Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Esophageal Motility Disorders Based on the Chicago Classification

  • Motility (T Lembo, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

The Chicago Classification divides esophageal motor disorders based on the recorded value of the integrated relaxation pressure (IRP). The first group includes those with an elevated mean IRP that is associated with peristaltic abnormalities such as achalasia and esophagogastric junction outflow obstruction. The second group includes those with a normal mean IRP that is associated with esophageal hypermotility disorders such as distal esophageal spasm, hypercontractile esophagus (jackhammer esophagus), and hypertensive peristalsis (nutcracker esophagus). The third group includes those with a normal mean IRP that is associated with esophageal hypomotility peristaltic abnormalities such as absent peristalsis, weak peristalsis with small or large breaks, and frequent failed peristalsis. The therapeutic options vary greatly between the different groups of esophageal motor disorders. In achalasia patients, potential treatment strategies comprise medical therapy (calcium channel blockers, nitrates, and phosphodiesterase 5 inhibitors), endoscopic procedures (botulinum toxin A injection, pneumatic dilation, or peroral endoscopic myotomy) or surgery (Heller myotomy). Patients with a normal IRP and esophageal hypermotility disorder are candidates for medical therapy (nitrates, calcium channel blockers, phosphodiesterase 5 inhibitors, cimetropium/ipratropium bromide, proton pump inhibitors, benzodiazepines, tricyclic antidepressants, trazodone, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors), endoscopic procedures (botulinum toxin A injection and peroral endoscopic myotomy), or surgery (Heller myotomy). Lastly, in patients with a normal IRP and esophageal hypomotility disorder, treatment is primarily focused on controlling the presence of gastroesophageal reflux with proton pump inhibitors and lifestyle modifications (soft and liquid diet and eating in the upright position) to address patient’s dysphagia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;261(4 Pt 1):G677–84.

    PubMed  CAS  Google Scholar 

  2. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24 Suppl 1:57–65.

    PubMed  PubMed Central  Google Scholar 

  3. Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95(10):2720–30.

    PubMed  CAS  Google Scholar 

  4. Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut. 2008;57(3):405–23.

    PubMed  CAS  Google Scholar 

  5. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol. 2008;42(5):627–35.

    PubMed  PubMed Central  Google Scholar 

  6. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526–33.

    PubMed  PubMed Central  Google Scholar 

  7. Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol. 2005;100(6):1404–14.

    PubMed  Google Scholar 

  8. Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):235–48, v.

    PubMed  CAS  Google Scholar 

  9. Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986–2005. Dysphagia. 2008;23(2):161–4.

    PubMed  Google Scholar 

  10. Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):e256–61.

    PubMed  CAS  Google Scholar 

  11. Birgisson S, Richter JE. Achalasia in Iceland, 1952-2002: an epidemiologic study. Dig Dis Sci. 2007;52(8):1855–60.

    PubMed  Google Scholar 

  12. Gennaro N, Portale G, Gallo C, et al. Esophageal achalasia in the Veneto region: epidemiology and treatment. Epidemiology and treatment of achalasia. J Gastrointest Surg. 2011;15(3):423–8.

    PubMed  Google Scholar 

  13. Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;14(4):718–25. quiz e13–4.

    Google Scholar 

  14. Salvador R, Costantini M, Zaninotto G, et al. The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg. 2010;14(11):1635–45.

    PubMed  Google Scholar 

  15. Pratap N, Kalapala R, Darisetty S, et al. Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneumatic balloon dilatation. J Neurogastroenterol Motil. 2011;17(1):48–53.

    PubMed  PubMed Central  Google Scholar 

  16. Bortolotti M, Mari C, Lopilato C, Porrazzo G, Miglioli M. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology. 2000;118(2):253–7.

    PubMed  CAS  Google Scholar 

  17. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of Achalasia. Am J Gastroenterol. 2013;108(8):1238–49. This article provides the most recent guidelines for the management of all achalasia subtypes.

    PubMed  Google Scholar 

  18. Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol. 1998;27(1):21–35.

    PubMed  CAS  Google Scholar 

  19. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology. 1982;83(5):963–9.

    PubMed  CAS  Google Scholar 

  20. Bortolotti M, Labo G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology. 1981;80(1):39–44.

    PubMed  CAS  Google Scholar 

  21. Traube M, Dubovik S, Lange RC, McCallum RW. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol. 1989;84(10):1259–62.

    PubMed  CAS  Google Scholar 

  22. Triadafilopoulos G, Aaronson M, Sackel S, Burakoff R. Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo. Dig Dis Sci. 1991;36(3):260–7.

    PubMed  CAS  Google Scholar 

  23. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014;383(9911):83–93.

  24. Richter JE, Spurling TJ, Cordova CM, Castell DO. Effects of oral calcium blocker, diltiazem, on esophageal contractions. Studies in volunteers and patients with nutcracker esophagus. Dig Dis Sci. 1984;29(7):649–56.

    PubMed  CAS  Google Scholar 

  25. Rosenthal T, Ezra D. Calcium antagonists. Drug interactions of clinical significance. Drug Saf. 1995;13(3):157–87.

    PubMed  CAS  Google Scholar 

  26. Richter JE. Achalasia - an update. J Neurogastroenterol Moti. 2010;16(3):232–42.

    Google Scholar 

  27. Gelfond M, Rozen P, Keren S, Gilat T. Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid. Gut. 1981;22(4):312–8.

    PubMed  CAS  PubMed Central  Google Scholar 

  28. Wen ZH, Gardener E, Wang YP. Nitrates for achalasia. Cochrane Database Syst Rev. 2004 (1):CD002299

  29. Wong RK, Maydonovitch C, Garcia JE, Johnson LF, Castell DO. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. J Clin Gastroenterol. 1987;9(4):386–9.

    PubMed  CAS  Google Scholar 

  30. Bassotti G, Annese V. Review article: pharmacological options in achalasia. Aliment Pharmacol Ther. 1999;13(11):1391–6.

    PubMed  CAS  Google Scholar 

  31. Cheitlin MD, Hutter Jr AM, Brindis RG, et al. ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol. 1999;33(1):273–82.

    PubMed  CAS  Google Scholar 

  32. Daiber A, Wenzel P, Oelze M, Munzel T. New insights into bioactivation of organic nitrates, nitrate tolerance and cross-tolerance. Clin Res Cardiol. 2008;97(1):12–20.

    PubMed  CAS  Google Scholar 

  33. Fung HL. Clinical pharmacology of organic nitrates. Am J Cardiol. 1993;72(8):9–13C. discussion 4C–5C.

    Google Scholar 

  34. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med. 1995;332(12):774–8.

    PubMed  CAS  Google Scholar 

  35. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996;110(5):1410–5.

    PubMed  CAS  Google Scholar 

  36. Patti MG, Feo CV, Arcerito M, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44(11):2270–6.

    PubMed  CAS  Google Scholar 

  37. Horgan S, Hudda K, Eubanks T, McAllister J, Pellegrini CA. Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc. 1999;13(6):576–9.

    PubMed  CAS  Google Scholar 

  38. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006;243(5):579–84. discussion 84–6.

    PubMed  PubMed Central  Google Scholar 

  39. Neubrand M, Scheurlen C, Schepke M, Sauerbruch T. Long-term results and prognostic factors in the treatment of achalasia with botulinum toxin. Endoscopy. 2002;34(7):519–23.

    PubMed  CAS  Google Scholar 

  40. Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut. 2000;46(5):597–600.

    PubMed  CAS  PubMed Central  Google Scholar 

  41. Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. 1999;44(2):231–9.

    PubMed  CAS  PubMed Central  Google Scholar 

  42. Zaninotto G, Annese V, Costantini M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. 2004;239(3):364–70.

    PubMed  PubMed Central  Google Scholar 

  43. Richter JE, Boeckxstaens GE. Management of achalasia: surgery or pneumatic dilation. Gut. 2011;60(6):869–76.

    PubMed  Google Scholar 

  44. Kadakia SC, Wong RK. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol. 1993;88(1):34–8.

    PubMed  CAS  Google Scholar 

  45. Kadakia SC, Wong RK. Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):325–46. vii.

    PubMed  CAS  Google Scholar 

  46. Vela MF, Richter JE, Khandwala F, et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006;4(5):580–7.

    PubMed  Google Scholar 

  47. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57.

    PubMed  Google Scholar 

  48. Hulselmans M, Vanuytsel T, Degreef T, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol. 2010;8(1):30–5.

    PubMed  Google Scholar 

  49. Muehldorfer SM, Schneider TH, Hochberger J, Martus P, Hahn EG, Ell C. Esophageal achalasia: intrasphincteric injection of botulinum toxin A versus balloon dilation. Endoscopy. 1999;31(7):517–21.

    PubMed  CAS  Google Scholar 

  50. Bansal R, Nostrant TT, Scheiman JM, et al. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol. 2003;36(3):209–14.

    PubMed  CAS  Google Scholar 

  51. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2006 (4):CD005046.

  52. Lee JY, Kim N, Kim SE, et al. Clinical characteristics and treatment outcomes of 3 subtypes of achalasia according to the chicago classification in a tertiary institute in Korea. J Neurogastroenterol Moti. 2013;19(4):485–94.

    Google Scholar 

  53. Boeckxstaens GE, Annese V, Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807–16.

    PubMed  CAS  Google Scholar 

  54. Eckardt VF, Kanzler G, Westermeier T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study. Gastrointest Endosc. 1997;45(5):349–53.

    PubMed  CAS  Google Scholar 

  55. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732–8.

    PubMed  CAS  Google Scholar 

  56. Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J. Treatment of achalasia with pneumatic dilatations. Gut. 1971;12(4):268–75.

    PubMed  CAS  PubMed Central  Google Scholar 

  57. Ghoshal UC, Kumar S, Saraswat VA, Aggarwal R, Misra A, Choudhuri G. Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence. Am J Gastroenterol. 2004;99(12):2304–10.

    PubMed  CAS  Google Scholar 

  58. Vaezi MF, Baker ME, Achkar E, Richter JE. Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut. 2002;50(6):765–70.

    PubMed  CAS  PubMed Central  Google Scholar 

  59. Maradey-Romero C, Fass R. New therapies for non-cardiac chest pain. Curr Gastroenterol Rep. 2014;16(6):390.

    PubMed  Google Scholar 

  60. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.

    PubMed  CAS  Google Scholar 

  61. von Renteln D, Inoue H, Minami H, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107(3):411–7.

    Google Scholar 

  62. Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis. 2012;44(10):827–32.

    PubMed  Google Scholar 

  63. Maselli R, Inoue H, Misawa M, et al. Peroral endoscopic myotomy (POEM) in a 3-year-old girl with severe growth retardation, achalasia, and Down syndrome. Endoscopy. 2012;44(Suppl 2 UCTN):E285–7.

    PubMed  Google Scholar 

  64. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanstrom LL. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77(5):719–25.

    PubMed  Google Scholar 

  65. Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg. 2011;213(6):751–6.

    PubMed  Google Scholar 

  66. Saxena P, Chavez YH, Kord Valeshabad A, Kalloo AN, Khashab MA. An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device. Endoscopy. 2013;45(7):579–81.

    PubMed  CAS  Google Scholar 

  67. Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145(2):309–11.

  68. Li HK, Linghu EQ. New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy. World J Gastroenterol. 2013;19(4):556–60.

    PubMed  PubMed Central  Google Scholar 

  69. Bredenoord AJ, Rosch T, Fockens P. Peroral endoscopic myotomy for achalasia. Neurogastroenterol Motil. 2014;26(1):3–12.

    PubMed  CAS  Google Scholar 

  70. Sharata A, Kurian AA, Dunst CM, Bhayani NH, Reavis KM, Swanstrom LL. Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. J Gastrointest Surg. 2013;17(7):1188–92.

    PubMed  Google Scholar 

  71. Ren Z, Zhong Y, Zhou P, et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc. 2012;26(11):3267–72.

    PubMed  Google Scholar 

  72. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg. 1992;216(3):291–6. discussion 6–9.

    PubMed  CAS  PubMed Central  Google Scholar 

  73. Ali A, Pellegrini CA. Laparoscopic myotomy: technique and efficacy in treating achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):347–58. vii.

    PubMed  CAS  Google Scholar 

  74. Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A. Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc. 2013;78(3):468–75.

    PubMed  Google Scholar 

  75. Schoenberg MB, Marx S, Kersten JF, et al. Laparoscopic Heller myotomy versus endoscopic balloon dilatation for the treatment of achalasia: a network meta-analysis. Ann Surg. 2013;258(6):943–52.

    PubMed  Google Scholar 

  76. Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012;26(2):296–311.

    PubMed  Google Scholar 

  77. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008;248(6):1023–30.

    PubMed  Google Scholar 

  78. Rawlings A, Soper NJ, Oelschlager B, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26(1):18–26.

    PubMed  Google Scholar 

  79. Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg. 2009;13(12):2219–25.

    PubMed  PubMed Central  Google Scholar 

  80. Pandolfino JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology. 2011;141(2):469–75.

    PubMed  PubMed Central  Google Scholar 

  81. Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Moti. 2011;17(2):110–23.

    Google Scholar 

  82. Fass R, Fennerty MB, Ofman JJ, et al. The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology. 1998;115(1):42–9.

    PubMed  CAS  Google Scholar 

  83. Achem SR, Kolts BE, MacMath T, et al. Effects of omeprazole versus placebo in treatment of noncardiac chest pain and gastroesophageal reflux. Dig Dis Sci. 1997;42(10):2138–45.

    PubMed  CAS  Google Scholar 

  84. Hershcovici T, Achem SR, Jha LK, Fass R. Systematic review: the treatment of noncardiac chest pain. Aliment Pharmacol Ther. 2012;35(1):5–14. This is a systematic review of all the latest therapeutic modalities for NCCP, including those patients with an underlying motor abnormality.

    PubMed  CAS  Google Scholar 

  85. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007;151(6):737–48.

    PubMed  CAS  PubMed Central  Google Scholar 

  86. Cannon 3rd RO, Quyyumi AA, Mincemoyer R, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med. 1994;330(20):1411–7.

    PubMed  Google Scholar 

  87. Thiwan S, Drossman DA, Morris CB, et al. Not all side effects associated with tricyclic antidepressant therapy are true side effects. Clin Gastroenterol Hepatol. 2009;7(4):446–51.

    PubMed  CAS  PubMed Central  Google Scholar 

  88. Park SW, Lee H, Lee HJ, et al. Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain. World J Gastroenterol. 2013;19(30):4958–65.

    PubMed  PubMed Central  Google Scholar 

  89. Tutuian R, Castell DO. Review article: oesophageal spasm - diagnosis and management. Aliment Pharmacol Ther. 2006;23(10):1393–402.

    PubMed  CAS  Google Scholar 

  90. Grubel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol. 2008;103(2):450–7.

    PubMed  Google Scholar 

  91. Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial. Gastroenterology. 1987;92(4):1027–36.

    PubMed  CAS  Google Scholar 

  92. Trazodone hydrochloride tablet, Qualitest Pharmaceuticals. [US prescribing information]. 2012;Huntsville (AL) (Vintage Pharmaceuticals-Huntsville).

  93. Varia I, Logue E, O'Connor C, et al. Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin. Am Heart J. 2000;140(3):367–72.

    PubMed  CAS  Google Scholar 

  94. Doraiswamy PM, Varia I, Hellegers C, et al. A randomized controlled trial of paroxetine for noncardiac chest pain. Psychopharmacol Bull. 2006;39(1):15–24.

    PubMed  Google Scholar 

  95. Viazis N, Keyoglou A, Kanellopoulos AK, et al. Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study. Am J Gastroenterol. 2012;107(11):1662–7.

    PubMed  CAS  Google Scholar 

  96. Nguyen TM, Eslick GD. Systematic review: the treatment of noncardiac chest pain with antidepressants. Aliment Pharmacol Ther. 2012;35(5):493–500.

    PubMed  CAS  Google Scholar 

  97. Celexa (R) (citalopram hydrobromide). [US prescribing information]. 2013;St. Louis (MO)(Forest Laboratories, Inc.).

  98. Harvey AT, Rudolph RL, Preskorn SH. Evidence of the dual mechanisms of action of venlafaxine. Arch Gen Psychiatry. 2000;57(5):503–9.

    PubMed  CAS  Google Scholar 

  99. Lee H, Kim JH, Min BH, et al. Efficacy of venlafaxine for symptomatic relief in young adult patients with functional chest pain: a randomized, double-blind, placebo-controlled, crossover trial. Am J Gastroenterol. 2010;105(7):1504–12.

    PubMed  CAS  Google Scholar 

  100. Effexor XR(R) extended-release oral capsules (venlafaxine hydrochloride extended-release oral capsules). [US prescribing information]. 2009;Philadelphia (PA)(Wyeth Pharmaceuticals, Inc.).

  101. Miller LS, Parkman HP, Schiano TD, et al. Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter. Dig Dis Sci. 1996;41(10):2025–31.

    PubMed  CAS  Google Scholar 

  102. Storr M, Allescher HD, Rosch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injections of botulinum toxin: a prospective study with long-term follow-up. Gastrointest Endosc. 2001;54(6):754–9.

    PubMed  CAS  Google Scholar 

  103. Nebendahl JCBB, von Schrenck T, et al. Effective treatment of diffuse esophageal spasm (DES) by endoscopic injection of botulinum toxin (BTX) (abstract). Gastroenterology. 1998;114:A240.

    Google Scholar 

  104. Nebendahl JCBB, von Schrenck T, et al. Treatment of diffuse esophageal spasm with botulinum toxin: a prospective study with 6 month follow up (abstract). Gastroenterology. 1999;116:A802.

    Google Scholar 

  105. Miller LS, Pullela SV, Parkman HP, et al. Treatment of chest pain in patients with noncardiac, nonreflux, nonachalasia spastic esophageal motor disorders using botulinum toxin injection into the gastroesophageal junction. Am J Gastroenterol. 2002;97(7):1640–6.

    PubMed  Google Scholar 

  106. Khashab MA, Saxena P, Kumbhari V, et al. Peroral endoscopic myotomy as a platform for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc. 2014;79(1):136–9.

    PubMed  Google Scholar 

  107. Shiwaku H, Inoue H, Beppu R, et al. Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy. Gastrointest Endosc. 2013;77(1):149–50.

    PubMed  Google Scholar 

  108. Kandulski A, Fuchs KH, Weigt J, Malfertheiner P. Jackhammer esophagus: high-resolution manometry and therapeutic approach using peroral endoscopic myotomy (POEM). Dis Esophagus. 2014 Jan 27.

  109. Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with Dysphagia. Am J Gastroenterol. 2011;106(2):349–56.

    PubMed  PubMed Central  Google Scholar 

  110. Tutuian R, Castell DO. Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients. Am J Gastroenterol. 2004;99(6):1011–9.

    PubMed  Google Scholar 

  111. Bulsiewicz WJ, Kahrilas PJ, Kwiatek MA, Ghosh SK, Meek A, Pandolfino JE. Esophageal pressure topography criteria indicative of incomplete bolus clearance: a study using high-resolution impedance manometry. Am J Gastroenterol. 2009;104(11):2721–8.

    PubMed  PubMed Central  Google Scholar 

  112. Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109(1):46–51. In this paper the authors evaluated the physiological and clinical consequences of having weak peristalsis as it was defined by the Chicago Classification on GERD.

    PubMed  CAS  Google Scholar 

  113. Fox M, Hebbard G, Janiak P, et al. High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil. 2004;16(5):533–42.

    PubMed  CAS  Google Scholar 

  114. Smout A, Fox M. Weak and absent peristalsis. Neurogastroenterol Motil. 2012;24 Suppl 1:40–7.

    PubMed  CAS  Google Scholar 

  115. Hendel L, Hage E, Hendel J, Stentoft P. Omeprazole in the long-term treatment of severe gastro-oesophageal reflux disease in patients with systemic sclerosis. Aliment Pharmacol Ther. 1992;6(5):565–77.

    PubMed  CAS  Google Scholar 

  116. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965–71.

    PubMed  Google Scholar 

  117. Pouderoux P, Shi G, Tatum RP, Kahrilas PJ. Esophageal solid bolus transit: studies using concurrent videofluoroscopy and manometry. Am J Gastroenterol. 1999;94(6):1457–63.

    PubMed  CAS  Google Scholar 

  118. Simren M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut. 2003;52(6):784–90.

    PubMed  CAS  PubMed Central  Google Scholar 

  119. Mohammed SH, Hegedus V. Dislodgement of impacted oesophageal foreign bodies with carbonated beverages. Clin Radiol. 1986;37(6):589–92.

    PubMed  CAS  Google Scholar 

  120. Blonski W, Vela MF, Freeman J, Sharma N, Castell DO. The effect of oral buspirone, pyridostigmine, and bethanechol on esophageal function evaluated with combined multichannel esophageal impedance-manometry in healthy volunteers. J Clin Gastroenterol. 2009;43(3):253–60.

    PubMed  CAS  Google Scholar 

  121. Johnson DA, Drane WE, Curran J, et al. Metoclopramide response in patients with progressive systemic sclerosis. Effect on esophageal and gastric motility abnormalities. Arch Intern Med. 1987;147(9):1597–601.

    PubMed  CAS  Google Scholar 

  122. Chrysos E, Tzovaras G, Epanomeritakis E, et al. Erythromycin enhances oesophageal motility in patients with gastro-oesophageal reflux. ANZ J Surg. 2001;71(2):98–102.

    PubMed  CAS  Google Scholar 

  123. Chang CT, Shiau YC, Lin CC, Li TC, Lee CC, Kao CH. Improvement of esophageal and gastric motility after 2-week treatment of oral erythromycin in patients with non-insulin-dependent diabetes mellitus. J Diabetes Complicat. 2003;17(3):141–4.

    PubMed  Google Scholar 

  124. Staiano A, Clouse RE. The effects of cisapride on the topography of oesophageal peristalsis. Aliment Pharmacol Ther. 1996;10(6):875–82.

    PubMed  CAS  Google Scholar 

  125. Fox M, Menne D, Stutz B, Fried M, Schwizer W. The effects of tegaserod on oesophageal function and bolus transport in healthy volunteers: studies using concurrent high-resolution manometry and videofluoroscopy. Aliment Pharmacol Ther. 2006;24(7):1017–27.

    PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Scott Gabbard and Carla Maradey-Romero declare that they have no conflict of interest.

Ronnie Fass has received grant from Ironwood Pharmaceuticals. Dr. Fass

has received consultancy fees from GSK, Reckitt Benckiser, and Vecta. Dr. Fass has also received honoraria payments from Takeda and Mederi Therapeutics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109 -1998, USA

    Carla Maradey-Romero MD & Ronnie Fass MD

  2. Center for Swallowing & Esophageal Disorders, Digestive Disease Institute, Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, OH, USA

    Scott Gabbard MD

Authors
  1. Carla Maradey-Romero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Gabbard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronnie Fass MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronnie Fass MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maradey-Romero, C., Gabbard, S. & Fass, R. Treatment of Esophageal Motility Disorders Based on the Chicago Classification. Curr Treat Options Gastro 12, 441–455 (2014). https://doi.org/10.1007/s11938-014-0032-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-014-0032-9

Keywords

Search

Navigation