using special endoscopic instruments to produce what is done surgicallyDrug treatmentGastro-esophageal reflux should be excluded first (trial of proton pump inhibitor) followed by:1. Nitrates.2. Calcium-channel blockers - e.g., nifedipine or diltiazem.3. Antidepressants - e.g., trazodone, imipramine or sertraline work as 'visceral analgesics'.4.
Phosphodiesterase inhibitors (sildenafil, etc) - gave symptom relief5. Peppermint oil - enhanced manometric findings6. Theophylline - improved non-cardiac chest pain and may relax the esophageal wallAvoidance of cold fluids and taking hot liquids with meals helps some patientsTABLE OF CONTENTIntroductionChapter 1 Esophageal Motility DisorderChapter 2 CausesChapter 3 SymptomsChapter 4 ...