Insights Gained from Symptom Evaluation of Esophageal Motility Disorders: A Review of 4,215 Patients

Abstract

Background/Aims: Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NE), and nonspecific motility disorder (NSMD) are described primary esophageal body motility disorders; however, their clinical symptom correlation is poorly understood. The aim of this study is to examine the association between a patient’s presenting symptoms and their manometric diagnosis. Methods: Manometric findings and reported symptoms of all patients undergoing esophageal manometry at the Creighton University Medical Center were prospectively entered in a database. Twenty-four-year data from 1984 through 2008 were accessed and analyzed. Results: Of the 4,215 patients, 130 (3.1%) had Ach, 192 (4.6%) had DES, 290 (6.9%) had NE, 508 (12.1%) had NSMD, and 3,095 (73.4%) had normal esophageal body motility. There was significant symptom overlap between the groups. Ach and DES had a similar symptom distribution, with dysphagia being the predominant symptom. Patients with NE, normal body motility, and NSMD presented predominantly with reflux symptoms. There was an increasing prevalence of esophageal dysmotility (DES and NSMD) with age, and women were found to be more likely to have NE than men. Conclusion: In an individual, reported symptoms do not correlate with their manometric diagnosis in a predictable fashion, and a thorough physiological assessment should be obtained to understand and diagnose the disease process. Esophageal motility deteriorates with age.

Incidence of Achalasia in South Australia Based on Esophageal Manometry Findings

“…It currently is accepted that achalasia has no sex predilection, [1][2][3][4][5][6][7]26 which is supported by our results. In addition, there was no difference in incidence between the Capital City and regional/remote populations and therefore no potential environmental causes for the disease were identified.…”

“…The prevalence of achalasia, DES, and NSMD all increase with age. [26][27][28][29] We deliberately reported the incidence as a range to ensure we had not overestimated by including ambiguous reports.…”

How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease

“…Exclusion criteria were (1) patients with esophageal dysphagia with concomitant reflux symptoms, as the correlation between esophageal motor disorder and reflux symptoms are not very consistent 17 and to avoid any overlapping of symptoms between the 2 study groups, (2) previous surgical or endoscopic treatments on the EGJ, (3) GERD symptoms and normal pH monitoring, and (4) presence of organic disease by barium esophagogram or upper gastrointestinal endoscopy. From the initially enrolled patients, 10 patients who had undergone treatments on the EGJ, 10 patients with dysphagia and concomitant GERD symptoms and 31 patients with GERD symptoms but normal pH result were excluded according to these criteria.…”

Esophageal Motility after Extensive Circumferential Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

“…With the advent of the HRM, the Chicago Classification of esophageal motility disorders was proposed to standardize diagnosis of esophageal dysmotility [10], and diagnostic capability has developed dramatically. Disease pathology is increasingly being determined from the view of esophageal motility, and there are now a number of reports of esophageal motility related to clinical symptoms, proton pump inhibitor-resistant non-erosive reflux disease, and achalasia [11-13]. …”