Etiology of Motility Disorders in EA and CES
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The etiology of esophageal dysfunction in cases of CES after repair of EA is complex; it may be due to CES or EA each alone or in combination. An acquired origin and a congenital origin were proposed. An acquired etiology is due to surgical intervention with extensive dissection or injury to vagal nerves. Congenitally, there are abnormal intrinsic and extrinsic nerve supplies in the atretic esophagus. The problem can become more severe when a structural pathology (esophageal stricture or CES) is superimposed on the underlying disordered motility. Clinical evaluation, esophagogram and manometry are used to evaluate the anatomy and motor function of the esophagus and the esophagogastric junction (EGJ). Manometry is the diagnostic tool of choice. Pressure-flow analysis (PFA) was introduced to allow for integrated analysis of simultaneously recorded esophageal motility and bolus flow.
The primary motility disorder is due to abnormal development of the esophageal muscles or to the innervations of the esophagus whether extrinsic or intrinsic. The secondary motility disorder is caused by surgery and GER. The tertiary motility disorder is caused by structural pathology due to anastomotic stricture or CES or peptic stricture due to GER.
KeywordsCongenital esophageal stenosis Esophageal atresia Esophageal motility disorder
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