A Case of Symptomatic Diffuse Esophageal Spasm During Multiple Rapid Swallowing Test on High-Resolution Manometry

The pathophysiology of esophageal epiphrenic diverticula is still uncertain even though a concomitant motility disorder is found in the majority of patients in different series. High resolution manometry may allow detection of motor abnormalities in a higher number of patients with esophageal epiphrenic diverticula compared with conventional manometry. This study aims to evaluate the high resolution manometry findings in patients with esophageal epiphrenic diverticula. Nine individuals (mean age 63 ± 10 years, 4 females) with esophageal epiphrenic diverticula underwent high resolution manometry. A single diverticulum was observed in eight patients and multiple diverticula in one. Visual analysis of conventional tracings and color pressure plots for identification of segmental abnormalities was performed by two researchers experienced in high resolution manometry. Upper esophageal sphincter was normal in all patients. Esophageal body was abnormal in eight patients; lower esophageal sphincter was abnormal in seven patients. Named esophageal motility disorders were found in seven patients: achalasia in six, diffuse esophageal spasm in one. In one patient, a segmental hypercontractile zone was noticed with pressure of 196 mm Hg. High resolution manometry demonstrated motor abnormalities in all patients with esophageal epiphrenic diverticula.

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Sa1320 Manometric Correlates of Radiographic Esophageal Spasm: A Comparison Between the Chicago Classification and Conventional Criteria Using High Resolution Manometry

Gastroenterology ◽

10.1016/s0016-5085(13)60925-7 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-261-S-262

Author(s):

Kunjal Gandhi ◽

Elizabeth S. Rosenblatt ◽

Sameer Dhalla ◽

Victor Chedid ◽

Ellen M. Stein ◽

...

Keyword(s):

High Resolution ◽

High Resolution Manometry ◽

Chicago Classification ◽

Esophageal Spasm

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Esophageal Dysmotility in Patients following Total Laryngectomy

Otolaryngology ◽

10.1177/0194599817736507 ◽

2017 ◽

Vol 158 (2) ◽

pp. 323-330 ◽

Cited By ~ 3

Author(s):

Teng Zhang ◽

Julia Maclean ◽

Michal Szczesniak ◽

Paul P. Bertrand ◽

Harry Quon ◽

...

Keyword(s):

Total Laryngectomy ◽

Clinical History ◽

Cross Sectional Study ◽

Diffuse Esophageal Spasm ◽

Esophageal Dysmotility ◽

Cross Sectional ◽

High Resolution Manometry ◽

Esophageal Clearance ◽

Esophageal Spasm ◽

Motor Abnormalities

Objectives Dysphagia is common in total laryngectomees, with some symptoms suggesting esophageal dysmotility. Tracheoesophageal (TE) phonation requires effective esophagopharyngeal air passage. Hence, esophageal dysmotility may affect deglutition or TE phonation. This study aimed to determine (1) the characteristics of esophageal dysmotility in laryngectomees, (2) whether clinical history is sensitive in detecting esophageal dysmotility, and (3) the relationship between esophageal dysmotility and TE prosthesis dysfunction. Study Design Multidisciplinary cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods For 31 participants undergone total laryngectomy 1 to 12 years prior, clinical histories were taken by a gastroenterologist and a speech pathologist experienced in managing dysphagia. Esophageal high-resolution manometry was performed and analyzed using Chicago Classification v3.0. Results Interpretable manometric studies were obtained in 23 (1 normal manometry). Esophageal dysmotility patterns included achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and other major (30%) and minor (50%) peristaltic disorders. The sensitivity of predicting any esophageal dysmotility was 28%, but it is noteworthy that patients with achalasia and diffuse esophageal spasm (DES) were predicted. Two of 4 participants with TE puncture leakage had poor esophageal clearance. Of 20 TE speakers, 12 had voice problems, no correlation between poor voice, and any dysmotility pattern. Conclusions Peristaltic and lower esophageal sphincter dysfunction are common in laryngectomees. Clinical history, while not predictive of minor motor abnormalities, predicted correctly cases with treatable spastic motor disorders. Dysmotility was not associated with poor phonation, although TE puncture leakage might be linked to poor esophageal clearance. Esophageal dysmotility should be considered in the laryngectomees with persisting dysphagia or leaking TE puncture.

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Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report

BMC Gastroenterology ◽

10.1186/s12876-021-01808-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Apichet Sirinawasatien ◽

Pallop Sakulthongthawin

Keyword(s):

Chest Pain ◽

High Resolution ◽

Gastrointestinal Endoscopy ◽

Motility Disorder ◽

Upper Gastrointestinal Endoscopy ◽

Channel Blockers ◽

Esophageal Motility Disorder ◽

High Resolution Manometry ◽

Esophageal Spasm ◽

Upper Gastrointestinal

Abstract Background Jackhammer esophagus is a rare esophageal motility disorder that can result in dysphagia, chest pain, and gastro-esophageal reflux symptoms. High-resolution manometry is the gold standard for diagnosis, while corkscrew esophagus on upper gastrointestinal endoscopy is an uncommon manifestation. Case presentation 72-year-old man who presented with progressive dysphagia for three months without symptoms of chest pain or heartburn. Initial workup showed a corkscrew esophagus on upper gastrointestinal endoscopy; subsequently, high-resolution manometry revealed an esophago-gastric junction outflow obstruction with hypercontractile (jackhammer) esophagus. Treatment with calcium channel blockers and proton pump inhibitors was successful and relieved his symptoms near completion. Conclusions Even though the corkscrew esophagus is typically for distal esophageal spasm, the hypercontractile (jackhammer) esophagus can appear. The high-resolution manometry can help to distinguish each specific motility disorder.

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Distal esophageal spasm: Update on diagnosis and management in the era of high-resolution manometry

World Journal of Clinical Cases ◽

10.12998/wjcc.v8.i6.1026 ◽

2020 ◽

Vol 8 (6) ◽

pp. 1026-1032

Author(s):

Harika Gorti ◽

Salih Samo ◽

Nikrad Shahnavaz ◽

Emad Qayed

Keyword(s):

High Resolution ◽

High Resolution Manometry ◽

Diagnosis And Management ◽

Esophageal Spasm

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373 ESOPHAGEAL BODY PERISTALSIS IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER: ARE VIDEO ESOPHAGOGRAM AND HIGH-RESOLUTION MANOMETRY IN AGREEMENT?

Diseases of the Esophagus ◽

10.1093/dote/doaa087.90 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

D Razia ◽

L Giulini ◽

R Bremner ◽

S Mittal

Keyword(s):

High Resolution ◽

Lower Esophageal Sphincter ◽

Prone Position ◽

Transit Time ◽

Bolus Transit ◽

High Resolution Manometry ◽

Esophageal Body ◽

Esophageal Clearance ◽

Esophageal Spasm ◽

Esophageal Sphincter

Abstract Peristaltic disorders of the esophageal body have been categorized according to how they appear on high-resolution manometry. Abnormalities in peristalsis may lead to abnormal esophageal clearance and dysphagia. The aim of our retrospective analysis was to study bolus transit patterns on barium esophagogram in patients with various grades of esophageal body peristalsis as diagnosed by high-resolution manometry. Methods After Institutional Review Board approval, we queried an esophageal center database to identify patients with normal lower esophageal sphincter parameters. Patients with jackhammer esophagus, esophageal spasm, previous foregut surgery, hiatal hernia, and fragmented peristalsis were excluded. Remaining patients were divided into 11 groups based on their percentages of normal swallows out of 10 swallows (0%–100% swallows normal, DCI > 450 mmHg.s.cm). All previously obtained video esophagograms were re-evaluated in blinded fashion. Bolus transit time through the esophagus was measured in upright and prone positions, using live time stamps at the entry and exit of the bolus. ANOVA and χ2 were used. Results In total, 146 patients were included in the analysis. 73 (50%) were men. Mean age and body mass index were 58.4 ± 14.7 years and 22.8 ± 10.4 kg/m2, respectively. Bolus transit time in prone-position swallows increased in tandem with increases in number of abnormal swallows (11.3 ± 3.7, 22 ± 15.5, 29.5 ± 24.3, 42.7 ± 39.5, 42.4 ± 46.9, 64 ± 70.8, 59.4 ± 34.6, 58.8 ± 37.9, 110 ± 66.6, 83.2 ± 49.6 and 105.6 ± 72.5 seconds, p < 0.0001) but no difference was noted in upright-position bolus transit time (p = 0.317). There was a dropoff in level of significance at Group 5 (60% swallows normal) compared to Group 11 (absent contractility), after which there were no inter-group differences (Fig. 1). Conclusion Bolus transit time in prone-position swallows progressively increases as percentage of normal swallows decreases. Further work associated with symptoms to define a cutoff between normal and ineffective peristalsis would be useful.

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A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

Einstein (São Paulo) ◽

10.1590/s1679-45082016md3444 ◽

2016 ◽

Vol 14 (3) ◽

pp. 439-442 ◽

Cited By ~ 8

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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Changes in high-resolution manometric diagnosis over time: implications for clinical decision-making

Diseases of the Esophagus ◽

10.1093/dote/doz094 ◽

2020 ◽

Vol 33 (3) ◽

Author(s):

George Triadafilopoulos ◽

Afrin Kamal ◽

Thomas Zikos ◽

Linda Nguyen ◽

John O Clarke

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Clinical Decision Making ◽

Clinical Decision ◽

Primary Objective ◽

Diffuse Esophageal Spasm ◽

Ineffective Esophageal Motility ◽

Esophageal Spasm ◽

The Stability ◽

Over Time

Summary Although High resolution esophageal manometry (HRM) is the gold standard to assess esophageal motility, little is known about the stability of the manometric diagnosis over time and its implications for management. To assess the stability and usefulness of repeat HRM in patients presenting with esophageal symptoms over time we performed this retrospective study of patients with esophageal symptoms. Medical records, questionnaires, and HRM tracing were independently reviewed using the Chicago classification. The primary objective was to assess the stability of the manometric diagnosis over time; secondary objective was its change (positive or negative). At least one repeat study was performed in 86 patients (36% women, ages 20–86, with mild to moderate symptoms), while 26 had a third procedure. Mean intervals between studies were 15 ± 1.6 months (for baseline v. first study) and 13 ± 0.8 months (for second to third study). Of the 27 patients initially with a normal study, 11 changed (five had esophago-gastric junction outflow obstruction [EGJOO], two diffuse esophageal spasm [DES], one jackhammer esophagus [JE], and three ineffective esophageal motility [IEM] [41% change]). Of the 24 patients with initial EGJOO, only nine retained it (65.2% change). Of nine patients with initial DES, four changed (44.4% change). Similarly, different diagnosis was seen in 7 of 24 initial IEM patients (22.7% change). Only one patient had achalasia initially and this remained stable. Additional changes were noted on a third HRM. Fluidity in the HRM diagnosis over time questions its validity at any timepoint and raises doubts about the need for intervention.

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