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. 2022 Sep 23;101(38):e30573.
doi: 10.1097/MD.0000000000030573.

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

Mariam S Zaghloul  1 , Yasmine A Elshaer  1 , Mohamed E Ramadan  2 , Hassan E ElBatae  1
Affiliations

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

Mariam S Zaghloul et al. Medicine (Baltimore). .

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.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Classification of patients with esophageal dysphagia based on their etiology.
Figure 2.
Figure 2.
(A) Distribution of EMD in NOD patients according to Chicago Classification v3.0 by HRM. (B) Prevalence of different achalasia subtypes. EMD = esophageal motility disorder, HRM = high-resolution manometry, NOD = nonbstructive dysphagia.
Figure 3.
Figure 3.
Comparison between achalasia and nonachalasia patients according to prevalence of the main presenting symptoms.
See this image and copyright information in PMC

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