Esophageal Motility Disorders (Nutcracker Esophagus)

Disorders affecting the motor function of the UPPER ESOPHAGEAL SPHINCTER; LOWER ESOPHAGEAL SPHINCTER; the ESOPHAGUS body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in gastric reflux of food and acid into the esophagus (GASTROESOPHAGEAL REFLUX). Other disorders include hypermotility (spastic disorders) and markedly increased amplitude in contraction (nutcracker esophagus).

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Networked: 515 relevant articles (34 outcomes, 76 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Esophageal Achalasia (Megaesophagus)
2.	Muscle Spasticity (Spastic)
3.	Gastroesophageal Reflux (GERD)
4.	Chest Pain (Chest Pains)
5.	Diverticulum

Experts

1.	Inoue, Haruhiro: 13 articles (11/2022 - 09/2015)
2.	Abe, Hirofumi: 7 articles (11/2022 - 08/2019)
3.	Sato, Hiroki: 7 articles (11/2022 - 09/2015)
4.	Tanaka, Shinwa: 7 articles (06/2022 - 10/2018)
5.	Onimaru, Manabu: 6 articles (11/2022 - 01/2016)
6.	Dunst, Christy M: 6 articles (10/2021 - 12/2011)
7.	Swanström, Lee L: 6 articles (10/2021 - 12/2011)
8.	Ariyoshi, Ryusuke: 6 articles (01/2021 - 10/2018)
9.	Kawara, Fumiaki: 6 articles (01/2021 - 10/2018)
10.	Toyonaga, Takashi: 6 articles (01/2021 - 10/2018)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Esophageal Motility Disorders:

1.	Botulinum Toxins (Botulinum Toxin)IBA 10/01/1996 - "We conclude that botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia esophageal motility disorders. " 01/01/2019 - "One can interpret the lack of effect of botulinum toxin over placebo as indicative of the benign natural history of hypercontractile esophageal motility disorders or be convinced that many patients with hypercontractility on manometry actually have functional symptoms not related to the manometric findings, and thus, treatment of hypercontractility is not more effective than placebo. " 01/01/2021 - "Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. " 12/01/2018 - "The Role of Botulinum Toxin Injections for Esophageal Motility Disorders." 09/01/2018 - "While esophageal dysmotility can be treated through botulinum toxin injection and esophageal dilation as demonstrated in our patient, for longer term results, operative cricopharyngeal myotomy is superior. "
2.	BariumIBA 01/01/2021 - "The aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM). " 12/01/2007 - "Careful evaluation of esophageal motility on postoperative barium studies may help to identify esophageal dysmotility and to differentiate this finding from structural complications of the wrap as a cause of refractory symptoms in these patients." 10/01/2022 - "To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM). " 10/01/2022 - "Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study." 07/01/2006 - "The presence of this specific form of esophageal dysmotility on barium studies therefore should suggest underlying reflux disease."
3.	AntibodiesIBA 05/01/2006 - "Anticentromere antibodies (ACA) are useful in assessing and classifying patients with mild variant of systemic sclerosis called calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias (CREST) syndrome. " 05/01/1985 - "Twenty-eight patients hd diffuse skin disease, and 14 had the CREST variant of systemic sclerosis (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasis) with anticentromere antibodies. " 01/01/2023 - "A rare overlap syndrome between CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome and primary biliary cholangitis (PBC) is described as PACK syndrome, an acronym for primary biliary cholangitis, anticentromere antibodies, CREST syndrome, and keratoconjunctivitis sicca. " 08/17/2013 - "Neither was esophageal dysmotility associated with IgG antibodies (OR = 2.500, 95% CI = 0.259-24.096). " 08/17/2013 - "Esophageal dysmotility (69%) or gastroparesis (18%) were not associated with the presence of IgM antibodies (OR = 0.589, 95% CI = 0.143-2.424 and OR = 3.407, 95% CI = 0.633-18.350, respectively). "
4.	Opioid Analgesics (Opioids)IBA 09/01/2023 - "Recent studies have shown that chronic opioid use is associated with an increased risk of symptomatic esophageal motility disorders. " 12/01/2023 - "Chronic opioid exposure is associated with an increased frequency esophageal dysmotility disorders. " 12/01/2023 - "Systematic Review With Meta-Analysis: Chronic Opioid Use Is Associated With Esophageal Dysmotility in Symptomatic Patients." 09/01/2023 - "Opioid-Induced Esophageal Dysmotility (OIED) - A Case Report." 01/01/2023 - "Esophageal dysmotility has been attributed to opioid use. "
5.	Proton Pump InhibitorsIBA 12/01/2010 - "There was no significant difference in age, sex, typical esophageal symptoms, presence of esophageal erosion, esophageal dysmotility, improvement with proton pump inhibitor medication, symptom index ≥ 50%, percentage of time clearance pH below 4 ≥ 4%, and all reflux time ≥ 1.4% in the fasting period between the two groups. " 01/01/2020 - "Male gender, preoperative esophageal dysmotility, proton pump inhibitor use and redo fundoplication were associated with AST use following fundoplication. " 01/01/2020 - "Preoperative factors associated with AST use following fundoplication were male gender (HR1.6, p = 0.019), esophageal dysmotility (HR1.7, p = 0.004), proton pump inhibitor use (HR2.3, p < 0.001) and prior history of fundoplication (HR1.8, p = 0.006). " 02/01/2008 - "Inclusion criteria were chronic and symptomatic GERD, proton pump inhibitor (PPI) dependence, and the absence of esophageal motility disorder. " 01/01/2007 - "The aim of this study was to investigate the relationship between the severity of reflux esophagitis and esophageal dysmotility and evaluate the effect of prolonged treatment with proton pump inhibitor (lansoprazole 30 mg/day) on esophageal motility in patients with severe reflux esophagitis associated with esophageal motility disorder. "
6.	naloxegolIBA 01/01/2022 - "Based on these observational studies, we propose that formal studies be conducted to assess the effect of naloxegol on opioid-induced esophageal dysmotility." 01/01/2022 - "Effect of Naloxegol on Opioid-Induced Esophageal Motility Disorder." 01/01/2022 - "We report a case series of 3 patients with coexisting esophageal dysmotility and constipation on chronic opioids that improved both symptoms after starting naloxegol. "
7.	Cholinergic Antagonists (Anticholinergics)IBA 05/27/1992 - "The efficacy of anticholinergic drugs in hypercontractile esophageal motility disorders has not been reported. " 04/01/1988 - "An esophageal motility disorder may be treated with an anticholinergic agent, nitro-glycerinlike product, or mild tranquilizer. " 10/01/1996 - "These observations suggest a new (sensory) pathway for the induction of DES and raise the intriguing possibility that inhaled anticholinergics may have a therapeutic role in the management of spastic esophageal motility disorders." 01/01/1993 - "Medical treatment of esophageal motility disorders involves the uses of agents that either reduce (anti-cholinergic agents, nitrates, calcium antagonists) or enhance (prokinetic agents) esophageal contractility. "
8.	Cyclosporine (Ciclosporin)FDA LinkGeneric 08/27/2003 - "Cyclosporine A-induced achalasia-like esophageal motility disorder in a liver transplant recipient: successful conversion to tacrolimus." 08/01/2002 - "Combination therapy of corticosteroids, methotrexate (MTX), and cyclosporine resulted in improved skin thickness and muscle strength scores in all cases, as well as in lung restrictive syndrome in 2, but was not effective regarding the progression of intestinal malabsorption in one patient, esophageal dysmotility in 3 patients, and dilated cardiomyopathy in 3. Endstage cardiac failure caused 2 deaths. "
9.	Adrenal Cortex Hormones (Corticosteroids)IBA 07/01/1996 - "To our knowledge, this is the first case of sarcoidosis presenting with dysphagia and documented esophageal dysmotility in which symptoms and manometric abnormalities normalized after therapy with systemic corticosteroids." 08/01/2002 - "Combination therapy of corticosteroids, methotrexate (MTX), and cyclosporine resulted in improved skin thickness and muscle strength scores in all cases, as well as in lung restrictive syndrome in 2, but was not effective regarding the progression of intestinal malabsorption in one patient, esophageal dysmotility in 3 patients, and dilated cardiomyopathy in 3. Endstage cardiac failure caused 2 deaths. "
10.	Prealbumin (Transthyretin)IBA 08/01/2019 - "The findings show that effective treatment improved the body composition of patients with esophageal motility disorder and that the Eckardt score and serum prealbumin may aid the prediction of increased appendicular skeletal muscle mass after treatment, resulting in a better quality of life."

Therapies and Procedures

1.	Myotomy 01/01/2021 - "Although peroral endoscopic myotomy (POEM) has emerged as a highly efficacious procedure in the treatment of a variety of esophageal motility disorders, currently no standard pathway for postprocedural care exists. " 01/01/2021 - "Esophagogastric junction outflow obstruction (EGJOO) is a rare but increasingly recognized diagnosis as described by The Chicago Classification of Esophageal Motility Disorders version 3.0 (version 3.0).1 On high-resolution manometry (HRM), EGJOO is characterized by increased integrated relaxation pressure (IRP) of the lower esophageal sphincter (LES), yet with some preserved esophageal peristalsis.2-4 Little consensus exists on the preferred therapeutic approach.3 Although conceptually per-oral endoscopic myotomy (POEM) should address the measurable dysfunction in the LES, few data exist to support this.5 Thus, we aimed to evaluate the safety and efficacy of POEM for the treatment of symptomatic EGJOO." 01/01/2021 - "Peroral endoscopic myotomy (POEM) is an effective treatment for esophageal motility disorder. " 01/01/2021 - "This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians. " 10/21/2023 - "Peroral Endoscopic Myotomy (POEM) is a minimally invasive technique used to treat esophageal motility disorders. "
2.	Therapeutics 03/01/2013 - "Primary malformations of the esophagus are now amenable to improved surgical and gastroenterological therapies; however, they often lead to persistent long-term esophageal dysmotility. " 11/01/2023 - "[Therapy of esophageal motility disorders]." 06/01/2023 - "High resolution manometry (HRM) has substantially redefined the actual approach of esophageal motility disorders with the major changes in instrumental use, diagnostic algorithms, and therapeutics. " 02/01/2023 - "[Therapy of esophageal motility disorders]." 01/01/2022 - "In this review, we discuss the current approach to diagnosis and therapeutics of various esophageal motility disorders."
3.	Fundoplication 04/01/2013 - "This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders. " 04/01/2006 - "This study aimed to evaluate the long-term impact of laparoscopic Nissen fundoplication on esophageal motility in patients with preoperative esophageal dysmotility. " 12/01/2023 - "All 6 (25%) patients who previously had fundoplication had esophageal dysmotility. " 01/01/2023 - "Laparoscopic Fundoplication: Technique of Choice in Patients with Esophageal Dysmotility." 12/01/2022 - "Patients with esophageal dysmotility had similar outcomes compared to those with normal motility after fundoplication, suggesting the tailored approach favoring partial fundoplication for patients with dysmotility as part of an appropriate treatment algorithm."
4.	Pyloromyotomy 10/01/2021 - "The aim of this study was to evaluate the clinical outcomes of the POEM procedure for esophageal motility disorders in a large cohort in which all patients had at least 5 years of follow-up. " 04/01/2019 - "Therefore, we conducted this study to elucidate mid-term effects of POEM procedures, and to examine whether postoperative changes in esophageal muscle layer thickness were related to particular clinico-pathological features in patients with esophageal motility disorders. " 07/01/2018 - "Seventy-four consecutive patients with esophageal motility disorders who underwent POEM procedures at Kobe University Hospital from April 2015 to December 2016 were prospectively recruited into this study. " 01/01/2021 - "As more than 6000 POEM procedures have been performed to date throughout the world, we aim to summarize the history and current state of POEM in the treatment of esophageal motility disorders. " 07/01/2018 - "The aims of this study are to elucidate the clinical significance of esophageal muscle layer thickness in patients with esophageal motility disorders who undergo peroral endoscopic myotomy (POEM), and to identify predictors of a longer POEM procedure time. "
5.	Heller Myotomy 06/01/2021 - "The surgical gold standard for esophageal motility disorders is laparoscopic Heller myotomy (LHM). " 01/01/2020 - "The purpose of this study was to compare demographics, symptoms, prior interventions, operation, and outcomes of patients who underwent Heller myotomy for esophageal motility disorders and epiphrenic diverticulectomy with Heller myotomy. " 01/01/2020 - "We identified all patients who underwent Heller myotomy for esophageal motility disorders with and without esophageal diverticulectomy over an 80-month period. " 11/10/2023 - "Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders." 01/01/2022 - "Peroral endoscopic myotomy (POEM) is a promising natural orifice transluminal endoscopic procedure for the treatment of esophageal motility disorders, with similar effectiveness as of Heller myotomy. "