Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology

Abstract

High-resolution manometry (HRM) and peroral endoscopic myotomy (POEM) have contributed significantly to the field of esophageal motility disorders in recent years. The development of HRM has categorized various esophageal motility disorders with a focus on a diverse range of manometric anomalies. Additionally, the Chicago classification criteria is widely used for manometric diagnosis. Moreover, POEM was introduced as a minimally invasive radical therapy for achalasia and shows promise for other spastic esophageal motility disorders as well. POEM has also enabled a transluminal endoscopic approach for determining the histology of the esophageal muscle layer, which is expected to assist in elucidating the etiology of disorders associated with esophageal motility. The purpose of this review is to update the diagnosis, pathology, and treatment of esophageal motility disorders, with a focus on the recent advances in this field.

Markedly Effective Steroid Treatment of Three Patients with Allergy-related Jackhammer Esophagus

“…Sato et al (16) proposed EoEM as a subtype of EoE. EoEM is not seen in eosinophil invasion of the esophageal epithelium; instead, it is localized in the esophageal muscle layers.…”

Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease

“…Moreover, manometry should also be included in the diagnostic workup as it has the sensitivity to identify the problem according to its pathophysiology (nerve and muscle injury of the lower esophageal sphincter) and is considered a diagnostic gold standard 14 . Manometry is essential for pre-operative evaluations since the type of operation is defined depending on the function of the esophagus thus avoiding very tight anti-flow valves that lead to dysphagia or incompetent valves that will lead to gastroesophageal reflux after myotomy 15 . However, many health institutions do use manometry, which delays a correct diagnosis.…”

Secondary Achalasia in Myotonic Dystrophy May Have a Different Pathology and Management

“…Achalasia is a rare acquired esophageal motility disorder of an unknown etiology and may be associated with autoimmune mechanisms, viral infection, and genetic susceptibility (2,3). In achalasia, the esophageal branch of the vagal nerve is damaged, and the Auerbach plexus in the esophagus is histologically degenerated.…”