Videoendoscopic diagnosis of esophageal motility disorders.
BACKGROUND
Esophageal motility disorders are usually diagnosed by manometry. We evaluated videoendoscopy as a diagnostic test.


METHODS
In this study, 20 patients with achalasia, 13 with scleroderma, and 33 control subjects had a standard endoscopic examination followed by protocol videotaping of swallows to observe contractions in the esophagus and in the lower esophageal sphincter. Tapes were later reviewed by 2 blinded observers who recorded their motility findings and diagnoses.


RESULTS
In the mid esophagus at 25 cm, lumen-occluding peristaltic contractions were identified in 26 of 33 control subjects versus 1 of 20 achalasia (p < 0.001) and 3 of 13 scleroderma patients (p < 0.005). As viewed in the lower esophagus, the lower esophageal sphincter opened normally in 31 of 33 control subjects versus 1 of 20 achalasia (p < 0.001). In scleroderma, the sphincter never closed in 12 of 13 patients (p < 0. 001 versus control subjects). A diagnostic sequence of sphincter opening followed by contraction in the esophageal body and subsequent sphincter closing was seen in 33 of 33 control subjects, 2 of 20 achalasia, and 1 of 13 scleroderma patients (both, p < 0. 001). The observers made the correct diagnosis in 96% of cases.


CONCLUSIONS
Achalasia and esophageal scleroderma can be identified by endoscopic observation of motility. This procedure may represent an adjunctive diagnostic test to manometry.
Cameron
A J
AJ
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Malcolm
A
A
Prather
C M
CM
Phillips
S F
SF
D016145:Endoscopy, Digestive System / Q000379:methods; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015588:Observer Variation; D010528:Peristalsis; D011312:Pressure; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis; D014741:Video Recording