Treatment Implications of High-Resolution Manometry Findings: Options for Patients With Esophageal Dysmotility

Opinion statement High-resolution manometry (HRM) has significantly impacted diagnosis and management of achalasia in particular, and has improved characterization of other motor disorders. Achalasia, the most profound esophageal motor disorder, is characterized by esophageal outflow obstruction fro...

Full description

Saved in:
Bibliographic Details
Published in:Current treatment options in gastroenterology 2014-03, Vol.12 (1), p.34-48
Main Authors: Bolkhir, Ahmed, Gyawali, C. Prakash
Format: Article
Language:English
Subjects:
Esophagus (E Dellon
Gastroenterology
Medicine
Medicine & Public Health
Section Editor
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Opinion statement High-resolution manometry (HRM) has significantly impacted diagnosis and management of achalasia in particular, and has improved characterization of other motor disorders. Achalasia, the most profound esophageal motor disorder, is characterized by esophageal outflow obstruction from abnormal relaxation of the lower esophageal sphincter (LES) during swallowing, and presents with transit symptoms (dysphagia, regurgitation). Esophageal body motor disorders include both inhibitory nerve dysfunction associated with hypermotility or spasm, and hypomotility disorders with poor contraction. The implications of hypermotility disorders are both perceptive and obstructive. On the other hand, hypomotility disorders have reflux implications because of abnormal barrier function at the LES, and abnormal bolus clearance. Esophageal outflow obstruction in achalasia responds favorably to disruption of the LES, and outcome may be predicted by HRM subtyping of achalasia. Identification of dominant (perceptive vs. obstructive) mechanisms of symptom generation help direct therapy of hypermotility disorders, while hypomotility disorders typically require management of concurrent reflux disease.
ISSN:1092-8472
1534-309X
DOI:10.1007/s11938-013-0003-6