Esophageal motility disorder

Last updated
Esophageal motility disorder
Other namesEsophageal dysmotility (ED)
Diagnostic method Esophageal motility study
Functional Lumen Imaging Probe
Treatmenttreatment depends on cause

An esophageal motility disorder (EMD) is any medical disorder resulting from dysfunction of the coordinated movement of esophagus, which causes dysphagia (i.e. difficulty in swallowing, regurgitation of food). [1]

Contents

Primary motility disorders are: [1]

An esophageal motility disorder can also be secondary to other diseases. [1] For example, it may be a result of CREST syndrome, referring to the five main features: calcinosis, Raynaud syndrome, esophageal dysmotility, sclerodactyly and telangiectasia. [2]

Symptoms

The most common symptom of esophageal motility disorders is dysphagia. Compared to causes of mechanical obstruction, which usually coincide with difficulties only with solids, dysphagia occurs in both solid foods and liquids. Heartburn, odynophagia, chest pain, and dyspnea are frequent symptoms of esophageal motility disorders, as they are in other esophageal disorders. Advanced achalasia is characterized by regurgitation of previously swallowed, undigested food material. Individuals with diffuse esophageal spasm or nutcracker esophagus, due to disordered peristalsis propagation, may experience severe chest pain and dysphagia, mimicking cardiac ischemia. [3]

Achalasia's most common symptoms include dysphagia (difficulty swallowing solids and liquids), regurgitation of undigested food, respiratory issues (aspiration and nocturnal cough), chest pain, and weight loss. [4]

Diffuse esophageal spasm (DES) is a motility disorder characterized by recurrent episodes of chest pain or dysphagia as well as nonpropulsive (tertiary) contractions on radiographs. [5]

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]

Diagnosis

Testing to diagnose EMD includes barium esophagography, upper endoscopy, and esophageal manometry. [8]

Treatment

There is no cure for EMD, but symptoms can be managed. Some symptom management includes eating slower and taking smaller bites; in some cases medications can be useful to manage other issues that contribute to EMD such as a proton pump inhibitor to ease gastroesophageal reflux (acid reflux), or a smooth muscle relaxant for issues with the muscles. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Esophagus</span> Vertebrate organ through which food passes to the stomach

The esophagus or oesophagus, colloquially known also as the food pipe, food tube, or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. The esophagus is a fibromuscular tube, about 25 cm (10 in) long in adults, that travels behind the trachea and heart, passes through the diaphragm, and empties into the uppermost region of the stomach. During swallowing, the epiglottis tilts backwards to prevent food from going down the larynx and lungs. The word oesophagus is from Ancient Greek οἰσοφάγος (oisophágos), from οἴσω (oísō), future form of φέρω + ἔφαγον.

<span class="mw-page-title-main">Esophageal achalasia</span> Inability of the sphincter between the esophagus and stomach to open

Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease. The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in. It closes to avoid stomach acids from coming back up. A fully understood cause to the disease is unknown, as are factors that increase the risk of its appearance. Suggestions of a genetically transmittable form of achalasia exist, but this is neither fully understood, nor agreed upon.

Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD).

Heller myotomy is a surgical procedure in which the muscles of the cardia 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.

<span class="mw-page-title-main">Dysphagia</span> Difficulty in swallowing

Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.

<span class="mw-page-title-main">Gastroesophageal reflux disease</span> Flow of stomach contents into the esophagus

Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. In the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise.

<span class="mw-page-title-main">Esophageal motility study</span> Medical test

An esophageal motility study (EMS) or esophageal manometry is a test to assess motor function of the upper esophageal sphincter (UES), esophageal body and lower esophageal sphincter (LES).

<span class="mw-page-title-main">Hiatal hernia</span> Entrance of abdominal organs into the middle chest through the diaphragm

A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction.

<span class="mw-page-title-main">Nissen fundoplication</span> Surgical procedure to treat gastric reflux and hiatal hernia

A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.

<span class="mw-page-title-main">CREST syndrome</span> Connective tissue disorder

CREST syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder. The acronym "CREST" refers to the five main features: calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.

Esophageal dysphagia is a form of dysphagia where the underlying cause arises from the body of the esophagus, lower esophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problems.

<span class="mw-page-title-main">Schatzki ring</span> Narrowing of the lower esophagus due to mucosal or muscular tissue

A Schatzki ring or Schatzki–Gary ring is a narrowing of the lower esophagus that can cause difficulty swallowing (dysphagia). The narrowing is caused by a ring of mucosal tissue or muscular tissue. A Schatzki ring is a specific type of "esophageal ring", and Schatzki rings are further subdivided into those above the esophagus/stomach junction, and those found at the squamocolumnar junction in the lower esophagus.

Esophageal spasm is a disorder of motility of the esophagus.

<span class="mw-page-title-main">Nutcracker esophagus</span> Excessively strong or long contractions of the esophagus

Nutcracker esophagus, jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration. Nutcracker esophagus is one of several motility disorders of the esophagus, including achalasia and diffuse esophageal spasm. It causes difficulty swallowing (dysphagia) with both solid and liquid foods, and can cause significant chest pain; it may also be asymptomatic. Nutcracker esophagus can affect people of any age but is more common in the sixth and seventh decades of life.

<span class="mw-page-title-main">Diffuse esophageal spasm</span> Uncoordinated contractions of the esophagus

Diffuse esophageal spasm (DES), also known as distal esophageal spasm, is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may cause symptoms such as chest pain, similar to heart disease. In many cases, the cause of DES remains unknown.

<span class="mw-page-title-main">Esophageal disease</span> Medical condition

Esophageal diseases can derive from congenital conditions, or they can be acquired later in life.

Cricopharyngeal spasms occur in the cricopharyngeus muscle of the pharynx. Cricopharyngeal spasm is an uncomfortable but harmless and temporary disorder.

<span class="mw-page-title-main">Esophageal intramural pseudodiverticulosis</span> Medical condition

Esophageal intramucosal pseudodiverticulosis (EIPD) is a rare condition wherein the esophagus wall develops numerous small outpouchings (pseudodiverticulae). Individuals with the condition typically develop difficulty swallowing. The outpouchings represent the ducts of the submucosal glands of the esophagus. It typically affects individuals in their sixth and seventh decades of life. While it is associated with certain chronic conditions, particularly alcoholism, diabetes and gastroesophageal reflux disease, the cause of the condition is unknown. Treatment involves medications to treat concomitant conditions such as reflux esophageal spasm, and dilation of strictures in the esophagus.

Functional Lumen Imaging Probe (FLIP) is a test used to evaluate the function of the esophagus, by measuring the dimensions of the esophageal lumen using impedance planimetry. Typically performed with sedation during upper endoscopy, FLIP is used to evaluate for esophageal motility disorders, such as achalasia, diffuse esophageal spasm, etc.

Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by increased pressure where the esophagus connects to the stomach at the lower esophageal sphincter. EGJOO is diagnosed by esophageal manometry. However, EGJOO has a variety of etiologies; evaluating the cause of obstruction with additional testing, such as upper endoscopy, computed tomography, or endoscopic ultrasound may be necessary. When possible, treatment of EGJOO should be directed at the cause of obstruction. When no cause for obstruction is found, observation alone may be considered if symptoms are minimal. Functional EGJOO with significant or refractory symptoms may be treated with pneumatic dilation, per-oral endoscopic myotomy (POEM), or botulinum toxin injection.

References

  1. 1 2 3 Goyal, Manjeet; Nagalli, Shivaraj (2023), "Esophageal Motility Disorders", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32965826 , retrieved 2023-10-20
  2. ↑ Winterbauer RH (1964). "Multiple telangiectasia, Raynaud's phenomenon, sclerodactyly, and subcutaneous calcinosis: a syndrome mimicking hereditary hemorrhagic telangiectasia". Bulletin of the Johns Hopkins Hospital 114: 31–83. PMID   14171636.
  3. ↑ Guth, Todd A. (2013). "Esophageal Disorders". Emergency Medicine. Elsevier. pp. 269–278.e1. doi:10.1016/b978-1-4377-3548-2.00031-8. ISBN   978-1-4377-3548-2 . Retrieved November 18, 2023.
  4. ↑ Boeckxstaens, G.E.E. (2007). "Achalasia". Best Practice & Research Clinical Gastroenterology. 21 (4). Elsevier BV: 595–608. doi:10.1016/j.bpg.2007.03.004. ISSN   1521-6918 . Retrieved November 18, 2023.
  5. ↑ Almansa, Cristina; Hinder, Ronald A.; Smith, C. Daniel; Achem, Sami R. (December 11, 2007). "A Comprehensive Appraisal of the Surgical Treatment of Diffuse Esophageal Spasm". Journal of Gastrointestinal Surgery. 12 (6). Springer Science and Business Media LLC: 1133–1145. doi:10.1007/s11605-007-0439-x. ISSN   1091-255X. PMID   18071832. S2CID   20620057 . Retrieved November 18, 2023.
  6. ↑ Horton, Marshall L.; Goff, John S. (1986). "Surgical treatment of nutcracker esophagus". Digestive Diseases and Sciences. 31 (8). Springer Science and Business Media LLC: 878–883. doi:10.1007/bf01296058. ISSN   0163-2116. PMID   3731979. S2CID   24020786 . Retrieved November 18, 2023.
  7. ↑ Gad El-Hak, NabilA; Mostafa, Mohamed; AbdelHamid, Hussein; Haleem, Magdy (2006). "Hypertensive lower esophageal sphincter (HLES): Prevalence,symptoms genesis and effect of pneumatic balloon dilatation". Saudi Journal of Gastroenterology. 12 (2). Medknow: 77. doi: 10.4103/1319-3767.27850 . ISSN   1319-3767. PMID   19858590 . Retrieved November 18, 2023.
  8. 1 2 McQuaid, Kenneth (2022). Current Medical Diagnosis & Treatment 2022. McGraw Hill.
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