Dyskinesia of esophagus

Upper GI

Clinicals - History

Fact Explanation
Dysphagia Most of the patients present with dysphagia and or odynophagia. They complain of food getting stuck in the retrosternal area or in the suprasternal notch. Characteristic feature of esophageal motility disorders is that patients complain of intermittent dysphagia to both solids and liquids. In order to propel the swallowed food bolus esophageal muscle groups have to contract and relax in an organized manner ( contraction of the circular muscles should follow the contraction of longitudinal muscles of the mid-esophagus). Diffuse spasms of the body of the esophagus cause non-peritalsis and food gets stuck in the mid-esophagus, causing dysphagia. Dysphagia
Most of the patients present with dysphagia and or odynophagia. They complain of food getting stuck in the retrosternal area or in the suprasternal notch. Characteristic feature of esophageal motility disorders is that patients complain of intermittent dysphagia to both solids and liquids. In order to propel the swallowed food bolus esophageal muscle groups have to contract and relax in an organized manner ( contraction of the circular muscles should follow the contraction of longitudinal muscles of the mid-esophagus). Diffuse spasms of the body of the esophagus cause non-peritalsis and food gets stuck in the mid-esophagus, causing dysphagia.
Chest pain Patients present with severe retrosternal chest pain which often radiates to the back. Esophageal dyskinesia is considered a common cause for unexplained chest pain. Patients develop chest pain due to spasmodic contractions of the esophagus as well as due to esophageal distension. Chest pain
Patients present with severe retrosternal chest pain which often radiates to the back. Esophageal dyskinesia is considered a common cause for unexplained chest pain. Patients develop chest pain due to spasmodic contractions of the esophagus as well as due to esophageal distension.
Globus pharyngeus This refers to the sensation of a lump or foreign body in the throat, which is not painful.
Motor disorders of the esophagus can cause a diffuse sensation of a foreign body in the throat.
Globus pharyngeus
This refers to the sensation of a lump or foreign body in the throat, which is not painful.
Motor disorders of the esophagus can cause a diffuse sensation of a foreign body in the throat.

Clinicals - Examination

Fact Explanation
Loss of weight Some patients may refuse meals because of the dysphagia and odynophagia. Loss of weight
Some patients may refuse meals because of the dysphagia and odynophagia.

Investigations - Diagnosis

Fact Explanation
Upper gastrointestinal endoscopy (UGIE) UGIE shows helical folds of the esophageal lumen in nutcracker esophagus. Non-propagating and disordered esophageal contractions can be observed in some patients. Upper gastrointestinal endoscopy (UGIE)
UGIE shows helical folds of the esophageal lumen in nutcracker esophagus. Non-propagating and disordered esophageal contractions can be observed in some patients.
Barium swallow test This shows the corkscrew appearance and segmentation of esophagus in nutcracker esophagus. Barium swallow test
This shows the corkscrew appearance and segmentation of esophagus in nutcracker esophagus.
Esophageal manometry High-resolution manometry of the esophagus shows high-amplitude pressure waves. Esophageal manometry
High-resolution manometry of the esophagus shows high-amplitude pressure waves.
CT scan Patients with diffuse esophageal spasm can have thickened esophageal wall (more than 3mm) due to muscular hypertrophy. CT scan
Patients with diffuse esophageal spasm can have thickened esophageal wall (more than 3mm) due to muscular hypertrophy.
Endoscopic ultrasound scan Presence of thickened esophageal muscle walls indicates the presence of esophageal spasms and hypertrophy. Endoscopic ultrasound scan
Presence of thickened esophageal muscle walls indicates the presence of esophageal spasms and hypertrophy.

Management - Specific

Fact Explanation
Antispasmodics Antispasmodic drugs are indicated in the treatment of spastic contractions of the esophagus. Calcium channel blockers, sildenafil and nitrates are commonly used. Antispasmodics
Antispasmodic drugs are indicated in the treatment of spastic contractions of the esophagus. Calcium channel blockers, sildenafil and nitrates are commonly used.
Endoscopic injection of botulinum toxin Local injections of botulinum toxin is also useful in treating dyskinesia of the esophagus. Endoscopic injection of botulinum toxin
Local injections of botulinum toxin is also useful in treating dyskinesia of the esophagus.
Balloon dilatation Balloon dilatation of the spastic segments can be done to relieve dysphagia. Balloon dilatation
Balloon dilatation of the spastic segments can be done to relieve dysphagia.
Surgery If the symptoms do not resolve with initial medical management myotomy is indicated which reduces the spasms and dysphagia. Surgery
If the symptoms do not resolve with initial medical management myotomy is indicated which reduces the spasms and dysphagia.

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