Motility Disorders – MCQs
A. Second week of gestation
B. Third week of gestation
C. Fourth week of gestation
D. Fifth week of gestation
ANSWER – B
Third week of gestation
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Esophagus develops from the cranial portion of the foregut and is recognizable by the third week of gestation.
A. Achalasia Cardia
B. Nutcracker esophagus
C. Diffuse esophageal spasm
D. Hypertensive lower esophageal sphincter
ANSWER – B
Nutcracker esophagus
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High-amplitude contractions of the distal esophagus due to loss of the normal coordination of inner circular layer and outer longitudinal layer smooth muscle contractions.
A. Causes dysphagia to both solid and liquid foods
B. Can cause significant chest pain
C. More common in young females
D. Diagnosis is made by esophageal manometry
ANSWER – C.
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Nutcracker esophagus can affect people of any age but is more common in the sixth and seventh decades of life.
A. 90 mmHg
B. 130 mmHg
C. 160 mmHg
D. 180 mmHg
ANSWER – D.
180 mmHg
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Nutcracker esophagus diagnosis made when pressures exceed 180 mmHg
A. Disorder does not progress
B. Not associated with any complications
C. Surgical intervention required when pressure increases above 160 mmHg on esophageal manometry
D. Only symptomatic treatment
ANSWER – C.
180 mmHg
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Nutcracker esophagus diagnosis made when pressures exceed 180 mmHg.
The disorder does not progress, and is not associated with any complications; as a result, treatment of nutcracker esophagus targets control of symptoms only.
A. Schatzki rings
B. Eosinophilic esophagitis
C. Esophageal webs
D. Tracheoesophageal fistula
ANSWER – A.
Schatzki rings
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Food bolus obstruction is most commonly caused by Schatzki rings, which are mucosal rings of unknown cause in the lower esophagus.
In-Shorts
Esophageal manometry
Esophageal manometry allows separation of esophageal dysmotility into three principal forms-
– Nutcracker esophagus
– Diffuse esophageal spasm
– Hypertensive lower esophageal sphincter.
The term “nutcracker esophagus” comes from the finding of increased pressures during peristalsis, with a diagnosis made when pressures exceed 180 mmHg; this has been likened to the pressure of a mechanical nutcracker.
“steakhouse syndrome,” – food is consumed too fast and becomes stuck in the esophagus.
It is more common in older patients.
This syndrome can be caused by various etiologies: esophageal mechanical narrowing due to esophageal carcinoma, diverticulum, hiatal hernia, or eosinophilic esophagitis; or esophageal motility disturbances including esophageal achalasia, diffuse esophageal spasm, and esophagogastric junction outflow obstruction.
Pathological abnormality with achalasia – destruction of the Auerbach’s plexus
