Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification

2021 ◽  
Vol 1 (3) ◽  
pp. 254-262
Author(s):  
Mario Costantini ◽  
Renato Salvador ◽  
Andrea Costantini
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Current Knowledge ◽  
Unexpected Finding ◽  
Diffuse Esophageal Spasm ◽  
Extreme Caution ◽  
Motility Disorders ◽  
Diagnosis And Management ◽  
Chicago Classification ◽  
Esophageal Spasm

Spastic esophageal motility disorders are represented, as per the Chicago classification 4.0, by diffuse esophageal spasm and hypercontractile esophagus. They are very rare and therefore poorly understood. The diagnosis is usually made by manometry in presence of dysphagia or chest pain, but often it is often an unexpected finding. In this paper, the authors review the current knowledge and possible treatments of these disorders, when needed. They underline that invasive treatments, as surgical myotomy or POEM, are rarely necessary and that the indications for them are based on low quality studies. Therefore, they should be used with extreme caution in treating spastic motility disorders other than achalasia.

Dysphagia

2019 ◽  
Author(s):  
R. Sudhir Sundaresan ◽  
Anna L. McGuire
Keyword(s):  
Eosinophilic Esophagitis ◽  
Diagnostic Tests ◽  
Esophageal Motility ◽  
Esophageal Motility Disorders ◽  
Caustic Ingestion ◽  
Diffuse Esophageal Spasm ◽  
Epiphrenic Diverticulum ◽  
Motility Disorders ◽  
Esophageal Spasm ◽  
Schatzki Ring

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia.  This review contains 13 figures, 12 tables, and 68 references.  Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

scholarly journals Primary esophageal motility disorders: Concise review for clinicians

2006 ◽  
Vol 53 (3) ◽  
pp. 9-17 ◽  
Author(s):  
A. Simic ◽  
Z. Raznatovic ◽  
O. Skrobic ◽  
P. Pesko
Keyword(s):  
Esophageal Motility ◽  
Wide Spectrum ◽  
The Other ◽  
Esophageal Motility Disorders ◽  
Diffuse Esophageal Spasm ◽  
Nutcracker Esophagus ◽  
Motility Disorders ◽  
Esophageal Spasm ◽  
Concise Review ◽  
Primary Esophageal Motility Disorders

Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Some, such as achalasia, are diseases with a well defined pathology, characteristic manometric features, and good response to treatments directed towards the palliation of symptoms. Other disorders, such as diffuse esophageal spasm and nutcracker esophagus, have no well defined pathology and could represent a range of motility abnormalities associated with subtle neuropathic changes, gastresophageal reflux and anxiety states. On the other hand, hypocontracting esophagus is generally caused by weak musculature commonly associated with gastresophageal reflux disease. Although manometric patterns have been defined for these disorders, the relation with symptoms is poorly defined and in some cases the response to medical or surgical therapy unpredictable. The aim of this paper is to present a wide spectrum of the primary esophageal motility disorders, as well as to give a concise review for the clinicians encountering these specific diseases. .

Dysphagia

2019 ◽  
Author(s):  
R. Sudhir Sundaresan ◽  
Anna L. McGuire
Keyword(s):  
Eosinophilic Esophagitis ◽  
Diagnostic Tests ◽  
Esophageal Motility ◽  
Esophageal Motility Disorders ◽  
Caustic Ingestion ◽  
Diffuse Esophageal Spasm ◽  
Epiphrenic Diverticulum ◽  
Motility Disorders ◽  
Esophageal Spasm ◽  
Schatzki Ring

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia.  This review contains 13 figures, 12 tables, and 68 references.  Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

scholarly journals A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

2016 ◽  
Vol 14 (3) ◽  
pp. 439-442 ◽  
Author(s):  
Fernando Augusto Herbella ◽  
Priscila Rodrigues Armijo ◽  
Marco Giuseppe Patti
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Chicago Classification ◽  
Esophageal Spasm ◽  
Pictorial Presentation

ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.

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