Primary Esophageal Motility Disorders: Beyond Achalasia

Francisco Schlottmann, Marco G Patti, Francisco Schlottmann, Marco G Patti

Abstract

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis). The aim of this study was to review the current diagnosis and management of esophageal motility disorders other than achalasia.

Keywords: Chicago classification; esophageal motility disorders; high-resolution manometry.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distal esophageal spasm. Premature contractions (DL

Figure 2

Hypercontractile esophagus (jackhammer esophagus). DCI…

Figure 2

Hypercontractile esophagus (jackhammer esophagus). DCI > 8000 mmHg/s/cm in at least 20% of swallows…

Figure 2
Hypercontractile esophagus (jackhammer esophagus). DCI > 8000 mmHg/s/cm in at least 20% of swallows and normal DL.

Figure 3

Absent contractility. Aperistalsis in the…

Figure 3

Absent contractility. Aperistalsis in the setting of normal LES relaxation (IRP

Figure 3
Absent contractility. Aperistalsis in the setting of normal LES relaxation (IRP

Figure 4

Ineffective esophageal motility. Failed or…

Figure 4

Ineffective esophageal motility. Failed or weak peristalsis in at least 30% of swallows.

Figure 4
Ineffective esophageal motility. Failed or weak peristalsis in at least 30% of swallows.

Figure 5

Fragmented peristalsis with a 7…

Figure 5

Fragmented peristalsis with a 7 cm gap.

Figure 5
Fragmented peristalsis with a 7 cm gap.
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References
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Figure 2
Figure 2
Hypercontractile esophagus (jackhammer esophagus). DCI > 8000 mmHg/s/cm in at least 20% of swallows and normal DL.
Figure 3
Figure 3
Absent contractility. Aperistalsis in the setting of normal LES relaxation (IRP

Figure 4

Ineffective esophageal motility. Failed or…

Figure 4

Ineffective esophageal motility. Failed or weak peristalsis in at least 30% of swallows.

Figure 4
Ineffective esophageal motility. Failed or weak peristalsis in at least 30% of swallows.

Figure 5

Fragmented peristalsis with a 7…

Figure 5

Fragmented peristalsis with a 7 cm gap.

Figure 5
Fragmented peristalsis with a 7 cm gap.
Figure 4
Figure 4
Ineffective esophageal motility. Failed or weak peristalsis in at least 30% of swallows.
Figure 5
Figure 5
Fragmented peristalsis with a 7 cm gap.

References

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    1. Herbella F.A.M., del Grande J.C. New ambulatory techniques for assessment of esophageal motility and their applicability on achalasia study. Rev. CBC. 2008;35:199–202.
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