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Oesophageal Diagnostic Services
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DISEASES

Oesophageal Dysmotility
Reflux Disease
Hiatus Hernia
Paraoesophageal Hernia
Barrett’s Oesophagus
Diverticuli
Achalasia
Pseudoachalasia
Nutcracker Oesophagus
Diffuse Oesophageal Spasm
Presbyoesophagus
Scleroderma

 

^ Oesophageal Dysmotility

A disorder of muscle activity in either the oesophageal body or at the lower oesophageal sphincter. It can be responsible for symptoms such as chest pain and dysphagia with or without regurgitation.

Although dysmotility may have a non-specific nature there are three sub-groups with specific characteristics and where distinct changes have been identified at the microscopic level in both the nerves and muscle cells.   These are the 'primary' conditions of achalasia, diffuse oesophageal spasm and nutcracker oesophagus (see below).

Dysmotility may also arise as a consequence of infections, obstruction or simply aging.

 

^ Reflux Disease

An abnormal frequency of acid entering the oesophagus from the stomach causing the symptoms of heartburn or burning regurgitation and when severe may cause upper airways disease, a chronic cough or voice changes (dysphonia).

The initial problem appears to be a weakness in the lower oesophageal sphincter but, to date, the reason why this occurs is unknown.   Reflux disease is often associated to poor oesophageal peristalsis either as an initial event like the weakening of the sphincter or as a consequence to continuing acid attack.
 
As the oesophagus has limited defence to acid attack it may proceed to inflammation or oesophagitis and if allowed to continue may cause the oesophagus to burn and narrow to a stricture resulting in a mechanical obstruction to food.

The aim of drug therapy is to decrease the acid exposure to the unprotected oesophagus, reducing pain and allowing the natural healing mechanisms to reduce inflammation. 

 

^ Hiatus Hernia

Often associated with reflux disease, an hiatus hernia is where the top of the stomach and sphincter migrate from the abdomen through the natural opening in the diaphragm called the hiatus and into the chest.

In this instance the normal control to reflux is impaired and despite good drug therapy an irreversible anatomical defect without surgery. 

The aim of hiatus hernia or anti-reflux surgery is to return the intrathoracic stomach below the diaphragm and the weakened sphincter mechanism is strengthened by supporting this with a 'wrap' of stomach.  The most commonly performed version of this surgery is the Nissen fundoplication.

 

^ Paraoesophageal Hernia

Similar to the above but the side of the stomach is seen to herniate through the hiatus leaving the lower sphincter zone in the correct position at the diaphragm.

Symptoms are that of chest pain, regurgitation and dysphagia.  If large, there may be shortness of breath and a clinical anaemia due to erosions in the gastric wall.

A mixed hiatus hernia is a combination of both paraoesophageal and hiatal herniation.

 

^ Barrett’s Oesophagus

A potentially serious complication of reflux damage to the distal oesophagus.

In some instances, contact of gastric content may cause a change in the mucosal lining membrane from a normal squamous type to a more unstable gastric or columnar type. This carries a risk of further change to cancer.

 

^ Diverticulum

A pouch or pocket forming along the oesophagus. This is usually as a result of spasm but rarely may arise from an adjacent site of infection in the chest.

A Zenkers diverticulum or pharyngeal pouch, as the name suggests, is a pouch above the cricopharyngeal sphincter in the pharynx and usually associated to abnormal co-ordination of muscles in this area.

 

^ Achalasia

An uncommon disorder of muscle control in the lower oesophageal sphincter where it fails to relax and impedes the normal passage of food. The oesophageal body can become weak and be seen to widen on barium x-ray examination.

Achalasia usually presents in the twenty to fifty year age group and may in the early stages be associated to a cramping chest-pain.

 

^ Pseudoachalasia

A diagnosis based mainly on barium x-ray examinations with obstruction at the lower sphincter and widening of the oesophageal body.  An x-ray appearance similar to achalasia but with a different underlying pathology.  This is usually seen in the older age group of 70 years plus.  The differential diagnosis being long standing oesophageal stricture, cancer, an adjacent pressure from an enlarged aorta or presbyoesophagus.

 

^ Nutcracker Oesophagus

Or hyperperistalsis.  A variety of dysmotility causing an oesophageal cramping pain where the normal peristaltic squeezing is recorded to be powerful and prolonged in duration.

With the advent of modern manometric techniques this is now recognised as the most common of the 'primary' motility disorders.

 

^ Diffuse Oesophageal Spasm

A gross disorder of oesophageal motility where a swallow produces uncoordinated muscle responses or spasms and multiple squeezing events may arise spontaneously. Passage of solid food may be difficult and chest pain can arise both during meals and at any time of the day.

 

^ Presbyoesophagus

With age, the oesophagus can lose the normal peristaltic sequencing or become weak. It can result in poor oesophageal transit of food but is rarely painful.

 

^ Scleroderma

A systemic disease which affects the connective tissues of the body.  The oesophageal manifestations of scleroderma are weakness of peristalsis and a weakness at the lower sphincter zone which predisposes to significant acid reflux.  Symptoms may be both of poor transit of food (dysphagia) or heartburn.

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Oesophageal Diagnostic Services

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PO Box 385, Milsons Point  NSW  2061