Abstract
In order to determine the actual spectrum of abnormal esophageal motility, manometric patterns in 1013 consecutive tracings were established using a classification method that employs esophageal body and lower esophageal sphincter (LES) characteristics. Peristaltic performance and contraction wave parameters were measured in the esophageal body; basal pressure and relaxation were included for the LES. Nine hundred thirty (92%) of the tracings could be completely classified, and 33 different patterns were observed (15 occurring at a rate >1%). Abnormalities were most common in contraction wave parameters (661 tracings, 65%), and least common in LES relaxation (105 tracings, 10%). Patterns most typical of achalasia and diffuse esophageal spasm were found in 6.4% and 5.0% of tracings, respectively. Statistical analysis of the patterns demonstrated that significant bidirectional predictive associations between categories were restricted to features representing pathology-based motor disorders (ie, achalasia and “sclerodermaesophagus”). This systematic classification method is capable of recognizing and cataloging common findings of motor dysfunction in the esophageal body and LES as well as uncommon patterns representing traditional motility disorders. Our findings provide reference data for clinical esophageal manometry.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO: Esophageal testing in patients with non cardiac chest pain or dysphagia: Results of three years experience with 1161 patients. Ann Intern Med 106:593–597, 1987
Traube M, Albibi R, McCallum RW: High amplitude peristaltic esophageal contractions associated with chest pain. JAMA 250:2655–2659, 1983
Herrington JP, Burns TW, Balart LA: Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci 29:134–140, 1984
Clouse RE, Stainao A: Contraction abnormalities of the esophageal body in patients referred for manometry: A new approach to manometric classification. Dig Dis Sci 28:784–791, 1983
Benjamin SB, Gerhardt DC, Castell DO: High amplitude peristaltic esophageal contractions associated with chest pain and/or dysphagia. Gastroenterology 77:478–483, 1979
Vantrappen G, Clouse R, Corazziari E, Janssens J, Wienbeck M: Standardisation of oesophageal manometry: an outline of required measurements and technical standards. Gastroenterol Int 2:150–154, 1989
Dodds WJ, Hogan WJ, Stef JJ, Miller WN, Lyndom SB, Arndorfer RC: A rapid pull-through technique for measuring lower esophageal sphincter pressure. Gastroenterology 68:437–443, 1975
Aliperti G, Clouse RE: Incomplete lower esophageal sphincter (LES) relaxation in subjects without aperistalsis: Prevalence and clinical outcome. Am J Gastroenterol 1991 (in press)
Clouse RE, Lustman PJ, Reidel WL: Correlation of esophageal motility abnormalities with neuropsychiatric status in diabetics. Gastroenterology 90:1146–1154, 1986
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers: variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:5830592, 1987
SAS User's Guide: Statistics, Version 5 Edition. SAS Institute Inc, Cary, North Carolina, 1985
Sanderson DR, Ellis FH, Schlegel JF, Olsen AM: Syndrome of vigorous achalasia: Clinical and physiologic observations. Dis Chest 52:508–517, 1967
Vantrappen G, Janssen J, Hellemans J, Coremans G: Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76:450–457, 1979
Richter JE, Castell DO: Diffuse esophageal spasm: A reappraisal. Ann Intern Med 100:242–245, 1984
Schneider HA, Yonker RA, Longley S, Katz P, Mathias J, Panush RS: Scleroderma esophagus: a nonspecific entity. Ann Intern Med 100:848–849, 1984
Clouse RE: Motor disorders.In Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management. Fordtran JS, Sleisenger MH (eds). Philadelphia, WB Saunders, 1989, pp 559–593
Kahrilas PJ, Kishk SM, Helm JF, Dodds WJ, Hariq JM, Hogan WJ: Comparison of pseudoachalasia and achalasia. Am J Med 82:439–446, 1987
Castell DO, Dubois A, Davis CR, Cordova CM, Norman DO: Computer-aided analysis of human esophageal peristalsis. I. Technical description and comparison with manual analysis. Dig Dis Sci 29:65–72, 1984
Loo FD, Dodds WJ, Soergel KH, Arndorfer RC, Helm JF, Hogan WJ: Multipeaked esophageal peristaltic presure waves in patients with diabetic neuropathy. Gastroentetrology 88:485–491, 1985
Dodds WJ, Hogan WJ, Reid DP, Stewart ET, Arndorfer RC: A comparison between primary esophageal peristalsis following wet and dry swallows. J Appl Physiol 35:851–877, 1973
Meyer GW, Gerhardt DC, Castell DO: Human esophageal response to rapid swallowing: muscle refractory period or neural inhibition. Am J Physiol 241:G129-G136, 1981
Kaye MD, Wexler RM: Alteration of esophageal peristalsis by body position. Dig Dis Sci 26:897–901, 1981
Freidin N, Traube M, Mittal RK, McCallum RW: The hypertensive lower esophageal sphincter: Manometric and clinical aspects. Dig Dis Sci 34:1063–1067, 1989
Welch RW, Drake ST: Normal lower esophageal sphincter pressure: a comparison of rapid vs slow pull-through techniques. Gastroenterology 78:1446–1451, 1980
Goodall JR, Hay DJ, Temple JG: Assessment of the rapid pullthrough technique in oesophageal manometry. Gut 21:169–173, 1980
Boyle JT, Altschuler SM, Nixon TE, Tuchman DM, Pack AI, Cohen S: The role of the diaphragm in the genesis of lower esophageal sphincter pressure in the cat. Gastroenterology 88:723–730, 1985
Mittal RK, Rochester DF, McCallum RW: Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man. Gut 28:1564–1568, 1987
Dent J: A new technique for continuous sphincter pressure measurements. Gastroenterology 71:263–267, 1976
Reynolds JC, Parkman HP: Achalasia. Gastroenterol Clin North Am 18:223–255, 1989
Weihrauch TR: Esophageal manometry: Methods and Clinical Practice. Baltimore, Urban & Schwarzenberg, 1981, pp 105–109
Author information
Authors and Affiliations
Additional information
Supported in part by a grant (AMO7130) from the United States Public Health Service.
Rights and permissions
About this article
Cite this article
Clouse, R.E., Staiano, A. Manometric patterns using esophageal body and lower sphincter characteristics. Digest Dis Sci 37, 289–296 (1992). https://doi.org/10.1007/BF01308186
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01308186