Esophageal Motility Disorders and Achalasia

Swallowing depends on a wave of muscle contractions that moves food down the esophagus, and a valve at the bottom (the lower esophageal sphincter) that relaxes to let food into the stomach. Esophageal motility disorders happen when these muscles or nerves don't work normally.

Types

• Achalasia: the valve doesn't relax and the esophagus loses its squeezing wave
• Esophageal spasm and hypercontractile esophagus: contractions are too strong or poorly coordinated, which can cause chest pain
• Ineffective motility: contractions are too weak, often seen with reflux
• Motility problems from other conditions, such as scleroderma

Symptoms

• Food or liquid sticking in the chest (dysphagia)
• Food coming back up, sometimes at night
• Chest pain
• Heartburn that doesn't respond to medicine
• Weight loss

Tests

• Upper endoscopy (EGD) to rule out narrowing, inflammation, or a tumor
• Esophageal manometry, the key test that measures muscle pressure and coordination
• Barium swallow X-ray

Treatment

For achalasia, treatments open the tight valve:

• Pneumatic (balloon) dilation during endoscopy
• POEM (peroral endoscopic myotomy): the muscle is cut from inside the esophagus, with no skin incisions
• Heller myotomy: a laparoscopic surgery, often with a partial wrap to limit reflux
• Botox injection: temporary relief for people who can't have other treatments

Spasm and other disorders may be treated with acid control, medicines that relax smooth muscle, or, in selected cases, endoscopic therapy. Dr. Tim Chen's clinical interests include esophageal motility disorders.

Make an appointment

Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.

This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.