Esophageal dysmotility (ED) describes disorders where the coordinated muscular contractions of the esophagus are disrupted. The esophagus is a muscular tube that transports food and liquids from the pharynx to the stomach. This process relies on a wave-like motion called peristalsis and the proper opening and closing of muscular valves, or sphincters. When these muscle movements are uncoordinated, too weak, or too strong, food cannot pass efficiently into the stomach. This failure of transport causes the symptoms that define esophageal dysmotility.
The Primary Symptom: Dysphagia
The most frequent complaint among people with esophageal dysmotility is dysphagia, or difficulty swallowing. This sensation is often described as food feeling “stuck” or lodged in the chest, usually behind the breastbone or in the upper chest, a few seconds after swallowing begins.
The nature of dysphagia can offer clues about the underlying problem, as some disorders affect the ability to swallow both solids and liquids. For example, a failure of the lower esophageal sphincter to relax, seen in achalasia, typically causes difficulty with both solids and liquids from the start. Conversely, difficulty only with solid foods may suggest a mechanical blockage, though motility problems can also present this way. The sensation of food sticking results directly from the failure of the esophageal muscle to propel the food downward.
Pain and Pressure in the Chest
Many individuals with esophageal dysmotility experience pain or pressure in the chest, often independent of swallowing difficulty. This discomfort is frequently referred to as non-cardiac chest pain because it closely resembles the pain associated with a heart problem, or angina. The pain is commonly described as a tight squeeze, crushing pressure, or a burning sensation behind the breastbone.
This pain arises from misdirected or extremely forceful muscle contractions, such as those seen in esophageal spasm. When the esophageal muscle wall contracts in an uncoordinated manner, it triggers severe pain signals. Because the esophagus and the heart share similar nerve pathways, the brain interprets this discomfort as originating from the chest, making it difficult to distinguish from heart-related issues.
Gastrointestinal and Systemic Manifestations
The impaired function of the esophagus leads to several gastrointestinal and systemic effects. Regurgitation of undigested food and liquid is common because contents cannot pass into the stomach and remain pooled in the esophagus. Unlike vomiting, this regurgitation is generally effortless and does not involve forceful abdominal contractions.
The pooling of contents can lead to significant nocturnal symptoms, especially when lying down. These symptoms include coughing, choking, and the risk of aspirating material into the lungs. Furthermore, the poor clearance of food can cause heartburn-like sensations, or pyrosis, due to irritation from retained contents, even without classic acid reflux.
Over time, the fear of eating due to pain or choking, combined with difficulty consuming adequate nutrition, often results in unintended weight loss. This chronic restriction of food intake can lead to systemic issues like malnutrition.
When to Consult a Specialist
While mild swallowing problems may not be alarming, certain symptoms warrant prompt evaluation by a specialist. Any persistent or worsening difficulty swallowing, particularly if it affects both liquids and solids, requires professional diagnosis. Recurrent, severe chest pain that mimics a heart attack, even after a cardiac cause has been ruled out, should also be investigated.
Red Flag Symptoms
Serious underlying issues require urgent attention. These “red flag” symptoms may indicate complications like esophageal stricture or, in rare cases, malignancy. These include significant, unexplained weight loss, recurrent vomiting, or any evidence of bleeding, such as vomiting blood or developing anemia.