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Manometry
Esophageal manometry is an accurate method for assessing esophageal motility disorders including achalasia, diffuse esophageal spasm and scleroderma affecting the esophagus.
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Esophagus in Scleroderma
IM→GI→Esophagus→Motility Disorders→Scleroderma A 35 year old African American woman presents to your clinic with difficulty swallowing and heart burn. History reveals a diagnosis of scleroderma. Pathology: Scleroderma causes diffuse fibrosis of the esophagus which results in loss of LES (lower esophageal sphincter) function as well as absent peristalsis of smooth muscle in the distal esophagus. Presentation: Patients present with dysphagia as well as GERD. They will have history of scleroderma, look for a description of Raynaud’s phenomenon. Diagnosis: Manometry will show hypotensive/ absent peristalsis and LES tone. Management: Proton pump inhibitors (PPIs).
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Diffuse esophageal spasm (DES)
A 32 year old comes to your clinic complaining of difficulty swallowing with solids, as well as both hot and cold liquids. This has been happening intermittently for about a week. Pathology Impaired innervation of the esophagus –> uncoordinated simultaneous contractions (non-peristaltic). This primarily affects the distal esophagus, so this condition is also called Distal Esophageal Spasm (DES). Presentation Spontaneous odynophagia and dysphagia with both solids and liquids. May be described as “chest pain” when eating. Often precipitated by emotional stress. The chest pain is relieved by nitroglycerin and calcium channel blockers — they relax the esophageal myocytes. They often have regurgitation of food. Key features: – progressive dysphagia to…