Approach to Esophageal Motility Disorders

Esophageal motility disorders are a broad category of diseases with a variety of symptoms, ranging from dysphagia to chest pain. The pathophysiology is not always fully understood, but may involve alterations in inhibitory or excitatory innervation of the smooth muscle of the distal esophagus and LES. High-resolution manometry is the gold standard for its diagnosis, and the Chicago classification offers an organizational framework for better evaluation and management. Major disorders of motility are generally pathologic, and include achalasia, EGJOO, DES, hypertensive esophagus, and diseases of absent peristalsis, such as scleroderma. Treatments are targeted at the particular diagnosis. In achalasia, endoscopic and surgical options are preferred. For the remaining motility diagnoses, medical management forms the mainstay of treatment, which can be limited by side effect profiles.