Esophageal Dysmotility (Esophageal Motility Disorders)

What is esophageal dysmotility?

Esophageal dysmotility (esophageal motility disorders) refers to certain esophageal disorders that cause food and liquid to get stuck in your esophagus (food pipe) so they don’t move to your stomach.

Your esophagus is a tube in the center of your neck and chest. It carries food and liquid from your mouth and throat to your stomach. Normally, muscles in your esophagus work together to keep things moving along:

• First, a muscle at the top of your esophagus (upper esophageal sphincter) opens to let in food and fluid coming from your throat.
• Next, your esophagus muscles flex and relax (contract) as they move that food and liquid through it.
• Finally, your lower esophageal sphincter at the bottom of your esophagus opens to let food and liquid into your stomach.

What are the symptoms of esophageal dysmotility?

Common symptoms are:

• Chest pain that happens after you eat.
• Difficulty swallowing (dysphagia).
• Heartburn.

What causes esophageal dysmotility?

Several disorders are forms of esophageal dysmotility. Some only cause issues in your esophagus. A healthcare provider may refer to these as primary disorders. And there are certain disorders that affect your whole body, including your esophagus. A provider may call these secondary disorders.

The most common primary disorders are:

• Achalasia. In achalasia, your lower esophageal sphincter doesn’t relax, trapping food and liquid in your esophagus.
• Eosinophilic esophagitis. This condition causes your esophagus to narrow so much that food and liquid can’t get through to your stomach.
• Esophageal spasm. Unusually strong or uncoordinated muscle contractions make food back up in your esophagus.

Common secondary disorders that lead to esophageal dysmotility include:

• Chagas disease. A bite from a triatomine (kissing) bug may cause a chronic infection that spreads to your esophagus. The infection makes it hard for you to swallow.
• Esophageal sclerosis. Sclerosis is an autoimmune disorder. It makes your body produce unusually thick tissue. Thick tissue in your esophagus makes it hard for food to move through your esophagus.

A cancerous tumor in your esophagus is another condition that can cause esophageal dysmotility.

What are the complications of esophageal dysmotility?

Aspiration pneumonia and other lung infections are common potential complications that can develop if the food in your esophagus backs up into your trachea (windpipe) and then into your lungs.

How do healthcare providers diagnose esophageal dysmotility?

A healthcare provider will ask about your symptoms. They’ll do a physical examination. They may refer you to a gastroenterologist for more tests.

Gastroenterologists are healthcare providers who specialize in diagnosing and treating conditions that affect your digestive tract, including your esophagus. Your gastroenterologist may do tests to see how well food and liquid move through your esophagus. Tests may include:

• Barium swallow (esophagram) test. This is a fluoroscopic X-ray It makes videos of your esophagus in action.
• EndoFLIP. This test measures the inside of your esophagus. It also measures esophageal muscle activity.
• Esophageal manometry test. Like EndoFLIP, this is another check on esophageal muscle activity.
• Upper endoscopy. This test checks your upper digestive tract, including your esophagus. It uses an endoscope, a narrow tube with a light and a camera.

How is esophageal dysmotility treated?

Your treatment will depend on the disorder that causes esophageal dysmotility. If you have a primary disorder, treatment may be a combination of:

• Medications to relax your esophageal muscles or reduce inflammation
• Nonsurgical procedures like esophageal dilation that stretch your esophagus to make it easier for you to swallow
• Minimally invasive surgeries like Heller myotomy or peroral endoscopic myotomy to loosen your esophageal muscles

What’s the outlook for esophageal dysmotility?

The outlook is good if you have a condition like achalasia that only affects your esophagus. In that case, treatments like medication, nonsurgical procedures and surgery make it easier for food and liquid to move from your esophagus to your stomach. But your situation may be different from other people who have esophageal dysmotility. Ask your healthcare provider to explain what you can expect.

How do I take care of myself?

Changing how you eat is one way to take care of yourself. For example:

• Practice mindful eating. Slow down during meals and chew every bite very well.
• Sit up while you eat. That gives gravity a chance to help food move through your esophagus.
• Sip water. Moist morsels are easier to swallow than dry bites. And sipping water every few bites helps when you’re trying to eat more slowly.

What foods should I avoid?

In general, you should avoid food that:

• Takes time and effort to chew, like crisp vegetables and meat with lots of gristle and fat
• Is likely to congeal or clump up in your esophagus (think soft white bread, white rice and pasta)

When should I see my healthcare provider?

Contact your healthcare provider if your symptoms get worse after treatment.