Medical treatment of esophageal motility disorders

Abstract

Swallowing is a complex mechanism that is based on the coordinated interplay of tongue, pharynx, and esophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain, or regurgitation. The major esophageal motility disorders include achalasia, diffuse esophageal spasm, hypercontractile esophagus ("nutcracker esophagus"), and hypocontractile esophagus ("scleroderma esophagus"). Other esophageal diseases such as hypopharyngeal (Zenker's) diverticula or gastroesophageal reflux disease also may be sequelae of primary esophageal motility disorder. Finally, a substantial group of patients referred for evaluation of possible esophageal motor disorders have milder degrees of dysmotility--referred to as nonspecific esophageal motor disorder--that are of unclear clinical significance. Medical treatment of esophageal motility disorders involves the uses of agents that either reduce (anti-cholinergic agents, nitrates, calcium antagonists) or enhance (prokinetic agents) esophageal contractility. Despite the beneficial effect of the various drugs on esophageal motility parameters, the clinical benefit of medical treatment is often disappointing. From clinical and epidemiological studies there is some evidence for a "psychological" component in the pathogenesis or perception of esophageal symptoms. Further understanding of esophageal pathophysiology, as well as development of new receptor selective drugs, might increase our chances of successful treatment of esophageal motility disorders.

Usefulness of low- and high-volume multiple rapid swallowing during high-resolution manometry

“…This is clinically relevant especially in patients with weak peristalsis, and Shaker et al [7] have shown that the absence of a reserve in patients referred for anti-reflux surgery predicts post-surgical dysphagia. Furthermore, as it has been reported that prokinetic drugs lead to disappointing results in patients with weak peristalsis [17], ongoing studies are testing the hypothesis that the presence of a motor reserve at MRS identifies patients who may benefit from such drugs.…”

Use of Calcium Channel Blockers and Risk of Hospitalized Gastrointestinal Tract Bleeding

“…Because patients can take these medications without the knowledge of their physician and can purchase them without a prescription, it is likely that we did not identify all users. The antihypertensive medications examined in this study might sometimes be used to treat conditions that might be related to GI tract bleeding (eg, calcium channel blockers for esophageal motility disorders 18 and ␤-blockers for esophageal varices 19 ). However, all subjects in this study were being treated for hypertension, and these additional indications would be expected to be relatively uncommon.…”

Esophageal dysmotility in brothers with an FG-like syndrome

“…Nutcracker esophagus often responds well to calcium channel blockers such as nifedipine [Richter et al, 1987]. Other treatments include nitrates, anticholinergic drugs, sedatives, and surgery [Allescher and Ravich, 1993;Feussner et al, 1993]. Nutcracker esophagus is not well described in children.…”