Motility Disorders

“Motility” is a technical term that refers to the way in which material (such as food) is propelled from your throat to your stomach, and then through the rest of your digestive tract, via a series of muscle contractions. If these muscles, called sphincters, aren’t working properly, you may have what doctors call a motility disorder.

If you often find yourself gagging, choking, or having trouble swallowing, you may have a motility problem in your upper esophagus. If the sphincter muscles in the lower part of your esophagus aren’t functioning normally, stomach acid can flow backwards up through your esophagus, causing acid reflux (also known as GERD), heartburn, or chronic coughing.

• Achalasia occurs when the sphincter muscle located at the bottom of the esophagus stops working properly, making it difficult for food or liquid to pass into the stomach.

• Gastroesophageal reflux disease, also called GERD or acid reflux, occurs when acid flows backward out of your stomach and into the lower esophagus. Symptoms may include a sour or acidic taste in your mouth, heartburn, chest pain, difficulty swallowing or a hoarse voice.

• Esophageal spasms are abnormal, painful contractions in the esophagus that can last for several minutes or several hours at a time. These include diffuse esophageal spasms, which can cause food or beverage regurgitation, and especially strong contractions known as nutcracker esophagus.

• Hypertensive lower esophageal sphincter, a condition in which the lower esophageal sphincter muscle contracts too strongly, often making it difficult for food to pass from the esophagus into the stomach.

Scripps offers some of the most advanced tools available for diagnosing complex motility disorders.

These tools provide our doctors with objective data that allow them to make a more precise diagnosis. For example, if you’ve had trouble swallowing, your doctor can distinguish whether the dysfunction is occurring in your esophagus, which may require one course of treatment, versus a problem in your throat that requires a much different kind of treatment.

Our diagnostic services include:

High-resolution esophageal manometry

Manometry is a procedure that measures how the muscles in your esophagus contract and relax after you swallow, which is an indication of how well your esophagus is functioning. The high-resolution system offered at Scripps Center for Voice and Swallowing is the gold standard for diagnosing motility disorders, allowing your gastroenterologist to pinpoint the underlying cause of your symptoms and effectively treat them.

During the procedure, a thin rubber tube called a catheter is passed from your nose down into your esophagus. The catheter contains sensors that measure the rhythm, force and coordination of your esophageal muscles.

Esophageal pH testing

pH testing is used to measure whether acid is escaping from the stomach and flowing backward into the esophagus, a condition known by several names including acid reflux, gastroesophageal reflux, and GERD.

Scripps offers traditional 24-hour pH testing, in which a catheter containing a sensor that detects acid is passed through your nose and down into your esophagus. The tube remains in place for 24 hours.

We also offer 48-hour wireless pH testing. During this procedure, a small capsule is placed on the wall of your esophagus via a catheter. Once the catheter is removed, the device wirelessly transmits pH measurements to a receiver worn at your waist.

Scripps offers numerous medical and surgical treatment options for motility disorders, including:

• Medication is often used in combination with lifestyle changes to treat GERD symptoms, including heartburn. Your doctor may recommend you first try over-the-counter medications that help control acid. If those don’t work, your doctor may prescribe medications called H-2-receptor blockers (which reduce acid production) or proton pump inhibitors (which block acid production and can help heal the esophagus).

• Laparoscopic Heller myotomy is a minimally-invasive surgical procedure used to treat achalasia. During this procedure, the lower esophageal sphincter, or LES is surgically separated from the muscles that surround it, which helps to open the sphincter and allow food and liquids to pass into the stomach.

• Esophageal balloon dilation is a procedure that allows your doctor to widen a narrowed portion of your esophagus using a special balloon attached to an endoscope. When the balloon inflates, it stretches the portion of the esophagus that has become too narrow.

• Minimally-invasive fundoplication, or anti-reflux surgery, is a treatment for GERD. It is often used when patients have tried other options, including medication and lifestyle changes, without success.

• Incisionless GERD surgery is also used to treat chronic acid reflux. Scripps offers a procedure called transoral incisionless fundoplication, or TIF. A special device called an EsophyX is attached to an endoscope and guided through the mouth under general anesthesia. It allows surgeons to reinforce a weak esophageal sphincter.

Scripps gastroenterologists offer consultations or care for people with motility disorders at the following locations:

• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital (San Diego and Chula Vista)
• Scripps Green Hospital
• Scripps Clinic Carmel Valley
• Scripps Clinic Encinitas
• Scripps Clinic Rancho Bernardo
• Scripps Clinic Rancho San Diego
• Scripps Center for Voice and Swallowing