Chapter 13: Oropharyngeal & Esophageal Motility Disorders

INTRODUCTION

General Considerations

Oropharyngeal and esophageal motility disorders can have a significant impact on patients’ quality of life. Diagnosis and management can be challenging because mechanical and functional problems may interact to cause patients’ symptoms.

Dysphagia (difficulty swallowing) must be distinguished from odynophagia (pain on swallowing, suggestive of a defect in mucosal integrity, eg, from trauma, irradiation, inflammation, or infection) and aphagia (inability to swallow, generally suggestive of acute obstruction). Symptoms that do not necessarily correlate with the immediate process of swallowing, such as rumination and globus sensation, should also be discerned.

Dysphagia can considered arising from disorders in three anatomic phases of normal swallow (Table 13–1): (1) oral (also called preparatory) phase, (2) oropharyngeal phase (also called transfer dysphagia) involving the oropharynx, larynx, and upper esophageal sphincter (UES), and (3) esophageal phase, involving the esophageal body, lower esophageal sphincter (LES), and gastroesophageal junction (GEJ). The causes of dysphagia are many, and some may even overlap for both oropharyngeal and esophageal dysphagia (Figure 13–1). Specific entities are considered here.