Esophageal spasm/noncardiac chest pain hypertensive esophageal peristalsis, (nutcracker esophagus) and hypertensivelower esophageal sphincter

Abstract

Dysphagia and noncardiac chest pain can be associated with spastic and hypercontractile esophageal motor disorders, provided that structural lesions, inflammation, and gastroesophageal reflux are excluded. Currently one of the best methods used to identify and classify esophageal contractile abnormalities is esophageal manometry. In the last years, manometry has undergone a significant paradigm shift. Combination of solid-state high-resolution manometry with esophageal pressure topography (EPT) provides a seamless dynamic display of esophageal pressure morphology and function, which is subjectively easy to interpret, yet lends itself to more sophisticated analyses and detailed characterization of normal and abnormal esophageal motility. The purpose of this chapter is to provide an overview of pathophysiology underlying the esophageal spasm, spastic achalasia, hypertensive peristalsis, and hypercontractile lower esophageal sphincter, as well as the criteria for their diagnosis based on the features observable on EPT. Together with presenting patient complaint, phenotypes of esophageal motor disorders defined by EPT may help guide the management of spastic and hypercontractile esophageal motor disorders. Additionally, these phenotypes may also refine future clinical trials and improve our understanding of how these motor abnormalities may generate symptoms.