Esophageal Dyskinesia: Causes, Types, and Management

Esophageal dyskinesia encompasses motility disorders with abnormal peristalsis or sphincter function.

Major Types

• Achalasia – failed LES relaxation + absent peristalsis.
• Distal esophageal spasm (DES) – simultaneous, high-amplitude contractions.
• Jackhammer esophagus – extreme hypercontractility (DCI >8000 mmHg·s·cm).
• Ineffective esophageal motility (IEM) – weak/failed peristalsis (>50% swallows).
• EGJ outflow obstruction – elevated integrated relaxation pressure (IRP) with preserved peristalsis.

Causes

• Idiopathic (primary).
• Secondary: systemic sclerosis, diabetes, Chagas, post-fundoplication, medications (anticholinergics, opioids).

Symptoms

• Dysphagia (solids > liquids), regurgitation, chest pain, heartburn, weight loss.

Diagnosis

• High-resolution manometry (HRM) – Chicago Classification v4.0.
• Barium esophagram, endoscopy, pH-impedance.

Treatment

• Achalasia: pneumatic dilation, Heller myotomy (laparoscopic/POEM).
• Spastic disorders: smooth muscle relaxants (nitrates, CCB), botulinum toxin, POEM.
• IEM: treat reflux, dietary modification.