Dysphagia:
Achalasia:
Dysphagia for solids and liquids is the primary clinical feature.
,• Regurgitation, especially while recumbent, may result in aspiration.
• Vomiting: may be voluntary.
• Chest pain and heartburn not responding to PPIs.
• Weight loss.
A contrast swallow: primary screening test: Dilation of the esophagus.
Narrow esophagogastric junction ("bird‐beak“).
Aperistalsis & Delayed emptying of barium.
Esophageal manometry: establish the diagnosis:
Incomplete relaxation of LES.
Aperistalsis in the distal two‐thirds of the esophagus.
Upper endoscopy:
Retained food in the esophagus.
Resistance to passage of an endoscope through the
esophagogastric junction.
Treatment aims at disrupting LES:
Botulinum toxin injection (temporary).
Pneumatic dilatation.
Myotomy:
Endoscopic: per‐oral endoscopic myotomy (POEM).
Laparoscopic.
Surgical.
, Gastro‐esophageal
Reflux (GER)
A NORMAL PHYSIOLOGICAL PROCESS Transient LES relaxations. It is
extremely common in infancy (1st year).
It's caused by inappropriate relaxation of the lower esophageal sphincter
(LES) as a result of functional immaturity + Contribution of:
1. A predominantly fluid diet.
2. A mainly horizontal posture.
3. A short intra‐abdominal length of esophagus.
Natural history: Majority of typical reflux resolves spontaneously by 12
months of age.
1. recurrent regurgitation.
2. Vomiting. but:
Are putting on weight normally.
Are otherwise well.
Although the mess, smell and frequent changes of clothes is frustrating
for carers.
usually diagnosed clinically and no investigations are required.
Achalasia:
Dysphagia for solids and liquids is the primary clinical feature.
,• Regurgitation, especially while recumbent, may result in aspiration.
• Vomiting: may be voluntary.
• Chest pain and heartburn not responding to PPIs.
• Weight loss.
A contrast swallow: primary screening test: Dilation of the esophagus.
Narrow esophagogastric junction ("bird‐beak“).
Aperistalsis & Delayed emptying of barium.
Esophageal manometry: establish the diagnosis:
Incomplete relaxation of LES.
Aperistalsis in the distal two‐thirds of the esophagus.
Upper endoscopy:
Retained food in the esophagus.
Resistance to passage of an endoscope through the
esophagogastric junction.
Treatment aims at disrupting LES:
Botulinum toxin injection (temporary).
Pneumatic dilatation.
Myotomy:
Endoscopic: per‐oral endoscopic myotomy (POEM).
Laparoscopic.
Surgical.
, Gastro‐esophageal
Reflux (GER)
A NORMAL PHYSIOLOGICAL PROCESS Transient LES relaxations. It is
extremely common in infancy (1st year).
It's caused by inappropriate relaxation of the lower esophageal sphincter
(LES) as a result of functional immaturity + Contribution of:
1. A predominantly fluid diet.
2. A mainly horizontal posture.
3. A short intra‐abdominal length of esophagus.
Natural history: Majority of typical reflux resolves spontaneously by 12
months of age.
1. recurrent regurgitation.
2. Vomiting. but:
Are putting on weight normally.
Are otherwise well.
Although the mess, smell and frequent changes of clothes is frustrating
for carers.
usually diagnosed clinically and no investigations are required.
