Esophageal motility disorders

Having an esophageal motility disorder means that something isn’t working right to allow foods and liquids to pass smoothly down your esophagus (throat) to your stomach. Many conditions may contribute to esophageal dysmotility. Living with an esophageal motility disorder can have a negative impact on your everyday activities and some conditions can be life-threatening.

How does the esophagus work?

Your esophagus – a vital part of your body – is a hollow muscular tube that carries foods and fluids from your mouth to your stomach. The esophagus adds mucus to reduce friction as the food moves. It uses waves of muscular activity (peristalsis) to move and mix the contents as they travel to your stomach.

There are two muscular rings in your esophagus that help control the movement of foods and liquids. The top one (upper esophageal sphincter) relaxes when food is ready to enter the esophagus. The bottom one (lower esophageal sphincter) relaxes when food reaches it to let it pass into the stomach. The lower esophageal sphincter usually stays closed to keep contents from the stomach (including bile and stomach acid) from leaking or backing up into your throat.

When all those things work together smoothly, eating and swallowing is something you probably don’t think about much. But if there are problems with any of those processes or muscles, you may develop esophageal dysmotility. Esophagus problems that cause pain with swallowing are hard to ignore.

Esophageal motility disorder symptoms

Esophageal motility disorders are fairly rare. Symptoms need to be frequent for a disorder to be diagnosed.

Pain or pressure in the chest is one of the most common symptoms of esophageal dysmotility. The pain may happen before and after swallowing or it may be random. Some other esophageal motility disorder symptoms are:

• Heartburn
• Esophageal spasm
• Dysphagia (difficulty with swallowing)
• Mild to moderate weight loss
• Hoarseness or coughing
• Choking on food
• Globus – the feeling that there’s a lump or tightness in the throat
• Regurgitation (food coming up and out of the mouth)

Regurgitation is different from vomiting because the food doesn’t come up forcefully. When food or liquids are regurgitated they can get into the nearby trachea (windpipe) and may lead to coughing or infections in your lungs.

Conditions that cause esophageal motility disorders

These conditions may cause esophageal dysmotility:

• Achalasia: A rare disorder that means the lower esophageal sphincter doesn’t relax normally and the esophageal muscles stop working so peristalsis stops. Achalasia is more common in older adults.
• Esophageal scleroderma: An autoimmune disorder that makes the muscles of the esophagus thicken and become stiff so they don’t work right. Esophageal scleroderma may contribute to Barrett’s esophagus.
• Esophageal stricture: Narrowing of the esophagus that can be caused by pressure from tumors, an enlarged heart, lung cancer or other conditions.
• Tracheoesophageal fistula and esophageal atresia: A tracheoesophageal fistula is an abnormal opening between the trachea and the esophagus. Esophageal atresia occurs when the esophagus doesn’t connect to the stomach. These conditions are congenital defects (present at birth) and can be life-threatening.
• Esophageal obstructions: Can be caused by injury to the esophagus, tumor growth, food or foreign objects.
• Cancer: Cancer of the esophagus may be related to Barrett’s esophagus, smoking, alcohol use, gastroesophageal reflux disease (GERD) or esophageal diverticulitis.
• Functional esophageal disorders: When a person has symptoms but no cause can be found.
• Long-term opioid use

Diagnosing esophageal motility disorders

To diagnose esophageal motility disorders, your doctor will begin with a thorough physical and ask about your history of potential esophageal motility disorder symptoms. A diagnosis is made after eliminating other potential causes for your symptoms. If you have chest pain, your doctor will likely ask questions about cancer, heart disease and other illnesses to see if they’re causing your pain.

If it seems likely that your symptoms are related to an esophageal dysmotility, some of the tests that may be ordered are:

• Esophageal manometry: Measures the strength of esophagus muscle contractions.
• Esophagoscopy: Examines the esophagus using a flexible viewing tube and allows removal of tissue samples (biopsy).
• X-rays and barium swallow: After you swallow a solution with barium in it, X-rays are used to check for abnormalities in the shape of the esophagus.
• Computed tomography (CT): Uses many X-ray images to create detailed 3D images of the esophagus and surrounding tissues.
• MRI: Uses a magnetic field and radio waves to produce detailed images of the esophagus.

Esophageal dysmotility treatment

Lifestyle changes

For many esophageal motility disorders, lifestyle changes can make a big difference. Eating smaller, more frequent meals and softer foods takes pressure off your lower esophageal sphincter muscle so it’s easier for it to open when it needs to and stay closed when it’s supposed to. Avoiding foods or drinks that trigger symptoms keeps you more comfortable. If applicable, discontinuing or decreasing opioid use may make symptoms stop completely.

Medical treatments for esophageal dysmotility

Treatment depends on the type of disorder. Some of the most common treatments for various conditions that cause esophageal motility disorders are:

• Medications: Acid-suppressing drugs.
• Heller myotomy: Surgery on the lower esophageal sphincter muscle to make it easier for food to pass into the stomach.
• Esophageal dilation: A balloon is inserted and inflated to stretch the muscles of the esophagus to make it wider.

Cognitive behavior therapy, hypnosis and other complementary treatments have helped some people who have functional esophageal motility disorders.

Treatment for tracheoesophageal fistula or esophageal atresia

When a baby has tracheoesophageal fistula or esophageal atresia, prompt surgery is necessary to allow normal digestion and safe breathing. The baby may need repeat surgeries if the esophagus is too short. Until the esophagus can be made long enough, the baby will need to be fed artificially through a tube inserted into their stomach or through an IV (total parenteral nutrition).