Motility Disorders

Motility disorders of the esophagus can be divided into three groups:

1. Achalasia

2. Diffuse esophageal spasm

Table 10.1. Staging for esophageal carcinoma

Primary Tumor (T)

TX Primary tumor cannot be assessed (cytologically positive tumor not evident endoscopically or radiographically) TO No evidence of primary tumor (e.g., after treatment with radiation and chemotherapy) Tis Carcinoma in situ

T1 Tumor invades lamina propria or submucosa, but not beyond it

T2 Tumor invades muscularis propria T3 Tumor invades adventitia

T4 Tumor invades adjacent structures (e.g., aorta, tracheobronchial tree, vertebral bodies, pericardium)

Regional Lymph Nodes (N)

NX Regional nodes cannot be assessed NO No regional node metastasis N1 Regional node metastasis

Distant Metastasis (M)

M1 Distant metastasis

Stage Grouping

Stage IIA T2, NO, MO T3, NO, MO Stage IIB Tl, Nl, MO T2, Nl, MO Stage III T3, Nl, MO

3. Nutcracker esophagus

4. Hypertensive lower esophageal sphincter

Achalasia

Achalasia is characterized by esophageal aperstalisis, esophageal dilatation and failure of the lower esophageal sphincter to relax (Fig. 10.1).

Incidence

The incidence of achalasia in the US is 1/100,000; however this number may actually underestimate the true incidence.

Etiology

While the precise etiology of achalasia remains elusive, various theories have been proposed including infectious sources and heredity.

Pathophysiology

The development of achalasia is presumed secondary to neurodegeneration. Degeneration in the vagus nerve and Auerbach plexus have been shown histologically.

Figure 1O.1. Management of achalasia.

This results in hypertension of the LES and increased esophageal pressure with loss of perstalsis.

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