Clinical Updates in Esophageal Motility Disorders Beyond Achalasia - PubMed (original) (raw)

Clinical Updates in Esophageal Motility Disorders Beyond Achalasia

Kelli DeLay et al. Clin Gastroenterol Hepatol. 2021 Sep.

No abstract available

PubMed Disclaimer

Conflict of interest statement

Relevant Conflicts of Interest:

Rena Yadlapati: Institutional Consulting Agreement: Medtronic, Ironwood Pharmaceuticals, Diversatek; Consultant: Phathom Pharmaceuticals; Research support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix

Amanda Krause, Kelli DeLay: None

Figures

Figure 1:

Figure 1:

Manometric Differences in Esophageal Physiology. Peristaltic patterns of esophageal motor disorders range from hypomotility (absent contractility (normal median IRP and 100% failed peristalsis (DCI < 100mmgHg-s-cm), ineffective motility (>70% swallows ineffective or >50% of swallows failed) to spastic (distal esophageal spasm (normal median IRP and ≥20% premature swallows (distal latency < 4.5seconds)), hypercontractile esophagus (normal median IRP and ≥20% hypercontractile swallows (DCI > 8000mmHg-s-cm)to disorders of EGJ outflow (Type 1 achalasia (Elevated median IRP and 100% failed peristalsis), Type II achalasia (Elevated median IRP and 100% failed peristalsis with ≥20% panesophageal pressurization), Type 3 achalasia (Elevated median IRP and ≥20% premature swallows with all other peristalsis failed), EGJ outflow obstruction (Elevated supine and upright median IRP with intrabolus pressurization and evidence of peristalsis. *Note that EGJ outflow obstruction does not always present with spasticity)

Figure 2:

Figure 2:

Diagnostic and Therapeutic Considerations for Disorders of EGJ Outflow (A) and Disorders of Peristalsis (B). Clinical pathways for conclusive Disorders of EGJ Outflow and Peristalsis are clearly delineated. The gray boxes indicate non-manometric requirements (symptoms and additional testing) to meeting conclusive clinically relevant criteria. When manometric diagnoses are supported by clinical context and additional testing, treatments may be customized to meet patient needs.

References

    1. Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterol Motil 2021;33:e14058. -PMC -PubMed
    1. Gyawali CP, Carlson DA, Chen JW, et al. ACG Clinical Guidelines: Clinical Use of Esophageal Physiologic Testing. Am J Gastroenterol 2020;115:1412–1428. -PMC -PubMed
    1. Blonski W, Kumar A, Feldman J, et al. Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia. Am J Gastroenterol 2018;113:196–203. -PubMed
    1. Savarino E, di Pietro M, Bredenoord AJ, et al. Use of the Functional Lumen Imaging Probe in Clinical Esophagology. Am J Gastroenterol 2020;115:1786–1796. -PMC -PubMed
    1. Clayton SB, Patel R, Richter JE. Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes. Clin Gastroenterol Hepatol 2016;14:907–911. -PubMed

MeSH terms

LinkOut - more resources