Esophageal

Motility
Disorders

Richard Huang
SGU MS4

Introduction
Achalasia
DES
Scleroderma
GERD

Normal function of the

esophagus
1. Transport food from mouth to stomach:
peristalsis and gravity
2. Prevent retrograde flow of stomach
contents: constriction of LES

Diagnostics
o

o
o

Clinical: signs and symptoms

Radiologic: fluoroscopy, esophagram
Evaluate both structural and motor
abnormalities
Endoscopic: direct visualization
Manometry: motility patterns

Features:
o
o

Pathophysiology
o
o

Loss of intramural neurons that

regulate smooth muscle activity
Degeneration of nerve cell bodies

Signs and Symptoms

o
o
o

Loss of peristalsis
LES does not relax in response to
swallowing

Dysphagia, chest pain, and

regurgitation
Dysphagia with both liquids and solids
Symptoms of reflux point away from
achalasia

Diagnosis
o

Clinical: (see signs and symptoms)

o Radiologic:

o Barium swallow
shows esophageal
dilatation
o Terminal esophagus
shows persistent
bird beak
narrowing
representing a
constricted LES

o Radiologic:

o Normal peristalsis is lost in the

lower esophagus

o Manometry:

o Elevated basal
LES pressure
o Swallow
induced
relaxation of
LES is reduced
o Esophageal
body shows
reduced
contraction
amplitude

Features:
o
o

Pathophysiology
o
o

Dysfunction of inhibitory nerves that

regulate peristaltic smooth muscle
activity
Degeneration of nerve processes

Signs and Symptoms

o
o
o

Nonperistaltic contractions
LES relaxes normally in response to
swallowing

Chest pain triggered by swallowing

Dysphagia with both liquids and solids
Could mimic MI pain

Diagnosis
o
o

Clinical: (see signs and symptoms)

Radiologic: (see next)

o Radiologic:

o corkscrew
appearance is
classic

o Radiologic:

o Barium swallow shows

uncoordinated contractions

o Manometry:

o Esophageal
body shows
uncoordinated
contractions
o Contraction
amplitude is
increased

Features:
o
o

Pathophysiology
o
o

Autoimmune damage to esophageal

smooth muscle
Fibrosis replaces damaged smooth
muscle, which may form stricture

Signs and Symptoms

o
o

Weakness of lower esophagus

contractions
Incompetence of LES

Dysphagia to solids, and rarely liquids

GERD is a common complication

Diagnosis
o
o
o

Clinical: (see signs and symptoms)

Radiologic: (see next)
Manometry: (see next)

o Radiologic:

o Barium
swallow
shows
esophageal
dilatation
o Esophageal
wall is thin
and atrophic
o Fibrotic
stricture may
be seen, and
can also
involve LES

o Manometry:

o Reduced basal
LES pressure
o Swallow
induced
relaxation of
LES is reduced
o Esophageal
body shows
reduced
contraction
amplitude

Features:
o
o

Pathophysiology
o
o

Incompetent barrier at the GE junction

Occurs when the pressure gradient
between LES (high) and the stomach
(low) is reversed

Signs and Symptoms

o
o

Most prevalent GI disorder

Backflow of gastric acid into esophagus

Regurgitation, chest pain, dysphagia,

cough
Barretts esophagus is a common
complication; risk factor for
adenocarcinoma

Diagnosis
o

Clinical: (see signs and symptoms)

o Radiologic:

o Barium swallow shows reflux of

contrast agent

Than
k