VOLUME

ADVANCES IN MANAGEMENT OF ESOPHAGEAL MOTILITY DISORDERS

FEBRUARY 2017 - VOL.13 | REVIEWS ARTICLE

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.

DOI:

10.31524/bkkmedj.2017.02.013

MEDIA

Figure 1

Demonstration of esophageal HRM fndings (Medtronic, Minneapolis, MN, USA); a. demonstration of normal esophageal peristalsis and normally relaxing LES; b. demonstration of absent esophageal peristalsis with poorly relaxing LES, suggestive of type I achalasia; c. demonstration of panesophageal pressurization with poorly relaxing LES, suggestive of type II achalasia and d. demonstration of premature contraction with poorly relaxing LES, suggestive of type III achalasia.

Figure 2

Algorithm of the management in achalasia 19, 22

Figure 3

Demonstration of esophageal HRM fndings (Medtronic, Minneapolis, MN, USA) of EGJ outﬂow obstruction. Suboptimal relaxing LES is noted and esophageal body peristalsis still preserves.

Figure 4

Demonstration of esophageal HRM fndings (Medtronic, Minneapolis, MN, USA) of premature contraction. Swallows with greater or equal to 20% of premature contraction suggest of distal esophageal spasm (DES)

Figure 5

Algorithm for the management of distal esophageal spasm41

Figure 6

Demonstration of esophageal HRM fndings (Medtronic, Minneapolis, MN, USA) of hypercontractile contraction. Swallows with greater or equal to 20% of hypercontractile contraction suggest jackhammer esophagus.

Figure 7

Demonstration of esophageal HRM findings (Medtronic, Minneapolis, MN, USA); a. demonstration of fragmented contraction; b-c, demonstration of failed peristalsis; d. demonstration of weak peristalsis.

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