ASGE Endo Hangout: Esophageal Motility | February 2022-Esophageal Motility

Esophageal Motility

Pdf Summary

Esophageal manometry is a diagnostic test used to evaluate patients with swallowing difficulties and other esophageal disorders. This test involves placing a probe through the nose into the stomach, and the patient is asked to swallow small sips of liquid or perform specific maneuvers while the pressure changes within the esophagus are recorded.<br /><br />The Chicago Classification is a standardized system used to interpret the results of esophageal manometry. It provides definitions and metrics for various esophageal motility disorders. The metrics include the integrated relaxation pressure (IRP), which measures the relaxation of the lower esophageal sphincter (LES); the distal contractile integral (DCI), which measures the strength and vigor of esophageal contractions; and the distal latency (DL), which measures the timing of contractions.<br /><br />One common esophageal motility disorder is achalasia, which is characterized by impaired relaxation of the LES and absence of esophageal peristalsis. It is diagnosed based on the findings of high IRP and absent peristalsis on manometry. Treatment options for achalasia include pneumatic dilation, surgical myotomy, peroral endoscopic myotomy (POEM), and botulinum toxin injection.<br /><br />Another disorder is esophagogastric junction outflow obstruction (EGJOO), which is characterized by elevated IRP and normal peristalsis. It can cause symptoms such as dysphagia and chest pain. Additional investigations, such as endoFLIP or timed barium esophagram, may be needed to further clarify the diagnosis.<br /><br />Other esophageal motility disorders include absent contractility, distal esophageal spasm, and hypercontractile esophagus. These disorders have distinct manometric patterns and may require individualized treatment approaches.<br /><br />In patients with non-cardiac chest pain, esophageal motility disorders are a relatively infrequent cause. Other common causes include gastroesophageal reflux disease (GERD) and functional chest pain. Evaluation of non-cardiac chest pain involves ruling out cardiac causes, lifestyle modifications, and potentially further investigations such as esophageal manometry.<br /><br />Overall, esophageal manometry and the use of the Chicago Classification are important tools in diagnosing and classifying esophageal motility disorders. The classification helps guide treatment decisions and provides a common language for clinicians and researchers in the field.

Keywords

Esophageal manometry

swallowing difficulties

esophageal disorders

Chicago Classification

achalasia

esophagogastric junction outflow obstruction

non-cardiac chest pain

gastroesophageal reflux disease

functional chest pain

common language