Management der ösophagealen Motilitätsstörungen – Update 2024

Esophageal motility disorders encompass a variety of conditions that impair swallowing and esophageal function. Treatment varies depending on the cause and type of disorder. The therapy of primary motility disorders not caused by other diseases is particularly complex.

This paper aims to evaluate and update current management strategies for primary esophageal motility disorders, particularly focusing on diagnostic methods and therapeutic approaches.

The study is based on an analysis of current research findings and clinical guidelines, taking into account diagnostic criteria and classifications, especially Chicago Classification 4.0. Therapeutic measures were compared based on their effectiveness and safety.

High-resolution manometry is the gold standard for the diagnosis of primary motility disorders. Botulinum toxin injections and pneumatic dilation are effective short-term, while peroral endoscopic myotomy (POEM) and Heller myotomy show better long-term results. POEM is particularly effective for type III achalasia. Calcium antagonists and high-dose peppermint oil can provide symptomatic relief but are not long-term solutions. Hypomotile disorders remain challenging and are often treated symptomatically.

The treatment of esophageal motility disorders requires an individualized approach that is both symptom- and patient-oriented. POEM has proven to be safe and effective and is gaining importance. Surgical procedures like Heller myotomy remain relevant, especially when combined with fundoplication to prevent reflux. Future research should focus on long-term outcomes and optimizing therapeutic approaches.