Esophageal Motility Disorders
There are problems with the way the esophagus squeezes that can cause swallowing disorders and/or chest pain. These are diagnosed with esophageal manometry.
Ineffective Esophageal Motility Disorder
This is a very common disorder, often associated with reflux. The esophagus does not adequately squeeze to propel food or liquid into the stomach in 3 or more out of 10 swallows. This can result in feeling of fullness, throat clearing, or feeling like something is stuck in your throat or chest. Treatment of reflux disease, lifestyle modifications, and bethanechol may be of benefit.
Absent esophageal contractions and failure of the lower esophageal sphincter (LES) to relax. This is a very serious swallowing disorder with no cure. Treatments include botulinum toxin injections (to paralyze the muscle of the LES) and surgical cutting of the LES muscle (myotomy). These procedures allow some food and drink to pass through the esophagus into the stomach by gravity.
Scleroderma is a systemic disease that frequently causes dysphagia. The proximal skeletal muscle of the esophagus is spared, but the rest of the esophagus fails to contract. The LES is incompetent causing significant reflux.
Nutcracker esophagus is a disorder in which the esophagus squeezes in a sequential, peristaltic fashion, but the pressures are too high. In distal esophageal spasm, the pressures may or may not be too high, but the contractions follow each other too rapidly to be peristaltic (or they may occur simultaneously). These disorders may cause chest pain and/or dysphagia. Many medications are used for esophageal spasm, including Viagra/Cialis, peppermint oil, and calcium channel blockers.
Hypertensive or Poorly-relaxing Lower Eesophageal Sphincter (LES)
When the LES resting pressure is too high or it does not relax fully, swallowing problems may result because food does not pass easily into the esophagus. This can be treated in the office with botulinum toxin injections.