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Esophageal Motility Disorders: Treatment and Diagnosis

By James M. Stewart, MD

Difficulty swallowing (dysphagia) is a common problem that many people experience. Oftentimes, trouble swallowing is caused by acid reflux or even a small, but harmless, narrowing of the esophagus may cause food to stick in the throat. These conditions are usually assessed with an upper endoscopy where a dilation of the esophagus may be necessary. The diagnosis of acid reflux may require pharmacological control to improve swallowing mechanisms. However, there are some rare causes of dysphagia that do not respond to these techniques.

In order to swallow properly, a very coordinated series of muscle contractions must occur in order to move food from the back of the mouth and into the esophagus. Then a different set of muscle contractions further progress the food through the esophagus and into the stomach. Relaxation of the sphincter muscles (which act as valves) has to synchronize with the muscle contractions in order to move the food through the esophagus. As one might imagine, there are many opportunities for these muscles to function improperly, resulting in a feeling of strain or discomfort when swallowing.

Diagnosing Esophageal Motility Disorders

The best method of diagnosis for muscular disorders of the esophagus is through a test called a HIGH RESOLUTION ESOPHAGEAL MANOMETRY. This process involves placing a small catheter (tube) that contains multiple pressure sensors into the esophagus. The patient is then given a slightly salty sip of water to drink which activates a swallowing response. The manometry machine then records the measurement of pressure on each of the tube’s sensors. The observed patterns are then compared to what is considered a normal swallow. The differences can help show which area may not be functioning at an optimal level, and how to best address the issue. This test process takes about 30 minutes to complete. Esophageal muscular dysfunction of this level is not typical; therefore, this test is not a routine recommendation until after a patient has had an upper endoscopy and has also tried other therapy options first.

Treating Esophageal Motility Disorders

Since an esophageal manometry can diagnose many different muscular causes of difficulty swallowing, treatment largely depends on what the test shows as abnormal function. Sometimes surgery is indicated to open a part of the esophagus that may not appropriately relax, sometimes medications can be used to help the esophagus contract more vigorously or more gently, depending on the abnormality.

If you are experiencing difficulty when swallowing, make an appointment with one of the gastroenterology specialists at Granite Peaks GI for a proper evaluation and diagnosis. A full range of treatment options are available to appropriately address your needs for this condition.