Esophageal Motility Disorders
Esophageal Motility Disorders
The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. When a person swallows, the coordinated muscular contractions of the esophagus propel the food or fluid from the throat to the stomach. If the muscular contractions become uncoordinated, or too powerful, or too weak, interfering with movement of food down the esophagus, this condition is known as a motility disorder. Motility disorders cause difficulty in swallowing, regurgitation of food, and, in some people, a spasm-type chest pain. The reasons why the esophageal muscles fail to contract normally in patients with motility disorders are unknown.
Esophageal spasms are irregular, uncoordinated, and sometimes powerful contractions of the esophagus causing problems with food sticking or chest pain. The symptoms can happen on their own with eating or may be stimulated by heartburn. There are two main types of esophageal spasm, Diffuse Esophageal Spasm and Nutcracker esophagus.
The treatment for these conditions will vary depending upon how severe they are and how well they can be controlled with medications. There are surgical options, which might range from performing a simple anti-reflux procedure for Nutcracker esophagus to removing the esophagus for severe Diffuse Esophageal Spasm.
Achalasia occurs when the food tube (esophagus) loses the ability to squeeze food down, and the muscular valve between the esophagus and stomach doesn’t fully relax. The reason for these problems is damage to the nerves in the esophagus. There is no cure, but achalasia symptoms can usually be managed with minimally invasive (endoscopic) therapy or surgery.
The use of advanced laparoscopic techniques in the management of Achalasia has dramatically improved the treatment of the condition. Traditionally, surgery involved making a large incision through the chest and patients were often in the hospital for 1-2 weeks and had significant recovery issues because of pain from the incision. Now patients can undergo laparoscopic procedures that are less invasive and allow the patient to be discharged the day following surgery and are back to work within days. More importantly, > 90 % of patients have excellent results and report no further dysphagia symptoms.
Esophageal diverticuli are sacs or pouches, which can arise in the esophageal lining between the throat and stomach. There are different types of esophageal diverticuli based on the location in the esophagus and can be treated surgically if they are associated with significant symptoms. Symptoms can include difficulty swallowing, characterized by a feeling of food caught in the throat; regurgitation of swallowed food and saliva; pain when swallowing; cough; neck pain; pulmonary aspiration (the entry of secretions or foreign material into the trachea and lungs); and/or aspiration pneumonia (a lung infection caused by pulmonary aspiration).