RT Book, Section
A1 Burakoff, Robert
A1 Chan, Walter W.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Burt, Bryan M.
A2 Groth, Shawn S.
A2 Loor, Gabriel
A2 Wolf, Andrea S.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1170407354
T1 Overview of Esophageal Motility Disorders
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170407354
RD 2023/06/01
AB Primary  esophageal  motility  disorders  are  characterized  by  abnormalities  of  esophageal  peristalsis  or  contractions  that  interfere  with  swallowing  and  transit  of  food  through  the  esophagus,  producing  symptoms  of  dysphagia  and  chest  pain.  The  disorder  is  considered  primary  (idiopathic)  when  the  cause  of  the  patient’s  symptoms  and  altered  motility  cannot  be  attributed  to  other  systemic  diseases  (e.g.,  diabetes  mellitus,  scleroderma,  amyloidosis,  or  neuromuscular  disorders  that  affect  striated  muscle).  The  classic  presentation  is  achalasia,  a  disorder  characterized  by  failure  of  the  lower  esophageal  sphincter  (LES)  to  relax.  There  are  several  nonspecific  esophageal  motility  disorders,  including  diffuse  esophageal  spasm  (DES),  nutcracker  esophagus,  ineffective  esophageal  motility  (IEM),  and  other  abnormalities  of  the  LES.  Whether  these  represent  true  disorders,  a  continuum  of  disease,  or  merely  abnormal  motility  patterns  that  are  associated  with  but  not  the  physiologic  causes  of  symptoms  remains  a  controversy  (Table  33-1).  Lack  of  a  meaningful  classification  system  adds  to  this  confusion.  Current  systems  classify  the  disorder  based  on  aberrant  esophageal  motility  patterns  documented  on  manometric  studies  in  the  context  of  dysphagia  and  pain  that  cannot  be  explained  by  other  thoracic  or  cardiac  disease.  These  systems  fall  short  because  the  cause  of  most  motility  abnormalities  is  unknown.  Patients  can  have  abnormal  manometric  tracings  and  be  perfectly  healthy.  Conversely,  therapies  may  correct  the  abnormal  tracing,  but  symptoms  do  not  improve.  Strategies  for  managing  esophageal  dysmotility  disorders  include  conservative  management,  treatment  with  drugs  and  other  agents,  and  surgery.  In  the  sections  that  follow  we  review  current  knowledge  about  the  pathophysiology  of  the  primary  esophageal  motility  disorders  and  recent  advances  in  diagnosis  and  treatment.