From the Guidelines
Conservative treatment for weak esophageal muscle contractions should prioritize exercises and maneuvers, such as the Shaker head lift, chin-down, and effortful swallow, to improve swallowing physiology and reduce symptoms, as supported by recent studies 1.
Key Recommendations
- Start with exercises and maneuvers to improve swallowing physiology, such as:
- Shaker head lift: a head rising exercise with an isometric high-intensity portion and an isokinetic low-intensity portion 1
- Chin-down: a technique used for patients with decreased airway protection associated with delayed swallow initiation and/or reduced tongue base retraction 1
- Effortful swallow: a technique used for patients who present with clinically significant residue in the valleculae and/or pyriform sinuses as well as for patients who may have decreased airway closure 1
- Consider lifestyle modifications, such as:
- Eating smaller, more frequent meals
- Avoiding lying down for 2-3 hours after eating
- Eliminating trigger foods like spicy, acidic, or fatty foods
- Thoroughly chewing food before swallowing
- Elevate the head of the bed by 6-8 inches using blocks or a wedge pillow
- Medications, such as proton pump inhibitors, prokinetic agents, and smooth muscle relaxants, may be considered, but their use should be individualized and based on the patient's specific symptoms and needs, as recent studies suggest that alternative treatment methods, such as lifestyle modifications and cognitive-behavioral therapy, may serve a role in management of symptoms 1
Rationale
The provided evidence suggests that exercises and maneuvers are a crucial component of conservative treatment for weak esophageal muscle contractions, with studies demonstrating improvements in swallowing physiology and reductions in symptoms 1. Lifestyle modifications and medications may also be beneficial, but their use should be tailored to the individual patient's needs. Recent studies support the use of alternative treatment methods, such as lifestyle modifications and cognitive-behavioral therapy, in the management of symptoms 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Conservative Treatment Options
- Prokinetic agents are commonly prescribed as first line pharmacologic intervention to target esophageal smooth muscle contractility and improve esophageal motor functions 2
- Serotonergic agents, including buspirone, mosapride, and prucalopride, have been shown to improve parameters of esophageal motility although the effect on symptoms is less clear 2
- Nitrates, such as isosorbide dinitrate, can decrease lower esophageal sphincter pressure (LESp) and pressure wave amplitude, and may be effective in relieving symptoms of achalasia 3, 4
- Calcium channel blockers, such as nifedipine, can also decrease LESp, but may have a less intense effect than nitrates 3, 4
Considerations for Treatment
- The correlation between esophageal hypomotility and esophageal symptoms is not well established, and the clinical relevance of the motility pattern is not clear 2
- The effect of prokinetic agents on symptoms is limited, and the beneficial effects of these medications are only confined to some specific drugs 2
- Isosorbide dinitrate may increase the tendency towards gastroesophageal reflux in patients with esophageal dysmotility, and should be used with caution in these patients 5
- Treatment of esophageal motility disorders should be based on the Chicago Classification, and should take into account the specific characteristics of the disorder 6