Primary Esophageal Motility Disorders: Beyond Achalasia

Schlottmann, Francisco; Patti, Marco G.

doi:10.3390/ijms18071399

Cited by 27 publications

(22 citation statements)

References 19 publications

(18 reference statements)

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“…High resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders [ 1 ]. These are defined by the Chicago classification, which was revised in 2014 (version 3.0) [ 2 ]. The esophageal motility disorders are achalasia, esophagogastric junction outflow obstruction, major disorder of peristalsis (distal esophageal spasm, Jackhammer esophagus, absent contractility), and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…HRM allows evaluation of the esophagogastric junction relaxation through the integrated relaxation pressure (IRP), expressed in mmHg. In the latest Chicago classification, the IRP is the only recognized HRM parameter to make conclusions about the lower esophageal sphincter (LES) relaxation, even though basal and residual LES pressures are also measured [ 2 ]. HRM assesses the esophageal contractile vigor through the distal contractile integral (DCI) [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

Clément

Zhu

Neshkova

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Background. Jackhammer esophagus is a hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As little is known about its clinical presentation, the aim of this study was to identify the clinical characteristics associated with this new gastrointestinal motility disorder. Methods. A retrospective study was conducted on patients visiting the CHUM’s Gastro-Intestinal Motility Center from January 2015 to December 2017. The HRM diagnoses were collated in a database along with age and sex of every individual. The latest Chicago classification (version 3.0) was used. Among all the patients subjected to HRM, those diagnosed with Jackhammer esophagus were included in the study. Patient charts were reviewed to collect relevant demographic and clinical data. Key Results. A total of 36 patients with Jackhammer esophagus were included (62 ± 13 years age, 89% females). Their main symptoms were dysphagia (72%), pyrosis (42%), retrosternal chest pain (36%), and epigastralgia (33%). Other manometric findings were hypertonia (22%) and/or inadequate relaxation (19%) of the lower esophageal sphincter. Among the 26 patients who had esogastroduodenoscopy, hiatal hernia was seen in 3 patients. Pathological gastroesophageal reflux was found in 4 of the 10 patients investigated by pH-monitoring. Conclusions and Inferences. Jackhammer esophagus represents 3% of the HRM diagnoses in this study, with a significant female preponderance. In more than two-thirds of cases, the clinical presentation of Jackhammer esophagus is dysphagia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

Clément

Zhu

Neshkova

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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“…There is a diagnostic concern in sedation-assisted HRM for patients with the isolated finding of the elevated IRP. Beyond achalasia, the patients with elevated IRP with normal esophageal peristalsis are classified as EGJ outflow obstruction [21]. Atypical achalasia can manifest as EGJ obstruction; however, it will require further evaluation with imaging studies and endoscopic ultrasound prior to concluding the diagnosis as atypical achalasia [22].…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Reliability of the Endoscopy and Sedation-Assisted High-Resolution Esophageal Motility Assessment

et al. 2019

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Background Esophageal high-resolution manometry (HRM) is performed for evaluation of dysphagia or the pre-operative evaluation before esophageal surgery. The esophageal manometry parameters, interpreted as per the Chicago classification (CC), are meant to be acquired in an awake state. At times, the patient intolerance or inability to traverse the manometry catheter across the esophagogastric junction (EGJ) renders incomplete esophageal motility evaluation; hence, sedation or endoscopy assistance is required. There have been concerns raised regarding the use of sedation and resultant alteration of the manometry parameters. The aims were to study the effects of intravenous sedation on esophageal motility parameters and analyze its impact on outcomes of patients with dysphagia who are intolerant to awake manometry procedure. Methods The study population comprised patients who had sedation or the endoscopy assistance for the HRM. The indication for HRM, necessity for the sedation, manometry findings, barium esophagogram results, procedural timings and patient outcomes were reviewed. The diagnostic impact of the 10% correction in integrated relaxation pressure (IRP) was also studied. Results There were 14 patients from 179 awake manometry procedures that required the sedation or the endoscopy assistance. The mean age was 60.7 years and there was equal gender distribution. Dysphagia (n = 9) remained the predominant indication for the HRM, followed by the pre-operative evaluation for the esophageal surgery (n = 5). In eight patients, awake manometry failed due to the coiling of the catheter above the EGJ and six patients were intolerant to awake catheter insertion technique. Six patients were diagnosed with achalasia and two with EGJ obstruction. The correction of the possible 10% inflation of the IRP did not alter the final diagnosis in majority except one patient with the EGJ obstruction. The findings of the barium esophagogram corroborated the manometry diagnosis. Conclusion Esophageal HRM should be done in awake state as much as possible. Sedation may be a feasible option as against aborting the further workup in patients who fail with current techniques involving awake catheter insertion. However, one needs to be mindful of sedation effects on manometry parameters and interpret results carefully.

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“…Patients with esophageal motility disorders experience symptoms such as dysphagia, regurgitation, and chest pain. Achalasia is the best‐defined esophageal motility disorder 1 . However, symptoms do not reliably distinguish between different esophageal motility disorders; as patients with other esophageal motility disorders, that is, esophagogastric junction (EGJ) outflow obstruction, major and minor disorder of peristalsis may report similar symptoms 1,2 .…”

Section: Introductionmentioning

confidence: 99%

“…Achalasia is the best‐defined esophageal motility disorder 1 . However, symptoms do not reliably distinguish between different esophageal motility disorders; as patients with other esophageal motility disorders, that is, esophagogastric junction (EGJ) outflow obstruction, major and minor disorder of peristalsis may report similar symptoms 1,2 . Hence, the patients with symptoms suggestive of esophageal motility disorders need esophageal function testing to accurately diagnose their disorder and direct treatment plan 2 .…”

Section: Introductionmentioning

confidence: 99%

Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility

Jehangir

Tanner

Malik

et al. 2020

Neurogastroenterology Motil

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Background Proximal esophageal striated muscle contractility may be abnormal in patients with esophageal symptoms, but is not assessed in the Chicago Classification (CC) v3.0. We aimed to (a) determine the prevalence of abnormal proximal esophageal contractility in patients with esophageal symptoms; (b) compare proximal esophageal contractility in patients with different esophageal motility disorders; (c) assess the association of abnormal proximal esophageal contractility with esophageal symptoms. Methods Patients undergoing high‐resolution esophageal manometry (HREM) from 7/2019 to 11/2019 and healthy volunteers (HVs) were studied. Measurements of the proximal esophageal segment included the vigor of contractility of the proximal esophagus (proximal contractile integral/PCI). Patients rated gastrointestinal symptoms’ severity. Key Results HREM was performed on 221 patients (63.8% females, mean age 57.1 ± 1.1 years) and 19 HVs. Mean PCI in HVs was 299.5 ± 30.6 (95% CI 32.3‐566.7 mm Hg.s.cm). Of all patients, 61 (27.6%) had abnormal PCI. HVs and patients with different esophageal motility disorders had significantly different PCI (P < .01). Type 1 achalasia patients had weaker PCI than patients with absent contractility (P = .02). Patients with abnormal PCI had more severe dysphagia (P = .02), nausea (P = .03), vomiting (P = .03), and lower bolus clearance (P < .01) than patients with normal PCI. Conclusions and Inferences Abnormal PCI was found in a fourth of patients with esophageal symptoms. PCI may be useful to distinguish some esophageal motility disorders. Patients with abnormal PCI had a higher severity of some upper gastrointestinal symptoms than patients with normal PCI. Assessing the proximal esophageal segment on HREM may be useful in characterizing patients with esophageal symptoms.

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Primary Esophageal Motility Disorders: Beyond Achalasia

Cited by 27 publications

References 19 publications

Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation

Revisiting the Reliability of the Endoscopy and Sedation-Assisted High-Resolution Esophageal Motility Assessment

Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility

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