Insights Gained From the Symptomatic Evaluation of Classification of Esophageal Motility Disorders: A Review of 4215 Patients

Abstract

Purpose: Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NC), and non specific motility disorder (NSMD), are described primary esophageal body motility disorders. The relationship between manometric diagnosis and clinical symptoms is poorly understood. The aim of this study is to examine the correlation between patient's presenting symptoms and manometric findings. Methods: Manometric findings and reported symptoms of all patients undergoing esophageal manometry and pH studies at the Creighton University Medical Center were prospectively entered in a database. Twenty-four year data was accessed and analyzed to understand symptom correlation. Results: Of the 4215 patients, 130(3.1%) had Ach, 192 (4.6%) had DES, 290 (6.9%) had NC, 508 (12.1%) had NSMD and 3095 (73.4%) had normal esophageal body motility. There is significant symptom overlap between the groups. The pattern of symptom distribution is similar in patients with Ach and DES with dysphagia correlating with increasing simultaneous waves. Patients with NC, normal body motility and NSMD predominantly presented with reflux symptoms. Twenty-four hour pH score and reflux associated symptoms are inversely related to the LES competence. Conclusion: Symptoms and manometric diagnosis do not correlate well on an individual basis. Achalasia- DES seem to be part of the same clinical spectrum. Lower esophageal sphincter competence plays an important role in preventing gastro-esophageal reflux. Treatment of GERD and its related esophageal body motility disturbances should be directed at restoring LES competence.