الفهرس 
General methods of oesophageal investigationsOnly 14 pages are availabe for public view
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Abstract
The oesophagus is a muscular tube serves as
a conduit for the passage of food from the pharynx
to the stomach. Separating its lower end from the
stomach is a zone of increased pressure that acts
as a barrier to reflux of stomach contents but
allows materials to pass in both directions.
The act of swallowing is accomplished by the
coordinated movement of striated muscles and the
striated and smooth musculature of the tubular
oesophagus, all under central control.
Each individual has an unique swallowing pattern
and the increasingly widespread use of various
oesophageal function tests has clarified the nature
of a variety of oesophageal motility disorders.
As a result, most benign conditions of the oesophagus
can now be classified according to their specific
abnormal motility pattern.
The oesophageal motility disorders classified
according to the system affected to; diseases affect
the upper oesophageal sphincter and those involving
the body of the oesophagus and lower oesophageal
sphincter.
..Upper oesophageal dysphagia may follow certain
lessions of the central nervous system; muscular
diseases due to impairment of pharyngeal contractions
and after extensive operations on the oropharynx,
presumbly because of impaired function of the cricopharyngeus
muscle. ”Spasm” or hypertension of the
upper oesophageal sphincter is another possible
cause of oropharyngeal dysphagia. The most common
entity responsible for upper oesophageal dysphagia
is pharyngo-oesophageal diverticulum or Zenker’s
diverticulum. Cricopharyngeal myotomy has played
an increasing role in the management of abnormalities
of function of the upper oesophageal sphincter.
More is known about the abnormalities affecting
the body of the oesophagus and its lower sphincter
than about those of the upper sphincter, hence,
this rather arbitary division in the classification.
A further division into abnormalities of function
characterized by hypo-and-hypermotility is useful
for it has clinical and therapeutic implication.
Even so, many major gaps in our knowledge remain
regarding the function of the body and the lower
sphincter, as indicated by the number of conditions
listed under ”miscellaneous” which ·reflects the
complixity of the response of this part of the
oesophagus to a wide variety of conditions.
Oesophageal achalasia is a disease of unknown
origin characterized by the absence of peristalsis
in the body of the oesophagus, failure of or incom(
plete relaxation of the lower oesophageal sphincter
in response to swallowing and a. higher than normal
resting lower oesophageal sphincter pressure. Surgical
treatment provides a higher success rate and
long lasting relief of dysphagia than forceful
dilation.
One of the most common abnormalities of oesophageal
function is gastro-oesophageal reflux secondary
to hypotension of the lower oesophageal sphincter.
Hypotensive lower oesophageal sphincter exists
in a variety of conditions, probably the most Common
of which is sliding oesophageal hiatus hernia.
The diagnosis of gastro-oesophageal reflux secondary
to hypotensive lower oesophageal sphincter is based
on clinical, roentogenographic, endoscopic and
manometric criteria. Objective evidence of gastrooesophageal
reflux must be sought in such patients
because the symptoms may not always definitive
to confirm the diagnosis. Probably the most sensitive
test for reflux is the pH reflux test, with manometry
and cinefluorography being less reliable indexes.
Treatment is primarily medical and is designed
to minimize the occasions of reflux and its effects
by reducing gastric acids. In a small percentage
of patients, surgical treatment in the form of
aifantireflux poceduros required.
Hypermotility disturbances of the oesophagus
(137)
are less common than hypomotility disturbances.
Most frequently encountered is diffuse spasm of
the oesophagus, a functional abnormality that may
or may not be associated with elevated lower oesophageal
sphincter pressures. Manometric studies usually
identify the abnormality as restricted to the lower
two third of the oesophagus. The deglutitory peristaltic
front is usually lost and is replaced by
simultaneous, repetitive, prolonged contractions
of great amplitude that may occur spontaneously.
Medical treatment. is usually unavailing although
some success has been reported with nitroglycerine.
Dilatation has been successful in some patients.
Surgical treatment in the form of oesophagomyotomy
has been useful in relieving the symptoms of pain
and dysphagia.
Vigorous achalasia and Chagas disease does not
follbw any classifications. Manometric character
in vigorous achalasia, are simultaneous oesophageal
contractions frequently of high amplitude occur in
response to swallowing symptomatic disturbance of
oesophageal motility found soon after acute phase
of Chagas disease.