Esophageal dysmotility: Description, Causes and Risk Factors:
Esophageal dysmotility is medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. The most prominent one is dysphagia.
The function of the esophagus is to transport food from the mouth to the stomach. For food to be transported efficiently and correctly, the muscles of the esophagus must coordinate in a very structured fashion to transport food to the stomach while ensuring that the stomach contents do not escape. An esophageal dysmotility disorder is one in which this process has been disrupted. These types of disorders can prevent food from being delivered to the stomach or cause stomach contents to be regurgitated. These problems can lead to esophageal dysmotility symptoms such as chest pain, pain when swallowing or the feeling of a permanent lump in the throat.
Disorders related to the upper esophageal sphincter or cricopharyngeal muscle are usually related to extremely high contraction of this muscle. This leads to difficulty swallowing, and over time can lead to an out-pouching above this sphincter known as a Zenker's diverticulum.
Disorders related to the lower esophageal sphincter can be due to either extremely high muscle contraction tone or extremely low contraction tone. If the sphincter tone is too high and does not open with swallowing, patients often experience difficulty passing food. This may be associated with complete loss of peristalsis in the body of the esophagus in a condition known as achalasia. It may also be an isolated disorder that can be associated with an out-pouching of the esophagus above it, known as an epiphrenic diverticulum. In some cases, a hypertensive lower esophageal sphincter can paradoxically occur in the setting of reflux disease. If the lower esophageal sphincter tone is too low, uncontrolled reflux of gastric contents may occur. Other than in the setting of GERD, this finding may occur with some connective tissue disorders, such as scleroderma.
Esophageal dysmotility disorder may also be the result of the build-up of scar tissue in the esophagus.
These problems can lead to symptoms such as chest pain, pain when swallowing or the feeling of a permanent lump in the throat.
A chest radiograph is not required to establish the diagnosis. In patients with long-standing achalasia, the esophagus dilates and exhibits a sigmoid appearance. An air-fluid level, a widened mediastinum, and the absence of a gastric air bubble often are observed. Patients with spastic esophageal motility disorders show no abnormalities on chest radiographs.
Esophagram: Advanced achalasia produces a dilated intrathoracic esophagus with an air-fluid level. The classic sign is a tapering of the LES, creating the characteristic "bird-beak" appearance. Early achalasia would reveal a normal anatomical esophagus with loss of peristalsis and transient stasis just above the GEJ.
- Occasionally, epiphrenic diverticula are noted immediately above the LES.
- Hiatal hernia reportedly is observed in 10-20% of patients with achalasia.
- In patients with DES, the classic esophagram findings are of a "corkscrew" or "rosary bead" esophagus. Pseudodiverticula and curling also suggest DES.
- In patients with scleroderma esophagus, the esophagram shows a slightly dilated esophagus, weak or absent peristalsis, and free reflux often is demonstrated.
Other Tests: Esophageal manometry evaluates esophageal motor pattern, contraction amplitude, and LES pressure and function.
Dysmotility disorders of the esophagus are generally incurable. The main objective of treatment is, therefore, symptom management and relief. Several types of medication can be used for esophageal dysmotility treatment, including calcium channel blockers and botulinum toxin. Dietary modifications can help relieve symptoms, and some disorders can be improved with surgery.
Some dysmotility disorders can be treated with surgery. In the case of achalasia, the most common procedure is a Heller's myotomy, in which the sphincter muscle is cut so that it is no longer permanently contracted. This procedure also is performed to treat other types of esophagus dysmotility, including spastic esophageal motility disorder.
NOTE: The above information is for educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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