Dysphagia is a common symptom with significant impact on quality of life. Esophageal motility disorders can cause chest pain, heartburn, or dysphagia. (Wilkinson et al, 2020)
Esophageal Spasm (ES) is defined as uncoordinated motor activity in the smooth muscle portion of the esophagus. Patients with ES can present with chest pain, but often this is more indicative of reflux. Patients will often complain of dysphagia and possibly regurgitation. (O'Rourke et al, 2011)
Distal esophageal spasm (DES) is a rare esophageal motility disorder associated with dysphagia and chest pain. It might be secondary to medications, especially opiates. (Roman & Kahrilas, 2015)
Achalasia is a rare neurogenic motility disorder of the esophagus where patients have symptoms of progressive dysphagia, weight loss, and regurgitation. (Islam, 2017) Achalasia represents the classic esophageal motility disorder thought to arise from a selective loss of inhibitory neurons in the myenteric plexus of the distal esophagus.
Esophagogastroduodenoscopy is a requisite in the evaluation of patients with suspected esophageal dysmotility because it can enable direct mucosal visualization. High-resolution esophageal manometry has improved the sensitivity for detecting achalasia and has also enhanced our understanding of spastic and hypomotility disorders of the esophageal body. Radiographic imaging with ingested barium contrast to assess bolus transport through the esophagus and into the gastric lumen has remained an important adjunctive diagnostic modality in patients with dysphagia. (Patel et al, 2021)
Treatment modalities include surgical and pharmacological approaches. Botulinum toxin can provide effective initial treatment results, but the benefit dissipates over time and nearly half of the patients might need repeat injections for symptom relief at 6 months. (Patel et al, 2021)
Wilkinson JM, Halland M. Esophageal Motility Disorders. Am Fam Physician. 2020 Sep 1;102(5):291-296. PMID: 32866357.
O'Rourke AK, Weinberger PM, Postma GN. Esophageal spasm. Ear Nose Throat J. 2011 Nov;90(11):516. doi: 10.1177/014556131109001104. PMID: 22109917.
Roman S, Kahrilas PJ. Distal esophageal spasm. Curr Opin Gastroenterol. 2015 Jul;31(4):328-33. doi: 10.1097/MOG.0000000000000187. PMID: 26039725.
Islam S. Achalasia. Semin Pediatr Surg. 2017 Apr;26(2):116-120. doi: 10.1053/j.sempedsurg.2017.02.001. Epub 2017 Feb 3. PMID: 28550869.
Patel DA, Yadlapati R, Vaezi MF. Esophageal Motility Disorders: Current Approach to Diagnostics and Therapeutics. Gastroenterology. 2022 May;162(6):1617-1634. doi: 10.1053/j.gastro.2021.12.289. Epub 2022 Feb 25. PMID: 35227779; PMCID: PMC9405585.