Oesophageal
Diagnostic
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Oesophageal Dysmotility

 

A disorder of muscle activity in the oesophageal body or oesophageal sphincters. It may result in symptoms such as chest pain, dysphagia and regurgitation.

Although dysmotility may have a non-specific nature there are three sub-groups with specific characteristics.  These are the 'primary' conditions of achalasia, diffuse oesophageal spasm and nutcracker oesophagus.

Dysmotility may be a consequence of infections, obstruction or simply aging.

 

Acid Reflux Disease / GORD

 

An abnormal frequency of acid entering the oesophagus from the stomach causing symptoms of heartburn or burning regurgitation and when severe may cause upper airways disease, a chronic cough or voice changes (dysphonia).

There appears to be a weakness in the lower oesophageal sphincter and at times related to poor oesophageal peristalsis either as an initial event like the weakening of the sphincter or as a consequence to continuing acid attack.
 
As the oesophagus has limited defence to acid attack it may result in inflammation or oesophagitis.  The aim of drug therapy is to decrease the acid exposure to the unprotected oesophagus, reducing pain and allowing the natural healing mechanisms to reduce inflammation. 

 

Hiatus Hernia

 

Often associated with reflux disease, an hiatus hernia is where the top of the stomach and lower sphincter migrate from the abdomen through the natural opening in the diaphragm called the hiatus and into the chest.

In this instance the normal control to reflux is impaired and despite good drug therapy an irreversible anatomical defect exists.

The aim of hiatus hernia or anti-reflux surgery is to return the intrathoracic stomach below the diaphragm and the weakened sphincter mechanism is strengthened by supporting with a 'wrap' of stomach.  The most commonly performed version of this surgery is the Nissen fundoplication.

 

Paraoesophageal Hernia

 

Similar to the above but the side of the stomach can also herniate into the chest.

Symptoms are that of chest pain, regurgitation and dysphagia.  If large, there may be shortness of breath, a clinical anaemia due to erosions in the gastric wall and even a cardiac arrythmia.  Often associated with curvature of the spine.

 

A mixed hernia is a combination of both paraoesophageal and hiatal herniation.

 

Barrett’s Oesophagus

 

A potentially serious complication of reflux damage to the distal oesophagus.

 

In some instances, contact of gastric content may trigger a change in the mucosal lining membrane from a normal squamous cell type to a more unstable gastric or columnar type. Untreated, this carries a risk of further change to cancer.

 

Diverticulum

 

A pouch or pocket forming along the oesophagus. This is often a result of spasm but rarely may arise from an adjacent site of infection in the chest.

 

A pharyngeal pouch, as the name suggests, is a pouch above the upper sphincter in the pharynx and associated to abnormal co-ordination of muscles in this area.

 

Achalasia

 

An uncommon disorder of muscle control in the lower sphincter where it fails to relax and impedes the normal passage of food. The oesophageal body can become weak and be seen to widen on barium x-ray examination.

 

Achalasia usually presents in the 20 to 50 year age group. It may be associated to a cramping chest-pain. Often coincident to higher academic achievement.

 

Pseudoachalasia

 

A diagnosis based mainly on barium x-ray examinations with obstruction at the lower sphincter and widening of the oesophageal body.  An x-ray appearance similar to achalasia but with a different underlying pathology.  This is usually seen in the older age group of 60 years plus.  The differential diagnosis being long standing oesophageal stricture, cancer or external compression from an enlarged aorta or lymph node.

 

Nutcracker Oesophagus

 

Or hyperperistalsis.  A variety of dysmotility causing dysphagia and a cramping pain where the normal peristaltic squeeze is recorded to be powerful and prolonged in duration.

 

With the advent of modern manometric techniques this is now recognised as the most common of the 'primary' motility disorders.

 

Diffuse Oesophageal Spasm

 

Gross disorder of oesophageal motility where a swallow produces uncoordinated muscle responses or spasms.  Passage of solid food may be difficult and chest pain can arise both during meals and at any time of the day.

 

Presbyoesophagus

 

Over some 70 years of age, the oesophagus can lose the normal peristaltic sequencing or become weak. This may result in poor oesophageal transit of food but is rarely painful.

 

Scleroderma

 

One of the auto-immune diseases affecting the connective tissues of the body.  The oesophageal manifestations of scleroderma are weakness of peristalsis and lower sphincter zone and may result in significant acid reflux. 

 

There are many other auto-immune diseases such as SLE that may effect the oesophagus to a lesser degree.

 

The Normal Oesophagus

 

It is vital to establish normal oesophageal function in those with symptoms that do not arise from an oesophageal pathology, in particular those with anxiety, globus or burning mouth syndromes.