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]
| Esophageal motility disorder | |
|---|---|
| Other names | Esophageal dysmotility (ED) |
| Diagnostic method | Esophageal motility study Functional Lumen Imaging Probe |
| Treatment | treatment depends on cause |
Primary motility disorders are:[1]
- Achalasia
- Diffuse esophageal spasm
- Nutcracker esophagus
- Hypertensive lower esophageal sphincter
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
editThe 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
editTesting to diagnose EMD includes barium esophagography, upper endoscopy, and esophageal manometry.[8]
Treatment
editThere 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
editReferences
edit- ^ a b c Goyal, Manjeet; Nagalli, Shivaraj (2023), "Esophageal Motility Disorders", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32965826, retrieved 2023-10-20
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ a b McQuaid, Kenneth (2022). Current Medical Diagnosis & Treatment 2022. McGraw Hill.