Unclassified oesophageal motor disorders simulating achalasia.

Hogan, W. J.; Caflisch, Carlton R.; Winship, Daniel H.

doi:10.1136/gut.10.3.234

Cited by 30 publications

(5 citation statements)

References 15 publications

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“…5). Motility was abnormal in the remaining six patients also, but the patterns seen did not conform to the strict, and perhaps undesirably rigid (Hogan, Caflisch, and Winship 1969;Kaye, 1973), classifications that are currently fashionable. In…”

Section: Manometric Methodsmentioning

confidence: 73%

Oesophageal motor dysfunction in patients with diverticula of the mid-thoracic oesophagus

Kaye¹

1974

Thorax

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Section: Manometric Methodsmentioning

confidence: 73%

Oesophageal motor dysfunction in patients with diverticula of the mid-thoracic oesophagus

Kaye¹

1974

Thorax

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“…This led to the suggestion that achalasia is just one extreme of a spectrum of related motility disorders of the esophagus [9,10,16,17] al spasm to achalasia, as it has been observed in some patients, or treatment-induced motility changes in patients with achalasia [3][4][5][6][7][8][9]18] support this hypothesis of a spectrum of different interrelated diseases. The underlying mechanisms of these forms of impaired esophageal motor function might reflect different, and in some cases probably reversible, alteration of extrinsic or intrinsic innerration.…”

Section: Discussionmentioning

confidence: 80%

“…Several investigators reported difficulties in classifying different esophageal motility disorders [10,[15][16][17]. This led to the suggestion that achalasia is just one extreme of a spectrum of related motility disorders of the esophagus [9,10,16,17] al spasm to achalasia, as it has been observed in some patients, or treatment-induced motility changes in patients with achalasia [3][4][5][6][7][8][9]18] support this hypothesis of a spectrum of different interrelated diseases.…”

Section: Discussionmentioning

confidence: 99%

Motility changes in primary achalasia following pneumatic dilatation

1990

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The changes in esophageal motility after pneumatic dilatation were evaluated prospectively in 51 patients with achalasia. The patients were evaluated for a median of 14 months. Pneumatic dilatation led to a clinical improvement in 41 patients. On manometric evaluation, a significant decrease in lower esophageal sphincter pressure was observed (28.4 +/- 14.9 mmHg vs. 13.5 +/- 7.2 mmHg; p = 0.001); the resting pressure of the esophageal body dropped from 4.8 +/- 4.2 mmHg above gastric baseline to 0.1 +/- 3.9 mmHg below gastric baseline. After therapy, peristaltic activity was present in 10/51 (20%) patients; in 1 case, complete relaxation of the lower esophageal sphincter was recorded. Treatment-induced motility changes could not be predicted by clinical history or the lower esophageal sphincter pressure before or after therapy. However, the resting pressure of the esophageal body before and after therapy was significantly lower in these patients in whom peristalsis recurred after therapy than in patients with an unchanged motility pattern. The reappearance of peristaltic activity after pneumatic dilatation was unrelated to lower esophageal sphincter pressure. In conclusion, motility disturbances of the esophageal body in patients with achalasia do not simply reflect the functional obstruction of the lower esophageal sphincter. These findings support the hypothesis that achalasia is not a distinct motility disturbance but should be regarded as part of a broad spectrum of different interrelated esophageal motility disorders.

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“…In 1967, Sanderson et al (17) described three patients who were excluded from their evaluation of vigorous achalasia because esophageal manometric studies indicated occasional peristaltic waves. Subsequently, in 1969 Hogan et al (18) published data on a group of patients with “unclassified esophageal motor disorders,” in whom symptoms and radiologic studies suggested achalasia; however, manometry demonstrated esophageal peristaltic contractions and LES relaxation. Benjamin and Castell (19) used the term “nonspecific esophageal motility disorders” in 1983, to describe findings in a diverse group of patients with symptoms suggestive of an esophageal motor disorder (chest pain and/or dysphagia); esophageal manometric abnormalities that could not be classified as one of the established dysmotility syndromes (i.e.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific Esophageal Motility Disorders in Children Without Gastroesophageal Reflux

Rosario,

Medow,

Halata

et al. 1999

J. pediatr. gastroenterol. nutr.

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Background:Nonspecific esophageal motility disorders (NEMDs) have been identified in up to 50% of adults with noncardiac chest pain or dysphagia. This study sought to determine the incidence of NEMDs in children with upper gastrointestinal tract symptoms and to evaluate the clinical course of pediatric patients with these manometric abnormalities.Methods:The study involved 154 children aged 4 to 18 years (mean age, 11.6 ± 2.6 years [SE]) who had upper gastrointestinal, swallowing‐related symptoms. The children were evaluated by 24‐hour intraesophageal pH monitoring, esophageal manometry, and esophagogastroduodenoscopy.Results:Gastroesophageal reflux (GER) was diagnosed by pH study in 109 (71%) of 154 patients, and examination of biopsy specimens demonstrated esophagitis in 70 children with GER. Results of esophageal manometry were abnormal in 30 (67%) of 45 children without GER. A variety of motility disorders were diagnosed in 17 of the patients without GER, whereas NEMDs were diagnosed in the remaining 13 children (mean age, 10.6 ± 2.7 years; 10 boys, 3 girls). Patients with GER showed normal esophageal wave propagation; however, mean lower esophageal sphincter pressure was significantly lower in patients with GER than in children with NEMDs. The children with NEMDs exhibited a diverse array of symptoms, including esophageal food impaction in 4 of the 13 patients. During a 36.2 ± 4.3‐month follow‐up period, no correlation was found between therapeutic intervention and clinical course in the 13 patients with NEMDs. Symptomatic improvement occurred in 6 of 13 patients, including 3 children for whom no pharmacologic therapy was prescribed.Conclusions:These data indicate that NEMDs represent a common group of esophageal manometric abnormalities in children with upper gastrointestinal tract symptoms and without GER. Food impaction appears to be a relatively frequent complication, and NEMDs should be considered in children who have this finding.

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Unclassified oesophageal motor disorders simulating achalasia.

Cited by 30 publications

References 15 publications

Oesophageal motor dysfunction in patients with diverticula of the mid-thoracic oesophagus

Oesophageal motor dysfunction in patients with diverticula of the mid-thoracic oesophagus

Motility changes in primary achalasia following pneumatic dilatation

Nonspecific Esophageal Motility Disorders in Children Without Gastroesophageal Reflux

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