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The esophagus is the tube that carries food and drink from the mouth to the stomach. Normally, muscles in the walls of the esophagus contract in a coordinated way to move solids and liquids along. Esophageal motility disorder is a condition where the muscles do not move in a coordinated manner, or are too weak. This means that the esophagus is unable to propel substances down into the stomach effectively. Someone with an esophageal motility disorder may experience symptoms such as pain, difficulty swallowing and regurgitation of food and drink.
There are a number of different types of esophageal motility disorder. Primary esophageal motility disorders, or PEMDs, are the main diseases, which occur in their own right, while secondary esophageal motility disorders arise as the result of other illnesses. Esophageal dysmotility tends to be a long-term problem, lasting for months or years, and the symptoms vary according to the specific type of disease. For many forms of the disorder, the causes are not fully known.
Achalasia is probably the most thoroughly understood type of esophageal motility disorder. It is thought to be caused by loss of nerve cells inside the muscles in the esophageal walls. Over a number of years, a person with achalasia finds it gradually more difficult to swallow food and drink. Sometimes food is regurgitated, and there might be chest pain experienced behind the breastbone. Achalasia usually begins to develop between 20 and 60 years of age, and may result in weight loss.
In what are known as spastic esophageal motility disorders, the esophageal muscles contract abnormally, causing chest pain, which is sometimes accompanied by swallowing difficulties. Swallowing is not usually as severely affected as it is in achalasia. The chest pain associated with a spastic esophageal motility disorder may be confused with the pain of heart disease. It sometimes occurs during exercise and may result in emergency hospital visits. Spastic esophageal motility disorders are not as well understood as achalasia, and the causes of the abnormal muscle contractions in the esophagus are unknown.
As esophageal motility disorder cannot be cured. Treatment usually relies upon relieving symptoms if they become too severe. Simple measures can be helpful, such as eating more slowly and carefully, taking smaller meals more frequently, and avoiding lying down or exercising after eating. Drugs may be used to relax the esophageal muscles, or a type of balloon may be inflated inside the esophagus in order to dilate it. Sometimes surgical techniques are used to cut some of the muscles, allowing food to pass more easily.