Updates in Management of Esophageal Motility Disorders

Abstract

Esophageal motility disorders encompass a broad class of diseases that are manifest by abnormal contractions of the esophageal body as well as abnormal function of both the upper and lower esophageal sphincters. Esophageal motility disorders are not uncommon in gastroenterology. The spectrum of these disorders ranges from the well-defined primary esophageal motility disorders to very nonspecific disorders that may play a more indirect role in reflux disease and otherwise be asymptomatic .Also they occur as a manifestation of systemic diseases, referred to as secondary motility disorders. Pathophysiologic classification ofprimary esophageal motility disorders based on the type of innervations affected .They can be broadly classified into disorders of inhibitory or excitatory innervations. Disorders of inhibitory innervations may be those associated with decreased or increased inhibitory function. Decreased inhibitory nerve function include such conditions as diffuse esophageal spasm and achalasia . Increased inhibitory nerve function is manifested by transient lower esophageal sphincter relaxation (TLESR) and LES hypotension. Disorders of excitatory innervations may also include those associated with increased or decreased excitatory function . Manifestations of decreased excitatory nerve function include hypotensive peristalsis in the esophagus and hypotensive LES and LES with poor reflex contraction. Increased excitatory function may be responsible for hypertensive esophageal peristaltic contractions (nutcracker esophagus) or hypertensive and hypercontracting LES.