A report on Esophageal achalasia and Esophageal motility study

A chest X-ray showing achalasia ( arrows point to the outline of the massively dilated esophagus )
Diagram of esophageal motility study in 'nutcracker esophagus'. The disorder shows peristalsis with high pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 seconds.
Transhiatal oesophagectomy specimen from a patient suffering from late-stage achalasia. Diverticulum at the left lower end of the oesophagus.
An axial CT image showing marked dilatation of the esophagus in a person with achalasia.
"Bird's beak" appearance and "megaesophagus", typical in achalasia.
Schematic of manometry in achalasia showing aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.
Image of a stomach which has undergone Fundoplomy

These include achalasia, diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter.

- Esophageal motility study

Diagnosis is reached with esophageal manometry and barium swallow radiographic studies.

- Esophageal achalasia
A chest X-ray showing achalasia ( arrows point to the outline of the massively dilated esophagus )

3 related topics with Alpha

Overall
Normal peristalsis in time space graph. Nutcracker esophagus shows higher amplitude contractions (Z-axis) that take longer to pass (X-axis)

Nutcracker esophagus

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Disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.

Disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration.

Normal peristalsis in time space graph. Nutcracker esophagus shows higher amplitude contractions (Z-axis) that take longer to pass (X-axis)
Diagram of esophageal motility study in nutcracker esophagus: The disorder shows peristalsis with high-pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 sec.
Normal esophagus in (A). Nutcracker esophagus in (C): high-pressure waves in blue; cross-sectional areas (CSA) in fucsia.

Nutcracker esophagus is one of several motility disorders of the esophagus, including achalasia and diffuse esophageal spasm.

The diagnosis is made by an esophageal motility study (esophageal manometry), which evaluates the pressure of the esophagus at various points along its length.

The digestive tract, with the esophagus marked in red

Dysphagia

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Difficulty in swallowing.

Difficulty in swallowing.

The digestive tract, with the esophagus marked in red

Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids.

Esophageal motility study is useful in cases of esophageal achalasia and diffuse esophageal spasms.

A time-space diagram of a peristaltic wave after a water swallow. High-pressure values are red, zero pressure is blue-green. The ridge in the upper part of the picture is the high pressure of the upper esophageal sphincter which only opens for a short time to let water pass.

Peristalsis

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Radially symmetrical contraction and relaxation of muscles that propagates in a wave down a tube, in an anterograde direction.

Radially symmetrical contraction and relaxation of muscles that propagates in a wave down a tube, in an anterograde direction.

A time-space diagram of a peristaltic wave after a water swallow. High-pressure values are red, zero pressure is blue-green. The ridge in the upper part of the picture is the high pressure of the upper esophageal sphincter which only opens for a short time to let water pass.
A simplified image showing peristalsis
A simplified image showing Earthworm movement via peristalsis

If the bolus gets stuck or moves slower than the primary peristaltic wave (as can happen when it is poorly lubricated), then stretch receptors in the esophageal lining are stimulated and a local reflex response causes a secondary peristaltic wave around the bolus, forcing it further down the esophagus, and these secondary waves continue indefinitely until the bolus enters the stomach. The process of peristalsis is controlled by the medulla oblongata. Esophageal peristalsis is typically assessed by performing an esophageal motility study.

Aperistalsis refers to a lack of propulsion. It can result from achalasia of the smooth muscle involved.