Oesophago-Gastric Motility Disorders

Oesophageal motility disorders are notoriously difficult to diagnose and manage. They often manifest as dysphagia, regurgitation or chest pain. Oesophageal manometry is the primary investigation. High-resolution manometry refines the discrimination between different disorders and improves the diagnostic yield. Oesophageal motility disorders can be either primary or secondary to a number of systemic diseases such as diabetes. The main primary disorders include achalasia, diffuse spasm, nutcracker oesophagus and sphincter abnormalities. Pharmaceutical treatment is largely unsuccessful. Endoscopic treatments using pneumatic dilatation or botox injections provide short-term relief of dysphagia. Surgery should be considered for young and fit individuals. Gastroparesis is a chronic motility disorder of the stomach, which encompasses delayed gastric emptying in the absence of a fixed mechanical obstruction of the pylorus or duodenum. Symptoms include early satiety, nausea, bloating, vomiting, abdominal pain and weight loss. Diagnostic evaluation requires an initial endoscopy to rule out mechanical causes, followed by a gastric-emptying scintigraphy for diagnosis. Gastroparesis can be primary or secondary. Management includes dietary modification, pharmacological agents, endoscopic botox injections to pylorus, gastroenterostomy and gastric electrical stimulation. Most patients continue to be symptomatic despite all management modalities.

Keywords: Achalasia, Cardiomyotomy, Diffuse oesophageal spasm, Gastric electrical stimulation, Gastroparesis, Hypertensive sphincter, Manometry, Motility, Nutcracker oesophagus, Primary motility abnormalities, Secondary motility abnormalities.