From the Research
Introduction to Patulous Esophagus
A patulous esophagus refers to a condition where the esophagus remains open or dilated, rather than being in its normal, collapsed state. This condition can be associated with various esophageal disorders, including gastroesophageal reflux disease (GERD) 1 and esophageal hypomotility 2.
Pathophysiology and Diagnosis
The pathophysiology of a patulous esophagus is complex and involves the interplay of various factors, including esophageal motility, lower esophageal sphincter (LES) function, and gastroesophageal reflux 3. Diagnosis of a patulous esophagus can be made using various techniques, including endoscopy, esophageal manometry, and impedance-pH monitoring 1, 3.
Clinical Presentation and Management
Patients with a patulous esophagus may present with symptoms such as dysphagia, regurgitation, and chest pain 2, 4. Management of a patulous esophagus depends on the underlying cause and may involve lifestyle modifications, medication, and surgery. Prokinetic agents, such as serotonergic agents, may be used to improve esophageal motility 2. In some cases, botulinum toxin injection may be used to treat hypercontractile esophageal disorders 5.
Treatment Options
Treatment options for a patulous esophagus include:
- Lifestyle modifications, such as weight loss and smoking cessation 1
- Medication, such as proton pump inhibitors (PPIs) and prokinetic agents 1, 2
- Surgery, such as laparoscopic fundoplication and peroral endoscopic myotomy (POEM) 1, 4
- Botulinum toxin injection, which may be used to treat hypercontractile esophageal disorders 5
Dosing Information
The dosing of medication for a patulous esophagus may vary depending on the specific condition and treatment goals. For example, omeprazole 20 mg once daily may be used as initial therapy for GERD 1. Prokinetic agents, such as buspirone, may be used at a dose of 10-30 mg three times daily 2.
Differential Diagnosis and Caveats
A patulous esophagus should be differentiated from other esophageal disorders, such as achalasia and esophageal stricture 4. It is also important to consider the potential risks and benefits of treatment, including the risk of adverse effects from long-term PPI use 1.