Case Study for Chapter

Dysphagia

A 51-year-old woman is evaluated for difficulty in swallowing solid foods. She experiences chest pain while attempting to eat and often regurgitates swallowed food. Fluoroscopic examination of a barium swallow reveals a dilated lower esophagus with considerable residual barium remaining after the swallow. A manometric motility study of esophageal motility following a swallow reveals an absence of primary peristalsis in the distal third, without relaxation of contractile tone in the lower esophageal sphincter.

Questions

1. What is the explanation for the woman's dysphagia?

2. What is the most likely explanation for the failure of the lower esophageal sphincter relaxation during the swallow?

3. What are the possible treatments for the woman's condition?

Answers to Case Study Questions for Chapter 26

1. The best explanation for the patient's dysphagia is failure of the lower esophageal sphincter to relax (achalasia).

2. Loss of the ENS in the region of the lower esophageal sphincter and gastric cardia is the histoanatomic hallmark of lower esophageal sphincter achalasia. Failure of the sphincter to relax reflects the loss of inhibitory motor innervation of the sphincteric muscle.

3. There are several possible treatments. The time-tested treatment is pneumatic dilation of the lower esophageal sphincter, by placing a balloon in the lumen of the sphincter. Phar macological approaches include calcium channel blockers (e.g., nifedipine) to relax the smooth muscle of the sphincter, and local endoscopic injection of botulinum toxin, an inhibitor of ACh release from nerve terminals.

Reference

Richter JE. Motility disorders of the esophagus. In: Yamada T,

Alpers DH, Owyang C, Powell DW, Silverstein FE, eds. Textbook of Gastroenterology. 2nd Ed. Philadelphia: Lippincott,

1995;1174-1213.

Relaxation Audio Sounds Lazy Summer Day

Relaxation Audio Sounds Lazy Summer Day

This is an audio all about guiding you to relaxation. This is a Relaxation Audio Sounds with sounds from Lazy Summer Day.

Get My Free MP3 Audio


Post a comment