Match each clinical presentation and characteristic high-resolution esophageal manometry finding to the most appropriate esophageal motility disorder.
- Progressive dysphagia to solids and liquids; manometry reveals absent esophageal peristalsis and incomplete lower esophageal sphincter (LES) relaxation.Achalasia
- Intermittent noncardiac chest pain and dysphagia; manometry reveals premature, simultaneous distal esophageal contractions with normal LES relaxation.Distal esophageal spasm
- Severe chronic gastroesophageal reflux and dysphagia; manometry reveals absent peristalsis in the lower two-thirds of the esophagus and profoundly decreased LES resting pressure.Systemic sclerosis (Scleroderma)
- Intense episodic retrosternal chest pain; manometry reveals extreme high-amplitude, prolonged peristaltic contractions with normal LES relaxation.Hypercontractile (Jackhammer) esophagus
Cevap
Absent peristalsis/incomplete LES relaxation matches with Achalasia; premature/simultaneous contractions matches with Distal esophageal spasm; absent lower peristalsis/low LES pressure matches with Systemic sclerosis; extreme high-amplitude contractions matches with Hypercontractile esophagus.
Each motility disorder possesses a distinct manometric signature. Achalasia causes aperistalsis and incomplete LES relaxation. Distal esophageal spasm causes simultaneous contractions with a normal LES. Systemic sclerosis causes aperistalsis in the smooth muscle and a low LES pressure. Hypercontractile esophagus causes high-amplitude coordinated peristalsis.
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Anahtar Kavram
Diagnosis of esophageal motility disorders relies on evaluating both the contraction pattern of the esophageal body and the relaxation capacity of the lower esophageal sphincter on high-resolution manometry.