Esophageal Motility Disorders

Highresolution manometry (HRM), along with recently devised analysis algorithms characterized in the Chicago classification, has led to a major restructuring of the classification of esophageal motility disorders. The widespread use of HRM has led to better characterization of the motor features of achalasia. Per-oral endoscopic myotomy (POEM) is a relatively new technique for the treatment of achalasia, developed to reduce the invasiveness of the myotomy. Most of the treatments used for achalasia have also been used for spastic motility disorders: calcium channel blockers, nitrates, endoscopic botulinum toxin injection, pneumatic dilation, POEM, and surgical myotomy. Many experts believe the first-line treatment of spastic esophageal disorders is with proton pump inhibitors directed at reflux disease because most esophageal chest pain is attributable to reflux rather than spasm. Distal esophageal spasm and jackhammer esophagus are rare causes of dysphagia and chest pain.