Nam Q Nguyen1, Richard H Holloway. 1. Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, South Australia.
Abstract
PURPOSE OF REVIEW: Over the past year, further insights into the control of esophageal motility and disturbances associated with motor disorders, and additional information about the treatment of esophageal motor disorders has emerged. This review outlines the major developments in these areas. RECENT FINDINGS: The pharyngeal and esophageal phases of swallowing appear to be controlled by different areas within the vagal nuclei. Differences in the density and activation of calcium channels may explain differences in activity between the circular and clasp fibers of the lower esophageal sphincter and in the peristaltic function of the esophageal body. Tonic cholinergic input is the major determinant of esophageal tone. Experimental diabetes mellitus alters the mechanics of the esophageal body. Subtle abnormalities of peristalsis have been identified by high-resolution manometry and 24-hour ambulatory manometry that are not evident on standard manometry in patients with non-obstructive dysphagia. In achalasia, additional support has been provided for vagal damage in some patients with achalasia as well as evidence for a viral-induced immune damage to the myenteric plexus. The three main treatments for achalasia - botulinum toxin, pneumatic dilatation, and minimally invasive myotomy have been re-evaluated. Myotomy continues to provide the best results. Intraoperative manometry would seem to be a useful aid to minimize the risk of incomplete myotomy. The usefulness of glucagon in relieving food bolus obstruction has been revisited in a retrospective study. SUMMARY: These studies provide further information with which to more effectively manage esophageal motor disorders.
PURPOSE OF REVIEW: Over the past year, further insights into the control of esophageal motility and disturbances associated with motor disorders, and additional information about the treatment of esophageal motor disorders has emerged. This review outlines the major developments in these areas. RECENT FINDINGS: The pharyngeal and esophageal phases of swallowing appear to be controlled by different areas within the vagal nuclei. Differences in the density and activation of calcium channels may explain differences in activity between the circular and clasp fibers of the lower esophageal sphincter and in the peristaltic function of the esophageal body. Tonic cholinergic input is the major determinant of esophageal tone. Experimental diabetes mellitus alters the mechanics of the esophageal body. Subtle abnormalities of peristalsis have been identified by high-resolution manometry and 24-hour ambulatory manometry that are not evident on standard manometry in patients with non-obstructive dysphagia. In achalasia, additional support has been provided for vagal damage in some patients with achalasia as well as evidence for a viral-induced immune damage to the myenteric plexus. The three main treatments for achalasia - botulinum toxin, pneumatic dilatation, and minimally invasive myotomy have been re-evaluated. Myotomy continues to provide the best results. Intraoperative manometry would seem to be a useful aid to minimize the risk of incomplete myotomy. The usefulness of glucagon in relieving food bolus obstruction has been revisited in a retrospective study. SUMMARY: These studies provide further information with which to more effectively manage esophageal motor disorders.
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