الفهرس 
Esophageal AnatomyOnly 14 pages are availabe for public view
 |  | from | 166 |  |  |
| | | from | 166 | | |
Abstract
Esophageal motility disorders encompass a broad class of diseases that are manifest by abnormal contractions of the esophageal body as well as abnormal function of both the upper and lower esophageal sphincters.
Esophageal motility disorders are not uncommon in gastroenterology. The spectrum of these disorders ranges from the well-defined primary esophageal motility disorders to very nonspecific disorders that may play a more indirect role in reflux disease and otherwise be asymptomatic . Also they occur as a manifestation of systemic diseases, referred to as secondary motility disorders. Pathophysiologic classification of primary esophageal motility disorders based on the type of innervations affected .They can be broadly classified into disorders of inhibitory or excitatory innervations. Disorders of inhibitory innervations may be those associated with decreased or increased inhibitory function. Decreased inhibitory nerve function include such conditions as diffuse esophageal spasm and achalasia . Increased inhibitory nerve function is manifested by transient lower esophageal sphincter relaxation (TLESR) and LES hypotension. Disorders of excitatory innervations may also include those associated with increased or decreased excitatory function . Manifestations of decreased excitatory nerve function include hypotensive peristalsis in the esophagus and hypotensive LES and LES with poor reflex
Summary
127
contraction. Increased excitatory function may be responsible for hypertensive esophageal peristaltic contractions (nutcracker esophagus) or hypertensive and hypercontracting LES. Secondary esophageal motility disorders occur as a result of conditions such as connective tissue disease, diabetes, amyloidosis, sclerodermaand Chagas’ disease. Recent classification of Chicago was developed to facilitate the interpretation of clinical EPT studies, concurrent with the widespread adoption of HRM and EPT into clinical practice.
Symptoms are quite variable, and can manifest as the sensation of food sticking, chest pain, or regurgitation. These disorders are notoriously difficult to assess on the basis of symptoms only. Precise reliable tests is needed to make the correct diagnosis, as the rarity of these disorders, combined with the lack of specificity in their clinical presentation, makes early diagnosisa challange.
Several tests are available to help establish the diagnosis for example Chest x-rays, barium swallow test esophageal manometry, endoscopy, esophageal pH monitoring . Esophageal manometry is considered the gold standard for diagnosis of motility disease of esophagus.
All of the currently available management are at best palliative, and their benefit may be offset by side effects and complications that require additional therapy.
Despite treatment, progression of the underlying disorder occurs frequently, so that ongoing follow-up is necessary to manage symptom, relapse and complications.No treatment can restore muscle activity to the denervated esophagus. Therefore, treatment is directed at reducing the gradient across the LES with relieve the primary symptoms of dysphagia, chest pain, regurgitation, and improve esophageal emptying.
Overall, using single or multiple modalities of treatment, will do well . However, the disease is never ‗cured‘, and touch up treatments will be required over longer periods of follow-up . Available modalities of treatment include.
Pharmacologic agents nitrates and calcium channel blockers.
Endoscopic Treatment like.
o Botox injection .
o Pneumatic Dilatation.
o Endoscopic Sclerotherapy.
Surgical Treatment.
o LHM (Laparoscopic Heller Myotomy).
o Esophagectomy.
o POEM (Peroral Esophageal Myotomy).
o Self-Expanding Metallic Stents
Finally all the present approaches for the treatment of motility disorders are targeting the disruption of the esophagus rather than trying to correct the underlying abnormality and restore the motility function.
Recent researches are required to optimize therapy. The new technique of stem cell therapy to restore the functional anatomy of the LES may be promising in the future.