Abstract
Esophageal motility disorders broadly are characterized as a dysfunction of either outflow or peristalsis as described by the Chicago Classification v4.0 (CCv4.0). Within the group of disorders of outflow, there is achalasia and esophagogastric junction outflow obstruction (EGJOO). The differentiating characteristic, based on high-resolution esophageal manometry, is the presence of peristalsis. In achalasia, peristalsis is either uniformly failed or premature, whereas with EGJOO, there is preservation of peristalsis. Within the group of disorders of peristalsis, there is absent contractility, distal esophageal spasm, hypercontractile esophagus, and ineffective esophageal motility. The classification of disorders of peristalsis is based on characteristics such as absent peristalsis, premature contractions, hypercontractile swallows, and ineffective swallows, as defined through high-resolution esophageal manometry. The pathophysiology of esophageal motility disorders is wide-ranging and overlapping. In disorders of outflow, there are autoimmune, infectious, genetic, inflammatory, and mechanical etiologies leading to disruption of the inhibitory neurons as the final common pathway. In disorders of peristalsis, similar disruption of neuronal and muscular pathways is seen. Inciting causes include medications, autoimmune diseases, inflammation, gastroesophageal reflux disease, and obstructive processes. Diligent patient history and evaluation of potentially inciting etiologies are critical to providing an accurate diagnosis and subsequent individualized patient care.
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Nandwani, M., Newhams, K., Jobe, B. (2023). Pathophysiology of Esophageal Motility Disorders. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_27
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