Name two esophageal motor disorders that can cause dysphagia.

• A. Achalasia and distal esophageal spasm
• B. GERD and esophagitis
• C. Barrett's esophagus
• D. Pill-induced esophagitis

Answer: (A)

Dysphagia from the esophagus can come from problems with movement rather than a blockage. Esophageal motor disorders are those issues with how the esophagus contracts and how the lower esophageal sphincter relaxes. Achalasia illustrates this motor problem: the lower esophageal sphincter fails to relax and the esophageal body loses peristalsis, so a bolus has trouble passing through, causing trouble swallowing with solids and liquids alike. Distal esophageal spasm is another motor disorder, characterized by uncoordinated or abnormal contractions of the distal esophagus, which can produce intermittent dysphagia and chest pain as the bolus transit is disrupted. These conditions are classically grouped as esophageal motor disorders that cause dysphagia.

In contrast, GERD with esophagitis and Barrett’s esophagus involve mucosal irritation or metaplastic changes from acid exposure, not primary motor dysfunction. Pill-induced esophagitis is mucosal injury from a pill irritating the lining, not a problem with esophageal muscle activity. So the two esophageal motor disorders that can cause dysphagia are achalasia and distal esophageal spasm.