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Other Motility Disorders

The function of the esophagus is to transport food from the mouth to the stomach.  That process, called peristalsis, is dependent on coordinated waves of muscle contractions that are strong enough to push contents into the stomach through the lower esophageal sphincter (LES) at the end of the esophagus.  Generally speaking, if this process is not coordinated and/or the pressures at any point during swallowing in the esophagus or the LES are too high or too low, the swallowed food or liquid may not pass normally into the stomach.

Motility disorders of the esophagus vary widely.  Although they may be suspected based on symptoms, barium studies, and endoscopy, motility disorders of the esophagus are diagnosed with esophageal manometry.

Motility disorders you may experience could include:

ESOPHAGEAL DIVERTICULA

A diverticulum is an outpouching of tissue, and referenced most commonly in the colon.  Diverticula also occur in the esophagus, and there are several different types.  A Zenker’s diverticulum forms immediately above the muscle at the upper end of the esophagus, called the upper esophageal sphincter, or the cricopharyngeal muscle.  If this muscle consistently maintains high pressures and does not relax, it can become thickened and press into the esophagus.  This results in an outpouching just above this muscle through a natural area of weakness in the esophagus.  The “pocket” that forms can be small or very large.  Patients often complain of difficulty in the oropharyngeal (or transfer) phase of swallowing.  They can also aspirate or regurgitate on food or liquid that collects in the diverticulum.  Diverticula can also form further down in the esophagus.  When they occur just above the diaphragm, they are referred to as epiphrenic diverticula.  These are less common, but thought to primarily occur in patients with achalasia.  There is almost always a muscle band causing the diverticulum that can be cut to relieve symptoms, but the diverticulum may need to be removed.

ESOPHAGEAL SPASM
Patients are often and casually diagnosed with esophageal spasms, but true spastic motor disorders of the esophagus are very rare.  It can only be diagnosed with esophageal manometry and is generally treated with medications than help relax the esophageal muscles.

INEFFECTIVE ESOPHAGEAL MOTILITY (IEM)

Ineffective esophageal motility is a broad term that is includes patients who have no specific or defined abnormality, but clearly have “ineffective” esophageal contractions on their swallow study (esophageal manometry).  It is important to consider any abnormal testing in the context of the patient’s symptoms during an evaluation for difficulty swallowing, and certainly if surgery is being considered.