What Is the Esophagus?
The esophagus is a hollow muscular tube through which the food passes from the throat to the stomach. Muscles in the esophagus propel food down through the abdomen.
What Are Esophageal Motility Disorders?
They are a group of disorders of the esophagus that cause difficulties in swallowing, regurgitation of food contents from the stomach or the esophagus, and painful spasms.
What Are the Types of Esophageal Motility Disorders?
There are different esophageal motility disorders, including spastic esophageal motility disorders. This motility disorder comprises the following:
-
Diffuse Esophageal Spasm: This condition occurs due to painful muscle contractions within the muscular tube connecting the mouth and the stomach. They can feel sudden chest pain that lasts for a few minutes to hours.
-
The Nutcracker Esophagus: It is an abnormality in which the contractions during swallowing are intense.
-
Hypertensive Lower Esophageal Sphincter: It is an uncommon manometric condition found in patients with dysphagia (difficulty in swallowing) characterized by a rapid contraction of the lower esophageal sphincter (a group of muscles forming a lid that acts like a valve).
-
Achalasia: It is a rare disorder that makes it difficult for food and liquid to pass through the muscular tube called the esophagus, which connects the mouth and the stomach.
-
Esophageal Scleroderma: It is a rare progressive disease. In this condition, the lower esophageal muscle stops moving, leading to severe gastroesophageal reflux (a disease that occurs during digestion in which the stomach acid or bile irritates the esophagus lining).
What Are the Advances in the Management of Esophageal Motility Disorders?
-
The widespread adaptation of high-resolution manometry has led to the restructuring of the classification of esophageal motility disorders, widely used for diagnosis. The basic difference between conventional and high-resolution manometry is the number of pressure sensors used and the spacing between them. In contrast to conventional manometry, three to eight sensors are spaced at 3 cm to 5 cm intervals, and high-resolution manometry sensors are typically placed one centimeter apart along the length of the manometric assembly.
-
High-resolution manometry and peroral endoscopic myotomy (POEM) have contributed significantly to esophageal motility disorders in recent years. The peroral endoscopic myotomy enables a transluminal endoscopic approach to determine the histology (the study of the microscopic structure of tissues) of the muscle layer of the esophagus.
What Is Manometry?
It is a test that helps to check whether the esophagus is functioning correctly. After chewing, when the food is swallowed, the esophagus contracts and pushes the food into the stomach. Esophageal manometry measures those contractions, the force, and coordination of esophageal muscles as the food moves down the esophagus.
What Is the Use of This Procedure?
The doctor will recommend this procedure if the person has symptoms of esophageal motility disorders. It provides information about how the food is being moved down the esophagus. It also measures:
-
How well the muscles at the top and bottom of the esophagus open and close.
-
The pressure of the esophageal muscle.
-
Speed of the movements.
-
A pattern of esophageal muscle contractions.
Are There Any Restrictions to Be Followed Before the Procedure?
The patient should not eat or drink after midnight if the test is the following day. If the test is scheduled in the afternoon, the patient can have a light breakfast four hours before the test.
What Happens During This Procedure?
This test takes about 45 minutes to one hour. The technician will verify whether the patient has had anything to eat before. At the start of the test, the patient is seated in an upright position. One nostril is anesthetized with a numbing lubricant or gel.
During this procedure, a thin, flexible tube with pressure sensors measuring about one-eighth inch in diameter is passed through the anesthetized nostril, throat, esophagus, and stomach. Sometimes, the tube is put through the mouth and not the nose. The patient will lie on the back with the tube inside the esophagus. The pressure generated by the esophagus will be measured when the muscle rests and swallows. The technician will ask the patient to swallow some liquid during the test. The patient may be asked to swallow multiple times to measure the lower esophageal sphincter, esophagus, and upper esophageal sphincter. The pressures are recorded throughout the procedure. Then the patient is asked to sit up and repeat the same sequence depending on the protocol. Once the test is completed, the tube is withdrawn.
What Is Peroral Endoscopic Myotomy?
It treats swallowing disorders caused by problems like abnormal contractions and spasms in the esophagus. This procedure uses an endoscope, a thin, flexible tube with a camera inserted through the mouth to cut off the muscles in the esophagus. This cutting of muscles, also called myotomy, loosens them and prevents them from contracting, which may interfere with swallowing. It is not surgical since no incision is made through the skin. It is similar to Heller myotomy, which is a similar procedure that uses small incisions to reach the esophagus instead of accessing through the mouth. Finally, the doctor will use an endoscope to close the incision on the esophageal lining by using small clips. It causes less pain and results in quicker recovery.
What Are the Advantages of This Procedure?
The advantages of this procedure include the following:
-
Less pain and discomfort as it does not involve incisions.
-
A lesser amount of bleeding.
-
It is minimally invasive.
-
It leaves no visible scars.
-
It is 90 % effective in relieving muscle spasms.
What Are the Risks and Complications of This Procedure?
Because the procedure is minimally invasive, peroral endoscopic myotomy is safe. But it does carry some risks and complications, which include:
-
Inflammation of the esophagus.
-
Infection.
-
Bleeding due to injury to the esophagus.
-
Collapsed lung (pneumothorax).
Conclusion:
The advancements in high-resolution manometry have led to increased detection of clinically relevant disorders, particularly achalasia. These were possible only through the introduction of advanced techniques. With the introduction of high-resolution manometry, intraluminal pressure recordings were obtained with multiple closely placed pressure sensors, which will have only negligible pressure loss between the sensors.
