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Unifying Concepts

Characteristics of Esophageal Motility Disorders

The esophageal motility disorders are categorized as secondary and primary disorders. The pathogenesis of secondary motility disorders is associated with systemic diseases.

Characteristics of Esophageal Motility Disorders

Primary or idiopathic esophageal motility disorders
Major

  • Achalasia esophagus types 1, 2, and 3: Impaired relaxation of the lower esophageal sphincter and no peristalsis
  • Esophagogastric junction outflow obstruction: Impaired relaxation of the lower esophageal sphincter and normal peristalsis
  • Distal esophageal spasm Normal relaxation of the lower esophageal sphincter and reduced latency of
    distal esophageal contraction
  • Hypercontractility of the esophagus Also called nutcracker or jackhammer esophagus; normal relaxation of the lower esophageal sphincter with high-amplitude peristaltic contractions

Minor

  • Ineffective esophageal peristalsis: Low-amplitude esophageal contractions or fragmented esophageal peristalsis

Secondary esophageal motility disorders

  • Myasthenia gravis: Low pressure of upper esophageal sphincter and esophageal muscle fatigue with repetitive swallowing
  • Dermatomyositis: Low pressure of upper esophageal sphincter and esophageal muscle fatigue with repetitive swallowing
  • Scleroderma esophagus: Low to absent pressure of lower esophageal sphincter; absence of esophageal contractions and peristalsis in smooth muscle of the esophagus
  • Connective-tissue disorders: Low to absent pressure of lower esophageal sphincter; absence of esophageal contractions and peristalsis in smooth muscle of the esophagus
  • Diabetes mellitus: Low-amplitude, multipeaked esophageal contractions and low pressure of the lower esophageal sphincter
  • Secondary achalasia esophagus: Associated with neoplastic infiltration of lower esophageal sphincter or Chagas’ disease

 

References:

  1. Mittal R, Vaezi MF. Esophageal Motility Disorders and Gastroesophageal Reflux Disease. N Engl J Med. 2020 Nov 12;383(20):1961-1972. [Medline]
  2. Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in Management of Esophageal Motility Disorders. Clin Gastroenterol Hepatol. 2018 Nov;16(11):1692-1700. [Medline]

 

Created Dec 15, 2020.

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