High Resolution Impedance Manometry: A Necessity or Luxury in Esophageal Motility Disorder?

Abstract

Case seriesPatient: Female, 71 • Male, 48 • Female, 44 • Female, 62Final Diagnosis: Esophageal motility disorderSymptoms: DysphagiaMedication: —Clinical Procedure: ManometrySpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:The esophagus can be affected by a variety of disorders that may be primary or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis and further management somewhat challenging. High resolution impedance manometry (HRiM) has established itself as a valuable tool in evaluating esophageal motility disorder. HRiM is superior in comparison with conventional water perfused manometric recordings in delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and in distinguishing the luminal pressurization of spastic esophageal contraction from a trapped bolus. Making these distinctions can help to identify achalasia, distal esophageal spasm, functional obstruction, and subtypes according to the latest Chicago Classification of Esophageal Motility Disorders version 3.0.Case Report:We report a case series of 4 patients that presented with dysphagia; and with the ancillary help of the HRiM, we are able to diagnose esophageal motility disorder and evaluate its pathogenetic mechanism. This approach aids in tailoring each management individually and avoiding disastrous mismanagement.Conclusions:From the series of case reports, we believe that HRiM has an important role to play in deciding appropriate management for patients presenting with esophageal motility disorders, and HRiM should be performed before deciding on management.

Prevalence of Different Types of Primary Esophageal Motility Disorders and Their Associated Factors in Patients Referring to Shariati Hospital during 2018-2019

“…12,13 Based on the Chicago Classification version 3.0, frequent EMDs include disturbances of the outflow of the esophagogastric junction (achalasia with minimal esophageal pressure (type I, classical), achalasia with esophageal compression (type II), achalasia with spasm (type III), and obstruction of the outflow of the esophagogastric junction), major disorders of peristalsis (distal or diffuse esophageal spasm (DES), hypercontractile esophagus, and lack of contractility) and minor disorders of peristalsis (ineffective esophageal motility and fragmented peristalsis). 3,4,7,14,15 Achalasia is a primary esophageal motility disorder caused by the failure of complete relaxation of LES during swallowing and ineffective peristalsis. The exact mechanism of achalasia is unknown, but it is believed that this disorder is caused by the denervation of the smooth muscles of the esophagus.…”

“… 2 EMDs can be a consequence of primary esophageal disease or secondary to other systemic diseases. 3 EMDs cause various symptoms such as dysphagia, retrosternal pain or discomfort, regurgitation, bolus obstruction, hoarseness, chronic cough, and weight loss. 4 In the past, conventional manometry was known for six decades as the gold standard diagnostic method for EMDs.…”

“… 12 , 13 Based on the Chicago Classification version 3.0, frequent EMDs include disturbances of the outflow of the esophagogastric junction (achalasia with minimal esophageal pressure (type I, classical), achalasia with esophageal compression (type II), achalasia with spasm (type III), and obstruction of the outflow of the esophagogastric junction), major disorders of peristalsis (distal or diffuse esophageal spasm (DES), hypercontractile esophagus, and lack of contractility) and minor disorders of peristalsis (ineffective esophageal motility and fragmented peristalsis). 3 , 4 , 7 , 14 , 15 …”