Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately.
Classification ; Deglutition Disorders ; Diagnosis* ; Esophageal Achalasia ; Esophageal Motility Disorders* ; Esophageal Spasm, Diffuse ; Humans ; Manometry*

No abstract available.
Esophageal Motility Disorders* ; Gastroesophageal Reflux*

BACKGROUND/AIMS: Some patients complaining chest pain have normal coronary angiograms. In these cases of noncardiac chest pain, esophageal disease might be a reasonable explanation. However, causal relationship between esophageal motility or reflux disease and chest pain may be difficult to be proven. Therefore, we performed this study to evaluate the esophageal abnormality as a potential cause of noncardiac chest pain. METHODS: We underwent esophagogastroduodenoscopy, esophageal mancenetry and 24 hour esophageal pH monitoring in 58 patients with chest pain and normal coronary arteriogram or negative thallium study. RESULTS: Of 58 patients, 17 patients (29.3%) had abnormal esophageal manometry test. There were 6 cases of nonspecific esophageal motility disorder, 5 cases of hypertensive lower esophageal sphincter, 5 cases of diffuse esophageal spasm and 1 case of nutcracker esophagus. In 56 patients with 24 hour pH monitoring, 13 patients had positive DeMeester score and 29 patients experienced chest pain during the test period. 11 patients (18.9%) had both positive DeMeester score and chest pain. Mean symptom index of these patients was 70.0% (range 40-100%). CONCLUSIONS: Esophageal motility disorders and gastroesophegeal reflux diseases were frequantly found in patients with noncardiac chest pain. Much efforts should be made to find esophageal cause in patients with noncardiac chest pain.
Chest Pain* ; Endoscopy, Digestive System ; Esophageal Diseases ; Esophageal Motility Disorders ; Esophageal pH Monitoring ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Thallium ; Thorax*

The aim of this study was to assess changes between primary classification of esophageal motility disease and follow-up classification by high resolution manometry (HRM) and to determine whether previously classified diseases could be recategorized according to the updated Chicago Classification published in 2011. We reviewed individual medical records and HRM findings twice for each of 13 subjects. We analyzed primary and follow-up HRM findings based on the original Chicago Classification. We then reclassified the same HRM findings according to the updated Chicago Classification. This case series revealed the variable course of esophageal motility disorders; some patients experienced improvement, whereas others experienced worsening symptoms. Four cases were reclassified from variant achalasia to peristaltic abnormality, one case from diffuse esophageal spasm to type II achalasia and one case from peristaltic abnormality to variant achalasia. Four unclassified findings were recategorized as variant achalasia. In conclusion, esophageal motility disorders are variable and may not be best conceptualized as an independent group. Original classifications can be recategorized according to the updated Chicago Classification system. More research is needed on this topic.
Chicago ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophagus ; Follow-Up Studies ; Humans ; Manometry ; Medical Records

BACKGROUND/AIMS: To evaluate the prevalence, relationship between symptoms and esophageal motility disorders, and the factors that could affect in esophageal motility, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms. METHODS: Records from 1746 patients referred to our manometric laboratory for evaluation of esophageal symptoms between September 1994 and September 2002 were enrolled. We used low compliance pneumohydraulic capillary infusion system to perform esophageal manometry. RESULTS: Among patients with abnormal esophageal motility, 390 cases of nonspecific esophageal motility disorder, 20 cases of nutcracker esophagus, 11 cases of achalasia, 4 cases of hypertensive lower esophageal sphincter, and 4 cases of diffuse esophageal spasm were present. The symptoms of 1746 patients were oropharyngeal dysphagia, esophageal dysphagia, non-cardiac chest pain or chest discomfort, substernal soreness or heartburn, regurgitation, and lump sensation. In multivariate analysis, age (OR=1.95; p=0.007) was an independent factor affecting esophageal motility. CONCLUSIONS: There are esophageal motility disorders in 24.6% of patients with esophageal symptoms, and various symptoms are present in them. The factor associated with the abnormal findings of esophageal manometry is age.
Capillaries ; Chest Pain ; Compliance ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Heartburn ; Humans ; Manometry ; Multivariate Analysis ; Prevalence ; Sensation ; Thorax

BACKGROUND/AIMS: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin injection to lower esophageal sphincter (LES). METHODS: This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with pH monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. RESULT: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31 mmHg vs 23 mmHg, p < 0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p < 0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups. CONCLUSION: Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body.
Barium ; Botulinum Toxins* ; Endosonography ; Esophageal Achalasia* ; Esophageal Motility Disorders* ; Esophageal Spasm, Diffuse* ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Hydrogen-Ion Concentration ; Manometry

BACKGROUND AND OBJECTIVES: High resolution manometry (HRM), a newly developed device that uses 36 channels to plot pressure topography of esophagus, has recently been applied to evaluate the esophageal and upper esophageal sphincter (UES) status; however, its definite role in laryngopharyngeal reflux disease (LPRD) is not well elucidated. The aim of this study was to evaluate clinical usefulness of HRM and to elucidate the association between HRM findings and dysphasia in LPRD patients. SUBJECTS AND METHOD: A total of 56 patients who had been diagnosed LPRD from July 2010 to July 2011 were prospectively enrolled in this study. Patients consisted of 20 men and 36 women, with the mean age of 51.4 years. Every patient performed the questionnaire and HRM examination. A comparative analysis was performed to evaluate the correlation between the HRM results and LPRD. RESULTS: Of 30 patients (53.6%), there were 11 peristaltic dysfunction (19.7%), 6 relaxation impairment of lower esophageal sphincter (LES)(10.7%), 4 diffuse esophageal spasm (7.1%), 4 hypotensive LES (7.1%), 3 Nutcracker esophagus (5.4%), and 2 relaxation impairment of UES (3.6%). The mean distance of UES from the nostril was 17.88+/-2.17 cm and the mean UES basal pressure was 63.10+/-24.49 mm Hg. Differences between the prevalence of abnormal findings shown by HRM and dysphasia symptoms were not statistically significant. CONCLUSION: In this study, a considerable amount of abnormalities in esophageal function were observed using HRM, and thus we think that HRM could provide useful information about esophagus dysfunction in LPRD patients.
Aphasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Female ; Humans ; Laryngopharyngeal Reflux* ; Male ; Manometry* ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Relaxation

Esophageal bezoars are rare, but are recognized as a distinct clinical entity. They are known to occur in patients with esophageal structural and functional abnormalities, but only a few cases of the development of esophageal bezoars in patients with esophageal motility disorders have only been described. We report a rare case of an esophageal bezoar that developed in a patient with achalasia, and review the literature concerning esophageal bezoars associated with esophageal motility disorders.
Bezoars ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophagus ; Humans

BACKGROUND/AIMS: Globus is a foreign body sense in the throat without dysphagia, odynophagia, esophageal motility disorders, or gastroesophageal reflux. The etiology is unclear. Previous studies suggested that increased upper esophageal sphincter pressure, gastroesophageal reflux and hypertonicity of esophageal body were possible etiologies. This study was to quantify the upper esophageal sphincter (UES) pressure, contractile front velocity (CFV), proximal contractile integral (PCI), distal contractile integral (DCI) and transition zone (TZ) in patient with globus gastroesophageal reflux disease (GERD) without globus, and normal controls to suggest the correlation of specific high-resolution manometry (HRM) findings and globus. METHODS: Fifty-seven globus patients, 24 GERD patients and 7 normal controls were studied with HRM since 2009. We reviewed the reports, and selected 5 swallowing plots suitable for analysis in each report, analyzed each individual plot with ManoView. The 5 parameters from each plot in 57 globus patients were compared with that of 24 GERD patients and 7 normal controls. RESULTS: There was no significant difference in the UES pressure, CFV, PCI and DCI. TZ (using 30 mmHg isobaric contour) in globus showed significant difference compared with normal controls and GERD patients. The median values of TZ were 4.26 cm (interquartile range [IQR], 2.30-5.85) in globus patients, 5.91 cm (IQR, 3.97-7.62) in GERD patients and 2.26 cm (IQR, 1.22-2.92) in normal controls (P = 0.001). CONCLUSIONS: HRM analysis suggested that UES pressure, CFV, PCI and DCI were not associated with globus. Instead increased length of TZ may be correlated with globus. Further study comparing HRM results in globus patients within larger population needs to confirm their correlation.
Deglutition ; Deglutition Disorders ; Esophageal Motility Disorders ; Esophageal Sphincter, Upper ; Gastroesophageal Reflux* ; Humans ; Manometry* ; Pharynx

OBJECTIVES: Nonspecific esophageal motility disorder(NEMD) is a vague category used to group poorly defined contraction abnormalities. We evaluated the clinical characteristics and esophageal transit time (ETT) in patients with NEMD. METHODS: Total 205 patients with NEMD were compared with 20healthy controls and 99patients with other motility disorders of the esophagus. Esophageal manometry was performed with a lowcompliance pneumohydraulic capillary infusion system and esophageal scintigraphy was performed for the liquid and solid swallow after manometric study. RESULTS: 1) Among the total 258abnormal contractions in 205patients with NEMD, non-transmitted contractions were 125(45.5%), low amplitude 110(42.6%), triple peaked 3(1.2%), prolonged duration contractions 12(4.7%) and isolated incomplete LES relaxation 8(3.1%). 2) NEMD patients have significantly delayed ETT similar to that seen in patients with diffuse esophageal spasm, nutcracker esophagus, hypertensive lower esophageal sphincter for liquid, and diffuse esophageal spasm, hypertensive lower esophageal sphincter for solid. 3) ETT for liquid and solid according to abnormal contractions were 39.0 and 55.6seconds in non-transmitted, 38.3, 68.4 seconds in low amplitude, 17.0, 30.0 seconds in triple peaked, 29.4, 25.8 seconds in prolonged-duration contractions and 13.7, 15.5 seconds in isolated incomplete LES relaxation, respectively. CONCLUSION: Patients with NEMD have significantly delayed ETT for liquid and solid compare to normal control. The main abnormal contractions of NEMD were non-transmitted and low amplitude contractions. And low amplitude contractions were the main cause of delayed solid transit in patients with NEMD(p<0.01).
Capillaries ; Esophageal Motility Disorders* ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Manometry ; Radionuclide Imaging ; Relaxation