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Incomplete transient lower esophageal sphincter relaxation in achalasia subtype III with proximal elevation of a nonrelaxing LES, after change from supine to upright posture. LES, lower esophageal sphincter.
Source publication
Abstract: High-resolution manometry (HRM) with closely spaced pressure sensors, enhances visualization and interpretation of esophageal pressures. HRM software displays two key physiological features of achalasia: inadequate swallow-induced lower esophageal sphincter (LES) relaxation, and the absence of normal esophageal primary peristalsis. HRM me...
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Background
It is debated whether high‐resolution manometric (HRM) integrated relaxation pressure (IRP) or functional lumen imaging probe (FLIP) distensibility index (DI) is the superior measure of esophagogastric junction (EGJ) opening. We examined the relationship between the DI and IRP and assessed correlations with dysphagia symptoms in patients...
Introduction
Long‐term outcome data are limited for non‐achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus).
Methods
Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2...
Background
Esophageal motility disorders (EMDs) are often diagnosed manometrically, yet the underlying pathology is not always clear. Esophageal function testing (EFT), which incorporates manometry and multichannel intraluminal impedance (MII), is considered a useful tool in the assessment of EMDs.
Objective
This study aims to assess the most like...
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Background
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Citations
... Further, the presence of dysphagia and/or noncardiac chest pain must accompany manometric findings for diagnosis of hypercontractile esophagus. Esophageal hypercontractility can occur due to multiple secondary etiologies, including gastroesophageal reflux disease (GERD), EGJ mechanical obstruction, and medications, such as opioids [19]. However, true primary hypercontractile esophagus must occur in the absence of EGJ outflow obstruction (i.e. ...
Purpose of Review
Chicago Classification has standardized clinical approach to primary esophageal motility disorders. With new clinical data and advancing treatments, Chicago Classification has undergone multiple revisions to reflect updated findings and enhance diagnostic accuracy. This review will describe the recently published Chicago Classification version 4.0 (CCv4.0), which aimed to enhance diagnostic characterization and limit overdiagnosis of inconclusive esophageal motility diagnoses.
Recent Findings
Key revisions outlined in CCv4.0 include (1) a modified standardized HRM study protocol performed in supine and upright positions, (2) recommended ancillary testing and manometric provocation for inconclusive manometric diagnoses (3) the required presence of obstructive symptoms for conclusive diagnoses of esophagogastric junction outflow obstruction, distal esophageal spasm and hypercontractile esophagus, and (4) requirement of confirmatory testing for esophagogastric junction outflow obstruction.
Summary
These key modifications aim to improve diagnostic accuracy and consistency of clinically relevant esophageal motility disorders, and subsequently clinical outcomes.
Achalasia is defined as dysfunction of the esophageal wall myenteric plexus, which causes symptoms of dysphagia. While manometry is typically regarded as the gold standard for diagnosing and confirming achalasia, other imaging modalities such as barium swallow and upper endoscopy are often obtained initially. The barium swallow study can be a supportive or confirmatory test, whereas the upper endoscopy is typically used to rule out pseudo-achalasia. Additionally, barium swallow is an imaging modality of choice in resource-limited settings. A standardized approach for categorizing motility disorders is the Chicago Classification. This is a newer classification of achalasia based on high-resolution manometry. However, the role of barium contrast studies does not seem to have been evaluated in the context of the Chicago Classification of the three achalasia subtypes, suggesting an underappreciated role of fluoroscopy in the diagnostic evaluation of achalasia subtypes.
