Im Extremfall können sich Patienten mit Ösophagus-Motilitätsstörungen nicht ausreichend
ernähren – und auch pulmologische Komplikationen kommen vor. Die Achalasie ist die
wichtigste definierte Ösophagus-Motilitätsstörung. In den letzten 10–15 Jahren gewann
man neue Erkenntnisse zur Pathophysiologie; und neue diagnostische und therapeutische
Verfahren ermöglichen nun eine frühere Erkennung und zielgenauere Therapie dieser
und anderer Ösophagus-Motilitätsstörungen.
Abstract
Esophageal motor disorders are an important cause of dysphagia but can also be associated
with retrosternal pain and heartburn as well as regurgitation. In extreme cases, patients
are not able to eat appropriately and lose weight. Repetitive aspiration can occur
and may cause pulmonological complications. Achalasia represents the most important
and best-defined esophageal motor disorder and is characterized by insufficient relaxation
of the lower esophageal sphincter in combination with typical disturbances of esophageal
peristalsis. Additional defined motor disorders are distal esophageal spasm, hypercontractile
esophagus, absent contractility and ineffective peristalsis. Patients with appropriate
symptoms should primarily undergo esophagogastroduodenoscopy for exclusion of e.g.,
tumors and esophagitis. Esophageal high-resolution manometry is the reference method
for diagnosis and characterization of motor disorders in non-obstructive dysphagia.
An esophagogram with barium swallow may deliver complementary information or may be
used if manometry is not available. Balloon dilatation and Heller myotomy are long
established and more or less equally effective therapeutic options for patients with
achalasia. Peroral endoscopic myotomy (POEM) enhances the therapeutic armamentarium
for achalasia and hypertensive/spastic motor disorders since 2010. For hypotensive
motor disorders, which may occur as a complication of e.g., rheumatological diseases
or idiopathically, therapeutic options are still limited.
Schlüsselwörter
Motilitätsstörung - Ösophagus - Achalasie - Ösophagusspasmus - hyperkontraktil
Keywords
motility disorder - esophagus - achalasia - esophageal spasm - hypercontractile
