From the Guidelines
Treatment for esophageal dysmotility should prioritize systematic and sufficiently frequent swallowing therapy, making individualized use of the different exercises available, as recommended by the ESPEN guideline with a strong consensus of 100% agreement 1.
Key Considerations
- The goal of treatment is to improve swallowing function, reduce symptoms, and prevent complications such as aspiration pneumonia.
- Swallowing therapy exercises, such as the Shaker head lift, chin-down, and effortful swallow, have been shown to improve swallowing physiology and reduce aspiration risk 2.
- Pharmacological treatment, including TRPV1 agonists, dopaminergic agents, and ACE inhibitors, may also be beneficial in improving swallowing function, although more research is needed to fully explore their potential 3.
Treatment Options
- Lifestyle modifications: eating smaller, more frequent meals, avoiding trigger foods, and remaining upright for 2-3 hours after eating.
- Medications: proton pump inhibitors, prokinetics, and smooth muscle relaxants.
- Procedural interventions: pneumatic dilation, peroral endoscopic myotomy (POEM), and botulinum toxin injections.
Recent Advances
- POEM has emerged as a minimally invasive treatment option for achalasia, with comparable efficacy to laparoscopic Heller myotomy, although long-term outcomes data are limited 4, 5.
- The role of POEM in non-achalasia spastic motility disorders is not well-defined, and less invasive alternatives should be exhausted before consideration of POEM in these cases 4.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Esophageal Dysmotility
- Esophageal motility disorders can be treated with lifestyle and dietary modifications, oral pharmacologic therapy, and various endoscopic or surgical interventions 6
- The management of esophageal dysmotility varies widely according to the type of disorder, and durable management aimed at the lower esophageal sphincter should be considered in patients with achalasia 6
Pharmacologic Therapy
- Isosorbide dinitrate and nifedipine are two pharmacologic agents that have been studied for the treatment of achalasia, with isosorbide dinitrate being more effective in relieving symptoms 7
- Isosorbide dinitrate has been shown to decrease the lower esophageal sphincter pressure and improve esophageal emptying in patients with achalasia 7, 8
- However, isosorbide dinitrate may increase the tendency towards gastroesophageal reflux in patients with esophageal dysmotility, particularly those with Chagas' disease 9
Diagnostic Tools
- High-resolution esophageal manometry is the gold standard for the diagnosis of esophageal motility disorders, and the Chicago Classification v4.0 provides a standardized diagnosis and tailored therapeutic approach 6, 10
- Additional tests, such as timed barium esophagogram and EndoFLIP, can provide adjunctive information in cases where high-resolution esophageal manometry findings are inconclusive 6
Patient-Centered Care
- Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective, and have a critical role in providing patient-centered care 10