Diffuse Esophageal Spasm & Achalasia: Upper Digestive Tract Disorders

In a healthy esophagus, peristalsis propels food and fluid down the esophagus. Sometimes, however, these contractions become ineffective, resulting in an esophageal motility disorder.

The two most common esophageal motility disorders are diffuse esophageal spasm and achalasia. In diffuse esophageal spasm, several segments of the esophagus contract strongly and simultaneously, preventing the normal, wave-like contractions from moving food and fluid down the esophagus. In achalasia, there is an absence of normal, wave-like contractions in the lower half of the esophagus, and the lower esophageal sphincter fails to relax and allow food to enter the stomach.

Causes of esophageal motility disorders

The causes of esophageal spasm and achalasia are unknown. However, some believe that extremely hot or cold foods can trigger an esophageal spasm. Older age, being female, and having GERD also may predispose you to having spasms.

Symptoms of esophageal motility disorders

People with diffuse esophageal spasm experience intermittent episodes of dysphagia (difficulty swallowing), usually with both liquids and solids, as well as pain behind the breastbone. People with achalasia have gradually worsening swallowing problems for both solids and liquids, regurgitation of ingested food, and weight loss.

Diagnosis of esophageal motility disorders

The best test for diagnosing achalasia is esophageal manometry. In people with achalasia, manometry reveals very weak esophageal peristalsis as well as persistent elevated pressure in the lower esophageal sphincter (which indicates that the sphincter muscle cannot relax). In people with diffuse esophageal spasm, esophageal manometry will show intense contractions of the esophageal wall.

An upper GI series also can be used to diagnose these disorders. In people with diffuse esophageal spasm, the radiologist will see strong contractions of the esophagus, which interfere with the movement of barium through the esophagus. Barium x-rays in people with achalasia often reveal widening of the upper portion of the esophagus with a gradual narrowing at the lower end.

In many people with suspected achalasia, an upper endoscopy to obtain a tissue sample from the gastroesophageal junction is necessary to rule out cancer.

Treatment of esophageal motility disorders

Achalasia is initially treated with medications like calcium channel blockers and nitroglycerin to relax the lower esophageal sphincter. Unfortunately, these treatments are often ineffective, and most people require an endoscopic or surgical procedure to relax the lower esophageal sphincter.

Publication Review By: H. Franklin Herlong, M.D.

Published: 24 Mar 2011

Last Modified: 15 Dec 2014