Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
Digestion. 2024;105(1):11-17. doi: 10.1159/000533347. Epub 2023 Aug 25.
Esophageal motility disorders (EMDs) are caused by the impaired relaxation of the upper/lower esophageal sphincter and/or defective esophageal peristaltic contractions, resulting in dysphagia and noncardiac chest pain. High-resolution manometry (HRM) is essential for the diagnosis of primary EMD; however, the recognition of EMD and HRM by general practitioners in Japan is limited. This review summarizes the diagnosis of and treatment strategies for EMD.
HRM is a specific test for the diagnosis of EMD, whereas endoscopy and barium swallow as screening tests provide characteristic findings (i.e., esophageal rosette and bird's beak sign) in some cases. It is important to note that manometric diagnoses apart from achalasia are often clinically irrelevant; therefore, the recently updated guidelines suggest additional manometric maneuvers, such as the rapid drink challenge, and further testing, including functional lumen imaging, for a more accurate diagnosis before invasive treatment. Endoscopic/surgical myotomy, pneumatic dilation, and botulinum toxin injections need to be considered for patients with achalasia and clinically relevant esophagogastric junction outflow obstruction.
Since the detailed pathophysiology of EMD remains unclear, their diagnosis needs to be cautiously established prior to the initiation of invasive treatment.
食管动力障碍（EMD）是由上/下食管括约肌松弛障碍和/或食管蠕动收缩功能障碍引起的，其主要表现为吞咽困难和非心源性胸痛。高分辨率测压（HRM）是诊断原发性 EMD 的必要手段，然而在日本，一般执业医师对 EMD 和 HRM 的认识有限。本文对 EMD 的诊断和治疗策略进行了总结。
HRM 是 EMD 的特异性诊断方法，而内镜和钡餐检查作为筛查试验，在某些情况下可提供特征性发现（如食管玫瑰花结和鸟嘴样征）。需要注意的是，除贲门失弛缓症外，测压诊断往往与临床无关；因此，最近更新的指南建议进行额外的测压操作，如快速饮水挑战，以及进一步的检查，包括功能腔成像，以便在进行有创治疗之前更准确地诊断。对于贲门失弛缓症和有临床意义的胃食管交界处流出梗阻的患者，需要考虑内镜/手术肌切开术、气囊扩张术和肉毒毒素注射。
由于 EMD 的详细病理生理学仍不清楚，因此在开始有创治疗之前，需要谨慎确定其诊断。
