Barium swallow study showing a case of Presbyesophagus
Classification of esophageal motility disorder –
Classification of esophageal motility disorder –
Primary Motility Disorder -
1) Achalasia and variant
2) Diffuse esophageal spasm
3) Nutcracker esophagus
4) Nonspecific esophageal motility disorder.
5) PRESBYESOPHAGUS.
6) Hypertensive lower esophageal sphincter.
Secondary Motility Disorder –
1) Collagen vascular disorder.
2) chemical- reflux esophagitis, caustic esophagitis, radiation esophagitis
3) Infective causes.
4) DM
5) Alcoholism
6) Endocrine causes.
7) Neuromuscular disorder, CVA, myasthenia gravis, muscular dystrophies.
8) Idiopathic.
Achalasia—
- Characterized by aperistalsis and LES dysfunction.
-Cause is unknown, but histologic lesion found in dorsal vagal nucleus, vagal trunk, and myentreric ganglia.
- Ganglionic cell decreased in number in achalasia.
-Pathologically characterized by esophageal dilatation.
-Achalasia is characterized, manometrically by absence of primary peristalsis, elevated or normal resting LES pressure and incomplete or absent LES relaxation.
Diffuse esophageal spasm-
Manometric criteria-
1) Simultaneous contraction more than 10% of wet swallows and intermittently normal primary peristalsis.
2) Associated finding is repetitive and prolong duration contraction, high amplitude contraction, and frequent prolong duration contraction.
Radiological features –
1) Primary peristalsis present in cervical esophagus and intermittently absent in thoracic esophagus.
2) Non peristaltic contraction affect smooth muscle portion of esophagus replacing disrupted primary wave.
3) Contractions are repetitive and simultaneous and they may compartmentalize the esophageal lumen producing typical corkscrew or rosary bead appearance.
Nutcracker esophagus –
1) It is characterized on Manometric examination by normal peristalsis with distal contractions of abnormal high amplitude and prolongs duration.
2) In Manometric laboratory normal mean distal esophageal amplitude is 100 +_ 80 mmHg (+_2 SD).
3) Diagnosis of nutcracker esophagus required peristalsis contraction with average amplitudes greater than 180 mmHg.
4) Radiological examination is normal or reveals only non specific finding such as non specific contraction.
Non specific esophageal motility disorder-(NEMD)
1) It reveals esophageal motility abnormalities that do not fit criteria for specific motility disorder.
2) Manometric abnormalities includes intermittent absence of peristalsis on 20% or more of wet swallow, low amplitude peristalsis ,prolong duration peristalsis , repetitive or triple peak contractions, or incomplete LES relaxation .
3) Radiological finding may reveal these Manometric abnormalities. Disruptions of these primary peristalsis and non peristaltic contractions are typically seen.
Hypertensive lower esophageal sphincter-
1) It is described in patients with esophageal symptoms, who had usually high LES resting pressure.
2) This disorder is rare and cause is unknown.
3) Manometric criteria have usually included a resting LES pressure greater than 40 mmHg with normal LES relaxation and esophageal peristalsis.
4) Radiological examination including radionucliotide emptying study are usually normal, so like nutcracker esophagus, hypertensive LES also required Manometric diagnosis
Presbyesophagus
Presbyesophagus
It is referred to motility dysfunction associated with ageing.
Major manometric criteria included
1) decreased frequency of normal peristalsis,
2) Increased frequency of non peristaltic contractions.
3) and less commonly incomplete LES relaxation.
Many of manometric criteria for Presbyesophagus are similar to those for NEMD, which has become term to described esophageal dysfunction in these patients.