Esophageal Motility

Understanding Esophageal Motility

Some patients’ symptoms are not from reflux of gastric fluid/acid but from motility problems in the esophagus. The esophagus is a muscular tube that propels the food/fluid from the mouth to the stomach via a series of complex muscular contractions. There are numerous structural, mechanical, neuromuscular, and metabolic disorders that can affect how the esophagus and LES contract and relax. If the coordination is impaired, symptoms result.

In some cases, the contractions are too strong and pain or difficulty swallowing result. Diagnoses of esophageal spasm, nutcracker esophagus, jackhammer esophagus and a hypertensive LES are frequently made in our lab, and these can be managed successfully if correctly diagnosed.

In other cases, the contractions are so weak that patients struggle to get food to the stomach. Scleroderma can create a gradual atrophy of the smooth muscles in the esophagus resulting in weaker and weaker contractions over time. Achalasia is a well understood motility problem of the esophagus that is caused by the destruction of nerves responsible for the contraction of the esophagus and the relaxation of the LES. The consequence is severe chronic difficulty swallowing food/liquids with significant regurgitation and vomiting. It is often confused with reflux disease until proper evaluations are done.

What Causes Esophageal Motility Disorders?

Esophageal motility problems can develop for several reasons, including:

  • Nerve dysfunction
  • Muscle weakness or spasm
  • Autoimmune or connective tissue diseases
  • Chronic acid reflux
  • Structural changes in the esophagus

Some conditions are mild, while others significantly affect the ability to swallow.

Common Esophageal Motility Disorders

  • Achalasia
  • A rare disorder where the LES fails to relax and the esophagus loses its ability to push food downward. Symptoms include difficulty swallowing, regurgitation, and chest pain.
  • Diffuse Esophageal Spasm
  • Uncoordinated or intense spasms that can cause severe chest pain and intermittent swallowing difficulties.
  • Hypercontractile (“Jackhammer”) Esophagus
  • Excessively strong esophageal contractions leading to pain and trouble swallowing.
  • Ineffective Esophageal Motility (IEM)
  • Weak contractions that may be associated with GERD and cause a sensation of food “sticking.”

Symptoms of Esophageal Motility Problems

People with motility disorders may experience:

  • Trouble swallowing solids or liquids (dysphagia)
  • Chest pressure or pain unrelated to heart disease
  • Regurgitation of undigested food
  • A sensation of food getting stuck
  • Chronic cough or throat clearing
  • Unexplained weight loss

Seek medical attention if these symptoms persist.

How Esophageal Motility Is Diagnosed

A gastroenterologist may use specialized tests such as:

  • Esophageal Manometry
  • Measures muscle contractions and sphincter function using a thin catheter.
  • Barium Swallow X-ray
  • Provides images of how food or liquid moves through the esophagus.
  • Endoscopy
  • Allows direct visualization of the esophagus to rule out structural problems.

Gastroenterology Services

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