Skip to main content
SpringerLink
Log in
Book cover

Gastrointestinal Motility Disorders pp 55–65Cite as

Nonspecific Esophageal Motility Disorders

  • Chapter
  • First Online:

  • 1298 Accesses

Abstract

Esophageal body and esophagogastric junction (EGJ) motor abnormalities are well characterized by the Chicago Classification version 3.0, which identifies disorders under the broad categories of EGJ outflow obstruction, major motor disorders not encountered in health, and minor motor disorders that can be associated with bolus transit abnormalities. However, abnormalities of the esophageal body peristaltic wave (contraction wave abnormalities), breaks in peristaltic integrity, and morphologic and motor EGJ abnormalities can be encountered when esophageal motor function is designated normal under the Chicago Classification. Other nonspecific motor abnormalities can be encountered in supragastric belching and rumination. This chapter elaborates these nonspecific disorders of esophageal and EGJ motor function, and describes potential relationships to symptoms.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Gyawali CP, Bredenoord AJ, Conklin JL, et al. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil. 2013;25:99–133.

    Article  CAS  PubMed  Google Scholar 

  2. Gyawali CP. High resolution manometry: the ray Clouse legacy. Neurogastroenterol Motil. 2012;24(Suppl 1):2–4.

    Article  PubMed  Google Scholar 

  3. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  PubMed  Google Scholar 

  4. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(Suppl 1):57–65.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rao SS. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol. 2010;8:910–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Phys. 1991;261:G677–84.

    CAS  Google Scholar 

  7. Gyawali CP, Patel A. Esophageal motor function. technical aspects of manometry Gastrointest Endosc Clin N Am. 2014;24:527–43.

    Article  PubMed  Google Scholar 

  8. Ghosh SK, Pandolfino JE, Rice J, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol. 2007;293:G878–85.

    Article  CAS  PubMed  Google Scholar 

  9. Mello MD, Duraiswamy S, Price LH, et al. Exaggerated smooth muscle contraction segments on esophageal high-resolution manometry: prevalence and clinical relevance. Neurogastroenterol Motil. 2015;27:229–36.

    Article  CAS  PubMed  Google Scholar 

  10. Clouse RE, Prakash C. Topographic esophageal manometry: an emerging clinical and investigative approach. Dig Dis. 2000;18:64–74.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  12. Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sifrim D, Janssens J, Vantrappen G. Failing deglutitive inhibition in primary esophageal motility disorders. Gastroenterology. 1994;106:875–82.

    Article  CAS  PubMed  Google Scholar 

  14. Clouse RE, Staiano A, Alrakawi A. Topographic analysis of esophageal double-peaked waves. Gastroenterology. 2000;118:469–76.

    Article  CAS  PubMed  Google Scholar 

  15. Sifrim D, Janssens J, Vantrappen G. A wave of inhibition precedes primary peristaltic contractions in the human esophagus. Gastroenterology. 1992;103:876–82.

    Article  CAS  PubMed  Google Scholar 

  16. Roman S, Pandolfino JE, Chen J, et al. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107:37–45.

    Article  PubMed  Google Scholar 

  17. Roman S, Lin Z, Pandolfino JE, et al. Distal contraction latency: a measure of propagation velocity optimized for esophageal pressure topography studies. Am J Gastroenterol. 2011;106:443–51.

    Article  PubMed  Google Scholar 

  18. Borjesson M, Pilhall M, Eliasson T, et al. Esophageal visceral pain sensitivity: effects of TENS and correlation with manometric findings. Dig Dis Sci. 1998;43:1621–8.

    Article  CAS  PubMed  Google Scholar 

  19. Winslow ER, Clouse RE, Desai KM, et al. Influence of spastic motor disorders of the esophageal body on outcomes from laparoscopic antireflux surgery. Surg Endosc. 2003;17:738–45.

    Article  CAS  PubMed  Google Scholar 

  20. Kushnir VM, Prakash Gyawali C. High resolution manometry patterns distinguish acid sensitivity in non-cardiac chest pain. Neurogastroenterol Motil. 2011;23:1066–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Deschner WK, Maher KA, Cattau EL, Jr., et al. Manometric responses to balloon distention in patients with nonobstructive dysphagia. Gastroenterology 1989;97:1181–5.

    Google Scholar 

  22. Bohn B, Bonaz B, Gueddah N, et al. Oesophageal motor and sensitivity abnormalities in non-obstructive dysphagia. Eur J Gastroenterol Hepatol. 2002;14:271–7.

    Article  PubMed  Google Scholar 

  23. Akbarali HI, Hatakeyama N, Wang Q, et al. Transient outward current in opossum esophageal circular muscle. Am J Phys. 1995;268:G979–87.

    CAS  Google Scholar 

  24. Nguyen NQ, Holloway RH, Smout AJ, et al. Automated impedance-manometry analysis detects esophageal motor dysfunction in patients who have non-obstructive dysphagia with normal manometry. Neurogastroenterol Motil. 2013;25:238–45, e164.

    Article  CAS  PubMed  Google Scholar 

  25. Jung HY, Puckett JL, Bhalla V, et al. Asynchrony between the circular and the longitudinal muscle contraction in patients with nutcracker esophagus. Gastroenterology. 2005;128:1179–86.

    Article  PubMed  Google Scholar 

  26. Suntrup S, Teismann I, Wollbrink A, et al. Altered cortical swallowing processing in patients with functional dysphagia: a preliminary study. PLoS One. 2014;9:e89665.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gyawali CP, Kushnir VM. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis. Neurogastroenterol Motil. 2011;23:502–e197.

    Article  CAS  PubMed  Google Scholar 

  28. Sampath NJ, Bhargava V, Mittal RK. Genesis of multipeaked waves of the esophagus: repetitive contractions or motion artifact? Am J Physiol Gastrointest Liver Physiol. 2010;298:G927–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Clouse RE, Staiano A. Topography of normal and high-amplitude esophageal peristalsis. Am J Phys. 1993;265:G1098–107.

    CAS  Google Scholar 

  30. De Schepper HU, Ponds FA, Oors JM, et al. Distal esophageal spasm and the Chicago classification: is timing everything? Neurogastroenterol Motil. 2016;28:260–5.

    Article  PubMed  Google Scholar 

  31. Elvevi A, Mauro A, Consonni D, et al. Rapid air infusion into the oesophagus: motor response in patients with achalasia and nonobstructive dysphagia assessed with high-resolution manometry. United European Gastroenterol J. 2014;2:84–90.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Schoeman MN, Holloway RH. Secondary oesophageal peristalsis in patients with non-obstructive dysphagia. Gut. 1994;35:1523–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Carlson DA, Lin Z, Kahrilas PJ, et al. The functional lumen imaging probe detects esophageal contractility not observed with Manometry in patients with achalasia. Gastroenterology. 2015;

    Google Scholar 

  34. Richter JE, Barish CF, Castell DO. Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology. 1986;91:845–52.

    Article  CAS  PubMed  Google Scholar 

  35. Kumar N, Porter RF, Chanin JM, et al. Analysis of intersegmental trough and proximal latency of smooth muscle contraction using high-resolution esophageal manometry. J Clin Gastroenterol. 2012;​46:375–81.

    Article  PubMed  Google Scholar 

  36. Porter RF, Kumar N, Drapekin JE, et al. Fragmented esophageal smooth muscle contraction segments on high resolution manometry: a marker of esophageal hypomotility. Neurogastroenterol Motil. 2012;24:763–8, e353.

    Article  CAS  PubMed  Google Scholar 

  37. Ghosh SK, Pandolfino JE, Kwiatek MA, et al. Oesophageal peristaltic transition zone defects: real but few and far between. Neurogastroenterol Motil. 2008;20:1283–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Roman S, Lin Z, Kwiatek MA, et al. Weak peristalsis in esophageal pressure topography: classification and association with dysphagia. Am J Gastroenterol. 2011;106:349–56.

    Article  PubMed  Google Scholar 

  39. Ghosh SK, Janiak P, Fox M, et al. Physiology of the oesophageal transition zone in the presence of chronic bolus retention: studies using concurrent high resolution manometry and digital fluoroscopy. Neurogastroenterol Motil 2008;20:750–759.

    Google Scholar 

  40. Bulsiewicz WJ, Kahrilas PJ, Kwiatek MA, et al. Esophageal pressure topography criteria indicative of incomplete bolus clearance: a study using high-resolution impedance manometry. Am J Gastroenterol. 2009;104:2721–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Almansa C, Smith JA, Morris J, et al. Weak peristalsis with large breaks in chronic cough: association with poor esophageal clearance. Neurogastroenterol Motil. 2015;27:431–42.

    Article  CAS  PubMed  Google Scholar 

  42. Bredenoord AJ, Weusten BL, Curvers WL, et al. Determinants of perception of heartburn and regurgitation. Gut. 2006;55:313–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Zerbib F, Duriez A, Roman S, et al. Determinants of gastro-oesophageal reflux perception in patients with persistent symptoms despite proton pump inhibitors. Gut. 2008;57:156–60.

    Article  CAS  PubMed  Google Scholar 

  44. Pandolfino JE, Kim H, Ghosh SK, et al. High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102:1056–63.

    Article  PubMed  Google Scholar 

  45. Bredenoord AJ, Weusten BL, Timmer R, et al. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology. 2006;130:334–40.

    Article  PubMed  Google Scholar 

  46. Emerenziani S, Habib FI, Ribolsi M, et al. Effect of hiatal hernia on proximal oesophageal acid clearance in gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther. 2006;23:751–7.

    Article  CAS  PubMed  Google Scholar 

  47. Nicodeme F, Pipa-Muniz M, Khanna K, et al. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-contractile integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–60.

    Article  CAS  PubMed  Google Scholar 

  48. Gor P, Li Y, Munigala S, et al. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2015;

    Google Scholar 

  49. Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27:1175–82.

    Article  CAS  PubMed  Google Scholar 

  50. Tolone S, De Bortoli N, Marabotto E, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;

    Google Scholar 

  51. Weijenborg PW, van Hoeij FB, Smout AJ, et al. Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil. 2015;27:293–9.

    Article  CAS  PubMed  Google Scholar 

  52. Jia Y, Arenas J, Hejazi RA, et al. Frequency of jackhammer esophagus as the extreme phenotypes of esophageal Hypercontractility based on the new Chicago classification. J Clin Gastroenterol. 2016;50(8):615.

    Article  PubMed  Google Scholar 

  53. Hemmink GJ, Bredenoord AJ, Weusten BL, et al. Supragastric belching in patients with reflux symptoms. AmJGastroenterol. 2009;104:1992–7.

    Google Scholar 

  54. Kessing BF, Bredenoord AJ, Velosa M, et al. Supragastric belches are the main determinants of troublesome belching symptoms in patients with gastro-oesophageal reflux disease. In:Aliment.Pharmacol.Ther; 2012.

    Google Scholar 

  55. Tack J, Talley NJ, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466–79.

    Article  PubMed  Google Scholar 

  56. Chitkara DK, Bredenoord AJ, Talley NJ, et al. Aerophagia and rumination: recognition and therapy. CurrTreatOptionsGastroenterol. 2006;9:305–13.

    Google Scholar 

  57. Bredenoord AJ, Weusten BL, Sifrim D, et al. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut. 2004;53:1561–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kessing BF, Bredenoord AJ, Smout AJ. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol. 2014;109:52–9.

    Article  PubMed  Google Scholar 

  59. Amarnath RP, Abell TL, Malagelada JR. The rumination syndrome in adults. A characteristic manometric pattern. AnnInternMed. 1986;105:513–8.

    CAS  Google Scholar 

  60. Tutuian R, Castell DO. Rumination documented by using combined multichannel intraluminal impedance and manometry. ClinGastroenterolHepatol. 2004;2:340–3.

    Google Scholar 

  61. Rommel N, Tack J, Arts J, et al. Rumination or belching-regurgitation? Differential diagnosis using oesophageal impedance-manometry. NeurogastroenterolMotil. 2010;22:e97–104.

    Article  CAS  Google Scholar 

  62. Tucker E, Knowles K, Wright J, et al. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. AlimentPharmacolTher. 2013;37:263–74.

    CAS  Google Scholar 

  63. Kessing BF, Bredenoord AJ, Smout AJ. Gastric belching and supragastric belching are two distinct pathophysiological entities: a study using combined high-resolution manometry and impedance monitoring. Gastroenterology. 2012;142:282.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8124, St. Louis, MO, 63110, USA

    C. Prakash Gyawali M.D.

Authors
  1. C. Prakash Gyawali M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Prakash Gyawali M.D. .

Editor information

Editors and Affiliations

  1. Institute of Gastroenterology, Sheba medical Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel

    Eytan Bardan

  2. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Reza Shaker

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Prakash Gyawali, C. (2018). Nonspecific Esophageal Motility Disorders. In: Bardan, E., Shaker, R. (eds) Gastrointestinal Motility Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-59352-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59352-4_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59350-0

  • Online ISBN: 978-3-319-59352-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation