Esophageal motor disorders in patients with dysphagia

Endoscopy and radiology are usually suggested as the first line investigations in patients with dysphagia. Esophageal manometry is indicated if the above studies are unfruitful. Our aim was to evaluate the role of manometry in diagnosing motor disorders of the esophagus in patients with non-organic dysphagia. We retrospectively evaluated the results of seven years' experience with esophageal manometry performed in 114 patients with difficulty in swallowing not due to esophageal structural lesions or reflux esophagitis, both escluded by endoscopic and/or radiologic studies prior to manometric investigation. A variety of nonspecific esophageal motor disorders were the most common (32%) manometric abnormalities seen in patients with dysphagia. Achalasia was common (23%) too, whereas diffuse esophageal spasm (8%), nutcracker esophagus (6%) and hypertensive LES (1%) accounted for a few motility disorders associated with dysphagia. Low LES pressure was found in 3% of the patients, suggesting gastroesophageal reflux as the cause of their difficulty in swallowing. The study confirms the role of esophageal manometry in diagnosing the cause of a swallowing disorder, identified in 83 out of 114 patients (73%). Achalasia and nonspecific esophageal motor disorders accounted for more than 50% of the motility disorders in patients with dysphagia.