Esophageal Motor Disorders: Achalasia, Diffuse Esophageal Spasm, Nonspecific Motor Disorders, Eosinophilic Esophagitis

Abstract

The esophagus, which plays a primary role in food transport, is a collapsible organ with three main sections: upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES). This chapter details basic pathophysiologic aspects of four disorders of esophageal motility, esophageal achalasia, esophageal spasm, nutcracker esophagus, and eosinophilic esophagitis and briefly describes nonspecific esophageal motility disorders. Each disorder causes different eating and digestive symptoms (dysphagia, abdominal and chest pain, heart burn, regurgitation of digested food) and may appear to mimic GERD or esophageal reflux. In some disorders, such as achalasia, much of the literature is based on the adult population, while pediatric information is noted only in case and retrospective studies. On the other hand, eosinophilic esophagitis is more prevalent in the pediatric population and may be related to food and environmental allergens. Diffuse esophageal spasm and nutcracker esophagus are benign and very rare in the pediatric population.Prior to diagnosis, endoscopy, and fluoroscopy rule out organic pathology. Esophageal manometry is then used as the primary assessment method of esophageal motor activity or contractions, UES and LES pressures, esophageal body contraction amplitude, and peristaltic sequence. Bolus transit and clearance are evaluated by videocineroentgenography or videofluorography, esophageal transit scintigraphy, impedance, and pH monitoring. Esophageal function testing, a union of manometry and multichannel intraluminal impedance monitoring, gathers information on bolus transit patterns, swallow-associated events, nonobstructive dysphagia, chest pain, and general motility disorder.Treatment for most esophageal disorders focuses on relieving symptoms and improving the quality of life rather than curing the disorder. Primary treatments are pharmacologic, endoscopic, and surgical. Medications may improve symptoms; esophageal dilation is one of the most successful nonsurgical treatments, and in some cases, dietary management is effective; and surgical approaches can reduce LES pressure, alleviate pain, and decrease severity of symptoms.KeywordsLower Esophageal SphincterEsophageal ManometryLower Esophageal Sphincter PressureEosinophilic EsophagitisHeller MyotomyThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.