Abstract
Dysphagia, chest pain, pyrosis, and regurgitation may be caused by esophageal dysfunction. However, esophageal symptoms are non-specific; the majority of patients who present for evaluation have normal esophageal motility, and their symptoms can be explained by a functional disorder. The Chicago Classification v4.0 (CCv4.0) categorizes esophageal motility disorders into disorders of esophagogastric junction outflow and disorders of peristalsis based on metrics from esophageal high-resolution manometry (HRM). This chapter reviews epidemiology, pathophysiology, clinical presentation, and diagnostic evaluation of esophageal motility disorders defined by the Chicago Classification.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115(9):1393–411. https://doi.org/10.14309/ajg.0000000000000731.
Tustumi F, Bernardo WM, da Rocha JRM, Szachnowicz S, Seguro FC, Bianchi ET, et al. Esophageal achalasia: a risk factor for carcinoma. A systematic review and meta-analysis. Dis Esophagus. 2017;30(10):1–8. https://doi.org/10.1093/dote/dox072.
Mittal R, Vaezi MF. Esophageal motility disorders and gastroesophageal reflux disease. N Engl J Med. 2020;383(20):1961–72. https://doi.org/10.1056/NEJMra2000328.
Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, et al. Esophageal motility disorders on high-resolution manometry: Chicago Classification version 4.0(©). Neurogastroenterol Motil. 2021;33(1):e14058. https://doi.org/10.1111/nmo.14058.
Smout A, Fox M. Weak and absent peristalsis. Neurogastroenterol Motil. 2012;24(Suppl 1):40–7. https://doi.org/10.1111/j.1365-2982.2011.01831.x.
Kovacs B, Masuda T, Bremner RM, Mittal SK. Clinical spectrum and presentation of patients with absent contractility. Ann Gastroenterol. 2021;34(3):331–6. https://doi.org/10.20524/aog.2021.0583.
Khalaf M, Chowdhary S, Elias PS, Castell D. Distal esophageal spasm: a review. Am J Med. 2018;131(9):1034–40. https://doi.org/10.1016/j.amjmed.2018.02.031.
Gorti H, Samo S, Shahnavaz N, Qayed E. Distal esophageal spasm: update on diagnosis and management in the era of high-resolution manometry. World J Clin Cases. 2020;8(6):1026–32. https://doi.org/10.12998/wjcc.v8.i6.1026.
Snyder DL, Vela MF. Opioid-induced esophageal dysfunction. Curr Opin Gastroenterol. 2020;36(4):344–50. https://doi.org/10.1097/mog.0000000000000648.
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74. https://doi.org/10.1111/nmo.12477.
Roman S, Hebbard G, Jung KW, Katz P, Tutuian R, Wong R, et al. Chicago Classification Update (v4.0): technical review on diagnostic criteria for distal esophageal spasm. Neurogastroenterol Motil. 2021;33:e14119. https://doi.org/10.1111/nmo.14119.
Chen JW, Savarino E, Smout A, Xiao Y, de Bortoli N, Yadlapati R, et al. Chicago Classification Update (v4.0): technical review on diagnostic criteria for hypercontractile esophagus. Neurogastroenterol Motil. 2021;33:e14115. https://doi.org/10.1111/nmo.14115.
Savarino E, Smout A. The hypercontractile esophagus: still a tough nut to crack. Neurogastroenterol Motil. 2020;32(11):e14010. https://doi.org/10.1111/nmo.14010.
de Bortoli N, Gyawali PC, Roman S, Tolone S, Sifrim D, Tutuian R, et al. Hypercontractile esophagus from pathophysiology to management: proceedings of the Pisa Symposium. Am J Gastroenterol. 2021;116(2):263–73. https://doi.org/10.14309/ajg.0000000000001061.
Samo S, Qayed E. Esophagogastric junction outflow obstruction: where are we now in diagnosis and management? World J Gastroenterol. 2019;25(4):411–7. https://doi.org/10.3748/wjg.v25.i4.411.
Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil. 2017;29(10):1–9. https://doi.org/10.1111/nmo.13105.
Yadlapati R, Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. What is new in Chicago Classification version 4.0? Neurogastroenterol Motil. 2021;33(1):e14053. https://doi.org/10.1111/nmo.14053.
Gyawali CP, Sifrim D, Carlson DA, Hawn M, Katzka DA, Pandolfino JE, et al. Ineffective esophageal motility: concepts, future directions, and conclusions from the Stanford 2018 symposium. Neurogastroenterol Motil. 2019;31(9):e13584. https://doi.org/10.1111/nmo.13584.
Gyawali CP, Zerbib F, Bhatia S, Cisternas D, Coss-Adame E, Lazarescu A, et al. Chicago Classification Update (V4.0): technical review on diagnostic criteria for ineffective esophageal motility and absent contractility. Neurogastroenterol Motil. 2021;33:e14134. https://doi.org/10.1111/nmo.14134.
Shetler KP, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6):1–8. https://doi.org/10.1093/dote/dox012.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lammi, M., Gorham, J.K. (2023). Disorders of Esophagogastric Junction Outflow and Peristalsis. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_32
Download citation
DOI: https://doi.org/10.1007/978-3-031-19671-3_32
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-19670-6
Online ISBN: 978-3-031-19671-3
eBook Packages: MedicineMedicine (R0)