Introduction
Esophageal motility disorders are dysfunction of the esophagus due to esophageal disease, esophageal tumors, or compression. It causes symptoms like chest pain, food regurgitation, and difficulty swallowing solid or liquid foods. A few tests, like upper endoscopy and esophageal manometry, are performed to find the condition. There is no specific treatment for esophageal motility disorder. However, the symptoms can be reduced by recommending a proton pump inhibitor for regurgitation and muscle relaxants for muscle dysfunction.
What Is Esophagus?
The esophagus is a long tube-like structure that transfers food from the mouth to the stomach. The esophagus has a fibrous band of muscles called the esophageal sphincter. The upper esophageal sphincter is located in the lower part of the pharynx (windpipe) and prevents the air from entering the esophagus and prevents food from entering the pharynx during regurgitation. The lower esophageal sphincter shuts the esophagus from the stomach and prevents the backflow of the stomach contents into the esophagus.
What Is Esophageal Motility Disorder?
Esophageal motility is the movement of the food bolus down to the stomach. Any disruption in this movement causes esophageal motility disorder. Esophageal motility disorder is the dysfunction of the esophagus that leads to chest pain, difficulty in swallowing, and regurgitation.
What Causes Esophageal Motility Disorders?
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Ulcers, inflammation, or irritation in the esophagus.
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Infection, strictures (narrowing), or cancer in the esophagus.
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Poor muscle coordination of the mouth, throat, or esophagus.
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Nervous problems like a stroke cause muscle weakness in the throat, tongue, and throat muscles.
What Are the Types of Esophageal Motility Disorders?
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Primary Disorder: It occurs as a result of esophageal disease.
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Secondary Phenomenon: The esophageal dysfunction results due to disease conditions like pseudo-achalasia (achalasia-like dilatation pattern of the food pipe caused by a malignancy extending into the distal esophagus), Chagas disease (a disease caused by Trypanosoma cruzi, a parasite present in the feces of a bug called triatomine), and scleroderma (a disease that causes hardening and tightening of the skin and the connective tissues).
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Oropharyngeal Dysphagia: It is difficulty swallowing due to problems in the mouth or the throat.
What Are the Symptoms of Esophageal Motility Disorders?
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Heartburn.
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Regurgitation.
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Chest pain.
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Difficulty in swallowing.
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Experiencing a feeling of food stuck in the throat or the chest.
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Weight loss.
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Recurrent episodes of pneumonia.
What Are the Tests to Find Esophageal Motility Disorder?
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Barium Swallow Test: An imaging study involving drinking a chalky substance called barium. It is visible clearly on an x-ray. This study uses a specific x-ray called fluoroscopy to obtain images of the movements of the organs in real time. It obtains images of the mouth, the backside of the throat, the esophagus, the stomach, and the duodenum (the first part of the small intestine) and helps to find the abnormalities.
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Endoscope: In an endoscope, a flexible tube-like structure with a camera and a light at one end is used to view the internal organs. The tube is introduced into the upper gastrointestinal tract through the mouth, and the images are viewed on a monitor outside. Any defect detected will be noticed, and treatment will be planned accordingly.
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Endoscopic Ultrasound: It uses high-frequency sound waves and endoscopes to capture images of the internal part of the organs in the gastrointestinal tract and its surrounding structures.
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Esophageal Manometry: Esophageal manometry is a test used to detect movements of the muscles in the esophagus. It shows if the esophagus is functioning correctly or not.
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pH(Potential of Hydrogen) Test: This test measures the acid in the esophagus. It uses a catheter (a tiny hollow tube) or a pH probe to insert into the esophagus to check the acid levels for 24 to 96 hours.
How Is Esophageal Motility Disorder Treated?
The treatment depends on the type of underlying disease. However, a few steps are followed to reduce the severity of the symptoms.
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Medications:
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Medications like Nitrates (a medication for chest pain) and Nifedipine (a medication that lowers blood pressure and reduces chest pain) are the first choices to reduce esophageal motility disorders, and the symptoms are relieved. Other medications like Theophylline (used to treat asthma, shortness of breath, and other chest discomforts) and Nitroglycerine (medication used in chest pain due to heart issues) are also beneficial.
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Medications like proton pump inhibitors are used to treat heartburn and acid reflux.
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Botox Injections: Botulinum toxin is a neurotoxic protein that causes paralysis (inactivity of muscles). It is obtained from the bacterium Clostridium botulinum. Botox is injected into the muscles in the esophagus, which causes dysmotility.
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Pneumatic Balloon Dilatation: Esophagogastroduodenoscopy is performed to locate the site where a pneumatic rigiflex balloon dilates the narrowing and the esophagus. The balloon is dilated for a few centimeters to widen the esophagus. Repeated dilatation may be needed in some cases.
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Endo Flips Dilation System: It is performed by placing a balloon catheter into the stomach through the mouth. The balloon is inflated, and the esophagus function is assessed and treated. It is performed while doing an endoscope.
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Heller Myotomy: It is a minimally invasive procedure using a laparoscopic technique (keyhole surgery). A cut is made in the tightened, thick part of the lower esophagus and the upper part of the stomach. It releases the lower esophageal sphincter muscles from tightness, and the dysphagia (difficulty in swallowing) is relieved.
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Esophagectomy With Gastric Pull-up: In some malignancies, the lower esophagus is surgically removed, and the stomach tissues are pulled and transposed with the esophagus. This prevents constriction and difficulty in swallowing.
Who Is at Risk of Getting Esophageal Motility Disorder?
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Strictures: It is the hardening of the skin and connective tissue. It can be benign or malignant.
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Achalasia: It is an esophageal motor disorder resulting from damage to the esophagus nerve leading to swallowing disorders.
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Esophageal Spasm: It is a condition where the esophageal muscles cause painful contractions leading to chest pain.
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Multiple Sclerosis: A rare disease that causes the immune system to damage the nerve coverings. It leads to failure in brain and body coordination, leading to symptoms like loss of vision, impaired coordination, weakness, and tiredness.
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Myasthenia Gravis: Myasthenia gravis is a condition resulting from a loss of communication between the brain, nerves, and muscles. It leads to tiredness and weakness of muscles.
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Muscular Dystrophy: A group of disorders that affects muscle mass and causes progressive muscle weakness.
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Myopathy: A neuromuscular disease that causes muscle weakness due to malfunctioning of muscle fibers.
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Peripheral Neuropathy: It is damage to the nerves present outside the brain and the spinal cord, which causes weakness, numbness, and pain in the hands and feet.
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Spinal Muscular Atrophy: A genetic condition that causes muscle weakness and atrophy (muscles become smaller). It causes difficulty walking, sitting up, and affects the control of head movements.
What Are the Complications of Esophageal Motility Disorders?
If the main cause of the disorder is achalasia, the patient is at increased risk of developing squamous cell carcinoma.
What Is the Prognosis of Esophageal Motility Disorders?
The prognosis is good if the treatments are started in the initial stage of the condition. However, the prognosis is moderate in cases of achalasia since it is a progressive disease.
Conclusion
Esophageal motility disorder is a condition that causes disruptions in the movements of a food bolus from the esophagus to the stomach. It can be due to an underlying neurologic disease or malignancies that cause the narrowing of the esophagus. A few tests like endoscopy, barium swallow studies, and endoscopic ultrasound diagnose it. Esophageal motility disorder has no specific treatment. However, the severity of the symptoms is reduced by prescribing certain medications to treat chest pain and heartburn. In addition, some surgical procedures like esophagectomy with gastric pull-up and balloon dilatations are performed to relieve esophageal constrictions. Although this is not life-threatening, visiting the doctor when initial symptoms occur will improve the patient's lifespan and prevent complications.
