A practical approach to ineffective esophageal motility

Abstract

Ineffective esophageal motility (IEM) is the most frequently diagnosed esophageal motility abnormality and characterized by diminished esophageal peristaltic vigor and frequent weak, absent, and/or fragmented peristalsis on high-resolution esophageal manometry. Despite its commonplace occurrence, this condition can often provoke uncertainty for both patients and clinicians. Although the diagnostic criteria used to define this condition has generally become more stringent over time, it is unclear whether the updated criteria result in a more precise clinical diagnosis. While IEM is often implicated with symptoms of dysphagia and gastroesophageal reflux disease, the strength of these associations remains unclear. In this review, we share a practical approach to IEM highlighting its definition and evolution over time, commonly associated clinical symptoms, and important management and treatment considerations. We also share the significance of this condition in patients undergoing evaluation for anti-reflux surgery and consideration for lung transplantation.

Keywords: Chicago classification; dysphagia; esophageal manometry; gastroesophageal reflux disease; ineffective esophageal motility; multiple repetitive swallows.

Figure 1.

In contrast to a normal swallow (A), manometric findings that support a diagnosis of IEM include failed swallows (B), weak swallows (C), and fragmented swallows (D). The presence (E) of augmentation on multiple repetitive swallow sequence is also illustrated.

Figure 2.

An algorithm for diagnosis and management of IEM.