Description
Recognize symptoms such as dysphagia, bloating, and altered bowel habits indicative of motility issues. Assess movement through the digestive tract to diagnose motility disorders accurately. Innovative technology aids in studying the entire gastrointestinal transit in a non-invasive manner. Tailored management may include dietary adjustments, medications, or surgical interventions based on the underlying cause. Address conditions like achalasia or esophageal spasm through targeted therapies. Dietary modifications, medications, and in severe cases, gastric electrical stimulation may be considered. Targeted treatments address issues like pseudo-obstruction or colonic inertia. Collaboration among gastroenterologists, dietitians, and surgeons ensures comprehensive care. Empower individuals with motility disorders through education, fostering active participation in their care and management.
Résumé
- The esophagus is a muscular tube connecting the oral cavity to the stomach, approximately 25 cm long, with motility characterized by peristalsis divided into primary, secondary, and tertiary types. The upper third contains skeletal muscle while the lower two-thirds consist of smooth muscle. Primary peristalsis is triggered by swallowing, secondary by the presence of food, and tertiary are non-peristaltic contractions with no physiological role.
- Esophageal motility disorders can be primary (achalasia cardia, nutcracker esophagus, diffuse esophageal spasm, etc.) or secondary (scleroderma, diabetes mellitus, alcohol consumption, psychiatric disorders, etc.). Diagnosis relies on high-resolution manometry, which measures pressure changes at different levels of the esophagus in real-time using a catheter with multiple channels.
- Key manometry terms include integrated relaxation pressure (IRP) indicating lower esophageal sphincter relaxation, contractile deceleration point, distal latency, and distal contractile integral (DCI) which represents vigor of esophasial contraction. The degree of esophageal contraction is categorized as failed (DCI8000).
- Achalasia cardia, a common motility disorder, is characterized by impaired lower esophageal sphincter relaxation and aperistalsis, resulting from ganglion cell degeneration. Epidemiology shows equal incidence in men and women aged 30-60. It can be associated with AAA syndrome (achalasia, alacrima, Addison's disease). The pathogenesis is related to cytotoxic T-cells damaging ganglion cells.
- Clinical features of achalasia include dysphagia, regurgitation, weight loss, chest pain, and heartburn. Diagnosis involves endoscopy, barium esophagram, and high-resolution manometry. Barium esophagram shows esophageal dilation and a bird-beak appearance. Manometry classifies achalasia into types 1, 2, and 3 based on peristalsis patterns.
- Treatment options for achalasia include medical (calcium channel blockers, nitrates), endoscopic (botulinum toxin injections, pneumatic dilation, POEM), and surgical (Heller myotomy) approaches. Pneumatic dilation involves forcefully opening the LES with a balloon, but carries the risk of perforation. Heller myotomy is a laparoscopic procedure with good results but potential complications such as GERD and bleeding.
- POEM (peroral endoscopic myotomy) is a minimally invasive technique involving submucosal tunneling and myotomy. It boasts high success rates but can lead to GERD. Pharmacological therapies, like calcium channel blockers and nitrates, provide temporary relief but have limited effectiveness and potential side effects.
Exemple de certificat
À propos des intervenants
Dr Sriram Srikakulapu
Consultant Medical Gastroenterologist, Yashoda Hospitals
Commentaires
Commentaires
Vous devez être connecté pour laisser un commentaire.