ASGE Adult and Pediatric Gastroenterology and Endoscopy Board Preparatory and Review Course | 2022-Knots

Knots_Motilty Disorders of the GI tract

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This document is a summary of a presentation on motility disorders of the gastrointestinal (GI) tract. The presentation covers various questions and cases related to motility disorders, their diagnosis, and management.<br /><br />One case described a 64-year-old woman with dysphagia and weight loss. The next best step in management was determined to be esophageal manometry. Achalasia, a major esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter, was discussed. Useful tests for diagnosing achalasia include esophagram and upper endoscopy. Treatment options include medical management with calcium channel blockers and nitrates, mechanical dilation, chemical paralysis with botulinum toxin, and surgical or endoscopic myotomy.<br /><br />Another case involved a 68-year-old woman with progressive dysphagia. The next step in management was referral for a Heller myotomy. This case was of pseudoachalasia, which is caused by a tumor or compressive device at the gastroesophageal junction.<br /><br />The presentation also covered gastroparesis, a chronic condition characterized by delayed gastric emptying. The diagnosis is made through history and physical examination along with tests such as gastric emptying scintigraphy. Nutritional support and medical management with prokinetic medications are key in the treatment of gastroparesis.<br /><br />Constipation, specifically defecatory disorders, was discussed as well. Anorectal manometry is used for diagnosis, and biofeedback therapy is an effective treatment option. Conservative management involves dietary modifications and fiber supplementation.<br /><br />The presentation also touched on fecal incontinence, its evaluation, and treatment options such as biofeedback therapy and sacral nerve stimulation.<br /><br />Lastly, gastroesophageal reflux disease (GERD) in systemic sclerosis was mentioned. The characteristic findings on esophageal manometry in this case would be weak peristalsis with a hypotensive lower esophageal sphincter. Lifestyle measures and optimizing medical therapy are crucial in the management of GERD in systemic sclerosis.<br /><br />Overall, the presentation provides valuable information on the diagnosis and management of various motility disorders of the GI tract.

Keywords

motility disorders

gastrointestinal tract

diagnosis

management

esophageal manometry

achalasia

gastroparesis

constipation

biofeedback therapy

GERD