Section: UGI Sub-section: Oesophagus Curriculum: Curriculum, page 95
Definition
- Contraction abnormality of distal oesophagus associated with GORD
- Conclusive diagnosis as per the Chicago Classification 4.0 is states “a conclusive diagnosis of IEM requires more than 70% ineffective swallows or at least 50% failed peristalsis”
- May be secondary to injury of oesophageal body because of increased exposure to gastric contents
- Dampened oesophageal motility leads to further inability to clear acid
Clinical
- Reflux
- Dysphagia
- Heartburn, chest pain, regurgitation also noted
Investigations
- Manometry
- Low-amplitude distal oesophageal contractions and non-transmitted contractions
Management
-
Prevent GERD main strategy
-
Once altered motility occurs, becomes irreversible
-
If intractable surgery may be only option – tailor surgery to manometry findings
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Secondary Causes
- Scleroderma
- Oesophageal smooth muscle atrophy
- Weak peristalsis and poor LOS function/tone
- More likely to present with reflux than dysphagia
- Can confuse reflux with regurgitation
- Can be confused for achalasia
- Management
- Controversial – Partial fundoplication
- NB: Nissen fundoplication contra-indicated
- Controversial – Partial fundoplication
- Scleroderma