Esophageal Motility Disorders Follow-up

  • Author: Eric A Gaumnitz, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Further Outpatient Care

  • Patients require outpatient follow-up care.
    • Changes in medical therapy often are needed, and, with progression of disease, alternative endoscopic or surgical interventions might be needed.
    • Good planning and awareness of complications mandate multidisciplinary follow-up care, involving primary care, gastroenterology, dietary, and surgery services as needed.
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Transfer

  • Patients with achalasia, DES, or other motility disorders who need aggressive endoscopic or surgical interventions should be referred to centers with experienced gastrointestinal and surgical services.
  • Gastroenterologists dealing with such disease processes should be familiar with performance and interpretation of diagnostic and therapeutic procedures. This also is true for surgeons, who need to be familiar with the surgical intervention involved.
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Complications

  • Achalasia and squamous cell carcinoma
    • With achalasia, the risk of squamous cell carcinoma of the esophagus is higher than that of the general population.
    • No studies to date have shown convincing evidence that surveillance is worthwhile.
    • Pathogenesis is not well documented, but chronic mucosal irritation is incriminated.
    • Squamous cell carcinoma usually develops several years after the diagnosis of achalasia. The risk typically starts increasing after approximately 10 years of having the disease process.
    • At the time of diagnosis, the esophagus usually is dilated, and the tumor is advanced.
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Prognosis

  • Achalasia
    • Achalasia is a progressive disease that requires chronic therapy. Depending on the rate and extent of disease progression, therapy might include endoscopic and surgical interventions.
    • Advanced achalasia can lead to malnutrition, dehydration, and aspiration.
    • Even after therapy, patients continue to have mild symptoms related to aperistaltic esophagus and, thus, will want to still follow careful eating habits.
  • Scleroderma esophagus
    • Scleroderma is a systemic disease with a progressive nature.
    • Systemic complications are the major cause of mortality.
    • Significant acid reflux might lead to disabling symptoms, caused by reflux or its complications.
  • Spastic esophageal motility disorders
    • Whether or not symptomatic relief is achieved, prognosis in patients with spastic esophageal motility disorders is favorable.
    • Life expectancy is not affected, and weight loss is rare.
    • If symptoms progress, then workup should be repeated because DES can progress to achalasia.
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Patient Education

  • Patients should be counseled about their disease. They should be well informed about its lifelong nature. Possible complications, therapeutic options, expected outcomes, and dietary modifications should be explained.
  • Reassurance is important in patients with spastic motility disorders, especially in the setting of noncardiac chest pain.
  • For excellent patient education resources, visit eMedicine's Heartburn/GERD/Reflux Center and Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Reflux Disease (GERD) and Heartburn.
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Contributor Information and Disclosures
Author

Eric A Gaumnitz, MD  Professor of Medicine, Division of Gastroenterology, University of Wisconsin School of Medicine; Program Director, Gastroenterology and Hepatology Fellowship, University of Wisconsin School of Medicine and Public Health; Director, Motility Unit, University of Wisconsin Hospitals

Eric A Gaumnitz, MD is a member of the following medical societies: American Gastroenterological Association, American Motility Society, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Abdullah Fayyad, MD, MBBS  Gastroenterology Staff, Private Practice, Digestive and Liver Disease Consultants

Abdullah Fayyad, MD, MBBS is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Ronnie Fass, MD, FACP, FACG  Chief of Gastroenterology, Head of Neuroenteric Clinical Research Group, Southern Arizona Veterans Affairs Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association

Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting research; Eisai Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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The typical picture of achalasia. Note the "bird-beak" appearance of the lower esophageal sphincter (LES), with a dilated, barium-filled esophagus proximal to it. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
The response to amyl nitrate (a smooth muscle relaxant), with partial relaxation of the lower esophageal sphincter (LES), allows some barium to pass through it into the stomach. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Esophagram of a 65-year-old man with rapid-onset dysphagia over 1 year. Although esophagram shows a typical picture of achalasia, this patient had adenocarcinoma of the gastroesophageal junction. This is an example of pseudoachalasia, which reinforces the absolute need for esophagogastroduodenoscopy (EGD) in patients with radiologic diagnosis of achalasia. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
An esophagram demonstrating the corkscrew esophagus picture observed in a patient with manometry confirmed findings of diffuse esophageal spasm (DES). Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Response to amyl nitrate, with disappearance of the spasm on esophagram. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison.
Normal manometry results show normal esophageal body peristalsis with normal lower esophageal sphincter (LES) pressure and relaxation. The LES pressure tracing is at the level of the sleeve (tracing 6).
Achalasia manometry picture Note the nonrelaxing lower esophageal sphincter (LES) and the absence of esophageal body peristalsis. The LES pressure tracing is at the level of the sleeve (tracing 6).
Manometry demonstrates diffuse esophageal spasm with simultaneous contractions of the esophagus observed throughout the tracing. The lower esophageal sphincter (LES) pressure tracing is at the level of the sleeve (tracing 6).
 
 
 
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