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Gut. Jul 2001; 49(1): 145–151.
PMCID: PMC1728354

Classification of oesophageal motility abnormalities

Abstract

D O CASTELL

Department of Medicine
Graduate Hospital, Philadelphia, Pennsylvania, USA

Manometric examination of the oesophagus frequently reveals abnormalities whose cause is unknown and whose physiological importance is not clear. A large body of literature dealing with oesophageal motility abnormalities has evolved over the past few decades but comparisons among studies have been compromised by the lack of a widely accepted system for classifying the abnormal motility patterns, and by the lack of uniform diagnostic criteria for the putative disorders. Based on an extensive review and analysis of the literature, this report suggests an operational scheme to be used for the general classification of oesophageal motility abnormalities, and proposes standardised manometric criteria for the putative oesophageal motility disorders. By applying the guidelines proposed in this report, clinicians and researchers can determine if their patients fulfil the manometric criteria for a putative motility disorder. This should facilitate and improve comparisons among patients and studies. However, it is important to emphasise that fulfilment of the proposed criteria does not establish the clinical importance of the motility abnormalities.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cohen S, Parkman HP. Esophageal manometry in clinical practice: the need for evidence-based assessment of clinical efficacy. Am J Gastroenterol. 1998 Dec;93(12):2319–2320. [PubMed]
  • Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients. Ann Intern Med. 1987 Apr;106(4):593–597. [PubMed]
  • Cohen S. Esophageal motility disorders and their response to calcium channel antagonists. The sphinx revisited. Gastroenterology. 1987 Jul;93(1):201–203. [PubMed]
  • Richter JE, Bradley LA, Castell DO. Esophageal chest pain: current controversies in pathogenesis, diagnosis, and therapy. Ann Intern Med. 1989 Jan 1;110(1):66–78. [PubMed]
  • Kahrilas PJ. Nutcracker esophagus: an idea whose time has gone? Am J Gastroenterol. 1993 Feb;88(2):167–169. [PubMed]
  • Richter JE, Dalton CB, Bradley LA, Castell DO. Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus. Gastroenterology. 1987 Jul;93(1):21–28. [PubMed]
  • Spechler SJ, Souza RF, Rosenberg SJ, Ruben RA, Goyal RK. Heartburn in patients with achalasia. Gut. 1995 Sep;37(3):305–308. [PMC free article] [PubMed]
  • Clouse RE, Staiano A. Manometric patterns using esophageal body and lower sphincter characteristics. Findings in 1013 patients. Dig Dis Sci. 1992 Feb;37(2):289–296. [PubMed]
  • Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. [PubMed]
  • Kahrilas PJ, Lin S, Chen J, Manka M. The effect of hiatus hernia on gastro-oesophageal junction pressure. Gut. 1999 Apr;44(4):476–482. [PMC free article] [PubMed]
  • Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, 3rd, Castell JA, Castell DO. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions. Dig Dis Sci. 1987 Jun;32(6):583–592. [PubMed]
  • Reynolds JC, Parkman HP. Achalasia. Gastroenterol Clin North Am. 1989 Jun;18(2):223–255. [PubMed]
  • Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol. 1994 Apr;18(4):327–337. [PubMed]
  • Holloway RH, Dodds WJ, Helm JF, Hogan WJ, Dent J, Arndorfer RC. Integrity of cholinergic innervation to the lower esophageal sphincter in achalasia. Gastroenterology. 1986 Apr;90(4):924–929. [PubMed]
  • Saha JK, Sengupta JN, Goyal RK. Role of chloride ions in lower esophageal sphincter tone and relaxation. Am J Physiol. 1992 Jul;263(1 Pt 1):G115–G126. [PubMed]
  • Yamato S, Spechler SJ, Goyal RK. Role of nitric oxide in esophageal peristalsis in the opossum. Gastroenterology. 1992 Jul;103(1):197–204. [PubMed]
  • Goldenberg SP, Burrell M, Fette GG, Vos C, Traube M. Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. Gastroenterology. 1991 Sep;101(3):743–748. [PubMed]
  • de Oliveira RB, Rezende Filho J, Dantas RO, Iazigi N. The spectrum of esophageal motor disorders in Chagas' disease. Am J Gastroenterol. 1995 Jul;90(7):1119–1124. [PubMed]
  • Kahrilas PJ, Kishk SM, Helm JF, Dodds WJ, Harig JM, Hogan WJ. Comparison of pseudoachalasia and achalasia. Am J Med. 1987 Mar;82(3):439–446. [PubMed]
  • Spechler SJ. AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999 Jul;117(1):233–254. [PubMed]
  • Vantrappen G, Janssens J, Hellemans J, Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology. 1979 Mar;76(3):450–457. [PubMed]
  • Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology. 1996 Sep;111(3):648–654. [PubMed]
  • Katz PO, Richter JE, Cowan R, Castell DO. Apparent complete lower esophageal sphincter relaxation in achalasia. Gastroenterology. 1986 Apr;90(4):978–983. [PubMed]
  • Dudnick RS, Castell JA, Castell DO. Abnormal upper esophageal sphincter function in achalasia. Am J Gastroenterol. 1992 Dec;87(12):1712–1715. [PubMed]
  • Zhang ZG, Diamant NE. Repetitive contractions of the upper esophageal body and sphincter in achalasia. Dysphagia. 1994 Winter;9(1):12–19. [PubMed]
  • Massey BT, Hogan WJ, Dodds WJ, Dantas RO. Alteration of the upper esophageal sphincter belch reflex in patients with achalasia. Gastroenterology. 1992 Nov;103(5):1574–1579. [PubMed]
  • Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996 May;110(5):1410–1415. [PubMed]
  • Cuillière C, Ducrotté P, Zerbib F, Metman EH, de Looze D, Guillemot F, Hudziak H, Lamouliatte H, Grimaud JC, Ropert A, et al. Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin. Gut. 1997 Jul;41(1):87–92. [PMC free article] [PubMed]
  • Richter JE, Castell DO. Diffuse esophageal spasm: a reappraisal. Ann Intern Med. 1984 Feb;100(2):242–245. [PubMed]
  • Dalton CB, Castell DO, Hewson EG, Wu WC, Richter JE. Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci. 1991 Aug;36(8):1025–1028. [PubMed]
  • Allen ML, DiMarino AJ., Jr Manometric diagnosis of diffuse esophageal spasm. Dig Dis Sci. 1996 Jul;41(7):1346–1349. [PubMed]
  • Dalton CB, Castell DO, Richter JE. The changing faces of the nutcracker esophagus. Am J Gastroenterol. 1988 Jun;83(6):623–628. [PubMed]
  • Benjamin SB, Gerhardt DC, Castell DO. High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology. 1979 Sep;77(3):478–483. [PubMed]
  • Clouse RE, Staiano A. Topography of normal and high-amplitude esophageal peristalsis. Am J Physiol. 1993 Dec;265(6 Pt 1):G1098–G1107. [PubMed]
  • Achem SR, Kolts BE, Burton L. Segmental versus diffuse nutcracker esophagus: an intermittent motility pattern. Am J Gastroenterol. 1993 Jun;88(6):847–851. [PubMed]
  • Freidin N, Mittal RK, Traube M, McCallum RW. Segmental high amplitude peristaltic contractions in the distal esophagus. Am J Gastroenterol. 1989 Jun;84(6):619–623. [PubMed]
  • Herrington JP, Burns TW, Balart LA. Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci. 1984 Feb;29(2):134–140. [PubMed]
  • CODE CF, SCHLEGEL JF, KELLEY ML, Jr, OLSEN AM, ELLIS FH., Jr Hypertensive gastroesophageal sphincter. Proc Staff Meet Mayo Clin. 1960 Jul 6;35:391–399. [PubMed]
  • Bassotti G, Alunni G, Cocchieri M, Pelli MA, Morelli A. Isolated hypertensive lower esophageal sphincter. Clinical and manometric aspects of an uncommon esophageal motor abnormality. J Clin Gastroenterol. 1992 Jun;14(4):285–287. [PubMed]
  • Garrett JM, Godwin DH. Gastroesophageal hypercontracting sphincter. Manometric and clinical characteristics. JAMA. 1969 May 12;208(6):992–998. [PubMed]
  • Freidin N, Traube M, Mittal RK, McCallum RW. The hypertensive lower esophageal sphincter. Manometric and clinical aspects. Dig Dis Sci. 1989 Jul;34(7):1063–1067. [PubMed]
  • Katada N, Hinder RA, Hinder PR, Lund RJ, Perdikis G, Stalzer RA, McGinn TR. The hypertensive lower esophageal sphincter. Am J Surg. 1996 Nov;172(5):439–443. [PubMed]
  • Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter pressures and gastroesophageal reflux: an apparent paradox that is not unusual. Am J Gastroenterol. 1995 Feb;90(2):280–284. [PubMed]
  • Waterman DC, Dalton CB, Ott DJ, Castell JA, Bradley LA, Castell DO, Richter JE. Hypertensive lower esophageal sphincter: what does it mean? J Clin Gastroenterol. 1989 Apr;11(2):139–146. [PubMed]
  • Bassotti G, Battaglia E, Debernardi V, Germani U, Quiriconi F, Dughera L, Buonafede G, Puiatti P, Morelli A, Spinozzi F, et al. Esophageal dysfunction in scleroderma: relationship with disease subsets. Arthritis Rheum. 1997 Dec;40(12):2252–2259. [PubMed]
  • Lock G, Holstege A, Lang B, Schölmerich J. Gastrointestinal manifestations of progressive systemic sclerosis. Am J Gastroenterol. 1997 May;92(5):763–771. [PubMed]
  • Richter JE, Blackwell JN, Wu WC, Johns DN, Cowan RJ, Castell DO. Relationship of radionuclide liquid bolus transport and esophageal manometry. J Lab Clin Med. 1987 Feb;109(2):217–224. [PubMed]
  • Turner R, Lipshutz W, Miller W, Rittenberg G, Schumacher HR, Cohen S. Esophageal dysfunction in collagen disease. Am J Med Sci. 1973 Mar;265(3):191–199. [PubMed]
  • Cohen S. The gastrointestinal manifestations of scleroderma: pathogenesis and management. Gastroenterology. 1980 Jul;79(1):155–166. [PubMed]
  • Cohen S. Motor disorders of the esophagus. N Engl J Med. 1979 Jul 26;301(4):184–192. [PubMed]
  • Yarze JC, Varga J, Stampfl D, Castell DO, Jimenez SA. Esophageal function in systemic sclerosis: a prospective evaluation of motility and acid reflux in 36 patients. Am J Gastroenterol. 1993 Jun;88(6):870–876. [PubMed]
  • Zamost BJ, Hirschberg J, Ippoliti AF, Furst DE, Clements PJ, Weinstein WM. Esophagitis in scleroderma. Prevalence and risk factors. Gastroenterology. 1987 Feb;92(2):421–428. [PubMed]
  • Schneider HA, Yonker RA, Longley S, Katz P, Mathias J, Panush RS. Scleroderma esophagus: a nonspecific entity. Ann Intern Med. 1984 Jun;100(6):848–850. [PubMed]
  • Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997 Sep;42(9):1859–1865. [PubMed]

Figures and Tables

Figure 1
(A) Oesophageal manometry tracing from a patient with classic achalasia. The distal recording site, positioned in the lower oesophageal sphincter (LOS), shows high basal LOS pressure (approximately 60 mm Hg). Note that the two wet swallows (WS) ...
Figure 2
Oesophageal manometry tracing from a patient with diffuse oesophageal spasm. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note that the first wet swallow (WS) is followed by oesophageal ...
Figure 3
Oesophageal manometry tracing from a patient with nutcracker oesophagus. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note the high amplitude peristaltic contractions initiated by wet ...
Figure 4
Oesophageal manometry tracing from a patient with ineffective oesophageal motility. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note that the first and third wet swallows (WS) result ...

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