Esophageal Motility Disorder

Esophageal Motility Disorder

The esophagus contractions that move the food bolus from the pharynx toward the stomach are referred to as esophageal motility disorders. Esophageal dysmotility occurs when the esophagus contractions become irregular, unsynchronized, or absent.

The upper esophageal sphincter (UES), the body of the esophagus, or the lower esophageal sphincter are all possible locations of esophageal dysfunction (LES). The esophagus’ primary purpose is to transport food from the mouth to the stomach, where digestion can begin.

A coordinated and sequential motility pattern that propels food from above clears acid and bile reflux from below is required for efficient esophageal transport. The aberrant manometric patterns of esophageal motility disorders can be classified as primary or secondary esophageal motility disorders.

Neurologic and neuromuscular disorders can cause oropharyngeal and upper esophageal sphincter (UES) dysfunction, and sometimes reasons are unknown. Among these, oropharyngeal dysfunction can occur due to specific procedures like tracheostomy, laryngectomy, or cervical dissection.

Achalasia, broad esophageal spasm, nutcracker esophagus, hypertensive LES, and nonspecific esophageal motility abnormalities are instances of primary idiopathic motility disorders. The oesophageal contractions in patients suffering from reflux are usually normal. However, the amplitude of the contractions may decrease with long-term reflux disease.

Esophageal Motility Disorder Causes:

Several factors can cause swallowing problems. Neurological or neuromuscular disorders cause pharyngeal weakness, benign or malignant strictures, and esophageal motility disorders. Among these, achalasia (in which the lower esophageal sphincter does not relax) and esophageal spasm (in which esophageal contractions become uncoordinated) are more common.

Following are General causes of Esophageal Motility disorder;

  • An ulcer, stricture, irritation, infection, inflammation, or cancer in the esophagus can all induce esophageal dysmotility.
  • Mouth, throat, or esophageal muscles that are uncoordinated or aberrant.
  • An issue with the mouth, tongue, or throat muscles caused by a nerve or brain problem (such as a stroke).
  • Extremely high blood pressure
  • Anxiety
  • Depression
  • Red wine
  • Eating food that is either excessively hot or extremely cold

Esophageal Motility Disorder Diagnosis:

To diagnose EMD, a doctor may perform a test to monitor the pressure within the esophagus during swallowing or use an endoscope (a thin tube with a camera at the end) to check the esophagus lining. Moreover, your doctor will discuss with you to figure out what kind of EMD you have and how to treat it. Following are some other diagnostic tests that may be performed to identify esophageal motility disorder;

  • Pharyngeal manometry: It is a procedure of passing a pressure-sensitive tube into your stomach through your nose to determine the pressure inside your esophagus.
  • Barium X-Rays: During this procedure, you will be asked to consume a small amount of liquid containing barium. This contrast material coats your esophagus and gives better visibility on X-rays.
  • Esophageal impedance test: This test uses a catheter to assess the amount of gas or liquid refluxed into the esophagus. It can be used to determine whether non-acidic substances are regurgitated or not.
  • PH monitoring examination: A nasogastric tube is inserted into the lower esophagus through your nose for 24 to 48 hours to monitor how and when acid enters the esophagus. Your physician may discover a link between symptoms and reflux if you maintain a food diary (a log documenting the amounts and types of food eaten at specified times). This test can be done to see if reflux is causing any respiratory issues.
  • Upper endoscopy: Your doctor will numb your throat and lightly sedate you before putting an endoscope down your throat. The physician can observe the surface of your esophagus with a tiny camera attached at one end of an endoscope. If necessary, the physician may use forceps (tiny tweezers) passed through the endoscope to do a biopsy (get small tissue samples). A pathologist will examine the sample to see if the tissues are abnormal.

Esophageal Motility Disorder Symptoms:

The following are some of the signs and symptoms of esophageal dysmotility;

  • Heartburn
  • Regurgitation
  • Pain in the chest
  • Swallowing problems
  • The sensation of food being stuck in the throat or chest
  • Malnutrition and weight loss
  • Pneumonia attacks regularly

Esophageal Motility Disorder Treatment:

Treatment for esophageal dysmotility will depend on the type of disorder and its underlying cause. Some common treatments include;

  • Medications to reduce the spasms
  • Botox (botulinum toxin) injections into the area of dysmotility
  • Balloon dilation of the lower esophagus to disrupt dysmotility
  • Heller myotomy, a minimally invasive, laparoscopic surgical procedure

Primary esophageal spasm is rarely life-threatening. However, when dysphagia or chest pain is frequent or severe, the doctors usually prescribe drugs that decrease smooth muscle contractility. Unfortunately, in addition to lowering the pressure in the esophagus, these medications also reduce blood pressure. Recently, it has been identified that patients with chest pain presumed to be of esophageal origin are often unusually sensitive to esophageal stimulation. In this case, tricyclic antidepressant drugs have been effective in some patients. While the effect of these drugs occurs at low doses and does not present any link with depression.

Risk Factors:

Those who experience the following symptoms are at risk for esophageal dysmotility;

  • Benign or cancerous Strictures
  • The esophageal motor disorder includes;
  • Achalasia (in which the lower esophageal sphincter does not relax).
  • Spasm of the esophagus (in which esophageal contractions become uncoordinated).
  • Disorders of the nervous system or the muscles, such as;
  • Multiple sclerosis (MS)
  • Muscular dystrophy
  • Myasthenia gravis
  • Myopathy
  • Peripheral neuropathy (a condition that affects the peripheral nerves)
  • Atrophy of the spinal muscles
  • Polymyositis and dermatomyositis
  • Charcot-Marie-Tooth disease
  • Amyotrophic lateral sclerosis (ALS)

References:

  • https://lluh.org/conditions/esophageal-dysmotility retrieved on February 28, 2022.
  • https://emedicine.medscape.com/article/174783-overview retrieved on February 28, 2022.
  • https://www.nm.org/conditions-and-care-areas/gastroenterology/spastic-esophageal-motility-disorder/causes-and-diagnoses retrieved on February 28, 2022.

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