title: Insights gained from symptom evaluation of esophageal motility disorders: a review of 4,215 patients.
abstract: OBJECTIVE
  Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NE), and nonspecific motility disorder (NSMD) are described primary esophageal body motility disorders; however, their clinical symptom correlation is poorly understood. The aim of this study is to examine the association between a patient's presenting symptoms and their manometric diagnosis.
  
  
  METHODS
  Manometric findings and reported symptoms of all patients undergoing esophageal manometry at the Creighton University Medical Center were prospectively entered in a database. Twenty-four-year data from 1984 through 2008 were accessed and analyzed.
  
  
  RESULTS
  Of the 4,215 patients, 130 (3.1%) had Ach, 192 (4.6%) had DES, 290 (6.9%) had NE, 508 (12.1%) had NSMD, and 3,095 (73.4%) had normal esophageal body motility. There was significant symptom overlap between the groups. Ach and DES had a similar symptom distribution, with dysphagia being the predominant symptom. Patients with NE, normal body motility, and NSMD presented predominantly with reflux symptoms. There was an increasing prevalence of esophageal dysmotility (DES and NSMD) with age, and women were found to be more likely to have NE than men.
  
  
  CONCLUSIONS
  In an individual, reported symptoms do not correlate with their manometric diagnosis in a predictable fashion, and a thorough physiological assessment should be obtained to understand and diagnose the disease process. Esophageal motility deteriorates with age.
authors.affiliation: Department of Surgery, Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.forename: Ananth
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Hinder
authors.forename: Tom R
authors.initials: TR
authors.lastname: Demeester
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Filipi
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004931:Esophageal Achalasia / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015155:Esophageal Spasm, Diffuse / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult