Esophageal motility disorders

Esophageal motility disorder symptoms, such as difficulty with swallowing, heartburn or choking on food, may fill your day with pain and frustration. When essential acts like eating and drinking are difficult, you may spend a lot of time trying to figure out how to manage meals.

Our team at Aurora Health Care is committed to helping you navigate these disorders and will work with you to find a treatment option that brings relief.

What does esophageal motility disorder feel like?

Because an esophageal motility disorder affects how you eat, swallow and digest food, it can feel uncomfortable. Eating and swallowing food can be difficult, though the severity depends on which part of the esophagus is affected.

Common sensations include:

• Feeling like food is stuck in your throat when you swallow
• Difficulty swallowing (dysphagia)
• Chest pain or pressure (esophageal spasm)
• Heartburn or burning discomfort

What is the most common esophageal motility disorder?

While esophageal motility disorders are rare overall, achalasia is the most common among those diagnosed. Achalasia happens when the lower esophageal sphincter doesn’t relax like it should, so the esophagus loses its normal muscle contractions. This makes it hard for food and liquid to move into the stomach.

Common symptoms of esophageal motility disorders

One of the most common symptoms of esophageal motility disorders is feeling pain or pressure in your chest. You may notice it happening randomly or it may happen mainly before or after swallowing. Other symptoms of esophageal dysmotility are:

• Choking on food
• Difficulty swallowing (dysphagia)
• Chest pain or pressure (esophageal spasm)
• A feeling of tightness or a lump in your throat (globus)
• Heartburn
• Hoarseness or coughing
• Mild to moderate weight loss
• Regurgitation (when food comes back up your throat and out of your mouth)

Regurgitation can be an alarming experience, but it’s important to remember that it’s different from vomiting. If food accidentally gets into your windpipe (trachea), it may make you cough or lead to aspiration pneumonia or other lung infections. If this happens or if you have trouble breathing, call 911 immediately.

Causes of esophageal motility disorders

Esophageal motility disorders happen when the nerves or muscles that control swallowing don’t work correctly. That breakdown can come from:

• Achalasia, a rare condition that causes a loss of nerve cells in the lower esophagus
• Autoimmune and connective-tissue diseases, such as systemic sclerosis or scleroderma
• Infections that damage esophageal nerves, including Chagas disease
• Medications that affect how the esophagus moves (often long-term opioid use)
• Inflammation that stiffens or narrows the esophagus
• Cancers near the bottom of the esophagus in rare instances

Conditions related to esophageal motility disorders

Some conditions don’t directly affect the muscles or nerves of the esophagus but can cause similar symptoms, such as food feeling stuck or difficulty swallowing. They are often confused with motility disorders. These conditions include:

• Esophageal strictures: Narrowing of the esophagus that makes it harder for food to pass through
• Esophageal obstruction: A blockage caused by food, a foreign object, a tumor or injury to the esophagus
• Esophageal diverticula: Small pouches that form in the lining of the esophagus that can interfere with swallowing
• Functional esophageal disorders: Swallowing symptoms that occur even though testing shows the esophagus is functioning normally
• Tracheoesophageal fistula and esophageal atresia: Rare birth defects that affect how the esophagus is formed or connected that can lead to long-term swallowing problems

Risks for developing esophageal motility disorders

Esophageal motility disorders are uncommon, and many people who develop one don’t have a clear risk factor. Still, certain health conditions, medications and life circumstances can make problems with esophageal movement more likely.

Conditions that affect nerves or muscles

Anything that interferes with the nerves or muscles that control swallowing can increase the risk of developing a motility disorder. This includes autoimmune and connective‑tissue diseases, such as systemic sclerosis or scleroderma, which can weaken or stiffen the muscles of the esophagus over time.

Long‑term medication use and esophageal motility disorders

Some medications, especially opioids used for chronic pain, can affect how muscles in the digestive tract function. When taken long term, these medications may disrupt normal esophageal movement and lead to swallowing problems.

Chronic inflammation of the esophagus

Ongoing irritation or inflammation can change how flexible or responsive the esophagus is. Over time, this may interfere with normal swallowing patterns, particularly if inflammation causes the esophagus to stiffen or narrow.

Infections that affect the nervous system

Certain infections can damage the nerves that help control swallowing. Although uncommon in the U.S., these infections can increase the risk of abnormal esophageal movement.

Cancers involving the esophagus or nearby structures

In rare cases, cancers near the area where the esophagus meets the stomach can interfere with esophageal function, either by affecting nerves or by limiting how the lower esophageal sphincter opens.

Age and overall health and esophageal motility disorders

Esophageal motility disorders can occur at any age, but some types are diagnosed more often in adults. Having multiple health conditions that affect the nervous system or connective tissue may also raise risk.

How are esophageal motility disorders diagnosed?

Diagnosing an esophageal motility disorder depends on your symptoms and on eliminating other causes for those symptoms. Your doctor will need to rule out things like gastroesophageal reflux disease (GERD), hiatal hernia and heart disorders.

They’ll ask you about your potential esophageal motility disorder symptoms and your medical history.

If it seems like your symptoms may be because of esophageal dysmotility, your doctor may order one or more of these tests:

• Esophageal manometry: Measures the strength of muscle contractions in the esophagus
• Esophagoscopy: Used to view the esophagus and allow removal of tissue samples (biopsy)
• X-rays and barium swallow: Checks for abnormalities in the shape of the esophagus after you swallow a barium solution
• Computed tomography (CT): Builds detailed 3D images of the esophagus and surrounding tissues using multiple X-ray images
• MRI: Creates detailed images using a magnetic field and radio waves

Esophageal motility disorder treatment

Treatment for esophageal motility disorders depends on the type of disorder, the severity of symptoms and your overall health. Some people can manage symptoms with lifestyle changes alone, while others may need medication, procedures or surgery to help the esophagus move food more effectively.

Lifestyle changes to treat esophageal motility disorder

Esophageal motility disorders often respond well to changes in personal habits. You can lessen the amount of work needed from the muscles of your esophagus by eating softer foods in smaller, more frequent meals. Your doctor may have other suggestions to help control your symptoms.

Nonsurgical treatments for esophageal motility disorders

Esophageal motility disorder treatment options vary depending on the specific disorder and symptoms. Some people benefit from a combination of therapies. These include:

• Medications: Depending on symptoms, medications may be used to reduce acid reflux, relax esophageal muscles or improve swallowing comfort. Acid-suppressing drugs such as proton pump inhibitors are commonly prescribed.
• Behavioral and integrative therapies: In some cases, approaches such as cognitive behavioral therapy, hypnosis or other integrative therapies may help manage symptoms, especially when stress or heightened esophageal sensitivity plays a role.
• Botulinum toxin (Botox) injections: In certain motility disorders, Botox may be injected into the lower esophageal sphincter to temporarily relax the muscle and improve swallowing.

Endoscopic and surgical treatments for esophageal motility disorders

When symptoms are severe or don’t improve with conservative treatment, procedures may be recommended to help. These include:

• Esophageal dilation: A balloon is inserted and inflated to stretch the muscles of the esophagus and widen any narrowed sections.
• Heller myotomy: A surgery performed on the lower esophageal sphincter muscle makes it easier for food to pass into the stomach.
• Per oral endoscopic myotomy (POEM): A minimally invasive endoluminal surgery performed on the muscle at the bottom of the esophagus allows liquids and foods to pass more easily into the stomach.

Living with esophageal motility disorders

Living with an esophageal motility disorder often means learning how to work with your esophagus rather than against it. While symptoms can be frustrating, many people find that small changes to eating habits, food choices and daily routines make a big difference in comfort and quality of life.

Managing this condition usually involves some trial and error. What works well for one person may not work for another, so it’s important to pay attention to how your body responds and adjust as needed.

Esophageal motility disorder diet 

There isn’t a specific diet that works for everyone with an esophageal motility disorder. Foods that are soft, moist and easy to swallow do tend to be better tolerated than foods that are dry, sticky or hard to chew.

Many people find relief by choosing:

• Soft or well-cooked foods
• Foods with added moisture, such as soups, stews or foods with sauces
• Smooth textures, including foods like yogurt, oatmeal or mashed vegetables

Foods that are very dry, tough or crumbly may be harder for the esophagus to move and can increase discomfort. Some people may also notice that very hot or very cold foods worsen symptoms.

Keeping a food and symptom journal can help you identify which foods are easiest to eat and which ones tend to trigger problems.

How do you eat with esophageal motility disorder?

When you have an esophageal motility disorder, how you eat can be just as important as what you eat. Helpful strategies may include:

• Eating slowly and taking small bites
• Chewing food thoroughly before swallowing
• Eating smaller meals more often instead of large meals
• Staying upright during meals and for a period of time afterward

Some people also find it helpful to sip water or another liquid while eating to help food move through the esophagus. Others do better separating solids and liquids. Paying attention to your body’s signals can help you find the approach that works best for you.

If swallowing becomes difficult or uncomfortable, consider pausing, slowing down or stopping until symptoms improve. Over time, many people develop a rhythm and routine that helps make meals more manageable and less stressful.