Correlation of radiographic and manometric findings in patients with ineffective esophageal motility

  • J. S. Shakespear
  • D. Blom
  • J. E. Huprich
  • J. H. Peters
Original article


Background: Ineffective esophageal motility disorder (IEM) is a new, manometrically defined, esophageal motility disorder, associated with severe gastroesophageal reflux disease (GERD), GERD-associated respiratory symptoms, delayed acid clearance, and mucosal injury. Videoesophagram is an important, inexpensive, and widely available tool in the diagnostic evaluation of patients with esophageal pathologies. The efficacy of videoesophagography has not been rigorously examined in patients with IEM. The aim of this study was to determine the diagnostic value of videoesophagography in patients with IEM. Methods: The radiographic and manometric findings of 202 consecutive patients presenting with foregut symptoms were evaluated. IEM was defined by strict manometric criteria. All other named motility disorders such as achalasia were excluded. Videoesophagography was performed according to a standard protocol. Results: Of patients in this cohort, 16% (33/202) had IEM by manometric criteria. Of IEM patients, 55% (18/33) had an abnormal videoesophagram, while in 45% (15/33) this test was read as normal. Only 11% (15/137) of patients with a normal videoesophagram were found to have IEM. Sensitivity of videoesophagram was 54.6%, specificity 72.2%, positive predictive value only 27.7%, and negative predictive value 89.1% in the diagnosis of IEM. Conclusions: These data show that videoesophagram is relatively insensitive in detecting patients with IEM and should not be considered a valid diagnostic test for this disorder. We conclude that esophageal manometry is an indispensable diagnostic modality in the workup of a patient with suspected of IEM.


Ineffective esophageal motility Barium videoesophagram Manometry 


  1. 1.
    Achem, SR, Crittender, J, Kolts, B, Burton, L 1992Long-term clinical and manometric follow-up of patients with non-specific esophageal motility disorders.Am J Gastroenterol87825830PubMedGoogle Scholar
  2. 2.
    Aly, YA 2000Digital radiography in the evaluation of oesophageal motility disorders.Clin Radiol55561568CrossRefPubMedGoogle Scholar
  3. 3.
    Bell, RCW, Hanna, P, Mills, MR, Bowrey, D 1999Patterns of success and failure with laparoscopic Toupet fundoplication.Surg Endosc13118994PubMedGoogle Scholar
  4. 4.
    Blom, D, Peters, JH, DeMeester, TR, Crookes, PF, Hagen, JA, DeMeester, SR, Bremner, C 2002Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication.J Gastrointest Surg62228CrossRefPubMedGoogle Scholar
  5. 5.
    Castell, DO 2001Esophageal manometry prior to antireflux surgery: required, preferred or even needed?Gastroenterology121214216PubMedGoogle Scholar
  6. 6.
    Chen, MYM, Ott, DJ, Sinclair, JW, Wu, WC, Gelfand, DW 1992Gastroesophageal reflux disease:correlation of esophageal pH testing and radiographic findings.Radiology185483486PubMedGoogle Scholar
  7. 7.
    Chen, YM, Ott, DJ, Hewson, EG, Richter, JE, Wu, WC, Gelfand, DW, Castell, DO 1989Diffuse esophageal spasm: radiographic and manometric correlation.Radiology170807810PubMedGoogle Scholar
  8. 8.
    Crookes, PF, Peters, JH, DeMeester, TR 1995Physiology of the anti-reflux barrier and diagnostic tests of forgut function.Semin Laparosc Surg21026Google Scholar
  9. 9.
    Diener, U, Patti, MG, Molena, D, Fisichella, PM, Way, LW 2001Esophageal dysmotility and gastroesophageal reflux disease.J Gastrointest Surg5260265CrossRefPubMedGoogle Scholar
  10. 10.
    Fibbe, C, Layer, P, Keller, J, Strate, U, Emmermann, A, Zornig, C 2001Esophageal motility in reflux disease before and after fundoplication: a prospective randomized clinical and manometric study.Gastroenterology121514PubMedGoogle Scholar
  11. 11.
    Fouad, YM, Katz, PO, Hatlebakk, JG, Castell, DO 1999Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms.Am J Gastroenterol9414641467Google Scholar
  12. 12.
    Fuller, L, Huprich, JE, Theisen, J, Hagen, JA, Crookes, PF, Demeester, SR, Bremner, CG, Demeester, TR, Peters, JH 1999Abnormal esophageal body function: radiographic–manometric correlation.Am Surg65911914PubMedGoogle Scholar
  13. 13.
    Heider, TR, Behrns, KE, Koruda, MJ, Shaheen, NJ, Lucktong, TA, Bradshaw, B, Farrell, TM 2003Fundoplication improves disordered esophageal motility.J Gastrointest Surg7159163CrossRefPubMedGoogle Scholar
  14. 14.
    Ho, SC, Chang, CS, Wu, CY, Chen, GH 2002Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease.Dig Dis Sci47652656CrossRefPubMedGoogle Scholar
  15. 15.
    Kahrilas, PJ, Dodds, WJ, Hogan, WJ 1988Effect of peristaltic dysfunction on esophageal volume clearance.Gastroenterology947380Google Scholar
  16. 16.
    Kauer, WK, Peters, JH, DeMeester, TR, Heimbucher, J, Ireland, AP, Bremner, CG 1995A tailored approach to antireflux surgery.J Thorac Cardiovasc Surg110141147PubMedGoogle Scholar
  17. 17.
    Leite, LP, Johnston, BT, Barrett, J, Castell, JA, Castell, DO 1997Ineffective esophageal motility (IEM): the primary finding in patients with non-specific esophageal motility disorder.Dig Dis Sci4218531858CrossRefPubMedGoogle Scholar
  18. 18.
    Lund, RJ, Wetcher, GJ, Raiser, F, Glaser, K, Perdikis, G, Gadenstatter, G, Katada, N, Filipi, CJ, Hinder, RA 1997Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility.J Gastrointest Surg1301308CrossRefPubMedGoogle Scholar
  19. 19.
    Patti, MG, De Pinto, M, de Bellis, M, Arcerito, M, Tong, J, Wang, A, Mulvihill, SJ, Way, LW 1997Comparison of laparoscopic total and partial fundoplication for gastroesophageal reflux.J Gastrointest Surg1309315CrossRefPubMedGoogle Scholar
  20. 20.
    Richter, JE, Wu, WC, Johns, DN, Blackwell, JN, Nelson, JL, Castell, JA, Castell, DO 1987Esophageal manometry in 95 healthy volunteers: variability of pressures with age and frequency of “abnormal” contractions.Dig Dis Sci32583592PubMedGoogle Scholar
  21. 21.
    SAGES Committee on Standards of Practice (2001) Guideline for surgical treatment of gastroesophageal reflux disease (GERD). Society of American Gastrointestinal Endoscopic Surgeons, .
  22. 22.
    Spechler, SJ, Castell, DO 2001Classification of oesophageal motility abnormalities.Gut49145151CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson, JK, Koehler, RE, Richter, JE 1994Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring.Am J Roentgenol162621626Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • J. S. Shakespear
    • 1
  • D. Blom
    • 2
  • J. E. Huprich
    • 3
  • J. H. Peters
    • 4
  1. 1.Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226USA
  2. 2.Department of SurgeryMedical College of Wisconsin, Froedtert Hospital, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226USA
  3. 3.Department of RadiologyMayo Clinic, 200 First Street SW, Rochester, MN 55905USA
  4. 4.Department of SurgeryUniversity of Southern California, 1510 San Pablo Street, #514, Los Angeles, CA 90033USA

Personalised recommendations