Straight leg raise, a new complementary test in esophageal high-resolution manometry

Loss of Peristaltic Reserve, Determined by Multiple Rapid Swallows, Is the Most Frequent Esophageal Motility Abnormality in Patients With Systemic Sclerosis.

Introduction: NCCP is defined as recurring, angina-like, retrosternal chest pain of non-cardiac origin. It has been estimated that up to 30% of the non-GERD related NCCP patients demonstrate an esophageal motor disorder using conventional manometry (CM). Thus, the aim of the study was to determine if high resolution esophageal manometry (HREM), which has become the standard of care, improved the diagnosis of esophageal motor disorders, as compared with CM, in patients with NCCP. Methods: We evaluated 300 consecutive non-GERD related NCCP patients who underwent either HREM or CM. A total of 150 patients had CM and the other 150 patients HREM. The Chicago 3 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of patients undergoing HREM and CM, respectively. Results: In both HREM and CM groups, a normal esophageal motility study was the most frequent finding (47% vs. 36%, respectively). In patients who underwent CM, the most commonly demonstrated esophageal motility disorder was hypotensive lower esophageal sphincter. Hypotensive LES was a significantly more common finding in patients undergoing CM versus HREM (27.3% vs. 4.7%, p<0.001). Other less common motility disorders seen in the CM group were nonspecific esophageal motility disorders (NEMD) (12%), nutcracker esophagus (9.3%), ineffective esophageal motility (IEM) (6.7%), achalasia (2.7%), distal esophageal spasm (DES) (5.3%), and absent contractility (0.67%). In general, hypertensive motility disorders, like DES and nutcracker esophagus, were less common than hypotensive motility disorders (15% vs. 35%, p=0.9) in NCCP patients. There was no significant difference in the number of hypertensive or hypotensive motility disorders diagnosed with CM versus those diagnosed with HREM. In the HREM group, IEM was the most commonly diagnosed motility abnormality. The likelihood of finding an IEM was significantly more common in the HREM group as compared with the CM group (25% vs. 7%, p<0.001). Other motility abnormalities that were less commonly diagnosed with HREM included: achalasia (7.3%), esophagogastric junction outflow obstruction (4%), absent contractility (4%), jackhammer/nutcracker esophagus (3.3%), DES (2.7%) and NEMD (1.3%). Conclusion: HREM did not improve the percentage and type of esophageal motor disorders diagnosed in NCCP patients as compared with CM. This is likely due to limitations of Chicago 3 classification. Normal esophageal motility remains the most common finding.

High-resolution esophageal manometry (HREM) has become a leading tool in the assessment of esophageal motor disorders, replacing conventional manometry. However, there is limited data about the contribution of HREM as compared with conventional manometry to the assessment of esophageal motor disorders in patients with non-cardiac chest pain (NCCP). The aim of the study was to compare the distribution of esophageal motor disorders in patients with NCCP using HREM as compared with conventional manometry and to determine if HREM improved diagnosis of these disorders. In this study, we included 300 consecutive patients with NCCP who underwent either HREM or conventional manometry over a period of 10years. A total of 150 patients had conventional manometry and the other 150 patients HREM. The Chicago 3.0 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of NCCP patients undergoing HREM and conventional manometry, respectively. In both HREM and the conventional manometry groups, normal esophageal motility was the most frequent finding (47% and 36%; respectively, P=.054). Hypotensive lower esophageal sphincter was the most common motility disorder identified by conventional manometry (27.3%), while ineffective esophageal motility was the most common esophageal motor disorder identified by HREM (25.3%). There is a discrepancy in the type of esophageal motor disorders identified by HREM as compared with conventional manometry in NCCP patients. Hypotensive motility disorders are the most commonly diagnosed by both manometric techniques.

Introduction: High Resolution Esophageal Manometry (HREM) is an invaluable tool for evaluation of dysphagia and chest pain and plays an important role in preoperative planning for foregut surgeries. However, the utility of serial HREMs is unclear. A few studies have reported the manometric progression of various motility disorders or treatment effects of interventions. However, there are no studies to date reporting the natural progression of normal HREM. Methods: We performed a retrospective review of all patients who had >1 HREM performed at the Cleveland Clinic from January 1, 2004 to April 1, 2016. Of these HREMs, all patients who had an abnormal index HREM were excluded. The indications, final diagnoses, and demographic features of the remaining HREMs were analyzed. Results: A total of 543 patients who underwent 1,151 HREM were analyzed. 490 (90%) patients had 2, 43 (8%) had 3, and 9 (2%) and 1 (0.2%) patients had 4 and 5 HREMs. Indications include hiatal hernia in 232 (43%), lung transplant in 140 (26%), dysphagia in 67 (12%), chest pain in 35 (6%), cough in 44 (8%), and dyspepsia in 31 (6%) patients. 338 (62%) patients were female with a mean (SD) age of 62 (13) years. 160 (29%) patients had at least one HREM which was abnormal. Abnormal diagnoses include Ineffective Esophageal Motility (IEM) in 95 (17%), nutcracker esophagus in 16 (3%), jackhammer esophagus in 15 (3%), distal esophageal spasm in 14 (3%), esophagogastric junction outflow tract obstruction in 7 (1%), and achalasia and absent contractility in 3 (0.5%) patients each. Of note, of the patients who had at least one HREM with a diagnosis of IEM, 9 patients' HREM changed from normal to IEM and back to normal. In univariate analyses, patients' age, gender, and indication were not associated with change in diagnosis. However, when time between repeat HREM was categorized into quartiles, repeat HREM between 200 and 800 days after index (RR 2.18, 95%CI 1.25-3.81, p=0.006), and more than 800 days after the index (RR 3.18, 95%CI 1.85-5.48, p < 0.001) was associated with increasingly higher chance of a change in manometry results, when compared to repeated manometries the first 100 days after the index study. Conclusion: Our data show 12% of patients develop a major disorder and a further 17% develop a minor disorder of esophageal motility after initially being diagnosed with normal HREM. Time lapsed between repeat HREMs is a risk factor for the progression of diagnosis of normal HREM into abnormal.

Dysphagia is a common symptom in children with Down syndrome and is conventionally evaluated with imaging and endoscopy; high-resolution manometry is not routinely utilized. The aim of this study was to describe and correlate pharyngeal and esophageal manometry findings with contrast studies and endoscopy in patients with Down syndrome and dysphagia. Electronic medical records of patients with Down syndrome with dysphagia seen at our center between January 2008 and January 2022 were reviewed. Data collected included demographics, co-morbidities, symptoms, imaging, endoscopy, and manometry. Twenty-four patients with Down syndrome [median age of 14.9years (IQR 7.6, 20.5), 20.8% female] met inclusion criteria. Common presenting symptoms of dysphagia included vomiting or regurgitation in 15 (62.5%) patients, and choking, gagging, or retching in 10 (41.7%) patients. Esophageal manometry was abnormal in 18/22 (81.2%) patients. The most common findings were ineffective esophageal motility in 9 (40.9%) followed by esophageal aperistalsis in 8 (36.4%) patients. Rumination pattern was noted in 5 (22.8%) patients. All 6 (25%) patients who previously had fundoplication had esophageal dysmotility. Strong agreement was noted between upper gastrointestinal studies and high-resolution esophageal manometry (p = 1.0) but no agreement was found between pharyngeal manometry and video fluoroscopic swallow studies (p = 0.041). High-resolution pharyngeal and esophageal manometry provide complementary objective data that may be critical in tailoring therapeutic strategies for managing patients with Down syndrome with dysphagia.

the early diagnosis of achalasia requires a high degree of clinical suspicion, and delays in diagnosis are frequent. High-resolution esophageal manometry (HRM) is the gold standard for its diagnostic confirmation. There are two HRM systems, perfusion and solid-state, which allow its classification into three subtypes: I, or classical; II, or with pan-esophageal pressurization; and III, or spastic. to determine the clinical and manometric characteristics of the three subtypes with high-resolution perfusion and solid-state equipment and the time of evolution until diagnosis. this was a multicenter, observational, retrospective study of patients from the INTEGRA database of the Spanish Association of Neurogastroenterology and Motility who were diagnosed with primary achalasia confirmed by HRM, who fell under the Chicago Classification v3.0, and who had not been treated. the study included 110 patients (subtype I, n = 14; subtype II, n = 73; subtype III, n = 23). The HRM equipment was perfusion for 49 and solid-state for 61. The mean age was 61.8 ± 14 years (age range 44-81), the age was lower in subtype II, and sex distribution was similar. The time of clinical evolution until diagnosis was > 12 months (51.6 %), subtype II being the one that was diagnosed earlier and the most often (66.3 %). Dysphagia was the most frequent symptom (90.5 %). According to the comparative analysis by high-resolution perfusion and solid-state esophageal manometry equipment, the baseline pressure of the lower esophageal sphincter was higher in the solid-state esophagus, but the difference was not statistically significant. The median integrated relaxation pressure at four seconds (IRP4) was similar (21 mmHg) between the perfusion and solid-state measurements. We describe the ranges of IRP4 in achalasia patients with both systems and confirm the possibility of achalasia even when IRP4 is within the normal range. achalasia in our environment has a significant diagnostic delay. No significant differences were observed in the esophagogastric junction between the two groups diagnosed with perfusion and solid-state equipment.

How to Effectively Use High-Resolution Esophageal Manometry

Objective To explore the effect of cognitive education and behavioral intervention in solid-state high resolution esophageal manometry (HRM) examination. Methods From April 2016 to June 2017, 60 patients with solid-state HRM in the gastrointestinal motility room at the First Affiliated Hospital of Jiaotong University were as the research object. The 60 patients were divided into control group and experimental group with 30 cases each by the method of random numbers. The conventional methods was used in control group to conduct informed counseling before the examination and the coordination guidance in the examination. The conventional methods and cognitive behavioral intervention was used in experimental group at the same time. The successful rate of intubation, the time used for the examination, discomfort symptoms during intubation, the patient′s satisfaction in the whole check process and self-evaluation of intubation pain experience in two groups of patients were compared. Results The time used in the experimental group examination was (28.50±8.75) min, and the control group was (33.13±5.49) min. The difference between the two groups was statistically significant (t=2.584, P=0.015). In the experimental group, the number of nausea, vomiting, and coughing in the intubation process was 11, 0, and 1, respectively, and the control group was 20, 6, and 7, respectively. The difference was statistically significant (χ2=5.406, 4.630, 5.192, all P<0.05). In the experimental group, the scores of the 2, 3, 4, 5, 7, 8, 10, 11, 12, and 13 items of the intubation pain experience self-evaluation in the examination process were (1.00±0.64), (1.37±0.85), (2.80±0.96), (1.50±0.51), (0.87±0.63), (0.77±0.50), (0.60±0.56), (1.07±0.25), (0.57±0.57), (1.50±0.63) points, and the 2, 3, 4, 5, 7, 8, 10, 11, 12 and 13 scores of the control group they were (1.50±0.51), (2.03±0.76), (3.50±0.82), (2.03±0.76), (1.20±0.61), (1.03±0.41), (0.83±0.53), (1.23±0.43), (0.87±0.57), (2.00±1.05) points, respectively. The difference was statistically significant (t=-4.130--2.140, all P<0.05). Conclusions HRM is an important test before the clinical application of a wide range of clinical applications for the detection of esophageal motility disorders and gastroesophageal reflux disease. The degree of patient cooperation with the operation directly affects the high-resolution esophageal manometry test results and self-experience. Medical staff can give patients cognitive education and behavioral intervention before examination, which can effectively reduce the symptoms and pain caused by intubation, improve patient compliance, shorten the time for examinations, improve work efficiency, and improve patient satisfaction. It is worth further promotion and application in clinical examination. Key words: Cognitive education; Behavioral intervention; High resolution esophageal pressure; Intubation discomfort; Satisfaction

BackgroundAnecdotal reports suggest that access to pH/motility testing is problematic in Canada, but to date there is little data documenting this.AimsTo assess the volume and accessibility of motility lab testing in Canada.MethodsThe CNN developed a questionnaire directed at the scope, volume and accessibility of pH/motility testing in Canadian labs. Fifty-three labs were identified using lists provided by companies that supply pH/motility recording equipment in Canada. Of these, 12 labs were excluded (10 had incorrect or absent contact information, 1 had recently closed and 1 had just opened). Questionnaires were sent in early 2020 to the remaining 41 labs, and respondents were asked to use data from their last fiscal year pre-pandemic.Results26 completed questionnaires were returned (i.e., 63% response rate, but representing ~ 51% of active labs): 23 adult units (7 community, 15 academic and 1 private) and 3 academic pediatric units. Of the adult units, 6 performed studies in children <12 yrs old. All 3 pediatric units provided both esophageal and anorectal high-resolution manometry (HRM) and pH/Impedance recording, with wait times of < 3 months. All 23 adult labs provided esophageal HRM, but just 50% performed anorectal manometry and only 3 anorectal manometry with biofeedback. Ambulatory pH/Impedance was performed in all but 1 adult unit. 15 of 23 adult centres reported access to colon transit studies and only one performed colonic manometry. No units performed antroduodenal manometry. Five units offered Bravo wireless pH recording and 4 performed ENDOFLIP. In adult units, the median number of procedures per year were as follows: esophageal HRMs - 278 (range: 50–1140); pH/impedance - 225 (range: 40–634); anorectal manometry - 90 (range: 10–450). Corresponding median wait times in months were as follows: esophageal HRM - 4 (range: 0.5–14); pH/Impedance - 4.5 (range: 0.5–14); anorectal manometry - 4.6 (range: 2–9). Only 6 of the 23 adult units met recommended wait time targets of <2 months. Testing was performed by a nurse in ~ 80% of centres, while testing was done by technicians in 2 units and physicians in 3 units. 8 units accepted referrals from primary care physicians, whereas the remainder only accepted specialist referrals. 50% screened referrals for appropriateness and restricted access accordingly.ConclusionsThe scope of motility and pH testing across Canada is variable, with lower GI testing lacking in many regions. Wait times vary significantly across labs and the majority of centres exceed recommended limits of 2 months. The reasons underlying the identified limitations to pH/motility testing access warrant further study.Funding AgenciesNone

Objective To investigate the relationship between esophageal motility and distal latency （DL） in gastroesophageal reflux disease （GERD） using high resolution manometry （HRM）. Methods A total of 51 GERD patients underwent HRM and 24 h-esophageal pH monitoring. According to the HRM to- pography （characterized as either break peristalsis or normal esophageal movement） , all GERD patients were divided into two groups ： hypomotility group（ n = 28 ） and normal group（ n = 23 ）. Fourteen non-GERD con- trols were enrolled. The monitoring results were analyzed. Results The HRM DL of 28 esophageal hypomotility patients（54. 9%, 28/51 ）were the longest（7.27± 1.44）s. Patients with normal peristalsis also had longer latency （6. 70± 1.41 ） s than the non-GERD controls （5.86 ± 0. 96 ） s. All the differences were statisti- cally significant（P 〈0. 01 ）. DCI of hypotensive peristalsis patients（712.49 ± 703.10）mmHg · s· cm was lower compared with the other groups [ （ 1 285.85 ±850. 83 ） mmHg · s· cm, （ 1 109. 74± 611.70） mmHg · s· cm] （P 〈 0. 01 ）. Other indicators such as LES pressure, CFV and IBP showed no significant differences among groups （ P 〉 0. 05 ）. Conclusion Esophageal manometry of GERD patients indicates that esophageal hypomotility is accompanied with prolonged DL. Because DL of all GERD sufferers are extended, esophageal dysmotility has great implications for GERD＇s development. Key words: Gastroesophageal reflux disease; High resolution manometry; Distal latency; Esophageal motility

Background While motility disorders may evolve over time, there is scant guidance around the role of repeat high-resolution esophageal manometry (HRM). Given the invasive nature of HRM and the implications on financial cost and patient discomfort, it is obvious that the emphasis should be on minimizing unnecessary repeat examinations. However, there are no recommendations around indications or timing of repeat HRM. Aims We aimed to determine the outcomes in patients who underwent repeat manometry and look for predictors of progression to achalasia or major motility disorder. Methods Consecutive reports from HRM studies performed between Aug 2013 – May 2017 were retrospectively analyzed. All patients with ≥ 2 HRM studies were included. Studies without a Chicago classification diagnosis were excluded. Chi-squared analysis was performed to determine if initial HRM diagnosis was associated with change in diagnosis on follow-up HRM. Initial and follow-up manometric parameters were compared with paired T-tests. Binary logistic regression analysis was performed to look for predictors of progression to achalasia or major motility disorder. Results 134 patients underwent ≥ 2 HRM studies. Initial diagnoses were IEM (45 patients [33.6%], EGJOO (34 [25.4%], absent peristalsis (18 [13.4%], achalasia (11 [8.2%], DES (4 [3.0%]), and JH (3 [2.2%]; 29 (14.2%) of patients had a normal HRM. 109 (81.3%) patients underwent 2 HRM, 18 (13.4%) 3 HRM, 4 (3%) 4 HRM, and 3 (2.2%) 5 HRM. The final follow-up HRM occurred after a median 496 [80 – 1823] days. 72 (53.7%) of patients had no change from their initial diagnosis. Patients with an initial diagnosis of DES were significantly more likely to have a change in diagnosis on the final follow-up (3 normal:1 IEM) (p = .043). No other classes reached significance. Patients with IEM had a significantly higher mean DCI (395.1 [0 - 3248] vs 790.8 [0 – 10715.0], p = .006) and IRP (4.5 [-10.4 – 14.2] vs [6.6 [-6.2 – 21.0], p = .017) on their follow-up HRM. 4 patients without achalasia (3 EGJOO:1 IEM) on their index HRM had a diagnosis of achalasia on their final HRM. The median IRP in non-achalasia patients with a diagnosis of achalasia on final HRM (22.3 [8.4 – 30.7] was significantly higher than those without a diagnosis of achalasia on final HRM (6.6 [-10.4 – 39.8]) (p = .013); however no manometric criteria or initial HRM diagnoses predicted progression to achalasia or major motility disorder on binary logistic regression analysis. Conclusions In most patients, repeat manometry did not change the manometric diagnosis. Patients with DES were significantly likely to have their diagnosis change with repeat HRM, and most of these patients had normalization of their HRM. Manometric parameters in IEM appear to improve over time. This finding could reflect interval therapy, or shed some light on the natural history of this disease. Funding Agencies None

Objective To analyze the effects of different food bolus on esophageal motility in patients with non-obstructive esophageal dyshagia by high-resolution esophageal manometry. Methods From March 2014 to June 2015, 48 patients with non-obstructive esophageal dysphagia and 12 healthy volunteers (healthy control group) were enrolled. High-resolution manometry was tested when swallowing liquid food, semisolid food and solid food. The lower esophageal sphincter pressure (LESP), 4 second integrated relaxation pressure (4 s IRP), distal contractile integral (DCI), distal latency (DL), and breaks were analyzed. T test was performed for statistical analysis. Results According to the 2014 Chicago classification standard, among 48 patients with dysphagia, esophageal dysmotility was diagnosed in 35 patients (72.9%), while 13 patients (27.1%) had normal esophageal motility, and the most common type of esophageal motility disorder was ineffective esophageal motility (31.2%, 15/48). The LESP of the healthy control group was (10.85±3.75) mmHg (1 mmHg=0.133 kPa) and 4 s IRP was (1.90±0.84) mmHg. The LESP of dysphagia group was (12.20±8.93) mmHg and 4 s IRP was (3.25±1.02) mmHg. There was no significant difference in LESP and 4 s IRP between two groups (both P>0.05). The DCIs of liquid swallows, semisolid swallows and solid swallows of healthy control group were (589.00±292.90), (690.17±52.41) and (808.00±448.53) mmHg·s·cm, respectively, which were significantly lower than those of complete normal group in Chicago classification ((1 346.62±244.83), (1 542.46±231.19) and (1 890.31±363.26) mmHg·s·cm; t=4.76, 4.68 and 3.79; all P=0.001). The DL of solid swallows of healthy control group was (7.72±1.15) s, which was significantly lower than that of complete normal group in Chicago classification ((9.00±1.23) s; t=2.61, P=0.021). The breaks of liquid swallows, semisolid swallows and solid swallows of healthy control group were (2.33±1.74), (2.37±1.72) and (1.53±1.22) cm, respectively, which were higher than those of complete normal group in Chicago classification ((0.58±0.48), (0.52±0.47) and (0.85±0.53) cm), and the differences were statistically significant (t=3.02, 3.68 and 2.54, all P<0.05). Conclusions The most common type of esophageal motility disorder in patients with non-obstructive esophageal dysphagia is ineffective esophageal molitity. When swallowing food, the patients with dysphagia but normal results of esophageal manometry according to Chicago classification require more strength of the esophagus, more complete contraction and longer peristaltic time to swallow food bolus. Key words: High-resolution esophageal manometry; Non-obstructive esophageal dysphagia; Different food bolus swallow

High-resolution oesophageal manometry (HROM) and anorectal manometry (ARM) are invaluable diagnostic tools that significantly enhance our understanding of complex paediatric gastrointestinal (GI) motility disorders, providing detailed information into the neuromuscular...

Aim:To assess the correlation of symptoms with findings on esophageal high-resolution manometry (HRM) in Indian patients.Materials and methods:Prospective data collection of all patients undergoing esophageal manometry was done at two centers in India—Indore and Chennai—over a period of 18 months. Symptom profile of the study group was divided into four: Motor dysphagia, noncardiac chest pain (NCCP), gastroesophageal reflux (GER), and esophageal belchers. The symptoms were correlated with manometric findings.Results:Of the study group (154), 35.71% patients had a normal study, while major and minor peristaltic disorders were noted in 31.16 and 33.76% respectively. In patients with symptoms of dysphagia, achalasia cardia was the commonest cause (45.1%), followed by ineffective esophageal motility (IEM) (22.53%) and normal study (19.71%). In patients with NCCP, normal peristalsis (50%) and ineffective motility (31.25%) formed the major diagnosis. Of the 56 patients with GER symptoms, 26 (46.4%) had normal manometry. An equal number had ineffective motility. Of the 11 esophageal belchers, 7 (63.6%) of these had a normal study and 3 had major motility disorder. Dysphagia was the only symptom to have a high likelihood ratio and positive predictive value to pick up major motility disorder.Conclusion:Dysphagia correlates with high chance to pick up a major peristaltic abnormality in motor dysphagia. The role of manometry in other symptoms in Indian setting needs to be ascertained by larger studies.Clinical significance:The present study highlights lack of symptom correlation with manometry findings in Indian patients.How to cite this article: Jain M, Srinivas M, Bawane P, Venkataraman J. Does Chicago Classification address Symptom Correlation with High-resolution Esophageal Manometry? Euroasian J Hepato-Gastroenterol 2017;7(2):122-125.

Objective To analyze the distribution and esophageal motility characteristics of patients with non obstructive dysphagia (NOD).Methods From June 2010 to June 2012,ninety seven patients with a sense of obstruction when swallowing were selected and patients with esophageal organic stenosis was excluded through endoscopic examination and upper gastrointestinal radiography.While nine healthy volunteers were recruited as healthy control.High-resolution esophageal manometry was performed with high-resolution multi-channel Netherlands CTD Synectics gastrointestinal function monitoring system (Pcpolygraf polysomnography recording system) and MMS digestive power detection system.The observation parameter included upper esophageal sphincter pressure (UESP),upper esophageal sphincter relaxation rate (UESRR),the length of the lower esophageal sphincter (LESL),lower esophageal sphincter pressure (LESP),intergrated relaxation pressure (IRP),lower esophageal sphincter relaxation rate (LESRR),esophageal subordinate segments pressure and esophageal effective peristalsis ratio.The rank sum test was performed for comparison between groups.Results Among 97 patients with NOD,the percentage of achalasia,nonspecific esophageal motor disorder andgastroesophageal reflux disease (GERD) was 41.2％ (40/97),39.2％ (38/97)and 19.6％(19/97),respectively.Among patients with nonspecific esophageal motor disorder,the percentage of abnormal peristalsis,absent peristalsis,normal pressure and distal esophegesl spasm was 39.5％(15/38),36.8％(14/38),15.8％(6/38) and 7.9％(3/38),respectively.The differences in lESL,LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio among achalasia,GERD,nonspecific esophageal motor disorder and healthy control were statistically significant (F 6.143,57.490,50.559,10.155 and 22.046,all P＜0.05).LESP oF patients with achalasia was higher than that of healthy control,however LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control and the differences were statistically significant (F 2.276,11.113,-8.036 and -14.663,all P＜0.05).LESL and LESP of achalasia were both higher than those of GERD group,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of GERD group and the differences were statistically significant (F=4.325,15.983,-19.235,-3.410 and-4.351,all P＜0.05).LESL and LESP of achalasia group both were higher than those of nonspecific esophageal motor disorder group,LESRR and esophageal effective peristalsis ratio were both lower than those of GERD group and the differences were statistically significant (F=2.376,7.668,2.873 and-3.873,all P＜0.05).LESRR of GERDgroup was higher than that of healthy control group,LESL,LESP,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control group and the differences were statistically significant (F=5.931,-2.483,-14.618,-3.071 and-4.516,all P＜0.05).LESL and LESP of GERD group were both lower than those of nonspecific esophageal motor disorder group,LESRR was higher than that of nonspecific esophageal motor disorder group and the differences were statistically significant (F =--2.113,6.578 and 10.979,all P ＜ 0.05).LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio of nonspecific esophageal motor disorder group were all lower than those of healthy control group and the differences were statistically significant (F=-6.313,-3.580,-3.511 and-8.150,all P＜0.05).IRP of 40 patients with achalasia were all beyond the normal range.Conclusions NOD mainly included achalasia,nonspecific esophageal motor disorder and GERD.The reduction of effective esophageal peristalsis may be an important pathophysiological mechanism of NOD. Key words: Manometry; Deglutition disorders; Esophageal achalasia; Gastroesophageal reflux