Merck Manual

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Abnormal Propulsion of Food

(Esophageal Motility Disorders)


Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Mar 2022 | Modified Sep 2022
Topic Resources

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 Throat and Esophagus The throat (pharynx) lies behind and below the mouth. When food and fluids leave the mouth, they pass through the throat. Swallowing of food and fluids begins voluntarily and continues automatically... read more (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).

How the Esophagus Works

As a person swallows, food moves from the mouth to the throat, also called the pharynx (1). The upper esophageal sphincter opens (2) so that food can enter the esophagus, where waves of muscular contractions, called peristalsis, propel the food downward (3). The food then passes through the diaphragm (4) and lower esophageal sphincter (5) and moves into the stomach.

How the Esophagus Works

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

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 Dentures Teeth may be lost to a number of disorders including cavities, periodontal disease, or injury or may be removed when treatment fails. Missing teeth may cause cosmetic and speech problems and... read more .

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 Hiatus Hernia Hiatus hernia is an abnormal bulging of a portion of the stomach through the diaphragm. The cause of this disorder usually is not known, but age, obesity, and smoking are common factors. Some... read more , which may contribute to reflux.

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