Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience

Abstract

Esophageal motility disorders (EMDs) are the main etiology of nonobstructive dysphagia (NOD), but they are underestimated in Egypt. High-resolution manometry (HRM) with Chicago Classification version 3.0 (CC v3.0) is the current gold standard diagnostic modality to assess EMD in patients with NOD. In this HRM-based study, we aimed to classify EMD among Egyptian patients and explore the relationship between the severity of symptoms and the various groups of EMD. From January 2020 to January 2021, patients with dysphagia were subjected to diagnostic workup, which included symptom questionnaire for Eckardt score, esophagogastroduodenoscopy, barium esophagogram, and HRM. All patients were categorized based on the HRM results using CC version 3.0 after exclusion of those with obstructive esophageal lesions. Of 252 patients with dysphagia, 55 patients with NOD were analyzed according to CC version 3.0. Achalasia was diagnosed in 31 patients (56.4%) (type I: 18 [58.06%]; type II: 9 [29.03%], and type III: 4 [12.9%]), 3 patients (5.5%) with esophagogastric junction outflow obstruction, 2 patients (3.6%) with absent contractility, 4 patients (7.3%) with distal esophageal spasm, 7 patients (12.7%) with ineffective esophageal motility, and 8 patients (14.5%) with normal manometry. Patients with achalasia experienced significantly high regurgitation (96.8% vs 70.8%; P = .016) compared with those without achalasia. Achalasia was the most common EMD in Egyptian patients with NOD. Eckardt score was higher in patients with outflow obstruction and major motor disorder, but it could not differentiate different categories of CC of EMD. HRM is effective in characterization of EMD.

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

“…Variances in motility patterns across different demographics might not be adequately represented. For instance, recent studies from Asia and North Africa suggest different prevalence of achalasia subtypes compared to the United States [18,19 ▪ ]…”

Unraveling Functional Dysphagia: A Game-Changing Automated Machine-Learning Diagnostic Approach

“…However, only in a minority it is likely the cause of dysphagia because uncontrolled studies show that therapeutic strategies to address EGJOO (Botox, dilation, and myotomy) do not relieve patients' symptoms. Therefore, in a significant number of patients, the cause of dysphagia remains obscure, and these patients are currently thought to have functional dysphagia, which implies sensory dysfunction of the esophagus [4][5][6][7]. The current classification system (Chicago Classification 4.0, CC) [8] employs a hierarchical algorithm to assign the HRM diagnosis.…”