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Biochemical Pharmacology as an Approach to Gastrointestinal Disorders pp 141–167Cite as

Pathological Basis and Clinical Aspects of Oesophageal Motor Disorders

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Abstract

Among oesophageal motility disorders gastro-oesophageal reflux disease (GORD) affects a substantial number of population, whereas other motility disturbances including achalasia, hypertensive lower oesophageal sphincter, diffuse oesophageal spasm, and nutracker oesophagus occur relatively rarely. GORD is a complex motility disorder affecting the upper gut, which results in a pathologic reflux of gastric and intestinal contents to the oesophagus. Hypomotility changes involve both the oesophagus and the lower oesophageal sphincter (LOS), as well as the stomach. Pharmacologic basis of oesophageal motility disorder is not clearly understood, an improper release of acetylcholine or a vagally-mediated noncholinergic nonadrenergic inhibitory mechanism (candidate neurotransmitters are vasoactive intestinal peptide (VIP) and nitric oxide (NO)) is suspected. Failure of the motility defense mechanisms and tissue resistance of the oesophagus will lead to the development of symptoms and morphological alterations, e.g. reflux oesophagitis. In the development of atypical symptoms such as non-cardiac chest pain and respiratory complications, local factors, aspiration of the refluxed material and a vagally mediated coronary or bronchial spasm may be involved. Achalasia or cardiospasm is characterized by lack of relaxation of the LOS and loss of peristalsis in the lower two-thirds of the oesophagus. Motility disorder is caused mainly be denervation of postganglionic non-cholinergic non-adrenergic inhibitory neurons, resulting in a marked impairment of both acetylcholine and VIP or NO release. On the contrary, hypertensive LOS is characterized by increasing resting LOS pressure associated with normal sphincter relaxation and oesophageal peristalsis. In diffuse oesophageal spasm simultaneous or repetitive non-propagating contractions are recorded, while in nutcracker oesophagus manometry shows a pattern of high-amplitude but peristaltic contractions. In spastic motility disorders neural dysfunction may involve both afferent (sensory) and efferent fibres resulting in exaggerated response of the oesophagus to cholinergic stimulation. Nonspecific oesophageal motility disorders are associated with broad spectrum of manometric abnormalities including frequent nontransmitted contractions, retrograde contractions, low amplitude contractions, prolonged duration of peristaltic waves, and isolated incomplete LOS relaxation and their clinical significance is yet unknown.

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Authors and Affiliations

  1. First Department of Medicine, Albert Szent-Györgyi Medical University, Szeged, Hungary

    J. Lonovics

  2. Division of Gastroenterology, Szekszárd County Hospital, Szekszárd, Hungary

    L. Simon

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  1. J. Lonovics
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  2. L. Simon
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  1. School of Pharmacy, University of Wisconsin, Madison, WI, USA

    Timothy S. Gaginella

  2. First Department of Medicine, University Medical School of Pécs, Pécs, Hungary

    Gyula Mózsik

  3. Department of Biomedical Sciences, Sheffield Hallam University, Sheffield, UK

    K. D. Rainsford

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Lonovics, J., Simon, L. (1997). Pathological Basis and Clinical Aspects of Oesophageal Motor Disorders. In: Gaginella, T.S., Mózsik, G., Rainsford, K.D. (eds) Biochemical Pharmacology as an Approach to Gastrointestinal Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5390-4_14

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  • DOI: https://doi.org/10.1007/978-94-011-5390-4_14

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