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Treatment Implications of High-Resolution Manometry Findings: Options for Patients With Esophageal Dysmotility

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Opinion statement

High-resolution manometry (HRM) has significantly impacted diagnosis and management of achalasia in particular, and has improved characterization of other motor disorders. Achalasia, the most profound esophageal motor disorder, is characterized by esophageal outflow obstruction from abnormal relaxation of the lower esophageal sphincter (LES) during swallowing, and presents with transit symptoms (dysphagia, regurgitation). Esophageal body motor disorders include both inhibitory nerve dysfunction associated with hypermotility or spasm, and hypomotility disorders with poor contraction. The implications of hypermotility disorders are both perceptive and obstructive. On the other hand, hypomotility disorders have reflux implications because of abnormal barrier function at the LES, and abnormal bolus clearance. Esophageal outflow obstruction in achalasia responds favorably to disruption of the LES, and outcome may be predicted by HRM subtyping of achalasia. Identification of dominant (perceptive vs. obstructive) mechanisms of symptom generation help direct therapy of hypermotility disorders, while hypomotility disorders typically require management of concurrent reflux disease.

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Ahmed Bolkhir declares that he has no conflict of interest.

C. Prakash Gyawali has received research grants from Given Imaging.

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  1. Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8124, St. Louis, MO, 63110, USA

    Ahmed Bolkhir MD & C. Prakash Gyawali MD, MRCP

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Correspondence to C. Prakash Gyawali MD, MRCP.

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Bolkhir, A., Gyawali, C.P. Treatment Implications of High-Resolution Manometry Findings: Options for Patients With Esophageal Dysmotility. Curr Treat Options Gastro 12, 34–48 (2014). https://doi.org/10.1007/s11938-013-0003-6

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