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World J Hepatol. Dec 27, 2020; 12(12): 1158-1167
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1158
Spectrum of esophageal motility disorders in patients with liver cirrhosis
Mohamed Khalaf, Donald Castell, Puja Sukhwani Elias
Mohamed Khalaf, Puja Sukhwani Elias, Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29401, United States
Donald Castell, Department of Internal Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
Author contributions: Khalaf M, Castell D and Elias PS reviewed the literature and wrote the manuscript; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Khalaf, MD, MSc, Assistant Lecturer, Postdoctoral Fellow, Department of Gastroenterology and Hepatology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29401, United States. moh.h.khalaf@gmail.com
Received: August 1, 2020
Peer-review started: August 1, 2020
First decision: September 17, 2020
Revised: October 1, 2020
Accepted: November 6, 2020
Article in press: November 6, 2020
Published online: December 27, 2020
Processing time: 139 Days and 2.1 Hours
Abstract

Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies. In this review, we aim to provide an overview of the available evidence on esophageal motility disorders in cirrhosis and their clinical implications. This review delves into the following concepts: (1) Gastroesophageal reflux disease is common in liver cirrhosis due to many mechanisms; however, when symptomatic it is usually nocturnal and has an atypical presentation; (2) Endoscopic band ligation is better than sclerotherapy in terms of its effect on esophageal motility and seems to correct dysmotilities resulting from the mechanical effect of esophageal varices; (3) Chronic alcoholism has no major effects on esophageal motility activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy; (4) An association between primary biliary cholangitis and scleroderma can be present and esophageal hypomotility is not uncommon in this scenario; and (5) Cyclosporin-based immunosuppression in liver transplant patients can have a neurotoxic effect on the esophageal myenteric plexus leading to reversible achalasia-like manifestations.

Keywords: Esophagus; Motility; Cirrhosis; Dysmotility; Gastroesophageal reflux disease; Manometry

Core Tip: (1) The link between liver cirrhosis and esophageal motility; (2) The association of cirrhosis with gastroesophageal reflux disease; (3) Esophageal motility disorders in cirrhosis patients (with and without esophageal varices); (4) The impact of variceal treatment on esophageal motility and function; (5) The impact of some etiologies of cirrhosis on esophageal motility, particularly in cases of chronic alcoholism and primary biliary cholangitis; and (6) The effect of immunosuppressive therapy used in post liver transplantation patients on esophageal motility.