Abstract
The diagnosis, classification, and treatment of esophageal motor disorders can be difficult and frustrating for both the clinician and patient. This review attempts to clarify and summarize our current understanding of esophageal motor disorders and presents a rational approach to their management.
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Alban Davies, H., D. B. Jones, J. Rhodes, and R.G. Newcombe. 1985. Angina-like esophageal pain: differentiation from cardiac pain by history.J. Clin. Gastroenterol. 7:477–481.
Alban Davies, H., E.M. Rush, M.J. Lewis, Z. Page, A.L. Brown, M.C. Petch. 1985. Oesophageal stimulation lowers exertional angina threshold.Lancet i:1011–1014.
Barish, C.F., D.O. Castell, and J.E. Richter. 1986. Graded esophageal balloon distension — a new provocative test for noncardiac chest pain.Dig. Dis. Sci. 31:1292–1298.
Benjamin, S.B., J.E. Richter, C.M. Cordova, T.E. Knuff, D.O. Castell. 1983. Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction.Gastroenterology 84:893–901.
Bennett, J.R. 1985. Esophageal spasm — as clinicians see it.J. Clin. Gastroenterol. 7:463–466.
Bortolotti, M., and G. Labo. 1981. Clinical and manometric effects of nifedipine in patients with esophageal achalasia.Gastroenterology 80:39–44.
Brand, D.L., D. Martin, and C.E. Pope. 1977. Esophageal manometrics in patients with angina-like chest pain.Dig. Dis. 22:300–304.
Brandborg, L.L. 1979. Neoplasms of the esophagus. InTextbook of internal medicine, ed. P.B. Beeson, W. McDermott, and J.B. Wyngaarden, 1597–1599. Philadelphia: W.B. Saunders Co.
Christensen, and G.F. Lund. 1969. Esophageal response to distension and electrical stimulation.J. Clin. Invest. 48:408–419.
Clouse, R.E., and P.J. Lustman. 1983. Psychiatric illness and contraction abnormalities of the esophagus.N. Engl. J. Med. 309:1337–1342.
Clouse, R.E., and A. Staiano. 1983. Contraction abnormalities of the esophageal body in patients referred for manometry — a new approach to manometric classification.Dig. Dis. Sci. 28:784–791.
Clouse, R.E., A. Staiano, D.W. Landau, and J.L. Schlachter. 1983. Manometric findings during spontaneous chest pain in patients with presumed esophageal “spasms.”Gastroenterology 85:395–402.
Clouse, R.E., P.J. Lustman, and W.L. Reidel. 1986. Correlation of esophageal motility abnormalities with neuropsychiatric status in diabetics.Gastroenterology 90:1146–1154.
Cohen, S. 1979. Motor disorders of the esophagus.N. Engl. J. Med. 301:184–192.
Cohen, S. 1983. Classification of the esophageal motility disorders.Gastroenterology 84:1050–1058.
Creteur, V., R.F. Thoeni, M.P. Federle, J.P. Cello, A.A. Moss, S.H. Ominsky, H.I. Goldberg, and L. Axel. 1983. The role of single and double-contrast radiography in the diagnosis of reflux esophagitis.Radiology 147:71–75.
DeMeester, T.R., G.C. O'Sullivan, G. Bermudez, A.I. Midell, G.E. Cimochowski, and J. O'Drobinak. 1982. Esophageal function in patients with angina-like chest pain and normal coronary angiograms.Ann. Surg. 196:488–498.
DiPalma, J.A., and P.J. Perruca. 1983. An approach to the diagnosis and management of reflux esophagitis.Resident Staff Phys. 29: 5–9PC.
DiPalma, J.A., G. Prechter, and C.E. Brady. 1984. X-ray negative dysphagia — Is endoscopy necessary?J. Clin. Gastroenterol. 6:409–411.
DiPalma, J.A., P.J. Perucca, D.F. Martin, G.W. Meyer, and G. Vela. 1987. Metoclopramide effect on esophageal peristalsis in normal human volunteers.Am. J. Gastroenterol. 82:307–310.
Donaldson, I.M., P. Jenner, C.D. Marsden, R. Miller, and E. Peringer. 1976. Is metoclopramide a directly acting dopamine receptor antagonist?Br. J. Pharmacol. 56:26.
Dooley, C.P., A.W. Larson, N.H. Stace, I.G. Renner, J.E. Valenzuela, J. Eliasoph, P.M. Colletti, J.M. Halls, and J.M. Weiner. 1984. Double-contrast barium meal and upper gastrointestinal endoscopy — a comparative study.Ann. Intern. Med. 101:538–545.
Eastwood, G.L., B.H. Weiner, W.J. Dickerson, E.M. White, I.S. Ockene, C.I. Haffajee, and J.S. Alpert. 1981. Use of ergonovine to identify esophageal spasm in patients with chest pain.Ann. Intern. Med. 94:768–771.
Ebert, E.C., A. Ouyang, S.H. Wright, S. Cohen, and W.H. Lipshutz. 1983. Pneumatic dilatation in patients with symptomatic diffuse esophageal spasm and lower esophageal sphincter dysfunction.Dig. Dis. Sci. 28:481–485.
Ellis, F.H., and A.M. Olsen, ed. 1969. Historical Introduction. InAchalasia of the esophagus, ed. F.H. Ellis and A.M. Olsen, 1–12., Philadelphia: W.B. Saunders Co.
Ferrucci, J.T., and J.A. Long. 1977. Radiologic treatment of esophageal food impaction using intravenous glucagon.Radiology 125:25–28.
Gelfand, D.W., and D.J. Ott. 1981. Single- and double-contrast gastrointestinal studies: critical analysis of reported statistics.AJR 137:523–528.
Gelfond, M., P. Rozen, and T. Gilat. 1982. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation.Gastroenterology 83:963–969.
Gidda, J.S. 1985. Control of esophageal peristalsis.Viewpoints Dig. Dis. 17:13–16.
Halpert, R.D., P.J. Feczko, E.M. Spickler, and L.V. Ackerman. 1985. Radiological assessment of dysphagia with endoscopic correlation.Radiology 157:599–602.
Hargrove, M.D., and H.W. Boyce. 1970. Meat impaction of the esophagus.Arch. Intern. Med. 125:277–281.
Haubrich, W.S. 1977. In defense of the radiographic diagnosis of dysphagia.Gastrointest. Endosc. 23:214.
Hogan, W.J., W.J. Dodds, S.E. Hoke, D.P. Reid, R.K. Kalkhoff, and R.C. Arndorfer. 1975. Effect of glucagon on esophageal motor function.Gastroenterology 69:160–165.
Hollis, J.B., and D.O. Castell. 1974. Esophageal dysfunction in elderly men: a new look at “presbyesophagus.”Ann. Intern. Med. 80:371–374.
Hongo, M., M. Traube, R.G. McAllister, and R.W. McCallum. 1984. Effects of nifedipine on esophageal motor function in humans: correlation with plasma nifedipine concentration.Gastroenterology 86:8–12.
Horton, M.L., and J.S. Goff. 1986. Surgical treatment of nutcracker esophagus.Dig. Dis. Sci. 31:878–883.
Janssens, J., G. Vantrappen, and G. Ghillebert. 1986. 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain.Gastroenterology 90:1978–1984.
Jenkins, A.F., R.J. Cowan, and J.E. Richter. 1985. Gastroesophageal scintigraphy: is it a sensitive screening test for gastroesophageal reflux disease?J. Clin. Gastroenterol. 7:127–131.
Katz, P.O., and D.O. Castell. 1984. Chest pain: is it of esophageal origin?Med. Grand Rounds 3:335–343.
Katz, P.O., C.B. Dalton, J.E. Richter, W.C. Wu, and D.O. Castell. 1987. Esophageal testing of patients with noncardiac chest pain or dysphagia: results of three years' experience with 1161 patients.Ann. Intern. Med. 106:593–597.
Loo, F.D., W.J. Dodds, K.H. Soergel, R.C. Arndorfer, J.F. Helm, and W.J. Hogan. 1985. Multipeaked esophageal peristaltic waves in patients with diabetic neuropathy.Gastroenterology 88:485–491.
Magarian, G.J., and D.H. Hickam. 1986. Noncardiac causes of angina-like chest pain.Prog. Cardiovasc. Dis. 29:65–80.
Mamel, J.J. 1984. Bezoar of the esophagus occurring in achalasia.Gastrointest. Endosc. 30:317–318.
McKinney, M.K., C.E. Brady, and F.L. Weiland. 1983. Radionuclide esophageal transit: an evaluation of therapy in achalasia.South. Med. J. 76:1136–1138.
Mellow, M.H. 1982. Effect of isosorbide and hydralazine in painful primary motility disorders.Gastroenterology 83:364–370.
Mellow, M.H., A.G. Simpson, L. Watt, L. Schoomeester, and O.L. Haye. 1983. Esophageal acid perfusion in coronary artery disease- induction of myocardial ischemia.Gastroenterology 85:306–312.
Meshkinpour, H., M.E. Glick, P. Sanchez, and J. Tarvin. 1982. Esophageal manometry — a benefit and cost analysis.Dig. Dis. Sci. 27:772–775.
Meyer, G.W., and D.O. Castell. 1981. Evaluation and management of diseases of the esophagus.Am. J. Otolaryngol. 2:336–344.
Meyer, G.W., and D.O. Castell. 1981. Human esophageal response during chest pain induced by swallowing cold liquids.JAMA 246:2057–2059.
Meyer, G.W., R.M. Austin, C.E. Brady, D.O. Castell. 1986. Muscle anatomy of the human esophagus.J. Clin. Gastroenterol. 8:131–134.
Nasrallah, S.M., C.L. Tommaso, R.T. Singleton, and E.A. Backhaus. 1985. Primary esophageal motor disorders: clinical response to nifedipine.South. Med. J. 78:312–315.
Nostrant, T.T., J. Sams, and T. Huber. 1986. Bethanechol increases the diagnostic yield in patients with esophageal chest pain.Gastroenterology 91:1141–1146.
Ott, D.J., W.C. Wu, and D.W. Gelfand. 1981. Efficacy of radiology of the esophagus for evaluation of dysphagia.Gastrointest. Radiol. 6:109–110.
Ott, D.J., D.W. Gelfand, and W.C. Wu. 1983. Sensitivity of single-contrast radiology in esophageal disease: a study of 240 patients with endoscopically verified abnormality.Gastrointest. Radiol. 8:105–110.
Pope, C.E. 1984. One for the gripper?Dig. Dis. Sci. 29:657–658.
Reidel, W.L., and R.E. Clouse. 1985. Variations in clinical presentation of patients with esophageal contraction abnormalities.Dig. Dis. Sci. 30:1065–1071.
Richter, J.E., and D.O. Castell. 1982. Gastroesophageal reflux — pathogenesis, diagnosis therapy.Ann. Intern. Med. 97:93–103.
Richter, J.E., and D.O. Castell. 1984. Diffuse esophageal spasm: a reappraisal.Ann. Intern. Med. 100:242–245.
Richter, J.E., and D.O. Castell. 1987. Surgical myotomy for nutcracker esophagus — to be or not be?Dig. Dis. Sci. 32:95–96.
Richter, J.E., T.J. Spurling, C.M. Cordova, and D.O. Castell. 1984. Effects of oral calcium blocker, diltiazem, on esophageal contractions: studies in volunteers and patients with nutcracker esophagus.Dig. Dis. Sci. 29:649–656.
Richter, J.E., C.B. Dalton, R.G. Buice, and D.O. Castell. 1985. Nifedipine: a potent inhibitor of contractions in the body of the human esophagus — studies in healthy volunteers and patients with the nutcracker esophagus.Gastroenterology 89:549–554.
Richter, J.E., B.T. Hackshaw, W.C. Wu, and D.O. Castell. 1985. Edrophonium: a useful provocative test for esophageal chest pain.Ann. Intern. Med. 103:14–21.
Richter, J.E., W.F. Obrecht, L.A. Bradley, L.D. Young, and K.O. Anderson. 1986. Psychological comparison of patients with nutcracker esophagus and irritable bowel syndrome.Dig. Dis. Sci. 31:131–138.
Sandeman, D.R., M.R. Clements, and E.J. Perrins. 1980. Oesophageal obstruction due to hygroscopic gum laxative.Lancet 1:364–365.
Sharp, J.R. 1979. Mechanical and neurogenic factors in post vagotomy dysphagia.J. Clin. Gastroenterol. 1:321–324.
Schuster, M.M. 1983. Esophageal spasm and psychiatric disorder.N. Engl. J. Med. 309:1382–1383.
Silverstein, B.D., C.M. Kramer, and C.E. Pope. 1982. Treatment of esophageal motor disorders with a calciumblocker, diltiazem.Gastroenterology 82:1181.
Stiennon, O.A. 1968. On the cause of tertiary contractions and related disturbances of the esophagus.Am. J. Roentgen. 104:617–624.
Strombeck, D.R., and D. Harrold. 1985. Effects of atropine, acepromazine, meperidine and xylazine on gastroesophageal sphincter pressure in the dog.Am. J. Vet. Res. 46:963–965.
Swamy, N. 1977. Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrates.Gastroenterology 72:23–27.
Traube, M., and R.W. McCallum. 1984. Calcium-channel blockers and the gastrointestinal tract.Am. J. Gastroenterol. 74:892–896.
Traube, M., T. Vijayapasad, A.E. Baue, and R.W. McCallum. 1987. Surgical myotomy in patients with high-amplitude peristaltic esophageal contractions — manometric and clinical effects.Dig. Dis. Sci. 32:16–21.
Vantrappen, G., and J. Hellemans. 1980. Treatment of achalasia and related motor disorders.Gastroenterology 79:144–154.
Ward, B.W., W.C. Wu, J.E. Richter, B.T. Hackshaw, and D.O. Castell. 1987. Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful?Am. J. Gastroenterol. 82:215–218.
Weihrauch, T.R., C.F. Forster, and F. Naldeck. 1980. Effect of fenoterol on lower esophageal sphincter pressure and symptoms in achalasia.Gastroenterology 78:1288.
Winans, C.S. 1978. Diagnostic evaluation of esophageal function. Proceedings of the Second International Symposium on the Esophagus and Gastroesophageal Junction, Ixtapa, Mexico.
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The opinions and assertions contained herein are those of the authors and are not to be construed as reflecting opinions of the United States Air Force or the Department of Defense
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DiPalma, J.A., Meyer, G.W. A rational clinical approach to esophageal motor disorders. Dysphagia 2, 97–108 (1987). https://doi.org/10.1007/BF02408141
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DOI: https://doi.org/10.1007/BF02408141