From the Guidelines
Treatment of esophageal dysmotility should prioritize symptom management and addressing the underlying cause, with a focus on lifestyle modifications, medications, and interventions tailored to the specific type of dysmotility, as recommended by the most recent and highest quality study 1.
Overview of Treatment Approaches
- Lifestyle modifications: eating smaller, more frequent meals, avoiding lying down after eating, elevating the head of the bed, and avoiding trigger foods
- Medications: prokinetic agents, smooth muscle relaxants, acid suppression with proton pump inhibitors
- Interventions: botulinum toxin injection, pneumatic dilation, surgical myotomy for achalasia
Specific Treatment Considerations
- For hypomotility disorders: prokinetic agents like metoclopramide (10mg before meals and at bedtime) or erythromycin (250mg three times daily before meals) can improve gastric emptying
- For hypercontractile disorders: smooth muscle relaxants like calcium channel blockers (nifedipine 10-30mg daily) or nitrates (isosorbide dinitrate 5-10mg as needed) may help
- For achalasia: treatments include botulinum toxin injection into the lower esophageal sphincter (80-100 units), pneumatic dilation, or surgical myotomy, with per-oral endoscopic myotomy (POEM) considered as a primary therapy for type III achalasia 1
Rehabilitation Exercises and Maneuvers
- The Shaker head lift, chin-down, and effortful swallow are evidence-based exercises that can improve swallowing physiology and reduce aspiration risk
- Tongue strength training and expiratory muscle strength training (EMST) have also shown significant effects on swallowing safety
Importance of Individualized Treatment
- Patients with esophageal dysmotility have a highly variable pattern of specific swallowing abnormalities, requiring a tailored treatment approach that combines different adaptive, compensatory, and rehabilitative techniques 1
From the Research
Treatment Options for Esophageal Dysmotility
- The treatment of esophageal dysmotility disorders varies widely according to the type of disorder and can range from lifestyle and dietary modifications to oral pharmacologic therapy and various endoscopic or surgical interventions 2.
- For patients with achalasia, durable management aimed at the lower esophageal sphincter should strongly be considered 2.
- Isosorbide dinitrate has been shown to be effective in relieving symptoms of achalasia by reducing the lower esophageal sphincter pressure and improving esophageal emptying 3.
- Nifedipine has also been used to treat achalasia, but its effectiveness is less than that of isosorbide dinitrate 3.
- A multidisciplinary approach including a primary care physician, radiologist, gastroenterologist, and surgeon may be beneficial for accurate diagnosis and proper treatment of esophageal dysmotility disorders 4.
Diagnostic Tools
- High-resolution esophageal manometry is a reliable tool for assessing esophageal motor function and has improved the sensitivity for detecting achalasia and other esophageal motility disorders 5.
- Other diagnostic tools such as endoscopy, barium esophagram, and functional luminal imaging probe can aid in evaluating esophageal motility disorders 4.
- The Chicago Classification uses a hierarchical classification system that divides motility disorders as disorders of outflow obstruction and disorders of peristalsis, which can help guide diagnosis and treatment 4, 2.
Lifestyle and Dietary Modifications
- Lifestyle and dietary modifications can be an effective treatment for esophageal dysmotility disorders, especially for patients with mild symptoms 2.
- Patients with esophageal dysmotility disorders may need to avoid certain foods or eat smaller, more frequent meals to manage their symptoms 2.
- Weight loss may also be recommended for patients with esophageal dysmotility disorders who are overweight or obese 2.