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Esophageal Disorders

Esophageal Motility Disorders

Diagnosis, classification using Chicago v4.0, and management principles with high-resolution manometry

Edna Kamau
2025
GSK Clinical Research

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Objectives

Learning Objectives:

  • Diagnose and classify esophageal motility disorders (Chicago v4.0)
  • Highlight role of high-resolution manometry (HRM)
  • Review management principles

Clinical Presentation

Primary Symptoms

  • Dysphagia (to solids and liquids)
  • Food sticking in chest/neck
  • Non-cardiac chest pain

Secondary Symptoms

  • Regurgitation
  • Refractory heartburn

Diagnosis

Upper GI Endoscopy

Rules out structural/mucosal disease

Esophageal Manometry (Gold Standard)

High-Resolution Manometry (HRM) & Impedance Manometry

  • • Assess EGJ pressure
  • • Evaluate relaxation
  • • Measure peristalsis
  • • Detect spasms

Key Metrics

  • • Integrated Relaxation Pressure (IRP)
  • • Distal Contractile Integral (DCI)
  • • Distal Latency (DL)

Chicago Classification v4.0

EGJ Outflow Disorders

  • Achalasia
  • EGJ Outflow Obstruction (EGJOO)

    Evaluated with HRM, barium swallow, ENDOFLIP

Peristaltic Disorders

  • Hypomotility:
    • • Ineffective motility
    • • Absent contractility
  • Distal esophageal spasm:

    Abnormal premature contractions

Case Reports

Clinical Examples

Examples of patients with reduced DCI and peristaltic breaks showing ineffective motility.

Reduced DCI

Distal Contractile Integral below normal range

Peristaltic Breaks

Discontinuity in esophageal peristaltic wave

Clinical Value of HRM

Surgical Planning

  • • Guides surgical planning (e.g., fundoplication)
  • • Identifies patients at risk of postoperative dysphagia

Diagnostic Benefits

  • • Precise motility assessment
  • • Objective measurement of esophageal function
  • • Risk stratification for surgical procedures

Management Principles

Management Approach

Management depends on the underlying disorder and includes various therapeutic options.

Medical Therapy

Pharmacological interventions

Endoscopic Dilation

Mechanical dilation procedures

Surgical Intervention

Heller myotomy, POEM

Supportive Care

Symptom management

Key Takeaways

Summary Points:

  • High-resolution manometry is the gold standard for diagnosing esophageal motility disorders
  • Chicago Classification v4.0 provides systematic approach to classification
  • HRM guides surgical planning and identifies postoperative risks
  • Management is tailored to specific disorder type and patient presentation
  • Early diagnosis improves patient outcomes and quality of life