Advances in Management of Esophageal Motility Disorders
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Published:
Feb 20, 2017
Keywords:
esophageal manometry, esophageal motility disorder
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Abstract
Esophageal manometry is an important tool for evaluating esophageal function. It can be used for assessing the esophageal peristaltic pattern and also peristaltic intensity. Additionally, lower esophageal sphincter (LES) function can be studied simultaneously. This information allows clinicians to thoroughly investigate patients presenting with esophageal and/or respiratory symptoms without identifable structural cause. At present, high resolution manometry (HRM) is preferred over conventional manometry as it informs the result in pressure topography. These data correlate more precisely with the clinical presentation of patients with esophageal dysmotility. Consequently, the HRM working group has proposed the criteria known as Chicago classifcation to categorize and specify the esophageal motility abnormality based on the results from HRM. This article describes esophageal motility disorders according to the current diagnostic criteria and also how to manage them in brief.
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1.
Tangaroonsanti A, Siramolpiwat S, Mahachai V, Vilaichone R- korn. Advances in Management of Esophageal Motility Disorders. BKK Med J [Internet]. 2017 Feb. 20 [cited 2024 Nov. 24];13(1):76. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221800
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Reviews Article
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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9. Birgisson S, Richter JE. Achalasia in Iceland, 1952-2002: an epidemiologic study. Dig Dis Sci 2007;52:1855-60.
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11. Gennaro N, Portale G, Gallo C, et al. Esophageal achalasia in the Veneto region: epidemiology and treatment. Epidemiology and treatment of achalasia. J Gastrointest Surg 2011;15:423-8.
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17. Ates F, Vaezi MF. The Pathogenesis and Management of Achalasia: Current Status and Future Directions. Gut Liver 2015;9:449-63.
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20. Pandolfno JE, Gawron AJ, Msci. JAMA patient patient:Achalasia. JAMA 2015;313:1876.
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2011;24:354-9.
35. Pandolfno JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defning clinical phenotypes. Gastroenterology 2011;141:469-75.
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Gastroenterol 1995;30:1041-5.
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38. Crespin OM, Tatum RP, Yates RB, et al. Esophageal hypermotility: cause or effect? Dis Esophagus. 2015.
39. Herbella FA, Raz DJ, Nipomnick I, et al. Primary versus secondary esophageal motility disorders: diagnosis and implications for treatment. J Laparoendosc Adv Surg Tech A 2009;19:195-8.
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43. Cannon RO, 3rd, Quyyumi AA, Mincemoyer R, et al.Imipramine in patients with chest pain despite normal coronary angiograms.N Engl J Med 1994;330:1411-7.
44. Lee H, Kim JH, Min BH, et al. Effcacy of venlafaxine for symptomatic relief in young adult patients with functional chest pain: a randomized, double-blind, placebo-controlled, crossover trial.Am J Gastroenterol 2010;105:1504-12.
45. Varia I, Logue E, O’Connor C, et al. Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin.Am Heart J 2000;140:367-72.
46. Clouse RE, Lustman PJ, Eckert TC, et al. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebocontrolled trial. Gastroenterology 1987;92:1027-36.
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50. Ebert EC, Ouyang A, Wright SH, et al. Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction.Dig Dis Sci 1983;28:481-5.
51. Irving JD, Owen WJ, Linsell J, et al. Management of diffuse esophageal spasm with balloon dilatation. Gastrointest Radiol 1992;17:189-92.
52. Brand DL, Martin D, Pope CE, 2nd. Esophageal manometrics in patients with angina-like chest pain. Am J Dig Dis 1977;22:300-4.
53. Benjamin SB, Gerhardt DC, Castell DO. High amplitude, peristaltic esophageal contractions associated with chest
pain and/or dysphagia.Gastroenterology 1979;77:478-83.
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age and frequency of “abnormal” contractions.Dig Dis Sci1987;32:583-92.
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64. Roman S, Pandolfno JE, Chen J, et al. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT).Am J Gastroenterol 2012;107:37-45.
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of gastroesophageal reflux.Am J Gastroenterol 1993;88:187-92.
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2. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol 1991;261:G677-84.
3. Clouse RE, Staiano A, Alrakawi A, et al. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol 2000;95:2720-30.
4. Kahrilas PJ, Ghosh SK, Pandolfno JE. Esophageal motility disorders in terms of pressure topography: the Chicago
Classifcation. J Clin Gastroenterol 2008;42:627-35.
5. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classifcation criteria of esophageal motility disorders defned in high resolution esophageal pressure topography. Neurogastroenterol Motil 2012;24 Suppl 1:57-65.
6. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classifcation of esophageal motility disorders, v3.0.Neurogastroenterol Motil 2015;27:160-74.
7. Boeckxstaens GE. The lower oesophageal sphincter. Neurogastroenterol Motil 2005;17 Suppl 1:13-21.
8. Kahrilas PJ, Kishk SM, Helm JF, et al. Comparison of pseudoachalasia and achalasia. Am J Med 1987;82:439-46.
9. Birgisson S, Richter JE. Achalasia in Iceland, 1952-2002: an epidemiologic study. Dig Dis Sci 2007;52:1855-60.
10. Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986-2005. Dysphagia 2008;23:161-4.
11. Gennaro N, Portale G, Gallo C, et al. Esophageal achalasia in the Veneto region: epidemiology and treatment. Epidemiology and treatment of achalasia. J Gastrointest Surg 2011;15:423-8.
12. Ho KY, Tay HH, Kang JY. A prospective study of the clinical features, manometric fndings, incidence and prevalence of achalasia in Singapore. J Gastroenterol Hepatol 1999;14:791-5.
13. Sadowski DC, Ackah F, Jiang B, et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 2010;22:e256-61.
14. Mayberry JF, Atkinson M. Variations in the prevalence of achalasia in Great Britain and Ireland: an epidemiological study based on hospital admissions. Q J Med 1987;62:67-74.
15. Aggestrup S, Uddman R, Jensen SL, et al. Regulatory peptides in the lower esophageal sphincter of man. Regul Pept 1985;10:167-78.
16. Mearin F, Mourelle M, Guarner F, et al. Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction. Eur J Clin Invest 1993;23:724-8.
17. Ates F, Vaezi MF. The Pathogenesis and Management of Achalasia: Current Status and Future Directions. Gut Liver 2015;9:449-63.
18. Ruiz-de-Leon A, Mendoza J, Sevilla-Mantilla C, et al. Myenteric antiplexus antibodies and class II HLA in achalasia. Dig Dis Sci 2002;47:15-9.
19. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014;383:83-93.
20. Pandolfno JE, Gawron AJ, Msci. JAMA patient patient:Achalasia. JAMA 2015;313:1876.
21. Woodfeld CA, Levine MS, Rubesin SE, et al. Diagnosis of primary versus secondary achalasia: reassessment of clinical and radiographic criteria. AJR Am J Roentgenol 2000;175:727-31.
22. Vaezi MF, Pandolfno JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013;108:1238-49; quiz 50.
23. Perez-Fernandez MT, Santander C, Marinero A, et al. Characterization and follow-up of esophagogastric junction
outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil 2016;28:116-26.
24. van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction.
Neurogastroenterol Motil 2015;27:1310-6.
25. Ratuapli SK, Crowell MD, DiBaise JK, et al. Opioid Induced Esophageal Dysfunction (OIED) in Patients on Chronic Opioids. Am J Gastroenterol 2015;110:979-84.
26. Scherer JR, Kwiatek MA, Soper NJ, et al. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg 2009;13:2219-25.
27. Marjoux S, Brochard C, Roman S, et al. Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases? Dis Esophagus 2015;28:735-41.
28. Porter RF, Gyawali CP. Botulinum toxin injection in dysphagia syndromes with preserved esophageal peristalsis and incomplete lower esophageal sphincter relaxation. Neurogastroenterol Motil 2011;23:139-44, e27-8.
29. Osgood H. A peculiar form of oesophagismus. Boston MedSurg J 1889;120:401–5.
30. Moersch HJ, Camp JD. Diffuse spasm of the lower part of theesophagus. . Ann Otol Rhinol Laryngol 1934;43:1165–73.
31. Creamer B, Donoghue E, Code CF. Pattern of esophageal motility in diffuse spasm. Gastroenterology1958;34:782-96.
32. Almansa C, Heckman MG, DeVault KR, et al. Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients. Dis Esophagus 2012;25:214-21.
33. Katz PO, Dalton CB, Richter JE, et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients. Ann Intern Med 1987;106:593-7.
34. Tsuboi K, Mittal SK. Diffuse esophageal spasm: has the term lost its relevance? Analysis of 217 cases. Dis Esophagus
2011;24:354-9.
35. Pandolfno JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defning clinical phenotypes. Gastroenterology 2011;141:469-75.
36. Konturek JW, Gillessen A, Domschke W. Diffuse esophageal spasm: a malfunction that involves nitric oxide? Scand J
Gastroenterol 1995;30:1041-5.
37. Murray JA, Ledlow A, Launspach J, et al. The effects of recombinant human hemoglobin on esophageal motor functions in humans. Gastroenterology 1995;109:1241-8.
38. Crespin OM, Tatum RP, Yates RB, et al. Esophageal hypermotility: cause or effect? Dis Esophagus. 2015.
39. Herbella FA, Raz DJ, Nipomnick I, et al. Primary versus secondary esophageal motility disorders: diagnosis and implications for treatment. J Laparoendosc Adv Surg Tech A 2009;19:195-8.
40. Prabhakar A, Levine MS, Rubesin S, et al. Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients. AJR Am J Roentgenol 2004;183:409-13.
41. Achem SR, Gerson LB. Distal esophageal spasm: an update. Curr Gastroenterol Rep 2013;15:325.
42. Valdovinos MA, Zavala-Solares MR, Coss-Adame E. Esophageal hypomotility and spastic motor disorders: current diagnosis and treatment. Curr Gastroenterol Rep.2014;16:421.
43. Cannon RO, 3rd, Quyyumi AA, Mincemoyer R, et al.Imipramine in patients with chest pain despite normal coronary angiograms.N Engl J Med 1994;330:1411-7.
44. Lee H, Kim JH, Min BH, et al. Effcacy of venlafaxine for symptomatic relief in young adult patients with functional chest pain: a randomized, double-blind, placebo-controlled, crossover trial.Am J Gastroenterol 2010;105:1504-12.
45. Varia I, Logue E, O’Connor C, et al. Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin.Am Heart J 2000;140:367-72.
46. Clouse RE, Lustman PJ, Eckert TC, et al. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebocontrolled trial. Gastroenterology 1987;92:1027-36.
47. Handa M, Mine K, Yamamoto H, et al. Antidepressant treatment of patients with diffuse esophageal spasm: a psychosomatic approach.J Clin Gastroenterol 1999;28:228-32.
48. Miller LS, Parkman HP, Schiano TD, et al. Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter.Dig Dis Sci 1996;41:2025-31.
49. Miller LS, Pullela SV, Parkman HP, et al. Treatment of chest pain in patients with noncardiac, nonreflux, nonachalasia spastic esophageal motor disorders using botulinum toxin injection into the gastroesophageal junction.Am J Gastroenterol2002;97:1640-6.
50. Ebert EC, Ouyang A, Wright SH, et al. Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction.Dig Dis Sci 1983;28:481-5.
51. Irving JD, Owen WJ, Linsell J, et al. Management of diffuse esophageal spasm with balloon dilatation. Gastrointest Radiol 1992;17:189-92.
52. Brand DL, Martin D, Pope CE, 2nd. Esophageal manometrics in patients with angina-like chest pain. Am J Dig Dis 1977;22:300-4.
53. Benjamin SB, Gerhardt DC, Castell DO. High amplitude, peristaltic esophageal contractions associated with chest
pain and/or dysphagia.Gastroenterology 1979;77:478-83.
54. Tsuboi K, Mittal SK, Legner A, et al. Relationship between manometric fndings and reported symptoms in nutcracker esophagus: insights gained from a review of 313 patients. J Gastroenterol 2010;45:1033-8.
55. Lufrano R, Heckman MG, Diehl N, et al. Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.Dis Esophagus 2015;28:11-8.
56. Mallet AL, Ropert A, Bouguen G, et al. Prevalence and characteristics of acid gastro-oesophageal reflux disease in Jackhammer oesophagus.Dig Liver Dis 2016.
57. Jung HY, Puckett JL, Bhalla V, et al. Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus.Gastroenterology 2005;128:1179-86.
58. Korsapati H, Bhargava V, Mittal RK. Reversal of asynchrony between circular and longitudinal muscle contraction in nutcracker esophagus by atropine.Gastroenterology 2008;135:796-802.
59. Loo FD, Dodds WJ, Soergel KH, et al. Multipeaked esophageal peristaltic pressure waves in patients with diabetic neuropathy.Gastroenterology 1985;88:485-91.
60. Richter JE, Wu WC, Johns DN, et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with
age and frequency of “abnormal” contractions.Dig Dis Sci1987;32:583-92.
61. Dalton CB, Castell DO, Richter JE. The changing faces of the nutcracker esophagus. Am J Gastroenterol. 1988;83:623-8.
62. Agrawal A, Hila A, Tutuian R, et al. Clinical relevance of the nutcracker esophagus: suggested revision of criteria for diagnosis.J Clin Gastroenterol 2006;40:504-9.
63. Pandolfno JE, Ghosh SK, Rice J, et al. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls.Am J Gastroenterol 2008;103:27-37.
64. Roman S, Pandolfno JE, Chen J, et al. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT).Am J Gastroenterol 2012;107:37-45.
65. Achem SR, Kolts BE, Wears R, et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role
of gastroesophageal reflux.Am J Gastroenterol 1993;88:187-92.
66. Borjesson M, Rolny P, Mannheimer C, et al. Nutcracker oesophagus: a double-blind, placebo-controlled, cross-over study of the effects of lansoprazole.Aliment Pharmacol Ther2003;18:1129-35.
67. George N, Abdallah J, Maradey-Romero C, et al. Review article: the current treatment of non-cardiac chest pain. Aliment Pharmacol Ther 2016;43:213-39.
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