Introduction
The oesophagus functions to propel food from the mouth to the stomach for digestion. Oesophageal motility disorders comprise a broad spectrum of diseases that affect the ability of the oesophagus to contract normally.
Causes
Some motility disorders, such as achalasia, are well characterized with good treatment options, but as yet have no known cause. Eosinophilic oesophagitis is an allergic disorder caused by infiltration of inflammatory cells (‘eosinophils’) into the oesophageal wall.
Symptoms
The classical symptoms of motility disorders are dysphagia (swallowing difficulty) and chest pain (from spasm of the oesophagus). Some patients may find that reflux symptoms are more prominent.
Tests
Initial investigation is an upper endoscopy. Further investigations of oesophageal pH (acid reflux) studies and manometry (pressure testing) are required to differentiate motility disorders from conventional reflux.
Diagnosis
There is some overlap between symptoms and investigation findings for reflux disease and motility disorders. This can sometimes make the correct diagnosis challenging. Dr Dodd will complete a detailed assessment of your symptoms and investigations before recommending a treatment plan, considering both non-surgical and surgical treatment options.
Treatment
The best treatment option for oesophageal motility disorder depends on the nature of the disorder. Achalasia is best treated by surgery (‘laparoscopic cardiomyotomy’, or keyhole division of the lower oesophageal sphincter muscle) as this gives the greatest symptom improvement for the longest time possible. Endoscopic balloon dilatation/stretch is another option in some cases. If achalasia is advanced, with complete loss of oesophageal peristalsis (contractility), the only option for symptom relief may be surgical removal of the oesophagus (‘oesophagectomy’).
Eosinophilic oesophagitis is best treated by dietary modification, PPI medicines and swallowed steroid (anti-inflammatory) medication. Endoscopic balloon dilatation (stretch) of the oesophagus can sometimes be helpful. If there is associated severe reflux, laparoscopic fundoplication can be helpful in selected cases.