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Motility Disorders

At Boston Medical Center, our specialists will treat your esophageal conditions, such as motility disorders, with the compassion and expertise for which we are known.

What are Motility Disorders?

When you swallow, food travels down the esophagus by a series of muscular contractions called peristalsis. At the bottom of the esophagus is a muscular valve (the lower esophageal sphincter or LES) that opens to allow food to enter the stomach and then closes to prevent regurgitation of stomach contents back into the esophagus. Motility disorders occur when this process is disrupted. They are more common in men and women older than age 50.

Motility disorders include

  • Achalasia. This is a failure of peristalsis to push food along the esophagus and a failure of the lower esophageal sphincter to relax to allow food to enter the stomach. Most patients complain of difficulty swallowing (dysphagia), regurgitation and weight loss.
  • Diffuse esophageal spasm. In this disorder, the esophagus muscles can contract, but are not coordinated to push food along the esophagus. Patients may complain of pain or difficulty swallowing.
  • Nutcracker esophagus. In this disorder, the esophagus muscles contract but at a much higher pressure than normal. The main symptom with nutcracker esophagus is chest pain.
  • Nonspecific esophageal motility disorders. This refers to a mixture of motility disorders that don't easily fit a defined pattern such as those described above.
  • Secondary esophageal motility disorders. These occur as a result of another condition such as diabetes, alcohol consumption, or scleroderma. Treatment will usually be aimed at the disease causing the motility disorder, but sometimes specific treatment including surgery may be required to help with swallowing difficulties.

Treatment of motility disorders require an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.

What are the Symptoms of Motility Disorders?

Symptoms vary, and may include

  • Difficulty swallowing
  • Chest pain
  • Regurgitation
  • Heartburn
  • Unexplained weight loss

What are the Causes?

The causes of motility disorders are not completely understood, but researchers think infections and family history play a role.

How are Motility Disorders Diagnosed?

There are several ways that physicians may detect a motility disorder, after doing a medical history and physical examination.

Barium Swallow

A barium swallow (also called a contrast esophagram), is a series of x-rays of your esophagus. For the test, you will drink a barium-containing liquid, which coats the inside of the esophagus and makes its shape and contours appear on x-rays. As the liquid moves from the mouth down to the esophagus, the physician can assess any narrowing, enlargement or abnormalities. You will most likely be asked not to eat or drink for 8 to 10 hours before the test.

Endoscopy

You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.

Esophageal Manometry

This test measures the pressure inside the lower esophageal sphincter (LES). A thin tube is inserted through your mouth or nose and into your stomach. Once it is in place, the physician will gently pull the tube back into the esophagus and ask you to swallow. As you do so, the pressure and coordination of your muscle contractions will be measured. If the pressure is low or the LES is not relaxing properly, achalasia may be present. If the pressure is low or the LES is not contracting properly, it may indicate GERD (reflux disease).

How are Motility Disorders Treated?

Your treatment options will include:

Botox

Botulinum toxin, or botox, injections may ease symptoms in some patients with motility disorders.

Medication
Sometimes medications that relax muscles, such as calcium channel blockers, vasodilators or anti-cholinergics, are helpful.

Myotomy

Treatment options for esophageal conditions vary, but one of the most effective long-term therapies is myotomy, which is a generic term for surgery in which a muscle is cut. In esophageal conditions, the surgeon typically cuts the muscle fibers in the lower esophageal sphincter, or LES, to correct the condition.

There are three ways to perform a myotomy:

  • Open surgery, using thoracotomy or incision
  • Laparoscopically, meaning through tiny incisions in the abdomen. A thin, lighted tube called a laparoscope, as well as other surgical tools, are inserted through these incisions to allow the surgeon to work on the esophagus.
  • Robotic myotomy, in which the surgeon guides robotic instruments in the abdomen using a computer console. The surgeon's hand movements are conveyed to the robotic instruments mimicking the same movements that would be used if larger incisions, big enough for the surgeons hands, were used. Boston Medical Center was the first center in New England to perform thoracic procedures such as Heller myotomy using a robot.
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