EoE ToT Module 4 References-Mittal et al NEJM 2020 Esophageal motility disorders and GERD

Mittal et al NEJM 2020 Esophageal motility disorders and GERD

Pdf Summary

This review article delves into esophageal motility disorders and gastroesophageal reflux disease (GERD), examining their pathophysiology, diagnosis, and management. GERD, affecting 18-28% of North Americans, is the second most common gastrointestinal condition in ambulatory care, following abdominal pain. Common GERD symptoms include dysphagia, heartburn, regurgitation, and chest pain, and complications can involve strictures, Barrett’s esophagus, and esophageal adenocarcinoma. GERD treatments in 2015 alone cost $18.1 billion, primarily for acid-inhibition therapies.<br /><br />The article outlines the anatomy and function of the lower esophageal sphincter (LES) and crural diaphragm, emphasizing their roles in preventing reflux. The LES consists of smooth muscle, while the crural diaphragm is skeletal muscle, and both work in tandem to facilitate esophageal closure and prevent reflux. Factors like neural innervation and muscle architecture impact their functionality, central to understanding related disorders.<br /><br />Esophageal motility relies on coordinated muscle activities managed by the myenteric plexus, equipped with excitatory and inhibitory neurons. Peristalsis involves sequential contraction and relaxation, aiding bolus movement.<br /><br />Esophageal motility disorders are classified into primary (idiopathic) and secondary (systemic disease-related) types. Primary disorders include achalasia, esophagogastric junction outflow obstruction, distal esophageal spasm, and hypercontractile esophagus. Secondary disorders stem from conditions like scleroderma, diabetes, and neoplastic infiltrations. High-resolution manometry (HRM) is pivotal for diagnosing motility disorders, revealing contraction vigor, latency, and LES relaxation issues.<br /><br />Treatment for motility disorders varies by severity, ranging from pharmaceutical interventions to surgical procedures like pneumatic dilation and peroral endoscopic myotomy. GERD management involves acid suppression via proton-pump inhibitors and lifestyle modifications. Advanced diagnostic tools, including functional lumen imaging probe systems and impedance-pH monitoring, enhance treatment precision.<br /><br />Understanding these disorders' multifaceted pathogenesis and employing advanced diagnostics and tailored therapies can significantly improve patient outcomes.

Keywords

esophageal motility disorders

GERD

pathophysiology

diagnosis

management

lower esophageal sphincter

high-resolution manometry

achalasia

proton-pump inhibitors

peroral endoscopic myotomy