Background/Aims: Ineffective esophageal motility (IEM) is the most frequently encountered esophageal manometric abnormality. Nonobstructive dysphagia is frequently associated with severe esophageal peristaltic dysfunction. This study aims to evaluate the presenting symptoms and association between dysphagia and specific manometric findings in patients with IEM. Methods: We retrospectively reviewed 228 IEM patients diagnosed on high-resolution manometry at an academic institution (2010-2013). We collected data regarding the main presenting symptoms and manometric findings: bolus transit, distal esophageal pressure amplitude, and lower esophageal sphincter (LES) resting and relaxation pressure. Results: Dysphagia was the main presenting symptom (25%) in IEM patients. Bolus transit was incomplete in either liquid or viscous swallows (30%) and incomplete in both liquid and viscous swallows (59%) in IEM patients. The LES resting pressure and LES relaxation pressure were elevated (9% and 36%, respectively) in IEM patients. There was no significant difference between dysphagia and either poorly relaxing LES (P = 0.725) or defective bolus transit (DBT) to liquid and viscous swallows (P = 0.372) compared to the rest of the IEM patients. However, there was a significant association between dysphagia and the combination of poorly relaxing LES and DBT in liquid and viscous swallows (P = 0.006). Subgroup analysis comparing dysphagia with heartburn/regurgitation demonstrated a similar significant association between dysphagia and the combination of poorly relaxing LES and DBT during viscous and liquid swallows (P = 0.016). Conclusions Dysphagia is a variable symptom associated with complex esophageal motility abnormalities. IEM patients with a combination of poorly relaxing LES and DBT are more likely to have dysphagia.

Leptospirosis is an acute infectious disease that manifests as a biphasic sickness with an initial leptospiraemic and a subsequent immunological phase. It is caused by a spirochete belonging to the genus Leptospira. Leptospirosis seldom manifests clinically as a primary neurological impairment. We report a case of a middle -aged man who was initially diagnosed with leptospirosis and subsequently complicated by development of cerebral venous sinus thrombosis. This intriguing case study emphasises the importance of identifying uncommon leptospirosis symptoms in endemic regions such as Malaysia.