Esophageal Motility Disorders

ClassificationTop

Classification of esophageal motility disorders based on the underlying cause:

1) Primary: Achalasia (type I, II, and III); major disorders of esophageal peristalsis including distal esophageal spasm (formerly diffuse esophageal spasm) and hypercontractile (jackhammer) esophagus (previously nutcracker esophagus); other nonspecific abnormal motility patterns.

2) Secondary: In the course of chronic gastroesophageal reflux disease (GERD), scleroderma, diabetes mellitus, eosinophilic esophagitis, alcohol use disorder, psychiatric disorders, Chagas disease, malignancy such as paraneoplastic syndrome, and associated with aging.

Chicago classification of esophageal motility disorders based on the result of high-resolution manometry:

1) Lower esophageal sphincter (LES): Incomplete relaxation of the LES in achalasia or outflow obstruction of the esophagus-gastric junction, hypotensive LES in GERD, hiatal hernia, hypertensive LES, transit LES relaxation.

2) Significant esophageal body disorders: Loss of peristalsis in achalasia, distal esophageal spasm (formerly diffuse esophageal spasm), and hypercontractile (jackhammer) esophagus (previously nutcracker esophagus).

3) Mild motor disorders: Ineffective esophageal motility or segmental peristalsis.

4) Normal esophageal peristalsis.

5) Upper esophageal sphincter (UES): Hypotensive UES, incomplete relaxation of UES, cricopharyngeal bar, UES spasm, poor coordination of UES and surrounding muscles.