From the Guidelines
Fragmented peristalsis of the esophagus should be managed based on symptom severity, with a focus on lifestyle modifications and medical therapy, as there is limited evidence supporting the use of advanced therapies like POEM or LHM for this specific condition. The condition is characterized by breaks in the normal wave-like contractions that move food down the esophagus, and diagnosis typically requires esophageal manometry to visualize the fragmented peristaltic waves and rule out other motility disorders. Patients should avoid eating within 3 hours of bedtime, elevate the head of the bed by 6-8 inches, avoid trigger foods (spicy, acidic, fatty), and eat smaller, more frequent meals. For mild symptoms, over-the-counter antacids like Tums or Rolaids can provide relief. If symptoms persist, proton pump inhibitors such as omeprazole 20mg daily or pantoprazole 40mg daily for 4-8 weeks may help, especially if acid reflux is present, although the recent study on advances in per-oral endoscopic myotomy (POEM) and remaining questions 1 does not directly address fragmented peristalsis. Prokinetic medications like metoclopramide 5-10mg before meals can improve esophageal motility in some cases. It is essential to note that the study on POEM 1 focuses on achalasia treatment, which is a different condition, and its findings may not be directly applicable to fragmented peristalsis of the esophagus. Therefore, treatment decisions should be based on the individual patient's symptoms and response to therapy, rather than on the results of studies focused on other esophageal motility disorders. Some key points to consider in managing fragmented peristalsis of the esophagus include:
- Avoiding trigger foods and eating smaller meals
- Elevating the head of the bed to reduce symptoms
- Using antacids or proton pump inhibitors as needed
- Considering prokinetic medications for severe cases
- Ruling out other motility disorders through esophageal manometry.
From the Research
Fragmented Peristalsis of Esophagus
- Fragmented peristalsis is not explicitly mentioned in the provided studies, however, esophageal motility disorders are discussed in detail 2, 3, 4, 5.
- The Chicago Classification divides esophageal motor disorders into three groups based on the integrated relaxation pressure (IRP) and peristaltic abnormalities 2.
- Esophageal hypomotility peristaltic abnormalities, such as absent peristalsis, weak peristalsis, and frequent failed peristalsis, are associated with a normal mean IRP 2.
- Studies have shown that patients with esophageal motility disorders, including those with normal esophageal function testing, may experience dysphagia due to abnormal distensibility of the esophageal wall and relative dynamic obstruction to bolus flow 3, 4.
- Management of esophageal motility disorders varies widely and can include lifestyle and dietary modifications, oral pharmacologic therapy, and various endoscopic or surgical interventions 2, 4.
Esophageal Motility Disorders
- Esophageal motility disorders encompass a range of conditions, including achalasia, esophagogastric junction outflow obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus, and ineffective esophageal motility 4.
- High-resolution esophageal manometry and the Chicago Classification have revolutionized the diagnosis and management of esophageal motility disorders 4.
- Additional tests, such as timed barium esophagogram and EndoFLIP, can provide adjunctive information in cases where high-resolution esophageal manometry findings are inconclusive 4.
Treatment Options
- Treatment options for esophageal motility disorders vary depending on the type of disorder and can include medical therapy, endoscopic procedures, and surgery 2, 4.
- Medical therapy for achalasia and esophageal hypermotility disorders may include nitrates, calcium channel blockers, and phosphodiesterase 5 inhibitors 2, 6.
- Endoscopic procedures, such as botulinum toxin A injection and peroral endoscopic myotomy, and surgery, such as Heller myotomy, may also be considered for certain esophageal motility disorders 2, 4.