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Zorluk: OrtaGastroenterology and Hepatology

Match each esophageal motility disorder with its characteristic finding on high-resolution esophageal manometry.

  • AchalasiaAbsent distal esophageal peristalsis with incomplete lower esophageal sphincter relaxation
  • Jackhammer esophagusExtremely high-amplitude, prolonged peristaltic contractions in the distal esophagus
  • Distal esophageal spasmSimultaneous, uncoordinated contractions in the distal esophagus with normal lower esophageal sphincter relaxation
  • Systemic sclerosisAbsent peristalsis in the lower two-thirds of the esophagus with severely decreased lower esophageal sphincter resting pressure

Cevap

Achalasia correlates with absent peristalsis and incomplete LES relaxation. Jackhammer esophagus correlates with high-amplitude contractions. Distal esophageal spasm correlates with uncoordinated contractions. Systemic sclerosis correlates with absent distal peristalsis and severely decreased LES pressure.
Each esophageal motility disorder has distinctive high-resolution manometry features reflecting its underlying pathophysiology. Achalasia involves myenteric plexus damage leading to a non-relaxing lower esophageal sphincter and aperistalsis. Systemic sclerosis causes smooth muscle fibrosis, reducing lower esophageal sphincter tone and causing aperistalsis. Distal esophageal spasm is marked by premature, uncoordinated contractions. Jackhammer esophagus is defined by hypercontractile, high-amplitude waves.

Adım Adım Çözüm

1
Identify the primary manometric features of Achalasia.
Loss of inhibitory neurons causes the lower esophageal sphincter to fail to relax, accompanied by aperistalsis.
This establishes the match for Achalasia with absent distal esophageal peristalsis and incomplete LES relaxation.
2
Identify the primary manometric features of Systemic sclerosis.
Smooth muscle fibrosis leads to a weak LES and aperistalsis exclusively in the lower esophagus.
This differentiates it from achalasia by highlighting the presence of a hypotensive, rather than hypertensive or non-relaxing, lower esophageal sphincter.
3
Differentiate between the hypercontractile esophageal disorders.
Distal esophageal spasm features premature or simultaneous uncoordinated contractions, whereas Jackhammer esophagus features normally sequenced but extremely high-amplitude contractions.
This accurately pairs the remaining functional motility disorders with their respective distinct manometric profiles.

Anahtar Kavram

Esophageal Motility Disorders
Tahmini Süre:1m 0s
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Konular

Gastroenterology and Hepatology

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