How can esophageal motility abnormalities cause chest pain?
The mechanism or mechanisms by which motility abnormalities may cause chest pain are poorly understood. Specific mechanoreceptors have been identified in the esophageal mucosal and muscle layers. Abnormal contractions per se may be sufficient to stimulate these receptors and cause pain. Alternatively, the mechanoreceptors may be stimulated by esophageal distention, as a result of failed LES relaxation or retention of the bolus within the esophageal body. Yet another possibility is alteration of the threshold for esophageal sensation, which “tunes in” the patient to changes in esophageal pressure. A further theory is that high tension in the esophageal wall inhibits esophageal blood flow, causing myoischemia. However, the esophagus has an extensive blood supply, and contractions are unlikely to be sufficiently prolonged to induce ischemia. It is also possible that dysmotility per se is not the cause of pain. Rather, it may represent an epiphenomenon that, like pain, is induced by anothe
