Therapies for spastic esophageal motor disorders

Dustin A. Carlson*, Reena V. Chokshi, Ellen Stein

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Spastic esophageal disorders have been variably defined over the years, but with the advent of high-resolution esophageal manometry (HRM) and esophageal pressure topography as well as the Chicago Classification, the term "spastic disorders" now refers to type III achalasia, distal esophageal spasm (DES), and hypercontractile esophagus (HE). Type III achalasia is notable for functional outflow obstruction and aperistalsis with premature contractions. DES also has premature contractions but no outflow obstruction. HE is characterized by increased esophageal body contractility. The Chicago Classification version 4.0 criteria for each of these disorders, as well as representative Clouse plots, are shown in Fig. 33.1. Overall, the spastic disorders represent a rare diagnosis seen on HRM. Recent studies have estimated achalasia prevalence at 18/100,000 in patients under 65 years and 162/100,000 in those over 65 years, and of the three subtypes, type II achalasia is thought to be the most prevalent. HE represents approximately 2-3% of manometric diagnoses, and DES likely another 3-4%. Progression from HE or DES to achalasia is uncommon but can occur. The exact pathophysiology of these disorders remains unclear but represents a neural imbalance in the form of decreased inhibition, excess contractile drive, or both. These affect the smooth muscle anatomy and/or function and lead to spasm. Clinically relevant disorders typically manifest with dysphagia, chest pain, regurgitation, and/or reflux. Because of their unclear pathogenesis and heterogeneity, treatment decisions should be guided and measured.

Original languageEnglish (US)
Title of host publicationThe AFS Textbook of Foregut Disease
PublisherSpringer International Publishing
Pages321-327
Number of pages7
ISBN (Electronic)9783031196713
ISBN (Print)9783031196706
DOIs
StatePublished - Apr 21 2023

Keywords

  • Achalasia
  • Dysphagia
  • Esophageal spasm
  • Manometry
  • Myotomy
  • POEM

ASJC Scopus subject areas

  • General Medicine

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