Esophageal Motility Disorders
The esophagus is an important and sensitive tubular structure made of muscle tissue to connect the throat to the stomach. It sits between the trachea or windpipe and the spine and is around 11-12 inches long. The musculature of the esophagus contracts and relaxes to push food down into your stomach. At the very end of the esophagus is a valve known as the lower esophageal sphincter or LDS that allows one-way movement of food into the stomach. Proper function of the esophagus and LES allows food and drink to enter the stomach but prevents the reversal of stomach contents back into the esophagus unless needed for vomiting.
Esophageal mobility disorders are an all-encompassing term that describes problems with the sequential, coordinated muscular movements of the esophagus or integrity of the tubular structure. As you can imagine, vitality disorders are incredibly disruptive to a patient’s life, often making it difficult to eat or drink and receive appropriate nutrition. Difficulty swallowing is known as dysphagia. These esophageal motility disorders can be classified as primary, which includes any disease or condition directly associated with the esophagus, or secondary, where other diseases in other parts of the body affect the esophagus, such as neuromuscular disorders, adjacent tumors, or scleroderma, as an example.
The Most Common Primary Motility Disorders Include:
- Esophageal spasm
- Hypertensive LES
- Benign and malignant tumors
- Medication caused stricture and
- Peptic stricture (often from untreated GERD)
There are, of course, many other reasons why the esophagus could malfunction, so discussing any motility issues with your primary care physician or specialist is important.
There is some difficulty in estimating how many people have motility disorders in the US, but we believe that somewhere around 20% of the population over 50 has dysphasia. Only achalasia has truly accurate estimates of prevalence and incidence, with the latter being estimated at approximately three of every hundred thousand people in the United States.
Treatments for Common Esophageal Motility Disorders
Depending on the severity of the motility disorder, there are many treatment options for the various conditions. Mild to moderate dysphasia may be treated using lifestyle and medical interventions. Moderate to severe problems may require surgical intervention.
Achalasia, which represents the inability of the lower esophageal sphincter to relax, can be treated with a minimally invasive surgical procedure known as Heller’s myotomy, where the muscles of the LES are cut. We also treat achalasia with an advanced non-surgical option known as POEM.
Esophageal cancer is relatively rare but is typically brought about by chronic long-term exposure to acid refluxing from the stomach. Known as GERD, or gastroesophageal reflux disease, the constant acid wash can begin to change the esophagus’s cellular structure, creating a condition known as Barrett’s esophagus. This essentially turns the esophageal lining into something resembling stomach tissue. If left untreated, there’s a small chance of this becoming esophageal cancer.
GERD is most effectively treated using either fundoplication, where the top of the stomach is wrapped around the bottom of the esophagus, or the LINX procedure, which includes a titanium beaded bracelet placed around the LES to assist with closing pressure.
Esophageal cancer may be treated with chemotherapy, radiation therapy, or surgical resection of the esophagus, known as esophagectomy.
As you can see, effectively treating esophageal motility disorders requires proper identification and diagnosis followed by a treatment plan developed by an experienced specialist. Our surgeons at the Surgical Association of Mobile are highly trained and experienced in these disorders. As with all our surgical services, we look to find the least invasive and most effective option for each patient. Most importantly, you shouldn’t think you must live with a significant disability associated with esophageal motility concerns. There are options to help, and we look forward to discussing those with you soon during a consultation.