eMedicine Specialties > Gastroenterology > Esophagus
Esophageal Motility Disorders: Treatment & Medication
Updated: Aug 29, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
The primary underlying neuropathology process in patients with achalasia cannot be cured; therefore, the primary goal of treatment is symptomatic relief.5 As the myenteric nerves do not regenerate, treatment goals are directed at relieving the physiologic obstruction at the level of the LES by surgical or endoscopic balloon disruption of the LES muscle or, less effectively, through medications that relax the LES smooth muscle. In the spastic motility disorders, relaxation of the esophageal body and LES smooth muscle lends some relief of dysphagia and atypical chest pain. In patients with scleroderma esophagus, treatment is more targeted, involving aggressive antireflux therapy and management of reflux complications (eg, stricture dilation).
- Pharmacologic therapy
- Current pharmacologic therapy can provide some symptomatic relief to patients in the early stages of achalasia when disease activity is mild or moderate. More definitive therapy is spared for patients with advanced disease. In patients with spastic esophageal motility disorders, current pharmacologic therapy provides varying degrees of symptomatic relief.
- Smooth muscle relaxants, including nitrates and calcium channel blockers, were the first medications to be used in all patients with esophageal motility disorders. The greatest experience has been with isosorbide dinitrate and nifedipine. The efficacy of these agents was demonstrated in case reports and retrospective studies primarily. Other drugs used less extensively include different types of anticholinergics, amyl nitrite, nitroglycerin, theophylline, beta2-agonists, and, recently, phosphodiesterase inhibitors. The experience with these drugs is limited.
- Noncardiac chest pain in the setting of spastic esophageal dysmotility often shows good response to antireflux therapy, even in the absence of typical gastroesophageal reflux symptoms. Reassurance and control of anxiety is extremely important in this setting. If antireflux therapy fails, alternatives include different classes of muscle relaxants mentioned above and pain modulators such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and trazodone. Some studies report positive results from behavior modification programs and biofeedback.
- Chronic pain management with TCAs is effective in managing noncardiac chest pain that is resistant to other therapies.
- Botulinum toxin injection
- Botulinum toxin injections into the LES have been used in treating patients with achalasia. Botulinum toxin is a potent inhibitor of acetylcholine release from nerve terminals. A sclerotherapy needle is used to inject 80-100 units of botulinum toxin into the 4 quadrants of the LES.
- This therapy may be a good alternative for poor surgical candidates, such as elderly patients or frail individuals. The major disadvantages are the high cost and the need for repeated therapeutic sessions.
- Some data suggest efficacy in patients with DES and hypertensive LES dysfunction, especially focusing on symptomatic relief of pain, dysphagia, and regurgitation. More studies are needed to prove this effect.
- Endoscopic therapy
- Esophagogastroduodenoscopy (EGD) with pneumatic dilation is the standard endoscopic therapy for patients with achalasia and can be performed on an outpatient basis. Forceful distension of the LES to 3 cm with disruption of the circular muscle layer is needed for symptomatic relief. This distension and disruption cannot be achieved with the standard bougie (to 56F), which provides temporary benefit at best. Balloon dilators specifically designed to treat patients with achalasia achieve adequate diameter for lasting effectiveness. Achalasia dilators are long, noncompliant, cylindrical balloons that are positioned fluoroscopically or endoscopically across the LES and then inflated to a certain characteristic diameter: 30 mm, 35 mm, or 40 mm.
- Technique details are variable among different practitioners.
- Response rates vary from 50-93%. If no response is seen after 2 successive balloon dilations, it is unlikely to work.
- Chest pain is felt during inflation, even under sedation. The major complication is perforation, which occurs at a rate as high as 8%. Patients should be observed for 3-6 hours before discharge, or, alternatively, a water-soluble contrast esophagram should be performed postdilation.
- If no perforation is noted, the patient's diet can be advanced slowly over a few days. Acid suppression should be used after vigorous dilation with significant mucosal tears, as they are at risk for subsequent gastroesophageal reflux. If perforation complicates a pneumatic dilation, intervention varies according to severity. Small or intramural perforations can be managed with a conservative approach, including IV antibiotics, nothing by mouth, and observation; large perforations or progression of symptoms requires surgical repair, which carries favorable prognosis if performed early. At the time of surgery, a myotomy can be coupled with a repair operation.
- After pneumatic dilation, the best outcome predictor is measuring the residual LES pressure. If the pressure is less than 10 mm Hg, the outcome usually is excellent. If the LES pressure is more than 20 mm Hg postdilation, the clinical outcome usually is poor. The dilation can be repeated, although poor initial results and rapid recurrence postdilation indicate a poor response to repeat dilation. The overall success rate with endoscopic dilation is reportedly 30-98% in different series. This therapy has no effect on future Heller myotomy if surgery ultimately is needed.
- Pneumatic dilation showed positive results in a subset of patients with DES and LES dysfunction. This is based mainly on case reports and case series. Further verification of its role in this setting is needed.
Surgical Care
Similar to endoscopic balloon dilation for achalasia, surgical treatment targets to disrupt the LES (myotomy) and, therefore, to relieve the high pressures at the gastroesophageal junction.6 Since the development of laparoscopic technique for LES myotomy, a trend has emerged to treat younger and older patients with myotomy who are deemed good surgical candidates. Excellent results have been reported in 80-100% of patients. In advanced cases, when the esophageal anatomy is markedly distorted or when malignancy develops, esophagectomy becomes the surgical procedure of choice. In patients with other esophageal motility disorders, surgery rarely is indicated because these disorders generally are tolerable and do not cause malnutrition or dehydration.
- Heller myotomy
- Heller myotomy is the operative procedure of choice in patients with achalasia.
- Technically, an approximate 3- to 4-cm incision is made from the distal esophagus, across the GEJ, and onto the cardia and fundus of the stomach. The incisional depth is through both layers of the muscularis propria but not through the muscularis mucosa.
- Myotomy of the LES decreases the pressure across the gastroesophageal junction and eliminates dysphagia.
- Unfortunately, myotomy may lead to gastroesophageal reflux; therefore, fundoplication may be coupled with the myotomy at the time of the surgery.
- Myotomy can be performed through either transthoracic or transabdominal approaches; however, a transabdominal technique is favored. The laparoscopy and thoracoscopy techniques decrease perioperative morbidity and hospital stay.
- Efficacy is 60-100% in different series and is found to have a longer duration of efficacy compared to endoscopic balloon disruption.
- The major postoperative complication of Heller myotomy is postmyotomy reflux. Reflux symptoms tend to be particularly severe due to aperistalsis in the esophageal body preventing proper acid clearance from the esophagus. Severe esophagitis, stricturing, and Barrett changes are observed in approximately 15% of patients postoperatively.
- Adenocarcinoma of the esophagus also is described.
- Another significant complication is recurrent or persistent dysphagia, which is observed in 10-20% of patients postoperatively.
- Mortality is less than 0.2%.
- Esophagectomy with gastric pull up or intestinal interposition
- In patients with extremely advanced disease or refractory cases, 2 surgical options are esophagectomy with gastric pull up or intestinal interposition operation.
- Other indications for esophagectomy are unresolved obstructive symptoms, carcinoma, or perforation during dilation.
- Perioperative mortality for this surgery is 4%.
- Extended Heller myotomy
- Unlike achalasia, where surgical myotomy is considered early in management, in patients with refractory DES, surgical therapy is the last resort when dysphagia or pain is severe.
- The operative procedure involves an extended Heller myotomy of the LES, with proximal extension to the thoracic inlet. Compared to standard myotomy, this surgery is more complex and aggressive and should be used cautiously since the symptoms are frequently not relieved.
Consultations
Gastroenterology consultation should be obtained for any patient with a suspected esophageal motility disorder for proper evaluation.
Diet
- Dietary and eating habits should to be adjusted. Smaller, more frequent meals are preferred over the larger meals of the traditional 3 meals per day pattern. Liquid foods will ultimately pass down the esophagus and through the LES with less resistance.
- Patients should be instructed to take smaller bites of food, with thorough chewing and slow swallowing. Patients should follow food boluses with liquids frequently.
- Instruct patients to remain in the upright posture during and for some time after mealtime (at least 2 h) to enhance esophageal emptying. Straightening of the back, raising arms above the head, and standing can increase intraesophageal pressure and enhance esophageal clearance.
Activity
Avoiding exercise and avoiding lying down during and after mealtime can enhance esophageal emptying and improve symptoms.
Medication
Drug treatment targets relaxation of the smooth muscle of the LES and esophageal body for symptomatic relief. In a subset of patients with esophageal body spastic motility disorders, relieving anxiety has been shown to improve symptoms. Commonly used medications for patients with esophageal motility disorders include calcium channel blockers, smooth muscle relaxants, anticholinergics, and antianxiety medications. No one single drug has proven efficacy in the treatment of spastic motility disorders.
Calcium channel blockers
Inhibit calcium ions from entering slow channels, select voltage-sensitive areas, or vascular smooth muscle.
Nifedipine (Adalat, Procardia)
Relaxes smooth muscles, including those of the LES and esophageal body.
Adult
10-30 mg IR cap tid/qid 30 min ac; not to exceed 120 mg/d
30-120 mg SR tab qd; not to exceed 90-120 mg/d
Pediatric
Not established
Caution with coadministration of any agent that can lower BP, including beta-blockers and opioids; H2 blockers (cimetidine) may increase toxicity; NSAIDs in combination with nifedipine showed a possible increased risk of GI hemorrhage; occasionally, results in as much as a 50% increase in serum digoxin concentration; increased risk of phenytoin toxicity; alterations in theophylline serum concentration may occur
Documented hypersensitivity; MI within 4 wk; aortic stenosis; unstable angina pectoris
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause lower extremity edema; allergic hepatitis has occurred but is rare; angina at initiation of treatment or with increases in dosage may occur; caution in chronic renal insufficiency or CHF; withdraw nifedipine 36 h prior to surgery (severe hypotension observed if used with beta-adrenergic blockers during fentanyl anesthesia); GI hypermotility and obstruction with SR forms; erythema multiforme or exfoliative dermatitis reported
Amlodipine (Norvasc)
Relaxes smooth muscles, including those of the LES and esophageal body.
Adult
2.5-10 mg PO qd
Pediatric
Not established
Fentanyl may increase hypotensive effects; may increase cyclosporin levels; H2 blockers (cimetidine) may increase toxicity; NSAIDs in combination with amlodipine showed a possible increased risk of GI hemorrhage
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in renal/hepatic impairment; may cause lower extremity edema; allergic hepatitis has occurred but is rare; angina at initiation of treatment and with dosage increases may occur; aortic stenosis (reduced myocardial oxygenation with drug-induced hypotension) may occur; caution in CHF and hypotension; erythema multiforme or exfoliative dermatitis may occur
Vasodilators
Used for smooth muscle relaxation effects.
Isosorbide dinitrate (Isordil, Dilatrate-SR)
Relaxes smooth muscles, including those of the LES and esophageal body.
Adult
5-20 mg IR PO q6h 30-60 min ac; not to exceed 40 mg
40-80 mg SR PO bid; not to exceed 120 mg
Pediatric
Not established
Coadministration with alcohol may cause severe hypotension and cardiovascular collapse; aspirin may increase serum concentrations of isosorbide and actions; coadministration with channel blockers may increase symptomatic orthostatic hypotension (adjust dose of either agent); isosorbide may decrease effects of heparin
Documented hypersensitivity; severe anemia; closed-angle glaucoma; postural hypotension; head trauma; cerebral hemorrhage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Tolerance to vascular and antianginal effects of nitrates may develop; minimize tolerance by using smallest effective dose, pulse therapy (intermittent dosing), or by alternating with other coronary vasodilators (take last daily dose of short-acting agent no later than 7 pm); caution when administering to patients with glaucoma or acute myocardial infarction; caution in elderly patients; GI hypermotility and malabsorption syndromes may occur with SR form; caution in hyperthyroidism, hypertrophic cardiomyopathy, restrictive cardiomyopathy, pericardial tamponade, postural hypotension, volume depletion, and pregnant and breastfeeding women; withdraw gradually to avoid acute angina
Nitroglycerin (Nitro-Bid, Deponit, Nitro-Dur)
Relaxes smooth muscle all over the body, including those of the LES and esophageal body.
Adult
0.4 mg SL 30 min ac
2.5-6.5 mg SR PO tid; not to exceed 9 mg
Pediatric
Not established
Aspirin may increase nitrate serum concentrations; marked symptomatic orthostatic hypotension may occur with coadministration of calcium channel blockers (dose adjustment of either agent may be necessary); dihydroergotamine toxicity with peripheral ischemia, paresthesias, nausea, and vomiting; suggested negative effect on anticoagulant action of heparin; alcohol use enhances hypotensive effects
Documented hypersensitivity; severe anemia; shock; postural hypotension; head trauma; closed-angle glaucoma; cerebral hemorrhage; early MI with SL form
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in coronary artery disease, hyperthyroidism, hypertrophic cardiomyopathy, increased intraocular pressure, volume depletion, and low systolic blood pressure; acute myocardial infarction; postural hypotension may occur, especially in elderly patients; gastric hypermotility and malabsorption syndromes with SR form; withdraw gradually
Anticholinergics
Inhibit the cholinergic effect on the gut to induce relaxation.
Dicyclomine (Bentyl)
Treats GI motility disturbances. Blocks action of acetylcholine at parasympathetic sites in secretory glands, smooth muscle, and CNS.
Adult
10 mg PO qid 30-60 min ac; may increase to as much as 160 mg/d qid according to response obtained during first wk of therapy, unless adverse effects limit escalation
Pediatric
<6 months: Not recommended
>6 months: Not established
Effects are weakened when administered with anti-Parkinson drugs, haloperidol, and phenothiazines; toxicity increases when administered concurrently with amantadine, antihistamines, type I antiarrhythmics, phenothiazines, TCAs, or narcotic analgesics; antacids may interfere with absorption
Documented hypersensitivity; myasthenia gravis; narrow-angle glaucoma; unstable cardiovascular status in acute hemorrhage
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in hepatic or renal insufficiency, cardiovascular disease, urinary tract obstruction, ulcerative colitis, GI obstruction, hyperthyroidism, hypertension, autonomic neuropathy, children, elderly patients, CHF, hiatal hernia, ileostomy, colostomy, tachyrhythmia, and tachycardia; may cause heat prostration; avoid driving or hazardous activities; may cause neuromuscular blockade, resulting in weakness or paralysis
Hyoscyamine (Levbid)
Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and CNS, which, in turn, has antispasmodic effects. SL tabs may be administered orally, sublingually, or chewed.
Adult
IR: 0.125-0.25 mg PO/SL qid or prn; not to exceed 1.5 mg/d
SR: 0.375-0.75 mg PO q12h 30 min ac; dose may be adjusted to q8h if needed; not to exceed 1.5 mg/d
Pediatric
Not established
Effects decrease when used concurrently with antacids; toxicity increases when used concurrently with phenothiazines, amantadine, or haloperidol; MAOIs and tricyclic antidepressants; antacids may interfere with absorption; procainamide use may result in additive antivagal effects on atrioventricular nodal conduction
Documented hypersensitivity; obstructive uropathy; narrow-angle glaucoma; myasthenia gravis; obstructive GI tract disease; significant hepatic, renal, or pulmonary insufficiency; unstable cardiovascular status in acute hemorrhage
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in children and elderly patients; some products contain sodium metabisulfite, which can cause allergic-type reactions; caution in autonomic neuropathy, CHG, hypertension, hyperthyroidism, prostatic hypertrophy, tachyrhythmia, and tachycardia; may cause heat prostration; avoid driving or hazardous activities; may cause neuromuscular blockade, resulting in weakness or paralysis
Anxiolytics
Relief of anxiety related to symptoms experienced by some patients with esophageal motility disorders, resulting sometimes in symptomatic relief.
Alprazolam (Xanax)
Binds receptors at several sites within the CNS, including the limbic system and reticular formation. Effects may be mediated through GABA receptor system.
Adult
0.25-0.5 mg PO tid initial, titrated up q3-4d; not to exceed 4 mg/d
Pediatric
Not established
Carbamazepine and disulfiram decrease effects; toxicity increases with cimetidine, lithium, contraceptives, and CNS depressants (including alcohol); increases digoxin concentrations (5% to >100%) have been described; concomitant administration of azole antifungals may result in increased serum concentrations of alprazolam; theophylline has been shown to reverse the sedative effects of benzodiazepines
Documented hypersensitivity; severe respiratory depression; narrow-angle glaucoma; preexisting hypotension
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Withdrawal symptoms, including seizures, may occur upon abrupt discontinuation of drug; caution in liver disease or untreated open-angle glaucoma
Tricyclic antidepressants
Used in chronic pain management for noncardiac chest pain unresponsive to other treatment modalities.
Amitriptyline (Elavil)
Has analgesic effects for some forms of chronic and neuropathic pain.
Adult
10 mg/d PO hs, increase by 10-mg increments until desired effect is reached, intolerable adverse effects occur, or to a maximum dose of 150 mg/d
Pediatric
Not established
Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase amitriptyline levels; amitriptyline inhibits hypotensive effects of guanethidine; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram; phenytoin metabolism may be inhibited by amitriptyline, resulting in increased serum phenytoin concentration and possible toxicity; warfarin half-life and bioavailability can increase with the use of amitriptyline; fluoroquinolones may prolong QT interval, which may result in ventricular tachycardia, ventricular fibrillation, or torsades de pointes; sotalol has been shown to prolong QT interval at recommended therapeutic dose; tramadol is reported to cause seizures; some medications, including TCAs, are known to reduce the seizure threshold (concomitant use of tramadol and TCAs is not recommended)
Documented hypersensitivity; MAOIs taken in past 14 d; acute recovery phase following MI; history of seizures, cardiac arrhythmias, glaucoma, or urinary retention
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in cardiac conduction disturbances and history of hyperthyroidism or renal or hepatic impairment; avoid using in elderly patients; caution in pregnancy, schizophrenia, and bipolar disorder; potentially suicidal patients should not have access to large amounts of amitriptyline; caution if receiving concomitant electroshock therapy or large doses of ethchlorvynol
Nortriptyline (Pamelor)
Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, this drug increases the synaptic concentration of these neurotransmitters in the CNS. Pharmacodynamic effects (eg, desensitization of adenyl cyclase, down-regulation of beta-adrenergic and serotonin receptors) also appear to play a role in its mechanism of action.
Adult
10 mg/d PO hs, increase by 10-mg increments until desired effect is reached, intolerable adverse effects occur, or to a maximum dose of 150 mg/d
Pediatric
Not established
Cimetidine may increase nortriptyline levels when used concurrently; may increase PT in patients stabilized with warfarin; phenytoin metabolism can be inhibited by nortriptyline, resulting in increased serum phenytoin concentration and possible toxicity; fluoroquinolones may prolong QT interval, which may result in ventricular tachycardia, ventricular fibrillation, or torsades de pointes; concurrent administration of isocarboxazid and nortriptyline is contraindicated; sotalol has been shown to prolong QT interval at recommended therapeutic dose; tramadol is reported to cause seizures; some medications, including TCAs, are known to reduce the seizure threshold (concomitant use of tramadol and TCAs is not recommended)
Documented hypersensitivity; narrow-angle glaucoma; MAOIs taken in past 14 d; acute recovery period after MI
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in cardiac conduction disturbances and history of hyperthyroidism or renal or hepatic impairment; due to pronounced effects in cardiovascular system, best to avoid in elderly patients; caution in concomitant use of reserpine, schizophrenia, and large doses of MAOIs
Acetylcholine release inhibitors
Local anticholinergic use at the LES.
Botulinum toxin (BOTOX)
Binds to receptor sites on motor nerve terminals and inhibits release of acetylcholine, which, in turn, inhibits transmission of impulses in neuromuscular tissue.
Adult
80 U (4 injections of 1 mL at 20 U/L) intralesionally, within 1 cm proximal gastroesophageal junction
Pediatric
Not established
Aminoglycosides or drugs that interfere with neuromuscular transmission may potentiate effects of botulinum toxin; chloroquine antagonizes onset of paralysis caused by botulinum toxin
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not to exceed recommended doses and frequencies of administration; presence of antibodies to botulinum toxin type A may reduce effects of therapy; relative potencies of botulinum toxin preparations available in the UK and North America differ significantly; diseases of neuromuscular transmission and coagulopathy, including anticoagulant therapy; long-term data on toxicity of botulinum toxin are limited, advise patients to receive as few life-time doses as possible
Antiparasitic agents
For reduction in parasitemia and improvement of clinical signs and symptoms of Chagas disease.
Nifurtimox (Lampit)
5-nitrofuran derivative that is the current drug of choice in the United States for treatment of acute Chagas disease (American trypanosomiasis) due to T cruzi infection. Although the use of this drug is effective in reducing or eliminating parasitemia and clinical symptoms in acute disease, whether chronic sequelae are reliably prevented is unclear. In the chronic stage, a long-term parasitological cure may not be achieved, and the drug may not alter the course of the disease significantly.
Dose adjustments may be indicated in renal or hepatic disease. The toxicity of nifurtimox also is a limitation, and geographic variations in response to nifurtimox in patients with chronic disease have been reported.
Adult
8-10 mg/kg/d PO divided qid for 120 d
Pediatric
<1 year: Not established
1-10 years: 15-20 mg/kg/d PO divided qid for 90 d is recommended dose
11-16 years: 12.5-15 mg/kg/d PO divided qid for 90 d is recommended dose
>16 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in glucose-6-phosphate dehydrogenase deficiency; renal or hepatic disease; history of seizures or other neurological disorders; pulmonary disease
Benznidazole (Radanil, Rochagan, Ragonil)
A 2-nitroimidazole derivative that has inhibitory effect on protein synthesis and ribonucleic acid synthesis in T cruzi cells.
Benznidazole chemotherapy has been recommended as an alternative choice for treatment of the acute and indeterminate phases of Chagas disease, but it does not appear to offer a significant efficacy or toxicity advantage over nifurtimox. Benznidazole may be preferable in some regions based on experience with local strains. The propensity of both of these agents to induce chromosomal aberrations requires further study.
Adult
In acute, indeterminate, and chronic phases of Chagas disease, the following dosage regimens have been used:
5 mg/kg/d PO for 30-60 d
3 mg/kg/d PO for 90 d
10 mg/kg/d PO for 10 d plus 3 mg/kg/d for 50 d
Pediatric
For acute and indeterminate phase Chagas disease:
5 mg/kg/d PO divided bid for 30-60 d
7.5 mg/kg/d PO divided bid for 60 d also has been used
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Carcinogenic effects reported
More on Esophageal Motility Disorders |
| Overview: Esophageal Motility Disorders |
| Differential Diagnoses & Workup: Esophageal Motility Disorders |
 Treatment & Medication: Esophageal Motility Disorders |
| Follow-up: Esophageal Motility Disorders |
| Multimedia: Esophageal Motility Disorders |
| References |
| Further Reading |
| « Previous Page | Next Page » |
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Further Reading
Related eMedicine Topics
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- Achalasia [in the Radiology section]
- Esophageal Diverticula
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- Foreign Bodies, Gastrointestinal [in the Emergency Medicine section]
- Efficacy of Dark Chocolate in Achalasia Patients
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- ACR Appropriateness Criteria® dysphagia.
- American College of Radiology - Medical Specialty Society. 1998 (revised 2007). 6 pages. NGC:006986
- American Gastroenterological Association medical position statement: clinical use of esophageal manometry. American Gastroenterological Association Institute - Medical Specialty Society. 1994 Jul 15 (revised 2005 Jan). 2 pages. NGC:004013
- Gastrointestinal disorders. American Medical Directors Association - Professional Association. 2006. 28 pages. NGC:005026
- Guidelines for oesophageal manometry and pH monitoring. British Society of Gastroenterology - Medical Specialty Society. 2006 Nov. 11 pages. NGC:007150
Keywords
esophageal motility disorders, esophageal motility dysfunction, esophagus dysfunction, esophageal peristalsis dysfunction, esophageal peristalsis, achalasia, dysphagia, gastrointestinal motility, primary spastic esophageal motility disorders, diffuse esophageal spasm, DES, nutcracker esophagus, hypertensive lower esophageal sphincter, hypertensive LES, presbyesophagus, lower esophageal sphincter dysfunction, scleroderma esophagus, spastic motility disorder of the esophageal body, Heller myotomy, esophagectomy
