Dysphagia

Caustic Ingestion ◽

Epiphrenic Diverticulum ◽

Motility Disorders ◽

Esophageal Spasm ◽

Schatzki Ring

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Primary esophageal motility disorders: Concise review for clinicians

Acta chirurgica iugoslavica ◽

10.2298/aci0603009s ◽

2006 ◽

Vol 53 (3) ◽

pp. 9-17 ◽

Cited By ~ 1

Author(s):

A. Simic ◽

Z. Raznatovic ◽

O. Skrobic ◽

P. Pesko

Keyword(s):

Esophageal Motility ◽

Wide Spectrum ◽

The Other ◽

Primary Esophageal Motility Disorders

Nutcracker Esophagus ◽

Motility Disorders ◽

Esophageal Spasm ◽

Concise Review ◽

Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Some, such as achalasia, are diseases with a well defined pathology, characteristic manometric features, and good response to treatments directed towards the palliation of symptoms. Other disorders, such as diffuse esophageal spasm and nutcracker esophagus, have no well defined pathology and could represent a range of motility abnormalities associated with subtle neuropathic changes, gastresophageal reflux and anxiety states. On the other hand, hypocontracting esophagus is generally caused by weak musculature commonly associated with gastresophageal reflux disease. Although manometric patterns have been defined for these disorders, the relation with symptoms is poorly defined and in some cases the response to medical or surgical therapy unpredictable. The aim of this paper is to present a wide spectrum of the primary esophageal motility disorders, as well as to give a concise review for the clinicians encountering these specific diseases. .

Injection of botulinum toxin relieves symptoms in patients with diffuse esophageal spasm and non-specific esophageal motility disorders

Gastroenterology ◽

10.1016/0016-5085(95)23334-2 ◽

1995 ◽

Vol 108 (4) ◽

pp. A168

Keyword(s):

Botulinum Toxin ◽

Esophageal Motility ◽

Motility Disorders ◽

Esophageal Spasm

Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211044971 ◽

2021 ◽

Vol 1 (3) ◽

pp. 254-262

Author(s):

Mario Costantini ◽

Renato Salvador ◽

Andrea Costantini

Keyword(s):

Chest Pain ◽

Esophageal Motility ◽

Current Knowledge ◽

Unexpected Finding ◽

Extreme Caution ◽

Motility Disorders ◽

Diagnosis And Management ◽

Chicago Classification ◽

Esophageal Spasm

Spastic esophageal motility disorders are represented, as per the Chicago classification 4.0, by diffuse esophageal spasm and hypercontractile esophagus. They are very rare and therefore poorly understood. The diagnosis is usually made by manometry in presence of dysphagia or chest pain, but often it is often an unexpected finding. In this paper, the authors review the current knowledge and possible treatments of these disorders, when needed. They underline that invasive treatments, as surgical myotomy or POEM, are rarely necessary and that the indications for them are based on low quality studies. Therefore, they should be used with extreme caution in treating spastic motility disorders other than achalasia.

Esophageal Motility Disorders: Current Concepts of Pathogenesis and Treatment

Canadian Journal of Gastroenterology ◽

10.1155/2000/389709 ◽

2000 ◽

Vol 14 (3) ◽

pp. 221-231 ◽

Cited By ~ 30

Author(s):

Peter J Kahrilas

Keyword(s):

Rare Disease ◽

Esophageal Motility ◽

Laparoscopic Approach ◽

Primary Data ◽

Pneumatic Dilation ◽

Nutcracker Esophagus ◽

Functional Disturbance ◽

Motility Disorders

Current concepts of esophageal motility disorders are summarized. Primary data sources were located via MEDLINE or cross-citation. No attempt was made to be comprehensive or inclusive of the literature because fewer than 10% of citations are discussed. Instead, emphasis was placed on new developments in diagnosis, therapeutics, and practice patterns. Controlled therapeutic trials and pathophysiological observations are emphasized. Achalasia is a rare disease of failed lower sphincter relaxation and aperistalsis. Diffuse esophageal spasm (DES), an equally rare disease, is defined by non-propagated esophageal contractions. Nonspecific motility disorders, including nutcracker esophagus and hypertensive lower esophageal sphincter, are identified only by manometry and are ten times as prevalent. Neuromuscular pathology is evident only with achalasia (myenteric plexus neurons destruction). Pharmacological therapies have limited efficacy with achalasia; more limited with DES; and none with the nonspecific motility disorders. More efficacious therapies for the nonspecific disorders are directed at associated reflux disease or psychiatric disorders. Pneumatic dilation is effective therapy for achalasia 72% of instances, but frequently requires repeat dilation and is complicated by a 3% perforation rate. Surgical myotomy is effective in 88% of achalasics; morbidity from thoracotomy has been the major limitation but this has been sharply reduced with a laparoscopic approach. In conclusion, although it has been suggested that esophageal motility disorders are distinct clinical entities, critical review of the literature supports this only in the case of achalasia, a disease of well defined pathophysiology, functional disturbance, and therapies. This clarity diminishes progressively for DES and non-specific esophageal motility disorders.

T01.02.21 ESOPHAGEAL MOTILITY DISORDERS IN EOSINOPHILIC ESOPHAGITIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30653-8 ◽

2020 ◽

Vol 52 ◽

pp. S71-S72

Author(s):

M. Ghisa ◽

G. Laserra ◽

C. Marinelli ◽

B. Barberio ◽

I. Barbuscio ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Esophageal Motility ◽

Motility Disorders

Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients’ Quality of Life—A Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111138 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11138

Author(s):

Joanna Sarbinowska ◽

Benita Wiatrak ◽

Dorota Waśko-Czopnik

Keyword(s):

Quality Of Life ◽

Natural History ◽

Esophageal Motility ◽

Assessment Tool ◽

Motor Dysfunction ◽

High Power Field ◽

Motility Disorders ◽

Schatzki Ring

Background: Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE). Methods: This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, p ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162). Results: Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia. Conclusion: The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients’ quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis.