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Chapter: Medicine Study Notes : Gastro-Intestinal


Failure to relax lower sphincter



·        = Failure to relax lower sphincter

·        Symptoms & signs

o  Dysphagia: with both solids and liquids

o  Intermittent chest pain

o  Regurgitation/reflux

o  Weight loss

o  Nocturnal cough (related to regurgitation & aspiration)

·        Investigations

o  Chest x-ray: dilated oesophagus

o  Barium swallow: delayed passage through cardia, oesophageal dilation

o  Endoscopy: may be normal, may be food in oesophagus (® secondary oesophagitis)

o  Manometry: impaired relaxation of lower oesophageal sphincter, absent peristalsis

·        Differential diagnosis

o  Benign or malignant stricture

o  Malignancy at cardia

·        Treatment

o  Medical: nitrates and calcium antagonists ® ¯sphincter pressure

o  Balloon Dilation

o  Botulinus toxin injection

o  Cardiomyotomy

o  Retrosternal pain may continue following treatment.  May need H2 antagonist


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