Abstract
Background
We studied the spectrum of motor dysphagia in a northern Indian tertiary referral center.
Methods
In this retrospective study, consecutive patients with motor dysphagia referred to the Gastrointestinal Pathophysiology and Motility Laboratory from 2002 to 2007 were evaluated clinically and with eight-channel water-perfusion manometry. Causes of dysphagia were diagnosed using standard criteria.
Results
Of 250 patients (age 41.3 [15.0] years, 146 men), 193 (77%) had achalasia cardia (AC) and 57 (23%) had other causes (11, 4.4%: diffuse esophageal spasm [DES]; 9, 3.6%: hypertensive lower esophageal sphincter [Hy LES]); manometry was normal in 37 patients. Twenty-seven patients (14%) had vigorous AC. Duration of dysphagia at presentation was longer in those with AC and Hy LES than in normal manometry (NM) (21 months [1–180] vs. 6 [1–360], p = 0.000; 24 months [7–48] vs. 6 [1–360], p = 0.015). Regurgitation and bolus obstruction were more frequent in those with AC than in NM (89/154, 57.79% vs. 3/27, 11.11%, p = 0.000001). Heartburn was less frequent in patients with AC than in others (AC: 4/146, 2.73% vs. normal: 4/27, 14.8% [p = 0.02] and others: 3/15, 20% [p = 0.018]). Chest pain was reported by 74/135 (54.8%) classic and 12/19 (63.2%) vigorous AC (p = NS). Patients with NM had lower LES pressure than those with classic AC, Hy LES and vigorous AC (p < 0.0001 in each case). Patients with DES had lower LES pressure than in classic AC, Hy LES and vigorous AC (p = 0.043, p < 0.0001, and p = 0.002, respectively). Patients with classic AC had lower LES pressure than in Hy LES and vigorous AC (p = 0.024, p = 0.001, respectively).
Conclusion
Classic AC was the commonest cause of motor dysphagia in our center. AC was associated with higher LES pressure, longer duration of dysphagia, frequent regurgitation and bolus obstruction.
Similar content being viewed by others
References
Dent J, Holloway RH. Esophageal motility and reflux testing. State-of-the-art and clinical role in the twenty-first century. Gastroenterol Clin North Am 1996;25:51–73.
Dughera L, Cassolino P, Cisaro F, Chiaverina M. Achalasia. Minerva Gastroenterol Dietol 2008;54:277–285.
Stuart RC, Hennessy TP. Primary disorders of oesophageal motility. Br J Surg 1989;76:1111–1120.
Spechler SJ, Souza RF, Rosenberg SJ, Ruben RA, Goyal RK. Heartburn in patients with achalasia. Gut 1995;37:305–308.
Meshkinpour H, Haghighat P, Dutton C. Clinical spectrum of esophageal aperistalsis in the elderly. Am J Gastroenterol 1994;89:1480–1483.
Goldenberg SP, Burrell M, Fette GG, Vos C, Traube M. Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. Gastroenterology 1991;101:743–748.
Dalton CB, Castell DO, Hewson EG, Wu WC, Richter JE. Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci 1991;36:1025–1028.
Vantrappen G, Janssens J, Hellemans J, Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 1979;76:450–457.
Allen ML, DiMarino AJ, Jr. Manometric diagnosis of diffuse esophageal spasm. Dig Dis Sci 1996;41:1346–1349.
Dalton CB, Castell DO, Richter JE. The changing faces of the nutcracker esophagus. Am J Gastroenterol 1988;83:623–628.
Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001;49:145–151.
Code CF, Schlegel JF, Kelley ML Jr., Olsen AM, Ellis FH Jr. Hypertensive gastroesophageal sphincter. Proc Staff Meet Mayo Clin 1960;35:391–399.
Freidin N, Traube M, Mittal RK, McCallum RW. The hypertensive lower esophageal sphincter. Manometric and clinical aspects. Dig Dis Sci 1989;34:1063–1067.
Katada N, Hinder RA, Hinder PR, et al. The hypertensive lower esophageal sphincter. Am J Surg 1996;172:439–442; discussion 442–3.
Bhatia SJ, Malkan GH, Ravi P, Abraham P. Correlation of manometric and radiographic diagnosis in esophageal motility disorders. Indian J Gastroenterol 1995;14:124–127.
Ghoshal UC, Chourasia D, Tripathi S, Misra A, Singh K. Relationship of severity of gastroesophageal reflux disease with gastric acid secretory profile and esophageal acid exposure during nocturnal acid breakthrough: a study using 24-h dual-channel pH-metry. Scand J Gastroenterol 2008;43:654–661.
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;99:2304–2310.
Hirano I, Tatum RP, Shi G, Sang Q, Joehl RJ, Kahrilas PJ. Manometric heterogeneity in patients with idiopathic achalasia. Gastroenterology 2001;120:789–798.
Kahrilas PJ, Ghosh SK, Pandolfino JE. Challenging the limits of esophageal manometry. Gastroenterology 2008;134:16–18.
Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008;135:1526–1533.
Bassotti G, Alunni G, Cocchieri M, Pelli MA, Morelli A. Isolated hypertensive lower esophageal sphincter. Clinical and manometric aspects of an uncommon esophageal motor abnormality. J Clin Gastroenterol 1992;14:285–287.
Suthahar DR, Malathi S, Vidyanathan V, et al. Oesophageal manometry in noncardiac chest pain. Trop Gastroenterol 1994;15:87–97.
Dekel R, Pearson T, Wendel C, De Garmo P, Fennerty MB, Fass R. Assessment of oesophageal motor function in patients with dysphagia or chest pain — the Clinical Outcomes Research Initiative experience. Aliment Pharmacol Ther 2003;18:1083–1089.
Somani SK, Ghoshal UC, Saraswat VA, et al. Correlation of esophageal pH and motor abnormalities with endoscopic severity of reflux esophagitis. Dis Esophagus 2004;17:58–62.
Chourasia D, Ghoshal UC. Pathogenesis of gastrooesophageal reflux disease: what role do Helicobacter pylori and host genetic factors play? Trop Gastroenterol 2008;29:13–19.
Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol 2005;100:1404–1414.
Richter JE. Oesophageal motility disorders. Lancet 2001;358:823–828.
Longstreth GF, Foroozan P. Evolution of symptomatic diffuse esophageal spasm to achalasia. South Med J 1982;75:217–220.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Misra, A., Chourasia, D. & Ghoshal, U.C. Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India. Indian J Gastroenterol 29, 18–22 (2010). https://doi.org/10.1007/s12664-010-0002-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-010-0002-7