Esophageal Motor Abnormalities – Food Sticks In Esophagus

What Are Esophageal Motor Abnormalities?

[dropcap]E[/dropcap]sophageal motor abnormalities are disorders of the esophagus involving altered muscular motility characterized by impaired esophageal peristalsis, or the progressive wave-like movement that occurs automatically when food or fluids are swallowed.

Q: What is altered motility?

A: Altered motility describes the lack of coordinated muscular movements or weak muscular movement needed to rapidly propel food and fluids through the highly muscular esophagus from the throat to the stomach.

The esophagus is a tube-like organ that begins at the cricoid cartilage (Adam’s apple) as a continuation of the pharynx and ends at the lower esophageal sphincter (LES).

The LES is a very strong, circular muscle surrounding the junction of the esophagus and stomach. The LES opens to allow swallowed food and liquids to enter the stomach and closes to prevent their travelling back into the esophagus.

Failure of the lower esophageal sphincter to remain tightly closed after swallowing allows stomach contents to reenter the esophagus giving symptoms of heartburn.

On the other hand, failure of the LES to relax traps the contents of the esophagus so that it cannot quickly empty into the stomach as it should. Because the esophagus is not designed to hold food/fluids, the abnormal expansion results in pain, anxiety and possibly vomiting and choking.  If the contents are aspirated into the windpipe upon choking, there will be coughing with attempts to clear it.

What Are Esophageal Motor Abnormalities In Celiac Disease and/or Gluten Sensitivity?

• Esophageal motor abnormalities are an atypical sign of celiac disease.
• Celiac disease patients show a decrease in lower esophageal sphincter pressure, allowing esophagitis (inflammation of the esophagus).¹
• Delayed gastric emptying makes matters worse because food is poorly digested and remains in the stomach longer than normal. A study by Usai et al.  documented delayed gastric emptying after eating in about 50% of study patients and found that it was correlated with manometric results proving poor motility after eating.² A manometer is a device used to measure pressure in the organ.

How Prevalent Are Esophageal Motor Abnormalities In Celiac Disease and/or Gluten Sensitivity?

Esophageal motor abnormalities were detected by esophageal manometry and cardiovascular tests in about 50% of untreated patients with celiac disease. Ph-metry was abnormal in 30% of study patients, and up to 75% of celiac patients displayed gastrointestinal motility alterations.³

What Are The Symptoms Of Esophageal Motor Abnormalities?

Esophageal motor abnormalities are marked by these symptoms:

• Variable dysphagia (difficulty swallowing).
• Possible regurgitation with chest pain.
• Choking aspiration (gets into windpipe).
• Drooling heartburn.
• Belching.
• Nocturnal cough (occurs while sleeping).

How Do Esophageal Motor Abnormalities In Celiac Disease and/or Gluten Sensitivity Develop?

• Esophageal motor abnormalities result from unclear etiology involving gluten.
• Extrinsic motor neuropathy may play a role, although other pathophysiological mechanisms are likely.²

Do Esophageal Motor Abnormalities Respond To Gluten-Free Diet?

Yes. Celiac disease-related motility improves on a gluten free diet.⁴

The gluten free diet is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population. A rapid improvement was evidenced at 3 months after initial treatment with a gluten free diet with reflux scores comparable to healthy controls from this time point onward.⁵

6 Steps To Improve Esopageal Motor Abnormalities In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both esophageal and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory). Puree foods that cannot be safely swallowed.

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁷[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications and Nutritional Supplements Safely: 

[box type=”shadow” ] Certain prescription drugs used in treating esophageal motor abnormalities can deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Vitamin B12, Vitamin D, Zinc, Magnesium, Copper, Potassium.
• Prevacid®, Prilosec® deplete Vitamin B12.
• Alka Seltzer®, Baking Soda deplete Folic Acid, Magnesium, Proteins, Potassium.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Esophageal Motor Abnormalities In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet.” This study investigating GERD symptoms in 133 adult celiac patients at diagnosis and 70 healthy controls found that GERD symptoms are common in classically symptomatic untreated CD patients. The GFD is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population.

Fifty-three patients completed questionnaires every 3 months during the first year and more than 4 years after diagnosis. GERD symptoms were evaluated using a subdimension of the Gastrointestinal Symptoms Rating Scale for heartburn and regurgitation domains.

RESULTS: At diagnosis, celiac patients had a significantly higher reflux symptom mean score than healthy controls. At baseline, 30.1% of celiac patients had moderate to severe GERD (score >3) compared with 5.7% of controls. Moderate to severe symptoms were significantly associated with the classical clinical presentation of celiac disease (35.0%) compared with atypical/silent cases (15.2%). A rapid improvement was evidenced at 3 months after initial treatment with a GFD with reflux scores comparable to healthy controls from this time point onward.⁵

“Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease.” This study investigating upper gut-motor activity in 30 untreated celiac disease patients and exploring the role played by the autonomic nervous system in motility disturbances demonstrated that upper-gut motor abnormalities are frequently present in adult celiac disease.

Delayed gastric emptying was documented in about 50% of study patients and was correlated with manometric post-prandial hypomotility. Extrinsic motor neuropathy may play a role, although other pathophysiological mechanisms are likely.⁸

Sources:

1. Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet. Gut. Apr 2003;52(4):514-7. [↩]
2. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩] [↩]
3. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩]
4. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩]
5. Nachman F, Vázquez H, González A, Andrenacci P, Compagni L, Reyes H, Sugai E, Moreno ML, Smecuol E, Hwang HJ, Sánchez IP, Mauriño E, Bai JC. Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol. 2011 Mar;9(3):214-9. doi: 10.1016/j.cgh.2010.06.017. [↩] [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
8. Usai P, Usai Satta P, Lai M, et al. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. European Journal of Clinical Investigation. Dec 1997;27(12):1009-15. [↩]