Esophageal motility disorders

Esophageal motility disorder symptoms such as difficulty with swallowing, heartburn or choking on food may fill your day with pain and frustration. When essential acts like eating and drinking are difficult or painful, you may spend a lot of time trying to figure out how to manage meals.

How does the esophagus work?

The esophagus (throat) is the part of your digestive system that carries food and liquids to your stomach. On the way, it adds mucus to reduce friction and creates waves of muscular activity (peristalsis) to move and mix what you’ve eaten. Your esophagus has rings of muscles at the top and bottom that open to allow food to move through. The lower muscle (lower esophageal sphincter) is supposed to stay closed when you’re not eating so stomach acid and bile don’t back up into your throat and damage its lining.

Esophageal motility disorder symptoms

When you’re living with an esophageal motility disorder, one or more of the functions of the esophagus doesn’t work the way it should.

One of the most common symptoms of esophageal motility disorders is feeling pain or pressure in your chest. You may notice it happening randomly or it may happen mainly before or after swallowing. Other symptoms of esophageal dysmotility are:

• Choking on food
• Dysphagia (difficulty with swallowing)
• Esophageal spasm
• Globus –a feeling of tightness or a lump in the throat
• Heartburn
• Hoarseness or coughing
• Mild to moderate weight loss

Regurgitation, another symptom of esophageal dysmotility, is when food comes back up your throat and into or out of your mouth. It’s different from vomiting because the food comes up without force behind it. If such food accidentally gets into your windpipe (trachea) it may make you cough or lead to inspiration pneumonia or other infections of the lungs.

Conditions that cause esophageal dysmotility

• Achalasia: A rare disorder where the lower esophageal sphincter doesn’t relax normally and the esophageal muscles stop working so peristalsis stops. Achalasia is more common in older adults.
• Cancer: Esophageal dysmotility may be a secondary effect of some cancers such as esophageal cancer, laryngeal cancer or pharyngeal cancer.
• Esophageal diverticulitis: Small pouches form in the lining of the esophagus. This is a rare disorder.
• Esophageal obstructions: Can be caused by food, foreign object, tumor growth or injury to the esophagus.
• Esophageal scleroderma: An autoimmune disorder that makes the muscles of the esophagus become stiff and thick so they can’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.
• Functional esophageal disorders: When no cause can be found for a person’s potential symptoms of dysmotility. Esophagus testing shows normal functioning.
• Long-term opioid use.
• Tracheoesophageal fistula and esophageal atresia: A tracheoesophageal fistula is an abnormal opening between the trachea (windpipe) and the esophagus (throat). 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.

Diagnosing esophageal motility disorders

Diagnosing an esophageal motility disorder depends on what your symptoms are and on eliminating the possibility of other causes for those symptoms. So your doctor will need to rule out things like gastroesophageal reflux disease (GERD), hiatal hernia and heart disorders. They’ll ask you about your potential esophageal motility disorder symptoms and your medical history.

Some of the testing they may order if it seems like your symptoms may be because of esophageal dysmotility are:

• Esophageal manometry: Procedure to measure strength of muscle contractions in the esophagus.
  
• Esophagoscopy: Used to view the esophagus and allow 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): Builds detailed 3D images of the esophagus and surrounding tissues using multiple X-ray images.
  
• MRI: Creates detailed images using a magnetic field and radio waves.

Esophageal dysmotility treatment

Lifestyle changes

Esophageal motility disorders often respond well to changes in personal habits. You can lessen the amount of work needed from the muscles of your esophagus by eating softer foods in smaller, more frequent meals. If there are foods that trigger symptoms, you can avoid them. Your doctor may have other suggestions to help control your symptoms.

Medical treatments for esophageal motility disorders

Some people benefit from hypnosis, cognitive behavior therapy and integrative medicine treatments.

Your treatment will be different depending on your disorder. Some common treatments for different conditions are:

• Esophageal dilation: A balloon is inserted and inflated to stretch the muscles of the esophagus and open up the narrowed part.
  
• Heller myotomy: A surgery performed on the lower esophageal sphincter muscle to make it easier for food to pass into the stomach.
  
• Medications: Acid-suppressing drugs such as proton-pump inhibitors are prescribed.

Treatment for tracheoesophageal fistula or esophageal atresia

Treatment for a baby with a tracheoesophageal fistula or esophageal atresia needs to begin as soon as they are born. Surgery is necessary to allow safe breathing and normal digestion.

Multiple surgeries may need to be done over time if the esophagus is too short. In the meantime, any holes (fistulas) will be closed. The baby will need to be fed artificially using total parenteral nutrition through an IV or tube feeding through a gastrotomy tube (g-tube) that goes directly into the stomach.