الفهرس 
Oesophageal Anatomy EmbryologyOnly 14 pages are availabe for public view
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Abstract
Oesophageal motility disorders are defined as the problems in transport to stomach post swallow. They are classified as primary or secondary and hypoprestaltic or hyperprestaltic.
The Pathophysiological processes in secondary motor disorders are relatively well defined.
Classification of primary motor disorders is based on abnormalities of the LOS and oesophageal peristalsis, as recorded by manometry.
Primary motor disorders of the oesophagus affect neural as well as muscular elements of the oesophagus and LOS. It is tempting to speculate that these disorders represent a hypertrophic myopathic state of the oesophagus secondary to LOS dysfunction, and neural dysfunction may be secondary. The relationship between pain and muscle hypertrophy in primary motor disorders is worthy of investigation.
Achalasia of the oesophagus is the best characterised primary motor disorder.
Dysphagia, chest pain, regurgitation and heartburn are symptoms of oesophageal motor disorders whether primary or secondary. Dysphagia of primary oesophageal motor disorders is easier to treat than pain; the latter could be debilitating.
The evaluation of oesophageal motility disorders often begins with endoscopy. Many diagnoses can be made with endoscopy, although it usually require manometry or barium x-ray study for confirmation. With the Oesophageal manometry remaining the gold standard for the assessment of oesophageal motor activity.
Over the past decade, new technologies have been introduced for studying oesophageal function, including intraluminal impedance and ultrasound, whereas conventional techniques, such as manometry, have undergone substantial upgrades because of advances in transducer technology, computerization, and graphic data presentation.
Treatment options for oesophageal motility disorders are pneumatic dilation, botulinum toxin (Botox) injections or laparoscopic Heller myotomy. Diet control, life style modification and psychological support are as well important.
Muscle relaxants acting at the peripheral level do not appear be the answer for treatment of dysphagia and pain of primary motor disorders. On the other hand, blockade of either primary sensory nociceptor at the peripheral level or receptors involved in oesophageal hypersensitivity at the peripheral/central level in the management of oesophageal pain deserves exploration.
Motor abnormalities of the LOS and oesophageal peristalsis are also seen in reflux disease and it is not clear whether they are primary or secondary to reflux disease.