title: Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls.
abstract: OBJECTIVE
  This study aimed to devise a scheme for the systematic analysis of esophageal high-resolution manometry (HRM) studies displayed using topographic plotting.
  
  
  METHODS
  A total of 400 patients and 75 control subjects were studied with a 36-channel HRM assembly. Studies were analyzed in a stepwise fashion for: (a) the adequacy of deglutitive esophagogastric junction (EGJ) relaxation, (b) the presence and propagation characteristics of distal esophageal persitalsis, and (c) an integral of the magnitude and span of the distal esophageal contraction.
  
  
  RESULTS
  Two strengths of pressure topography plots compared to conventional manometric recordings were: (a) the ability to delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus, and (b) the ability to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm (DES), vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: (a) DES in 1.5% patients, (b) vigorous achalasia in 1.5%, and (c) a newly defined entity, spastic nutcracker, in 1.5%.
  
  
  CONCLUSIONS
  We developed a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant scheme is consistent with conventional classifications with the caveats that: (a) hypercontractile conditions are more specifically defined, (b) distinctions are made between rapidly propagated contractions and compartmentalized esophageal pressurization, and (c) there is no "nonspecific esophageal motor disorder" classification. We expect that pressure topography analysis, with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders.
authors: Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
authors: John E
authors: JE
authors: Pandolfino
authors: Sudip K
authors: SK
authors: Ghosh
authors: John
authors: J
authors: Rice
authors: John O
authors: JO
authors: Clarke
authors: Monika A
authors: MA
authors: Kwiatek
authors: Peter J
authors: PJ
authors: Kahrilas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004935:Esophageal Diseases / Q000145:classification* / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011312:Pressure; D015203:Reproducibility of Results; D012720:Severity of Illness Index