Esophageal Motility Disorders

The esophagus is a tube-shaped muscle that connects the mouth to the stomach. It resides mostly in the chest behind the trachea and heart with short segments in the neck and abdomen. The esophagus provides coordinated pushing (motility) of swallowed food or drink from the mouth into the stomach. An esophageal motility disorder occurs when food doesn’t move properly down the esophagus; several types of motility disorders exist.

Cause

Loss of coordination results in motility disorders. These disorders can involve lack of pushing or propulsion (achalasia), incoordination, or spasm (nutcracker esophagus).

Symptoms

  • Food getting “stuck”
  • Regurgitation of previously eaten food
  • Chest pain, usually severe
  • Foul breath

Diagnosing Esophageal Motility Disorders

  • Upper GI (gastrointestinal) series, also called a barium swallow: This test looks at the organs of the top part of the digestive system. After you swallow a metallic fluid called barium, which coats the organs so they can be seen on an X-ray, a provider checks the food pipe (esophagus), stomach and first part of the small intestine (duodenum).
  • Upper endoscopy or EGD (esophagogastroduodenoscopy): This test looks at the lining or inside of the esophagus, stomach and duodenum. The test is performed with an endoscope, a thin, lighted tube with a camera on the end. The endoscope is inserted into the mouth and throat. Then it goes into the esophagus, stomach and duodenum. Your provider can see inside these organs and take a small tissue sample (biopsy) if needed.
  • Esophageal manometry: This test checks the coordination and strength of esophagus muscles. A small tube is inserted into the nostril, then down the throat and into the esophagus. The tube checks how much pressure esophageal muscles make during rest and swallows.

Treatments

 Treatment depends on the type of motility disorder.  

In achalasia, medication is rarely effective. The lower esophageal sphincter can be paralyzed, dilated or cut, allowing food to enter the stomach without resistance.  

In esophageal spasm, muscle relaxing medications are often effective. If not, the muscle can be divided along the length of the esophagus.  

In the case of a completely nonfunctional esophagus, it is sometimes best to surgically remove and replace the esophagus with stomach.