Oesophageal dysmotility at The London Gastroenterology Centre

Oesophageal motility disorder is a term used to cover any medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. The term encompasses conditions such as: 1. Achalasia, which is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach. One of three diagnostic procedures can be used to diagnose the problem, e.g. Barium Swallow, Endoscopy and a Manometry (a tube passed through the mouth or nose, which measures the pressure in your gullet at different points. There are four methods of treatment; the first being medication to relax the gullet, the second being dilation (a balloon is passed down the gullet to dilate and stretch the muscle fibres of the gullet under general anaesthetic); the third being a Botulinum toxin (Botox injection), which can be injected relatively easily via an endoscopy, but may give only temporary relief. The final procedure is laparoscopic surgery, where the gullet sphincter is accessed through the stomach and the damaged muscle fibres are divided. This procedure usually involves only a one night stay in hospital. 2. Jackhammer oesophagus is another oesophageal motility disorder.It is characterised by oesophageal spasms that involve all or most of the muscles of the oesophagus. The spasms can be very intense and tend to last for a long time. Symptoms also overlap those with those of Achalasia. There is still uncertainty about the cause, but the condition often affects people with psychiatric disorders. The first line of treatment therefore are tricyclic antidepressants, but medications used for the treatment of Achalasia also apply for this disorder. For those patients who do not respond to medication, a surgical technique called Per Oral Endoscopic Myotomy (POEM) may be used, otherwise a standard myotomy (surgical procedure to cut esophageal muscle) may need to be performed.