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Heller myotomy is a surgical procedure [1] in which the muscles of the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach.It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
For reflux esophagitis, a fundooplication can be done to help strengthen the lower esophageal sphincter from allowing backflow of the stomach into the esophagus. For esophageal stricture, a gastroenterologist can perform a dilation of the esophagus. As of 2020 evidence for magnetic sphincter augmentation is poor. [11]
Nutcracker esophagus is characterized by high-amplitude peristaltic contractions that are frequently prolonged and cause dysphagia and chest pain. [6] HLES (hypertensive lower esophageal sphincter) is a rare manometric abnormality seen among individuals with dysphagia, chest pain, gastroesophageal reflux, and hiatal hernia. [7]
Myotomy is a surgical procedure that involves cutting a muscle to relieve constriction, often performed in the gastrointestinal or urological systems. The procedure can alleviate symptoms caused by muscle-related functional obstructions, particularly in cases of achalasia, a disorder that affects the esophagus.
It is a strap-like, C-shaped muscle at the base of the throat, behind the larynx. The upper esophageal sphincter encircles the proximal (upper) opening of the oesophagus. [9] The upper esophageal sphincter has a residual tone which is in fact augmented as it is stretched open. [10] Swallowing of air during eating and drinking is normal.
The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.
DES and nutcracker esophagus present similarly and can may require esophageal manometry for differentiation. [3] When the coordinated muscle contraction are irregular or uncoordinated, this condition may be called diffuse esophageal spasm. These spasms can prevent food from reaching the stomach where food gets stuck in the esophagus.
The circular muscle layer prevents food from travelling backward and the longitudinal layer shortens the tract. The thickness of the muscular layer varies in each part of the tract: In the colon, for example, the muscular layer is much thicker because the faeces are large and heavy and require more force to push along.