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Gut. Jul 2001; 49(1): 145–151.
PMCID: PMC1728354
Classification of oesophageal motility abnormalities
S SPECHLER and D CASTELL
Department of Medicine Dallas VA Medical Center and University of Texas Southwestern Medical Center at Dallas, Texas, USA. sjspechler/at/aol.com
D O CASTELL
Department of Medicine
Graduate Hospital, Philadelphia, Pennsylvania, USA
Manometric examination of the oesophagus frequently reveals abnormalities whose cause is unknown and whose physiological importance is not clear. A large body of literature dealing with oesophageal motility abnormalities has evolved over the past few decades but comparisons among studies have been compromised by the lack of a widely accepted system for classifying the abnormal motility patterns, and by the lack of uniform diagnostic criteria for the putative disorders. Based on an extensive review and analysis of the literature, this report suggests an operational scheme to be used for the general classification of oesophageal motility abnormalities, and proposes standardised manometric criteria for the putative oesophageal motility disorders. By applying the guidelines proposed in this report, clinicians and researchers can determine if their patients fulfil the manometric criteria for a putative motility disorder. This should facilitate and improve comparisons among patients and studies. However, it is important to emphasise that fulfilment of the proposed criteria does not establish the clinical importance of the motility abnormalities.

Figure 1
Figure 1  
(A) Oesophageal manometry tracing from a patient with classic achalasia. The distal recording site, positioned in the lower oesophageal sphincter (LOS), shows high basal LOS pressure (approximately 60 mm Hg). Note that the two wet swallows (WS) (more ...)
Figure 2
Figure 2  
Oesophageal manometry tracing from a patient with diffuse oesophageal spasm. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note that the first wet swallow (WS) is followed by oesophageal (more ...)
Figure 3
Figure 3  
Oesophageal manometry tracing from a patient with nutcracker oesophagus. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note the high amplitude peristaltic contractions initiated by wet (more ...)
Figure 4
Figure 4  
Oesophageal manometry tracing from a patient with ineffective oesophageal motility. The recording sites are positioned 3, 8, and 13 cm above the lower oesophageal sphincter. Note that the first and third wet swallows (WS) result (more ...)
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