Diagnosis and Management of Esophageal Motility Disorders Beyond Achalasia

Abstract

Abstract High-resolution esophageal manometry (HREM) is the gold standard for the diagnosis of esophageal motility disorders. Achalasia cardia has been the most extensively studied esophageal motility disorder. However, nonachalasia esophageal motility disorders are common too. The present review highlights the diagnosis and management strategies for these disorders. HREM needs to be complemented with clinical symptoms and timed barium esophagogram/functional lumen imaging probe to properly diagnose spastic and hypomotility disorders. Use of Indian normative values is essential to identify patients with these motility disorders accurately. Adjunctive tests such as multiple rapid swallows and rapid drink challenge increase the diagnostic accuracy of HREM studies. HREM is mainly useful in reflux patients with refractory symptoms and for preoperative assessment. Its role in postsurgical cases is evolving.