Clinical Use of Ambulatory 24-H Esophageal Motility Monitoring in the Evaluation of Patients with Primary Esophageal Motor Disorders

  • Hubert J. Stein
  • Tom R. DeMeester
Conference paper


Motor abnormalities of the esophageal body are frequently implicated as the cause of dysphagia, regurgitation, or non-cardiac chest pain [1–4]. The diagnosis and classification of esophageal motor abnormalities and the proof of a causal relation between the abnormality and a symptom has, however, been difficult in the past for the following reasons: First, there usually is no reliable mucosal lesion that can be observed on endoscopy to indicate the presence of an esophageal motor disorder; second, roentgenographic signs of esophageal motor disorders occur only in advanced disease; third, the current “gold-standard” for the diagnosis of esophageal motor disorders, i.e., stationary esophageal manometry, has several shortcomings—it is performed in a laboratory environment with the patient in a supine position, the analysis is based on the motor response to ten wet or dry swallows only, and intermittent motor abnormalities may be missed; fourth, the current classification of motor disorders is controversial, and does not allow for the quantitation of the severity of the abnormality; fifth, spontaneous symptoms rarely occur during a short-term stationary motility study; and sixth, the use of provocative tests, i.e., acid perfusion, administration of tensilon, or balloon distention, to reproduce the patient’s symptoms is not helpful since most of these tests have a low yield, symptoms are reproduced with unphysiologic stimuli, the endpoint is based on the patients symptom perception, and the results do not correlate with motility abnormalities associated with spontaneously occurring symptoms [4–6].


Esophageal Motility Diffuse Esophageal Spasm Nutcracker Esophagus Esophageal Myotomy Esophageal Motor Function 
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  1. 1.
    Vantrappen G, Janssens J, Hellemans J, et al (1979) Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76: 450–457PubMedGoogle Scholar
  2. 2.
    Hennington JP, Burns TW, Balart LA (1984) Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci 29: 134–140CrossRefGoogle Scholar
  3. 3.
    Brand DL, Martin D, Pope CE (1977) Esophageal manometries in patients with angina type chest pain. Am J Dig Dis 23: 300–304CrossRefGoogle Scholar
  4. 4.
    Katz PO, Dalton CB, Richter JE, et al (1987) Esophageal testing of patients with non-cardiac chest pain or dysphagia. Ann Int Med 106: 593–597PubMedGoogle Scholar
  5. 5.
    Stein HJ, DeMeester TR, Hinder, RA (1992) Outpatient physiological testing and surgical management of foregut motor disorders. Current Problems Surg 29: 415–555CrossRefGoogle Scholar
  6. 6.
    Hewson EG, Dalton CB, Richter JE (1990) Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 35: 320–309CrossRefGoogle Scholar
  7. 7.
    DeMeester TR (1982) Surgery for esophageal motor disorders. Ann Thorac Surg 34: 225–229PubMedCrossRefGoogle Scholar
  8. 8.
    Peters L, Maas L, Petty D, et al (1988) Spontaneous non-cardiac chest pain. Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94: 878–886PubMedGoogle Scholar
  9. 9.
    Eypasch EP, Stein HJ, DeMeester TR, et al (1990) A new technique to define and clarify esophageal motor disorders. Am J Surg 159: 144–151PubMedCrossRefGoogle Scholar
  10. 10.
    Stein HJ, DeMeester TR (1992) Integrated 24-hour ambulatory foregut monitoring in patients with complex foregut symptoms. Surg Ann 24: 161–180Google Scholar
  11. 11.
    Stein HJ, DeMeester TR, Eypasch EP, Klingman RP (1991) Ambulatory 24-hour esophageal manometry in the evaluation of esophageal motor disorders and non-cardiac chest pain. Surgery 110: 753–763PubMedGoogle Scholar
  12. 12.
    Castell DO, Richter JE, Dalton CB (eds) (1987) Esophageal motility testing. Elsevier, New YorkGoogle Scholar
  13. 13.
    Stein HJ, Eypasch EP, DeMeester TR, Smyrk TC, Attwood SEA (1990) Circadian esophageal motor function in patients with gastroesophageal reflux disease. Surgery 108: 769–778PubMedGoogle Scholar
  14. 14.
    Stein HJ, DeMeester TR (1991) Evaluation of esophageal motor disorders: 24-hour ambulatory esophageal motility monitoring. Gastroenterology International 4: 60–64Google Scholar
  15. 15.
    Clouse RE, Lustman JJ (1983) Psychiatric illnpss and contraction abnormalities of the esophagus. N Engl J Med 309: 1337–1342PubMedCrossRefGoogle Scholar
  16. 16.
    Singh S, Stein HJ, DeMeester TR, Hinder RA (1992) Non-obstructive dysphagia in gastroesophageal reflux disease—A study with combined ambulatory pH and motility monitoring. Am J Gastroenter 87: 562–567PubMedGoogle Scholar
  17. 17.
    Janssens J, Vantrappen G, Ghillebert G (1986) Twenty-four-hour recording of esophageal pressure and pH in patients with non-cardiac chest pain. Gastroenterology 90: 1978–1984PubMedGoogle Scholar
  18. 18.
    MacKenzie J, Belch J, Land D, Park R, McKillop J (1988) Oesophageal ischaemia in motility disorders associated with chest pain. Lancet II 592–595Google Scholar
  19. 19.
    Stein HJ, Eypasch EP, DeMeester TR (1989) “Esophageal claudication” as the cause of chest pain in diffuse spasm and nutcracker esophagus? Gastroenterology 96:A491Google Scholar
  20. 20.
    Stein HJ, DeMeester TR (1992) Therapy of non-cardiac chest pain: Is there a role for surgery? Am J Med 92: 122S–126SPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1993

Authors and Affiliations

  • Hubert J. Stein
    • 1
  • Tom R. DeMeester
    • 2
  1. 1.Klinikum rechts der IsarTU MünchenMünchenGermany
  2. 2.Department of SurgeryUniversity of Southern California School of MedicineLos AngelesUSA

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