Surgery

1. OESOPHAGEAL
MOTILITY
DISORDERS

2. Pain with or with out
swallowing.usually
intermittent
Associated with GORD
or a part of diffuse GI
motility disorders
Barium impregnated
food bolus seen to
stick to oesophagus

3.  DISORDERS OF PHARYNGO-OESOPHAGEAL JN
 Neurological-stroke ,motor neurone ds
,multiple sclerosis,parkinsons ds.
Myogenic-myasthenia gravis,mus dystrophy
Pharyngo-oesophageal(zenkers) diverticulum

4. DISORDERS
OF BODY OF
OESOPHAGUS
DIFFUSE
OESOPHAGEAL
SPASM
NUT CRACKER
OESOPHAGUS

5.  AUTOIMMUNE DISORDERS-ESPECIALLY
SYSTEMIC SCLEROSIS(CREST-
calcinosis,raynaud’s synd,esoph motility
disorders,sclerodactyly,telangiectasia)
 REFLEX ASSOCIATED
 IDIOPATHIC

6. ALLER
GIC
EOSINOPHILIC
OESOPHAGITIS
NON SPECIFIC
OESOPHAGEAL
DYSMOTILITY

7.  ACHALASIA
 INCOMPETENT LOWER OESOPHAGEAL
SPHINCTER(GORD)

8.  LOSS OF GANGLION CELLS IN MYENTERIC
PLEXUS IN LOWER OESOPHAGUS
 DILATATION , TORTUOSITY $ HYPERTROPHY
OF PROXIMAL OESOPHAGEAL SEGMENT
 HISTOLOGY -REDUCTION IN NO: OF GANGLION
CELLS WITH VARIABLE DEGREE OF C/C INFLMTN
 VIGOROUS ACHALASIA-NORMAL NO: OF
GANGLION CELLS WITH INFLMTN AND NEURAL
FIBROSIS
 AETIOLOGY:IDIOPATHIC, ASSOC WITH CHAGAS
DS,STRESS $ EMOTIONAL FACTORS, VIT DEF

10.  WOMEN AROUND 30-40 YRS COMMONLY
AFFECTED M:F=2:3
 DYSPHAGIA MAINLY FOR LIQUIDS
 RECCURENT RESP TRACT INFN
 COMPLICATIONS-INCREASED INCIDENCE OF
CARCINOMA

11.  Achalasia like usually produced by
adenocarcinoma of cardia and also by benign
tumors at this level
 Inability of sphincter to relax is due to
absent body peristalsis
 Also seen in carcinoma of bronchus $
pancreas

12. 1. BARIUM SWALLOW-uniform dilated oesph above
with tapering segmet below(BIRDS BEAK)
2. Oesophagoscopy-tight cardia and food residue
in oesophagus
3. PLAIN X-RAY ABD ERECT-ABSENTGASTRIC GAS
BUBBLE
4. Lower oesophageal sphincter pressure may be
increased
5. Oesophageal manometry:show simultaneous contrn
of oesoph body $ incomplete relxn of los

18. Forceful dilatation of
cardia:stretching of cardia with
balloon to disrupt muscle and render it
less competent.balloons of 30-40 mm
diameter inserted over guideline.

20. Hellers myotomy:it involves cutting
muscle of lower oesophagus and
cardia.used after failed dilatation.90%
success

22.  Botulinum toxin:interfere with cholinergic
excitatory neural activity at LOS.effect is
permanent so repeated for months.used in
elderly.
DRUGS:relieve symptoms.CALCIUM CHANNEL
BLOCKERS:Nifedipine S/L