Esophageal dysmotility is the excessive, uncoordinated contraction of esophageal smooth muscle. Debate exists over the correlation between symptoms (pain) and observed motor events.12 Dysmotility disorders can be divided into distinct entities based on manometric criteria. Achalasia and nutcracker esophagus were discussed above. The other motility disorders commonly recognized include diffuse esophageal spasm, hypertensive LES, and nonspecific motor disorder.
Clinically, chest pain is the presenting symptom in the majority of patients with these disorders. The onset is usually in the fifth decade. The pain often occurs at rest and is dull or colicky in nature. Stress or ingestion of liquids at the extremes of temperature may serve as a trigger. An acute episode of pain may be followed by hours of dull, achy, residual discomfort. Thirty to sixty percent of these patients will also experience dysphagia, which is usually intermittent. Pain from spasm may respond to nitroglycerin. Calcium channel blockers and anticholinergic agents can also be employed.
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