Abnormal Propulsion of Food

(Esophageal Motility Disorders)

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, University of Pennsylvania Health System

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version

Esophageal and Swallowing Disorders
Overview of the Esophagus
Abnormal Propulsion of Food
Achalasia
Eosinophilic Esophagitis
Esophageal Pouches (Diverticula)
Esophageal Spasm
Gastroesophageal Reflux Disease (GERD)
Hiatus Hernia
Infection of the Esophagus
Propulsion Disorders of the Throat
Overview of Injuries of the Esophagus
Erosive Esophagitis
Esophageal Laceration (Mallory-Weiss Syndrome)
Esophageal Ruptures
Overview of Obstructions of the Esophagus
Dysphagia Lusoria
Esophageal Webs
Lower Esophageal Ring

(See also Overview of the Esophagus.)

The movement of food from mouth to stomach requires normal and coordinated action of the mouth and throat, propulsive waves of muscular contractions of the esophagus (called peristalsis), and relaxation of the sphincters (the bands of muscle that need to open so that food can pass from the esophagus into the stomach).

A problem with any of these functions can cause difficulty swallowing (dysphagia), heartburn, chest pain, regurgitation (the spitting up of food from the esophagus or stomach without nausea or forceful contractions of abdominal muscles), vomiting, or aspiration of food (sucking food into the airways when inhaling).

Disorders of the throat also can cause problems with the movement of food (see Propulsion Disorders of the Throat).

The main causes of abnormal propulsion of food are movement (motility) disorders of the esophagus. The most common disorders include

Sometimes, disorders that affect the whole body also affect movement of the esophagus. Examples include systemic sclerosis and Chagas disease.

Doctors use various methods to diagnose movement disorders of the esophagus. Methods include endoscopy with biopsies, barium swallow x-rays, manometry, and acid-related or reflux-related tests.

Treatment of abnormal propulsion of food depends on the cause.

Spotlight on Aging: Problems with Swallowing

As people age, several changes may affect the ability to swallow. Slightly less saliva is produced. As a result, food is softened (macerated) less well and is drier before it is swallowed. The muscles in the jaws and throat may weaken slightly, making chewing and swallowing less efficient. Also, older people are more likely to have conditions that make chewing and swallowing difficult. For example, they are more likely to have loose teeth or to wear dentures. With aging, the contractions that move food through the esophagus become weaker. This change is very slight and usually has little effect on moving food to the stomach. But if older people try to eat while lying down or lie down just after eating, food may not easily move to the stomach. If reflux develops, the aging esophagus may be slower to move refluxed stomach acid back into the stomach. Some older people have a hiatus hernia, which may contribute to reflux.

As people age, several changes may affect the ability to swallow. Slightly less saliva is produced. As a result, food is softened (macerated) less well and is drier before it is swallowed. The muscles in the jaws and throat may weaken slightly, making chewing and swallowing less efficient. Also, older people are more likely to have conditions that make chewing and swallowing difficult. For example, they are more likely to have loose teeth or to wear dentures.

With aging, the contractions that move food through the esophagus become weaker. This change is very slight and usually has little effect on moving food to the stomach. But if older people try to eat while lying down or lie down just after eating, food may not easily move to the stomach. If reflux develops, the aging esophagus may be slower to move refluxed stomach acid back into the stomach. Some older people have a hiatus hernia, which may contribute to reflux.