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Esophageal Hypomotility and Spastic Motor Disorders: Current Diagnosis and Treatment

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
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Abstract

Esophageal hypomotility (EH) is characterized by abnormal esophageal peristalsis, either from a reduction or absence of contractions, whereas spastic motor disorders (SMD) are characterized by an increase in the vigor and/or propagation velocity of esophageal body contractions. Their pathophysiology is not clearly known. The reduced excitation of the smooth muscle contraction mediated by cholinergic neurons and the impairment of inhibitory ganglion neuronal function mediated by nitric oxide are likely mechanisms of the peristaltic abnormalities seen in EH and SMD, respectively. Dysphagia and chest pain are the most frequent clinical manifestations for both of these dysfunctions, and gastroesophageal reflux disease (GERD) is commonly associated with these motor disorders. The introduction of high-resolution manometry (HRM) and esophageal pressure topography (EPT) has significantly enhanced the ability to diagnose EH and SMD. Novel EPT metrics in particular the development of the Chicago Classification of esophageal motor disorders has enabled improved characterization of these abnormalities. The first step in the management of EH and SMD is to treat GERD, especially when esophageal testing shows pathologic reflux. Smooth muscle relaxants (nitrates, calcium channel blockers, 5-phosphodiesterase inhibitors) and pain modulators may be useful in the management of dysphagia or pain in SMD. Endoscopic Botox injection and pneumatic dilation are the second-line therapies. Extended myotomy of the esophageal body or peroral endoscopic myotomy (POEM) may be considered in highly selected cases but lack evidence.

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Miguel A. Valdovinos, Monica R. Zavala-Solares, and Enrique Coss-Adame declare that they have no conflict of interest.

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This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

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  1. Department of Gastroenterology, Gastrointestinal Motility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15, Tlalpan, 14000, Mexico City, Mexico

    Miguel A. Valdovinos, Monica R. Zavala-Solares & Enrique Coss-Adame

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  1. Miguel A. Valdovinos
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Correspondence to Miguel A. Valdovinos.

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This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

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Valdovinos, M.A., Zavala-Solares, M.R. & Coss-Adame, E. Esophageal Hypomotility and Spastic Motor Disorders: Current Diagnosis and Treatment. Curr Gastroenterol Rep 16, 421 (2014). https://doi.org/10.1007/s11894-014-0421-1

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