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DYSKINESIA OF OESOPHAGUS

UNDERSTANDING THE PROBLEM

The oesophagus is the tube that conveys food from the throat down to the stomach. Abnormal involuntary movements (AIMs) or dyskinesia of the oesophagus and also refrred to as oesophageal motility disorder, can be characterized by various symptoms and causes which have different mechanisms and modalities of treatment. Common examples of dyskinesia include tremor (tremors), chorea (uncontrolled movements), dystonia (muscular spasms) and myoclonus (spasmodic jerky contraction of muscles). Dyskinesia of the digestive tract specifically affects the tone and peristalsis of the digestive organs with smooth muscles like the oesophagus, stomach, biliary tract and intestines.

UNDERSTANDING WHO SUFFERS

The precise cause of dyskinesia is unknown. Possible factors involved are abnormalities in the nervous system; visceral hypersensitivity; gastro-oesophageal reflux (GERD) and smooth muscle thickening in the oesophageal wall
Causes of primary dyskinesia has been found in conjunction with other disorders including:

  • neurotic state, anxiety or depression
  • psycho-emotional stress situations (acute and chronic)
  • diabetes mellitus
  • hysteria
  • hereditary abnormalities of the neuromuscular system of the oesophagus
  • chronic alcoholism, alcoholic neuropathies
  • age-related changes
  • pseudo-obstruction, amyloidosis and scleroderma
POTENTIAL SIGNS AND SYMPTOMS

Symptoms can vary and can include:

  • Chest pain: Because the heart and oesophagus are in such close proximity, distinguishing oesophageal pain from cardiac pain can be difficult and oesophageal spasm is often initially diagnosed as angina pectoris. Oesophageal spasm can cause episodes of severe, crushing, retrosternal pain.
  • Pain may increase after eating, maybe gripping, pressing or stabbing. It is usually felt in the anterior chest, throat or epigastrium and can radiate to the neck, back or upper arms, as with cardiac chest pain.
  • Reflux-related symptoms - e.g., heartburn, regurgitation, cough and hoarseness.
  • General Difficulty swallowing liquids and solids
  • Unintentional weight loss
EXAMINATIONS USUALLY REQUIRED

Physical exam may show signs of anaemia or malnutrition.

Tests include:

  • Manometry, a test to measure how well the esophagus is working.
  • EGD or upper endoscopy, a test to examine the lining of the stomach and esophagus. It uses a flexible tube and camera.
  • Upper GI x-ray.
PROPOSING TREATMENT AND WHY AIMIS

The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids to pass easily into the stomach. Therapy may involve:

    • Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
    • Medicines, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
    • Surgery called a myotomy. In this procedure, the lower sphincter muscle is cut.
    • Widening (dilation) of the esophagus at the location of the narrowing.

A Myotomy also known as Heller Myotomy is most frequently performed using minimally invasive techniques (laparoscopic or robotic ) using small incisions although it can also be performed through an open incision in the abdomen or the left side of the chest between the ribs. The surgeon will cut the affected muscles in the esophagus and stomach to make it easier for food to reach the stomach.

AIMIS is an expert in Da Vinci Minimal invasive robotic Myotomy and Single Site ® Heller Myotomy and provides advanced techniques offering many advantages over standard laparoscopy such as:

      • Greater precision using wristed surgical instruments.
      • Virtually scar less surgery in Single site surgery with single incision through the belly button
      • Better margins with potential less disruption to surrounding tissue
      • Patient that are treated with a robotic myotomy will typically leave the hospital in one to two days and able to return to their normal activities within a week.

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

The two main presenting symptoms in Dykinesia and other esophageal motility disorders are dysphagia and chest pain. Several esophageal motility disorders (eg, nutcracker esophagus) have manometric findings that are often associated with gastroesophageal reflux disease (GERD), causing these disorders to potentially overlap with GERD. Nevertheless, the main symptoms remain dysphagia and chest pain.

FURTHER INFORMATION ON INCREASED RISK GROUPS

Esophageal spasm refers to uncoordinated muscle contractions or contractions of excessive amplitude in the tube (esophagus) that leads from the throat to the stomach. The contractions occur repeatedly and are abnormally powerful. This results in a failure to effectively propel food down into the stomach after being swallowed.

There are two main variants of esophageal spasm: diffuse esophageal spasm (with simultaneous or quickly propagated contractions of normal amplitude, but uncoordinated) and hypertensive peristalsis (nutcracker esophagus—coordinated contractions of excessive amplitude). The hyper contractile esophagus (jackhammer esophagus) is an extreme phenotype of hypertensive contractions (with contractions of extreme amplitude and long duration in most of the esophagus) (Malas).

The exact cause of esophageal spasm is unknown; however, risk factors include irritation of the esophagus by acid that washes up from the stomach (reflux esophagitis), obstructions in the esophagus, emotional stress or psychiatric disorders, or other conditions that may affect the normal function of the nervous system (e.g., diabetes, multiple sclerosis, amyotrophic lateral sclerosis). Esophageal spasm may also be related to an inability of the muscles in the lower esophagus to relax (achalasia).

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

These disorders are usually suspected based on symptoms and imaging modalities (esophagogastroduo-denoscopy or upper gastrointestinal radiography), but most of these motility disorders are diagnosed, defined, and labeled based on manometric findings.

The diagnosis by manometry must be correlated with the presentation when deciding therapy. The patients must have not only the manometric findings but also the clinical and radiologic findings to support the condition before treatment.

Tests therefore can include:

  • X-ray of upper digestive system: known as a barium swallow or upper GI series s-ray, this procedure involves drinking a chalky liquid those coats and fills the inside lining of the digestive tract. Then X-rays are taken of the upper digestive tract. This allows observation of a silhouette of the esophagus, stomach and upper intestine (duodenum).
  • Endoscopy is a way to visually examine the inside of the esophagus and stomach. During endoscopy, a thin, flexible tube equipped with a light and camera (endoscope) in inserted down the throat.
  • Esophageal motility testing (manometry) measures movement and pressure in the esophagus. The test involves placing a catheter through the nose and into the esophagus.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Upper Gastrointestinal Problems including:
Fundoplication Surgery, Minimally Invasive Heller Myotomy Surgery, Subtotal Gastrectomy Esophageal Stent Placement, Esophageal Surgical Repair, Esophagectomy, Esophagus Replacement and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Upper Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • High patient satisfaction
  • Minimal pain
OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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