Oesophageal dysmotility
Define oesophageal dysmotility or oesophageal motility disorder?
Oesophageal dysmotility is defined as motility that differs significantly from accepted normal variations. The clinical significance of this is unknown. With the exception of achalasia, the relationship between the manometric patterns and clinical symptoms remain controversial. Oesophageal dysmotility could be primary or secondary to systemic diseases like scleroderma, diabetes, Chagas disease, chronic GORD and chronic idiopathic intestinal pseudo obstruction.
Discuss the clinical features of oesophageal dysmotility?
Dysphagia and chest pain
Classify oesophageal motility disorders?
3 types- hypercontracting, hypocontracting, and discoordinated motility. Hypocontracting motility disorder may be caused by GORD
Discuss the manometric findings of motility disorders?
| Motility disorder | Manometric findings |
|---|---|
| Hypercontracting Nutcracker oesophagus Hypertensive LOS |
|
| Increased distal peristalsis amplitude and duration | |
| Increased resting LOS pressureIncreased resting LOS pressure | |
| Hypocontracting Ineffective motility Hypotensive LOS |
|
| Increased nontransmitted peristalsis and low distal peristaltic amplitude | |
| Decreased resting LOS pressure | |
| Discoordinated Diffuse oesophageal spasm |
Simultaneous and repetitive contractions of prolonged duration |
| Achalasia | Elevated resting LOS pressure Incomplete relaxation of LOS Absent distal peristalsis |
Discuss the management of motility disorders?
There are no effective treatments as the pathophysiology and the relation of the motility findings to symptoms remain obscure.
Calcium channel blockers (diltiazem 180-240 mg/day) or tricyclic antidepressant (trazodone 100-150 mg/day or imipramine 25-50 mg/day) may provide symptomatic relief.
There are anecdotal reports of use of nitrates, botulinum toxin, bougie dilatation etc.
