What Is Esophageal Motility Disorder?

Esophageal and cardiac achalasia is due to esophageal neuromuscular dysfunction. The lower esophageal sphincter is in a state of slackness. Food cannot pass through it and stays in the esophagus. It gradually causes esophageal tension loss, peristalsis and esophageal expansion. Difficulty swallowing, pain behind the sternum, and food reflux are the most common symptoms.

Esophageal and cardiac achalasia is due to esophageal neuromuscular dysfunction. The lower esophageal sphincter is in a state of slackness. Food cannot pass through it and stays in the esophagus. It gradually causes esophageal tension loss, peristalsis and esophageal expansion. Difficulty swallowing, pain behind the sternum, and food reflux are the most common symptoms.

Chinese name

Esophagus and achalasia

Foreign name

esophageal achalasia

Esophageal cardia achalasia I. Causes and common diseases:

The cause is unknown so far, and it is generally considered to be a neuronal disease caused by esophageal neuromuscular dysfunction. Individual patients have a family history, suggesting that the incidence of these patients may be genetically related.

Complications: Bronchial and pulmonary infections can occur after inhalation of food reflux, especially when the patient is asleep. The disease can be secondary to esophagitis, esophageal mucosal erosion, ulcers and bleeding, esophageal tracheal fistula and spontaneous esophageal rupture and esophageal cancer.

Esophageal cardia achalasia 2. Differential diagnosis:

(1) Reflux esophagitis:

The contents of reflux in patients with reflux esophagitis complicated by esophageal stenosis are different from esophageal-cardiac achalasia, and the reflux may have an acid odor and sometimes may contain bile.

(B) Diffuse esophageal spasm:

It is also a kind of primary esophageal dysmotility disorder, and it has a corkscrew-like appearance during X-ray barium meal examination.

(3) Scleroderma:

In addition to skin manifestations, patients often have smooth muscle damage and esophageal symptoms. Obvious immunological abnormalities and typical skin lesions are helpful for diagnosis.

(4) Malignant tumors:

Malignant tumor cells invade the esophageal myenteric plexus, impair the innervation of the LES after the ganglion, or the tumor surrounds the distal esophagus, compressing the esophagus, causing similar performance to esophageal-cardiac achalasia.

Esophageal cardia achalasia Three, check:

1. X-ray barium meal check:

The barium meal remained at the lower end of the esophagus and showed a length of 1 to 3 cm, symmetrical, neat and smooth edges with a conical, funnel-shaped, or beak-shaped narrowness. The upper part of the esophagus expanded, extended, and flexed to varying degrees without peristaltic waves. Taking nitroglycerin can relax the esophagus and cardia sphincter.

2. Endoscopy:

See the enlargement of the upper esophageal cavity, narrowing of the lower segment, hyperemia and edema of the mucosa, biopsy and differentiation of cancerous stenosis are needed.

3. Esophageal manometry:

(1) Basal sphincter pressure increased> 4kPa.

(2) The sphincter relaxation ability is low when swallowed, and there is no relaxation performance in severe cases.

(3) Lack of propulsive peristalsis in the middle and lower esophagus.

(4) The esophageal pressure in the stationary phase increases, but is higher than the gastric pressure.

4. Mecholyl test:

Normal people's esophageal peristalsis increased after subcutaneous injection of 5-10mg, but there was no significant increase in pressure. Patients with this disease have a strong contraction of the esophagus 1 to 2 minutes after injection, and the pressure in the esophagus increases sharply, causing severe pain and vomiting.

Esophageal cardia achalasia 4. Principles of treatment:

(1) General treatment:

Regulate diet, avoid frequent meals and avoid irritating foods. Nitroglycerin or inhaled isoamyl nitrite can be taken under the tongue at the onset, or nifedipine can be taken orally.

(B) expansion therapy:

The balloon or probe is used to expand, so that the junction of the esophagus and the stomach is relaxed. During expansion, a balloon with a probe as a guide is inserted orally under the perspective, and the probe is inserted into the stomach, and the balloon is fixed at the junction of the esophagus and the stomach. Unplug after 5-10 minutes. Attention should be paid to complications of esophageal rupture.

(Three) surgical treatment:

About 20% of cases require surgery. According to the expansion of the upper esophagus and the degree of stenosis of the lower esophagus, longitudinal incision of the cardiac muscle layer of the lower esophagus, or resection and reconstruction of the lower esophagus and cardia was selected.