Oesophageal motility disorders

Question 1

what are the treatment options for achalasia?

Answer 1

intra-sphincteric botulinum toxin

pneumatic balloon dilatation

heller cardio myotomy

Question 2

what investigations could carry to investigate suspected achalasia?

Answer 2

oesophageal manometry
- excessive LOS tone which doesn’t relax on swallowing

barium swallow

• grossly dilated oesophagus
• corkscrew appearance

CXR

• widened mediastinum
• air-fluid level due to lack of peristalsis
• birds peak appearance

Question 3

what is the pathophysiology of achalasia?

Answer 3

degenerative loss of ganglion cells in auerbach’s plexus

Question 4

what is eosinophilic oesophagi’s?

Answer 4

immune mediated disease resulting in eosinophil predominant inflammation of the oesophagus

occurs in response to food antigen

Question 5

what is the treatment for eosinophilic oesophagitis ?

Answer 5

topical steroids
PPI
allergen avoidance

Question 6

how would you manage diffuse oesophageal spasm?

Answer 6

nitrates 
CCB 
botulinum toxin 
PPI
surgical myotomy